bluuebunny/crossref_metadata_2025 huggingface dataset:
Arnold‐chiari malformation and the otolaryngologist: Place of magnetic resonance imaging and electronystagmography
Authors: Longridge Neil S. , Mallinson Arthur I.
Published: September 2006

The Arnold‐Chiuri malformation (ACM) is a rare congenital condition in which there is a downward displacement of the cerebellum through the foramen magnum. Patients with this condition frequently develop symptoms of ataxia, imbalance, or vertigo. As a result the patient is often referred to an otolaryngologist. Such a case is reported. A patient presented with imbalance, had downbeating nystagmus on down gaze, and had other eye movement abnormalities recorded on electronystagmography (ENG) which were strongly suggestive of central pathology. Although her computerized tomography (CT) scan was normal, the eye findings and neurological evaluation were strongly suggestive of an ACM. A repeat CT scan with intrathecal metrizamide was abnormal. A definite diagnosis of ACM was confirmed using the new investigative technique of magnetic resonance imaging (MRI).
Cheiloplasty in the treatment of facial paralysis
Authors: Conley John
Published: September 2006

There have been dramatic improvements in the treatment of facial paralysis. These include the successful use of free autogenous nerve grafting, nerve crossover techniques, regional masticatory muscle transposition, and free muscle grafts. The techniques are applied to total, partial, and regional paresis. The bulk of information on rehabilitation of the face has come from clinical empiricism, but basic research in nerve and muscle physiology and attempts at multiple classifications regarding indications and criteria have added to the splender of this drama. One facet that has not been emphasized is the use of cheiloplasty in long‐standing facial paralysis.

Long‐standing facial paralysis has both a neural and muscular deficit that cannot be rectified by a single concept or operation. It is essential to regionalize the rehabilitation, implant a kinetic muscular potential, supply some static support and elevation, and address the nonfunctional muscles about the paralyzed lips. This latter concept includes lip shortening and lip‐flap transposition. A coordinated combination of these techniques has the best opportunity of maximizing the improvement in long‐standing facial paralysis associated with severe muscle atrophy.
Medical management of chronic suppurative otitis media without cholesteatoma in children
Authors: Kenna Margaret A. , Bluestone Charles D. , Reilly James S. , Lusk Rodney P.
Published: September 2006

Tympanomastoid surgery is considered standard management for chronic suppurative otitis media (CSOM) without cholesteatoma, which is unresponsive to ototopical/oral antimicrobial therapy. The following makes this sequence of management less attractive today: 1. potential ototoxicity of ototopical agents; 2. lack of oral antimicrobial agents effective against most common pathogens (e.g., Pseudomonas aeruginosa); 3. frequent occurrence in children who have tympanostomy tubes; and 4. failure of tympanomastoid surgery to eradicate the disease in all cases. We conducted a study in 36 pediatric patients with chronic suppurative otitis media, in which all received parenteral antimicrobial therapy and daily aural toilet (mean duration of treatment = 9.7 days). Thirty‐two patients (89%) had resolution of their infection with medical therapy alone; four children required tympanomastoidectomy. Further investigation is needed to understand the etiology, pathogenesis, and most effective methods of management/prevention of CSOM in children.
A comparison of porp, torp, and incus homograft for ossicular reconstruction in chronic ear surgery
Authors: Silverstein Herbert , Mcdaniel Alan B. , Lichtenstein Richard
Published: September 2006

This report presents the results of 210 cases over a 10‐year period using PORPs, TORPs, and notched incus homografts (NIH), for ossicular reconstruction in chronic ear surgery. There were 192 adults and 18 children. The surgical technique utilized temporalis fascia in an underlay technique with canal skin covering the outer surface of the fascia. Intact canal wall mastoid‐tympanoplasty, as a one‐stage procedure, was used for most cases. Homograft nasal cartilage was placed between the Plasti‐Pore® prosthesis and the graft. Notched incus homografts were prepared prior to surgery and stored in 4% formalin. There were 149 mastoid‐tympanoplasties and 61 tympanoplasties performed. Revsion of our cases was performed in 16.6%.

Within 3 months of surgery, 86% of adults, and 44% (8/18) of children had dry, healed ears free of disease. The graft take rate was 96%. In adults, a total of 99 NIH, 50 TORPs, and 43 PORPs were implanted. In adults, the closure of the air‐bone gap to 20 dB or less occurred in 58% using TORPs, 67% using PORPs, 76% using NIH‐Partial replacement, and 20% using NIH‐Total replacement. Excluding the cases that failed for reasons other than conductive hearing loss, the results improved to 69% for TORPs, 77% for PORPs, 77% for NIH‐P, and 27% for NIH‐T. In adults, the extrusion rate was 5.5% for Plasti‐Pore® and 3% for NIH. In children, the extrusion rate was 17% for Plasti‐Pore® prostheses.

