bluuebunny/crossref_metadata_2025 huggingface dataset:
Mastoid Pneumatization in Otosclerosis
Authors: Sadé Jacob , Kremer Susan , Shatz Anat , Levit Irena
Published: October 2014

The extent of mastoid pneumatization in 150 otosclerotic ears was compared with that of 150 healthy control ears. The size of mastoid pneumatization was measured by use of the Schüller lateral x-ray projection with the help of computed planimetry. The measurements showed the average pneumatized area in otosclerotic ears to be 17.4 ± 5 cm2, in contrast to 12.9 ± 4 cm2 for the healthy control ears. The difference between the two groups was highly significant (p<.0001). While both groups showed a bell-shaped distribution of the measured pneumatized area, the curve of the otosclerotic ears was shifted significantly to the right. Our findings indicate a link between otosclerosis on the one hand and highly pneumatized mastoids on the other. This link between a hereditary disease and a specific type of pneumatization points to the likelihood that heredity also plays some role in determining the final type of pneumatization.
Growth and Chemosensitivity of Human Head and Neck Cancers Implanted under the Kidney Capsule of Cyclosporine-Immunosuppressed Mice
Authors: Bennett James A. , Parnes Steven M. , DeConti Ronald C.
Published: October 2014

Thirty-seven of 54 human squamous cell head and neck carcinomas were grown successfully as first transplant generation xenografts under the kidney capsule of conventional mice immunosuppressed by daily treatment with 60 mg/kg of cyclosporine. Eighteen different tumors were evaluated for chemosensitivity to cis-diamminedichloroplatinum (cisplatin), 5-fluorouracil, and methotrexate. Thirty-nine percent of the tumors responded to cisplatin, 19% to 5-fluorouracil, and 33% to methotrexate. This assay response is consistent with the clinical response of human squamous head and neck carcinoma to these drugs used as single agents. It is hoped that this model will become useful for new drug testing and, in certain cases, for selection of chemotherapy for patients with refractory tumors.
Mucociliary Disease of the Middle Ear during Experimental Otitis Media with Effusion Induced by Bacterial Endotoxin
Authors: Nakai Yoshiaki , Ikeoka Hiroshi , Ohashi Yoshihiro , Furuya Hiroyuki , Kato Shoko , Esaki Yusuke , Kato Motoaki
Published: October 2014

Lipopolysaccharide (10 μg/mL) derived from Klebsiella pneumoniae was injected into the middle ear of guinea pigs. The animals were killed painlessly on days 1, 3, and 7 after inoculation, and the mucosal samples from two sites within the tympanic cavity, close to the tympanic orifice and distal to the orifice, were examined for ciliary activity and epithelial morphology. At day 1 and day 3 serous effusion was observed and deterioration of ciliary activity and morphologic changes were observed. No effusion was recognized at day 7, when the ciliary activity in the distal mucosa was still diminished and that in the proximal mucosa had recovered to a normal level. Our data have shown that lipopolysaccharide extracted from K pneumoniae can produce otitis media with effusion in laboratory animals, and dysfunction of cilia due to lipopolysaccharide probably is responsible for the accumulation of middle ear effusion. The mucociliary system is indeed an important defense system and failure of such a system, especially in the mucosa close to the tympanic orifice, can cause the buildup of effusions.
Uvulopalatopharyngoplasty: Postoperative Management and Evaluation of Results
Authors: Macaluso Russell A. , Reams Carl , Vrabec Donald P. , Gibson William S. , Matragrano Andrew
Published: October 2014

Since the earliest report of success with the uvulopalatopharyngoplasty (UPPP) operation, several authors have reported less than optimal results in their experience with the procedure. Part of the difficulty in evaluating the objective results of postoperative sleep studies has been the variations in reporting data. In addition, no standard of postoperative care, including analgesia, and immediate postoperative monitoring has been described. Our experience with 42 UPPP patients (34 studied with preoperative and postoperative polysomnography) indicates a 76% response (56% successes, and an additional 20% with limited success) with use of the more stringent criteria described recently. We discuss our management of these cases, including postoperative oxygen saturation monitoring and avoidance of narcotic analgesia as necessary factors for success with this operation.
Analog and Digital Filtering of the Brain Stem Auditory Evoked Response
Authors: Kavanagh Kevin T. , Franks Renaee
Published: October 2014

This study compared the filtering effects on the auditory evoked potential of zero and standard phase shift digital filters (the former was a mathematical approximation of a standard Butterworth filter). Conventional filters were found to decrease the height of the evoked response in the majority of waveforms compared to zero phase shift filters. a 36-dB/octave zero phase shift high pass filter with a cutoff frequency of 100 Hz produced a 16% reduction in wave amplitude compared to the unfiltered control. a 36-dB/octave, 100-Hz standard phase shift high pass filter produced a 41% reduction, and a 12-dB/octave, 150-Hz standard phase shift high pass filter produced a 38% reduction in wave amplitude compared to the unfiltered control. a decrease in the mean along with an increase in the variability of wave IV/V latency was also noted with conventional compared to zero phase shift filters. The increase in the variability of the latency measurement was due to the difficulty in waveform identification caused by the phase shift distortion of the conventional filter along with the variable decrease in wave latency caused by phase shifting responses with different spectral content. Our results indicated that a zero phase shift high pass filter of 100 Hz was the most desirable filter studied for the mitigation of spontaneous brain activity and random muscle artifact.
Implantation of the Melbourne/Cochlear Multiple-Electrode Extracochlear Prosthesis
Authors: Franz Burkhard K.-H. G. , Lehnhardt Ernst , Patrick James F. , Kuzma Janusz A. , Clark Graeme M. , Laszig Roland
Published: October 2014

The Melbourne/Cochlear multiple-electrode extracochlear implant is designed for deaf patients who are unsuited to multiple-electrode intracochlear implantation. The implant consists of a receiver-stimulator package connected via a lead wire assembly to six individual stimulating electrodes. There is a choice of two alternative surgical procedures, both of which are via a combined middle ear approach using anterior and posterior tympanotomies. Four active electrodes shaped into compressible platinum-iridium soft-balls are fed through the mastoid cavity and across the facial recess, and placed into cavities that are made over the cochlear turns that project to the medial wall of the middle ear. One hard-ball active electrode is placed into the round window