From this study, it appears that PORPs and TORPs with homograft nasal cartilage are satisfactory prostheses for chronic ear surgery in adults. In children, Plasti‐Pore® prostheses should be avoided unless the ear is healed, aerated, and stable. NIHs are good prostheses when the stapes is intact, but they are inferior to the TORP when placed on the footplate. Also, the NIH requires preparation prior to surgery and may be difficult to obtain. We plan to continue using PORPs and TORPs in chronic ear surgery until a better technique is found, or the complication rate becomes unacceptable.
The disease of emperor frederick III
Authors: Minnigerode Bernhard
Published: September 2006

The disease and death of German Emperor Frederick III has often been described in historical and medical treatises. These were all based on official political and medical reports published during 1887–1888, the time of the disease. The assertion of laryngologists, made while Frederick III was still alive, that the laryngeal carcinoma developed from a specific syphilitic infection is examined here. On the basis of the relevant laryngological literature, as well as less well‐known sources, the probability of this assumption, the particular symptoms, and the fulminant course of the disease are documented. The behavior and the personality of Sir Morell Mackenzie is accordingly seen in a different light than in the past.
Videofluoroscopic and scintigraphic analysis of dysphagia in the head and neck cancer patient
Authors: Humphreys Brian , Mathog Robert , Rosen Robert , Miller Peter , Muz Jaroslaw , Nelson Richard
Published: September 2006

This paper presents two advances in the evaluation of swallowing function which better define the swallowing processes in the head and neck cancer patient. Videofluoroscopy, improved by computer‐assisted image analysis, provides more accurate information regarding oral and pharyngeal movement of structures. Radionuclide scintigraphy, a complementary technique, quantitatesbolus flow (transit times) and the degree of aspiration. Several cases demonstrate the advantages of the methods and their usefulness in evaluating the effects of cancer treatment. The improved techniques also provide opportunity for designing new strategies of medical and surgical rehabilitation.
Treatment of tinnitus with electrical stimulation: An evaluation of the audimax theraband
Authors: Thedinger Bradley S. , Karlsen Elizabeth , Schack Stanley H.
Published: September 2006

Several treatment forms exist for tinnitus. These multiple treatments speak to the elusive etiology of tinnitus. Many authors have reported tinnitus reduction or elimination with electrical stimulation. This study evaluates a new device (Audimax Theraband•) which delivers inaudible, transdermal, mastoid electrical stimulation. Thirty patients suffering from chronic tinnitus were evaluated in a single‐blind crossover fashion. Since the electrical stimulation is inaudible, each patient served as his or her own control. Patients received actual or placebo stimulation over a period of 2 weeks. They rated their tinnitus levels and the effectiveness of the device before and after using the Theraband. Only 2 subjects out of 30 (7%) obtained true positive results. Side effects were minimal and reversible.
Cephaloceles
Authors: Nager George T.
Published: September 2006

The meningoceles and enecphaloceles of the calvaria and base of the skull are reviewed with regard to origin and local behavior. An additional variant is added to the subgroup of nasopharyngeal cephaloceles, the basioccipital nasopharyngeal cephalocele, which only recently has become recognized. The clinical importance, techniques for its identification, and surgical management are discussed with the aid of a case report.
Intramuscular head and neck myxoma: Report of a case and review of the literature
Authors: Shugar Joel M. A. , Som Peter M. , Schaeffer B. Todd , Meyers Richard J.
Published: September 2006

Intramuscular myxoma of the head and neck is a rare lesion with only six cases documented in the literature. The tumor demonstrates a benign clinical course without a tendency to recur and is occasionally associated with fibrous dysplasia. It thus deserves to be considered in a separate class from other soft tissue myxomas. The seventh case of a head and neck intramuscular myxoma is presented and the clinical, pathological, and CT characteristics of this tumor are reviewed.
Acoustic tumor management in senior citizens
Authors: House John W. , Nissen Rick L. , Hitselberger William E.
Published: September 2006

We reviewed records of 116 consecutive acoustic tumor surgery patients aged 65 and older during the 10 years ending in 1984. One hundred six had total removal. Ninety‐four (81%) had no intraoperative complications and 66 (57%) had no post‐operative complications. Only one patient, who had previously undergone partial removal elsewhere, died.

Because tumors grow at 2 mm per year, and because elderly patients can expect to live up to 18 more years, we recommend planned total removal of an acoustic tumor as the management of choice for senior citizens in good health. We feel that the advantages of immediate surgery outweigh the risks of delayed surgery when age is advanced, the tumor is enlarged, and general health may be declining.
Ectopic gastric mucosa in the cervical esophagus
Authors: Schroeder Walter W. , Schechter Gary L. , Myer Charles M.
Published: September 2006

Ectopic gastric mucosa is a known entity of the mid and lower esophagus which was initially described by Schmidt in 1805. The presence of ectopic gastric mucosa in the cervical esophagus, however, was not described. A review of the literature reveals that ectopic gastric mucosa of the cervical esophagus is not uncommon, but symptoms rarely have been attributed to its presence.

This paper reports five patients with isolated inflamed ectopic gastric mucosa in the cervical esophagus who presented with odynophagia and/or dysphagia. Physical examination was unremarkable in each case, and an acid barium esophagram was negative in four of five patients. Factors that distinguish these patients from other cases of odynophagia and dysphagia, as well as detailed clinical findings and treatment, are described. Debate exists as to whether the origin of ectopic gastric mucosa is congenital or acquired. The embryology, gross and microscopic anatomy, and pathologic features are outlined.

Patients with persistent dysphagia should have flexible fiberoptic esophagoscopy with an index of suspicion to the existence of ectopic gastric mucosa. Inflamed or ulcerated ectopic gastric mucosa in the cervical esophagus should be treated to relieve symptoms and because of the potential for complications.
A middle ear implantable hearing device for controlled amplification of sound in the human: A preliminary report
Authors: Hough Jack , Himelick Tom , Richard Gordon , Dormer Kenneth , Vernon Jack , Meikel Mary
Published: September 2006

Millions of people in the United States suffer from hearing impairment that is not benefited or poorly benefited by surgery or conventional hearing aids. Recently, we introduced an implantable Temporal Bone Stimulator (TBS) designed for those patients having a hearing loss due to external canal conditions; such as, external canal atresia or disease, inoperable ossicular problems, atelectasis or eustachian tube malfunction, and chronic open‐cavity mastoid disease. This device requires relatively good cochlear function. However, the electromagnetic application of this device has led to the development of a new device we call the Implantable Hearing Device (IHD). This device stimulates, by an electromagnetic field, an independent electromagnetic sensitive prosthesis attached to the ossicular chain. This direct energy transfer to the ossicular chain provides a high degree of sound amplification and fidelity, thus providing benefit for those with various degrees of sensorineural hearing impairment.

Preliminary disclosure of the device design, the animal experimental results, and the data from human testing will be given.
Complications in the management of large glomus jugulae tumors
Authors: Cece John A. , Lawson William , Biller Hugh F. , Eden Avrim R. , Parisier Simon C.
Published: September 2006

This study analyzes the complications encountered in the surgical treatment of 17 patients with large glomus jugulare tumors. All 17 patients sustained either new cranial nerve palsies or exacerbation of preexisting palsies. These involved, in descending order of frequency, the facial nerve, the vagus and glossopharyngeal nerves, and the hypoglossal nerve. Post‐operative palsies of the facial nerve involved 17 patients, as compared to 5 preoperatively. Fifteen patients had postoperative partial or complete paralysis of the vagus nerve as compared to eight preoperatively. Ten patients had postoperative palsies of the hypoglossal nerve as compared to six preoperatively. Other complications included CSF leak, meningitis, and wound infection. Aspiration and dysphagia were encountered postoperatively in 13 patients. Teflonr̀ injection of paretic vocal cords and cricopharyngeal myotomy effectively improved the ability to swallow and the quality of the voice. Prompt recognition and treatment of complications is essential for effective surgical management of large glomus jugulare tumors.
Malignancies of the external ear canal and temporal bone: Surgical techniques and results
Authors: Kinney Sam E. , Wood Benjamin G.
Published: September 2006

A combined therapy approach to malignancies of the external auditory canal and middle ear has been developed. A technique of external canal resection and gross tumor removal from the middle ear, parotid gland, and superior cervical lymph nodes is followed by postoperative full‐therapy irradiation. This combined approach has been used in 30 patients with malignancies involving the external auditory canal and temporal bone. The preoperative evaluation and surgical technique, including the intraoperative decision‐making process, is described. Twenty‐four patients had squamous cell carcinoma of the external auditory canal, and two patients had basal cell carcinoma. There was one patient each with adenocystic carcinoma, acinic cell carcinoma, high grade mucoepidermoid carcinoma, and a giant cell tumor of bone.

This group of patients was broken down into three groups based on the extent of disease as determined at surgery. Overall control of disease, both locally and distant, for the 30 patients was 66%. There were 12 patients with disease limited to the ear canal. These patients had a 91% survival of this disease process. Seven patients were determined to have limited extension beyond the ear canal. These were treated with combined therapy with an overall control of disease of 72%. Eleven patients had extensive disease outside of middle ear into the carotid jugular spine, stylomastoid foramen, and skull base, with a survival rate of 45%.

It is concluded that a step‐wise removal of all gross tumor, as opposed to an en bloc dissection of the temporal bone and skull base, followed by full‐therapy irradiation gives equally as good, or even better, long‐term survival for this malignancy of the external auditory canal and middle ear.
Computed tomography in the evaluation of choanal atresia in infants and children
Authors: Crockett Dennis M. , Healy Gerald B. , Mcgill Trevor J. , Friedman Ellen M.
Published: September 2006

While traditional confirmatory clinical tests are helpful in establishing the diagnosis of choanal atresia, they give little useful information concerning the composition, position, and thickness of the atresia plate. Surgeons experienced in the repair of choanal atresia have recognized that detailed anatomic assessment is valuable in the preoperative selection of the method of repair and design of the repair once undertaken. The utilization of high‐resolution computerized tomography to provide such information in a group of infants and children with choanal atresia forms the basis for this report. The application of computed tomography in the evaluation of choanal atresia and preoperative surgical planning is discussed. Based on this experience, we feel that the introduction of high‐resolution computerized tomography is a significant advance in the diagnostic and therapeutic approach to choanal atresia and should be the single radiographic procedure of choice.
Observations on the size of the saccule in laryngectomy specimens
Authors: Birt Derek
Published: September 2006

Over 300 instances of the association of laryngocele with laryngeal carcinoma have been reported in Europe, but only seven in North America. In the present study, 353 serially sectioned total laryngectomy specimens were examined and the saccule measured with a steel ruler. Saccules extending superior or posterior to the thyroid cartilage were considered as large. Larynges were classified as “cancer” or “normal,” the latter being uninvaded organs from patients with adjacent disease. Among the 242 cancer larynges, there were 43 specimens where the saccule exceeded thyroid cartilage dimensions, a laryngocele rate of 17.8%. Mean saccule height was significantly greater in cancer than in normal specimens in coronal sections (P=0.04), and mean saccule length was significantly greater in cancer than in normal specimens in horizontal sections (P=0.001). The incidence of large saccules showed a difference between cancer and normal larynges which was highly significant (P=0.0002).
Cochlear action potentials threshold and systemic arterial pO2
Authors: Hildesheimer Minka , Muchnik Chava , Rubinstein Moshe
Published: September 2006

A progressive decrease in arterial pO2 was induced in Hartley guinea pigs (GP) by having them rebreathe the air entrapped in a closed circuit from which the CO2 was continuously absorbed. Following this slow‐developing hypoxemia, a sequence of events concerning the ear could be observed. Firstly, a fluctuation in cochlear action potentials (CAP) was noted. This appeared only at stimulus intensities near the threshold and was not evident at higher intensities. At a mean arterial pO2 level of 30 mm Hg, this phenomenon was observed in 60% of the GP. At a mean pO2 of 24.66 mm Hg, a shift in threshold occurred in all GP. Finally, when the blood pO2 reached an average of 14.92 mm Hg, no CAP response could be elicited, even at click intensity of 120 dB SPL. The 30 mm Hg oxygen concentration in the arterial blood was considered as a “critical level” at which the cochlear function starts to deteriorate in guinea pigs.
Voice intensity of prospective cochlear implant candidates and normal hearing adult males
Authors: Leder Steven B. , Spitzer Jaclyn B. , Milner Paul , Flevaris‐Phillips Carole , Cameron Kirchner J. , Richardson Frederick
Published: September 2006

Voice intensity in 19 prospective cochlear implant candidates, all adventitiously profoundly sensorineurally deaf adult males, was investigated. For the first time with objective data, it was shown that such deaf subjects spoke with significantly increased voice intensity and with greater intensity fluctuations than normal hearing male speakers. Neither length of time of profound deafness nor history of hearing aid use significantly affected voice intensity. Based on quantitative data, rehabilitation of voice intensity problems in the adventitiously deaf is indicated.
Videostroboscopy of the canine larynx: The effects of asymmetric laryngeal tension
Authors: Moore Dennis M. , Berke Gerald S. , Hanson David G. , Ward Paul H.
Published: September 2006

The effects of simulated paralysis of the peripheral laryngeal nerves on patterns of vocal cord vibrations were studied. Videostroboscopy was used in seven anesthetized mongrel dogs to record laryngeal vibrations during direct electrical stimulation of the recurrent and superior laryngeal nerves under conditions of constant airflow. Stroboscopic images obtained from both supraglottic and subglottic aspects were analyzed frame‐by‐frame. Results indicated that simulated paralysis of the recurrent laryngeal nerve or combined paralysis of the recurrent and superior laryngeal nerves produced a diminished mucosal wave bilaterally, with loss of the two‐mass system of vibration and diminished lateral excursion of the normal cord. In contrast, simulated paralysis of the superior laryngeal nerve was characterized by an abnormally exaggerated vertical movement of the paralyzed cord in relation to the normal cord and a horizontal shifting of the glottis from the paralyzed to the normal side during each vibratory cycle. Clinical implications are discussed and the literature reviewed.
Rhodamine‐123 as a new photochemosensitizing agent with the argon laser: “Nonthermal” and thermal effects on human squamous carcinoma cells in vitro
Authors: Castro Dan J. , Saxton Romaine E. , Castro Donna J. , Fetterman Harold R. , Ward Paul H.
Published: September 2006

A human squamous carcinoma cell line (P3) was first exposed to a nontoxic dose of Rhodamine‐123 (1 μg/m1 for 1 hour), then subjected to treatment with a single mode argon laser at 514.5 nm. The temperature and energy levels delivered to the target cells were determined by a reproducible method of dosimetry. Cell viability was assessed by the trypan blue exclusion test. Cell duplication and DNA synthesis were measured by the incorporation of 3H‐thymidine at 6 and 24 hours post‐treatment. The results indicate that Rhodamine‐123 at nontoxic doses of 1 μ/m1 enhanced the tumoricidal effects of the argon laser at reduced temperatures as low as 40 °C. Furthermore, at physiological temperature ranges as low as 28 to 39 °C, an immediate and/or delayed inhibition of cell duplication was demonstrated, while cell viability was not affected. These observations, suggest that Rhodamine‐123 can be used effectively as a chemosensitizing agent in the treatment of human tumor cells with the argon laser at 514.5 nm. This new technique of tumor cell targeting by Rhodamine sensitization and specific laser treatment may offer real advantages without the extreme photosensitivity associated with hematoporphyrin derivatives.
Hydrops due to syphilitic endolymphatic duct obliteration
Authors: Linthicum Fred H. , El‐Rahman Aly Gamal Abd
Published: September 2006

Three pairs of temporal bones with otologic syphilis were studied histopathologically to detect obliteration of the endolymphatic duct and the associated hydrops. All cases showed infiltration and obliteration of the endolymphatic duct by round cells, giant cells, and fibrous tissue. These findings may be related to failure of medical treatment and sac surgery to arrest or alleviate symptoms of advanced syphilis.
Surgical trauma to the lateral semicircular canal with preservation of hearing
Authors: Canalis Rinaldo F. , Gussen Ruth , Abemayor Elliot , Andrews James
Published: September 2006

Surgical trauma to the lateral semicircular canal (LSC) is a rare complication which does not always result in cochlear damage. The authors present six such cases, discuss the histopathological findings of one case, and review 12 previous reports. Transient cochlear depression with normalization of function within 6 weeks of trauma occurred in most instances. Vestibular symptoms were pronounced and, although compensation was not delayed, positional dizziness and instability usually persisted for several months and occasionally for a year or more. Histopathological findings (two specimens) were significant for obliterative scarring of the LSC at the site of injury and for the structural integrity of the labyrinth and cochlea. The mechanism of cochlear protection in these cases remains obscure; however, clean injuries away from the ampullary end of the canal occurring in patients without preexisting inner ear disease appear to have a better prognosis. Intraoperative closure of the defect, postoperative bed rest, and antibiotics are the basic elements of management.
The abnormally large frontal sinus. I. A practical method for its determination based upon an analysis of 100 normal patients
Authors: Urken Mark L. , Som Peter M. , Edelstein David , Lawson William , McAvay Gail , Biller Hugh F.
Published: September 2006

One hundred normal Caldwell view radiographs were examined on patients who had no signs or symptoms referable to the frontal sinuses. Magnification factors were determined for Caldwell views obtained on a dedicated head unit and as part of a skull series. The areas of the frontal sinuses were actually measured with a Zeiss Videoplan 2 computer and corrected for magnification. The area variation in this normal population was determined. Four linear measurements were individually correlated with these areas. Two of these lines had excellent correlation with the sinus area and if either of these lines exceeds a calculated value, the sinus area exceeds the 99th percentile of the normal population and can be considered abnormally enlarged. This technique provides a rapid, easy, and reliable method for assessing abnormally enlarged frontal sinus areas.
Abnormally large frontal sinus. II. nomenclature, pathology, and symptoms
Authors: Urken Mark L. , Som Peter M. , Edelstein David , Lawson William , Weber Alfred L. , Biller Hugh F.
Published: September 2006

Based on a review of the literature and analysis of six new cases, three categories of enlarged, aerated sinuses are defined, namely: hypersinus, pneumosinus dilatans, and pneumocele. The information gained by our study of the area variation of the frontal sinuses in a normal population (part I of this paper) was utilized to define the term hypersinus. In this condition there is generalized enlargement of the sinus beyond the upper limit of normal in an asymptomatic patient. The principal difference between pneumosinus dilatans and a pneumocele is the presence of bony thinning or erosion in the latter entity. The clinical findings and the possible etiologies of these conditions are discussed.
Effect of P15E related retroviral material isolated from head and neck carcinomas on delayed type hypersensitivity skin reactions in mice
Authors: Tan I. Bing , Drexhage Hemmo A. , Scheper Rik J. , Von Blomberg‐v.d.Flier B. Mary , De Haan‐Meulman Meeny , Snow Gordon B. , Balm Fons J. M.
Published: September 2006

Low molecular weight factors, derived from head and neck carcinomas (H/N ca LMWFs), exert a serious inhibitory effect on monocyte chemotaxis both in vivo and in vitro. This effect can be neutralized by the treatment of the factors with three different monoclonal antibodies to P15E, one of the structural envelope proteins of murine leukemia virus (MuLV).

In this study, we report the effect of the H/N ca LMWFs on the delayed type hypersensitivity responsiveness in mice: the factors significantly inhibited the 24 hour DNFB skin reaction. These effects of the H/N ca LMWFs were again neutralizable by antibodies to P15E. Additional experiments showed that the H/N ca LMWFs had equal suppressive effects on toxic skin reactions to croton oil, and this indicates that the P15E‐like H/N ca LMWFs exert their effect by aspecific mechanisms.
Injuries of the nasofrontal orifices in frontal sinus fractures
Authors: Stanley Robert B. , Becker Terry S.
Published: September 2006

Disruption of the nasofrontal ostia or ducts is an important factor in the development of immediate and delayed complications following frontal sinus fractures. Thorough evaluation of 50 consecutive patients with frontal sinus injuries caused by blunt trauma revealed several fracture patterns that frequently include injury to the drainage system. Anterior table fractures, even when displaced, do not produce such injuries unless associated with a fracture of the supraorbital rim or nasoethmoidal complex. Combined fractures of the anterior and posterior tables are almost always accompanied by injuries to the orifices. Severity of these injuries is variable but can be predicted from the sinus wall fracture patterns. Although CT scanning is incapable of directly imaging involvement of the ostia or ducts, it will give sufficient information to allow for accurate prediction of disruption of the drainage system.
Steps for a safer method of osteotomies in rhinoplasty
Authors: Thomas J. Regan , Griner Nancy R. , Remmler Daniel J.
Published: September 2006

Knowledge of osteotomy technique is essential to rhinoplasty. Using cadaver specimens, in addition to clinical observation, a safer method of osteotomy was acquired. Discussion of anatomy with reference to medial and lateral osteotomy follows. Several safety tips for each type of osteotomy are given.
Unilateral pulmonary edema as a complication of contralateral bronchial obstruction
Authors: Shikhani Alain H. , Salman Salah D. , Melhem Rafic
Published: September 2006

A unique case of acute unilateral bronchial obstruction complicated by contralateral pulmonary edema is reported. Postulated pathogenetic mechanisms are hypoxia and hyperfusion of one lung with resultant pulmonary capillary endothelial damage and lymphatic insufficiency.
Nasal resistance and sleep apnea
Authors: Blakley Brian W. , Mahowald Mark W.
Published: September 2006

This study explores the role of the nose in obstructive sleep apnea. If the nose acts as a Starling resistor, elevated nasal resistance may result in negative pharyngeal pressure that is of greater magnitude than the situation with normal nasal resistance. Large negative pharyngeal pressures could cause obstructive apnea. To test this hypothesis, nasal resistance studies were performed on 37 normal subjects and 53 patients with proven obstructive sleep apnea. The results suggest that although the patients had a significantly elevated nasal resistance, the increased nasal resistance did not correlate with parameters that predict the severity of obstructive sleep apnea. Although the nose probably contributes to sleep apnea, we conclude that nasal resistance is not a major factor in severe obstructive apnea.
Hearing preservation after acoustic tumor removal: Long‐term results
Authors: Shelton Clough , Hitselberger W. E. , House W. F. , Brackmann D. E.
Published: September 2006

This report examines the durability of preserved postoperative hearing in 25 middle fossa acoustic tumor patients with a minimum follow‐up of 3 years. The mean follow‐up time for this group was more than 8 years, with a maximum of almost 20 years. The initial postoperative au‐diogram was compared to the most recent audiogram for each patient, with change in the nonoperated ear serving as the control.

Fourteen of the patients (56%) had a significant loss of the preserved hearing in the operated ear over time. The mean loss of speech discrimination was 25%, and the mean loss of speech reception threshold was 12 dB. Only one of the 14 patients had a similar loss in the contralateral ear. No recurrent tumors were identified.

Good preoperative hearing is an obvious criterion for selection of candidates for hearing preservation surgery. Results of this study emphasize that a good initial postoperative hearing level is necessary to offset the potential deterioration of hearing that may occur over time.
Long‐term Results of Labyrinthectomy
Authors: Levine Samuel C. , Glasscock Michael , Mckennan Kevin X.
Published: September 2006

Ten years after labyrinthectomy, 38 patients responded to a questionnaire. There was a slight decline in relief of vertigo from 93% to 76%. Symptoms following the procedure are discussed. It is believed that the reason for the decline is secondary to the age of the patients, the occasional bilateral nature of Meniere's disease, and possibly post‐surgical neuroma formation. The ramifications of this study are discussed with respect to hearing‐conservation procedures.
The surgical treatment of snoring: A patient's perspective
Authors: Katsantonis George P. , Friedman William H. , Rosenblum Barry N. , Walsh James K.
Published: September 2006

An increasing number of loud snorers seek medical attention because of the social impact of snoring as well as its association with sleep apnea. Uvulopalatopharyngoplasty is reported to reduce or eliminate snoring in the majority of patients; however, little data are available to document the procedure's success.

From February 1987 through August 1988, 125 patients underwent uvulopalatopharyngoplasty for habitual snoring; many of these patients had also documented sleep apnea. Of the 74 patients who responded to a postoperative questionnaire, 64 (86.48%) indicated that their snoring was either completely eliminated or markedly reduced. Only two patients reported significant side effects.
Use of modified silicone tracheal cannula for obstructive sleep apnea
Authors: Strauss Melvin
Published: September 2006

Experience with the original Montgomery® silicone tracheal cannulas in 47 patients with obstructive sleep apnea has been reported. Further experience with 10 obstructive sleep apnea patients who used modified silicone tracheal cannulas that permit periodic self‐removal, cleaning, and reinsertion was analyzed. Two patients used the tube briefly and without complications. The remaining eight patients used the modified cannula for 18 to 24 months. The average number of office visits following insertion was three. Compared to the original cannulas, there were markedly fewer difficulties with granulations, infection, and tube malposition with the modified cannulas. The improvements make this modified device a useful tool worth further study in obstructive sleep apnea patients requiring tracheostomy.
Fourth branchial pouch sinus: Principles of diagnosis and management
Authors: Godin Michael S. , Kearns Donald B. , Pransky Seth M. , Seid Allan B. , Wilson Doris B.
Published: September 2006

The fourth branchial pouch sinus is a congenital anomaly which most frequently manifests itself by recurrent episodes of neck abscess or acute suppurative thyroiditis. This lesion usually becomes symptomatic before the age of 10 years and is more common than has previously been suspected. It has been found on the left side in 93% of the 28 cases reported in the English literature. Barium swallow during periods of quiescence and nasopharyngoscopy have frequently been successful in identifying the presence of these embryological remnants. Definitive therapy consists of total excision of the sinus tract, which can be facilitated by direct endoscopic placement of a Fogarty® catheter into the sinus lumen before surgical exploration. The embryological basis for the occurrence of these sinuses is discussed.
Evoked otoacoustic emissions in newborn hearing screening
Authors: Bonfils Pierre , Dumont Annie , Marie Philippe , Francois Martine , Narcy Philippe
Published: September 2006

Evoked otoacoustic emissions (EOEs) were recorded in a group of normally hearing neonates (n= 100 ears) to study the basic properties of EOEs and the parameters influencing them. The results obtained with EOE recordings were compared with those of behavioral screening investigations. The main properties of EOEs in neonates are: 1. EOEs can be recorded in 98% of the tested ears or neonates; 2. there were no statistically significant variations in EOE detection thresholds of neonates between the ages of 1 and 4 days; 3. no statistical difference in the EOE threshold was found between males and females; 4. all EOEs exhibited a broadband spectrum with high‐component frequencies; 5. EOEs demonstrating narrowband frequency peaks superimposed on the broadband component had detection thresholds lower than EOEs without narrowband frequency peaks. EOEs can be used as a screening test. The main clinical interest of this test is to detect the presence (i.e, normal auditory peripheral function) or the absence (i.e., pathological peripheral auditory function) of EOEs in response to a 30‐dBHL click stimulation. The results of this study have important applications concerning the possible clinical use of EOEs for screening peripheral auditory dysfunction in neonates.
Anatomical perspective, approach, and experience with multichannel intracochlear implantation
Authors: Goycoolea Marcos V. , Muchow David C. , Schirber Carol M. , Goycoolea Hortensia G. , Schellhas Kurt
Published: September 2006

An overall review of the authors' anatomical perspective, approach, and experience with multichannel intracochlear implantation is presented. This report includes pertinent anatomical observations and experimental surgical procedures on fresh temporal bones. Although the scala tym‐pani in the basal turn of the cochlea has an adequate space laterally for the insertion of electrodes, in the upper turns the adequate space is located medially. This is, in practice, the single‐most limiting factor for an electrode, inserted via the round window, to reach the apical turns without damaging the basilar membrane. An experimental surgical procedure is described in which a second electrode is inserted in the middle turn via a mastoidotomy‐tyinpanotomy approach and reaches a point near the apex. Studies of horizontal sections of human temporal bones include a review of potential structures that could be stimulated by the electrical currents generated by electrodes. The wall of the carotid artery, located at 750 μm from the basal turn at the level of the round window niche, is considered a potential structure to be affected by long‐term stimulation. Anatomical principles and surgical considerations for the mastoidotomy‐tym‐panotomy approach are described as an alternative to the facial recess approach. In the authors' experience, this procedure is technically easier, eliminates the possibility of postauricular flap complications, provides a better angle for insertion of electrodes, requires shorter hospitalization, and permits faster recovery than the facial recess approach. The authors' clinical approach, results, and observations are reviewed. Of note is a successful home‐based rehabilitation program.
Ultrastructural studies of the peripheral extensions (dendrites) of type i ganglion cells in the cat
Authors: Goycoolea Marcos V. , Stypulkowski Paul , Muchow David C.
Published: September 2006

An ultrastructural study of peripheral extensions (dendrites) of type I ganglion cells in seven healthy adult cats and one cat that underwent bilateral cochlear injection of neomycin was undertaken. Morphologic evidence revealed that the peripheral process (dendrite) consistently has a smaller diameter than the central process. As the dendrite reaches the cell body, there is a constricted segment with a length that ranges from 10 to 30 μm, and a diameter of 0.5 μm. This region is covered by a continuous myelin sheath that does not thin. The central process (axon) does not have a corresponding constriction, and consists of a myelin covered, smoothly tapered segment that extends to the first axonal node of Ranvier. In the deafened cat, some cell bodies of the surviving ganglion cells appeared to have a residual portion of dendrite. These morphologic characteristics might have physiologic implications both in the mechanisms of normal hearing and in cochlear implantation.
Systemic effects of severe trauma on the function and apoptosis of human skeletal cells
Authors: Eid K. , Labler L. , Ertel W. , Trentz O. , Keel M.
Published: September 2006

Systemic factors are believed to be pivotal for the development of heterotopic ossification in severely-injured patients. In this study, cell cultures of putative target cells (human fibroblastic cells, osteoblastic cells (MG-63), and bone-marrow stromal cells (hBM)) were incubated with serum from ten consecutive polytraumatised patients taken from post-traumatic day 1 to day 21 and with serum from 12 healthy control subjects.

The serum from the polytraumatised patients significantly stimulated the proliferation of fibroblasts, MG-63 and of hBM cells. The activity of alkaline phosphatase in MG-63 and hBM cells was significantly decreased when exposed to the serum of the severely-injured patient. After three weeks in 3D cell cultures, matrix production and osteogenic gene expression of hBM cells were equal in the patient and control groups. However, the serum from the polytraumatised patients significantly decreased apoptosis of hBM cells compared with the control serum (4.3% vs 19.1%, p = 0.031).

Increased proliferation of osteoblastic cells and reduced apoptosis of osteoprogenitors may be responsible for increased osteogenesis in severely-injured patients.
Inverted V-shaped high tibial osteotomy compared with closing-wedge high tibial osteotomy for osteoarthritis of the knee
Authors: Aoki Y. , Yasuda K. , Mikami S. , Ohmoto H. , Majima T. , Minami A.
Published: September 2006

We compared the results ten years after an inverted V-shaped high tibial osteotomy with those of a historical series of conventional closing-wedge osteotomies. The closing-wedge series consisted of 56 knees in 51 patients with a mean follow-up of 11 years (10 to 15). The inverted V-shaped osteotomy was evaluated in 48 knees in 43 patients at a mean follow-up of 14 years (10 to 19). All the patients were scored using the Japanese Orthopaedic Association rating scale for osteoarthritis of the knee and radiological assessment.

The pre-operative grade of osteoarthritis was similar in both groups. Post-operatively, the knee function score was graded as satisfactory in 63% (35) of the closing-wedge group but in 89% (43) of the inverted V-shaped osteotomy group. Post-operative radiological examination showed that delayed union and loss of correction occurred more often after a closing-wedge osteotomy than after an inverted V-shaped procedure.

Our study suggests that the inverted V-shaped osteotomy may offer more dependable long-term results than traditional closing-wedge osteotomy.
The outcome of total hip replacement in obese and non-obese patients at 10- to 18-years
Authors: McLaughlin J. R. , Lee K. R.
Published: September 2006

We studied a consecutive series of 285 uncemented total hip replacements in 260 patients using the Taperloc femoral component and the T-Tap acetabular component. The outcome of every hip was determined in both living and deceased patients. A complete clinical and radiological follow-up was obtained for 209 hips in 188 living patients, followed for a mean of 14.5 years (10 to 18.9). They were divided into two groups, obese and non-obese, as determined by their body mass index. There were 100 total hip replacements in 89 patients in the obese cohort (body mass index ≥ 30 kg/m2), and 109 in 99 non-obese (body mass index < 30 kg/m2) patients. A subgroup analysis of 31 patients of normal weight (body mass index 20 kg/m2 to 25 kg/m2) (33 hips) and 26 morbidly obese patients (body mass index ≥ 35 kg/m2) (30 hips) was also carried out.

In the obese group five femoral components (5%) were revised and one (1%) was loose by radiological criteria. Femoral cortical osteolysis was seen in eight hips (8%). The acetabular component was revised in 57 hips (57%) and a further 17 (17%) were loose. The mean Harris hip score improved from 52 (30 to 66) pre-operatively to 89 (49 to 100) at final follow-up. Peri-operative complications occurred in seven patients (7%).

In the non-obese group six (6%) femoral components were revised and one (1%) was loose. Femoral cortical osteolysis occurred in six hips (6%). The acetabular component was revised in 72 hips (66%) and a further 18 (17%) were loose. The mean Harris hip score increased from 53 (25 to 73) prior to surgery to 89 (53 to 100) at the time of each patient’s final follow-up radiograph.

No statistically significant difference was identified between the obese and non-obese patients with regards to clinical and radiological outcome or complications. The subgroup analysis of patients of normal weight and those who were morbidly obese showed no statistically significant difference in the rate of revision of either component.

Our findings suggest there is no evidence to support withholding total hip replacement from obese patients with arthritic hips on the grounds that their outcome will be less satisfactory than those who are not obese.
Outcomes of subcapital cuneiform osteotomy for the treatment of severe slipped capital femoral epiphysis after skeletal maturity
Authors: Biring G. S. , Hashemi-Nejad A. , Catterall A.
Published: September 2006

We reviewed prospectively, after skeletal maturity, a series of 24 patients (25 hips) with severe acute-on-chronic slipped capital femoral epiphysis which had been treated by subcapital cuneiform osteotomy. Patients were followed up for a mean of 8 years, 3 months (2 years, 5 months to 16 years, 4 months). Bedrest with ‘slings and springs’ had been used for a mean of 22 days (19 to 35) in 22 patients, and bedrest alone in two, before definitive surgery. The Iowa hip score, the Harris hip score and Boyer’s radiological classification for degenerative disease were used.

The mean Iowa hip score at follow-up was 93.7 (69 to 100) and the mean Harris hip score 95.6 (78 to 100). Degenerative joint changes were graded as 0 in 19 hips, grade 1 in four and grade 2 in two. The rate of avascular necrosis was 12% (3 of 25) and the rate of chondrolysis was 16% (4 of 25). We conclude that after a period of bed rest with slings and springs for three weeks to gain stability, subcapital cuneiform osteotomy for severe acute-on-chronic slipped capital femoral epiphysis is a satisfactory method of treatment with an acceptable rate of complication.
A knee-sparing distal femoral endoprosthesis using hydroxyapatite-coated extracortical plates
Authors: Gupta A. , Pollock R. , Cannon S. R. , Briggs T. W. R. , Skinner J. , Blunn G.
Published: September 2006

We used a knee-sparing distal femoral endoprosthesis in young patients with malignant bone tumours of the distal femur in whom it was possible to resect the tumour and to preserve the distal femoral condyles. The proximal shaft of the endoprosthesis had a coated hydroxyapatite collar, while the distal end had hydroxyapatite-coated extracortical plates to secure it to the small residual femoral condylar fragment. We reviewed the preliminary results of this endoprosthesis in eight patients with primary bone tumours of the distal femur. Their mean age at surgery was 17.years (14 to 21). The mean follow-up was 24 months (20 to 31). At final follow-up the mean flexion at the knee was 102° (20° to 120°) and the mean Musculoskeletal Tumour Society score was 80% (57% to 96.7%).

There was excellent osteointegration at the prosthesis-proximal bone interface with formation of new bone around the hydroxyapatite collar. The prosthesis allowed preservation of the knee and achieved a good functional result. Formation of new bone and remodelling at the interface make the implant more secure. Further follow-up is required to determine the long-term structural integrity of the prosthesis.
Management of arthritis of the hip in the young adult
Authors: Parvizi J. , Campfield A. , Clohisy J. C. , Rothman R. H. , Mont M. A.
Published: September 2006

Arthritis of the hip in the young adult can be a disabling condition. Recent years have witnessed extensive research related to the management of this condition. This article reviews the current status with regard to aetiology, diagnosis and treatment of arthritis of the hip in the young adult.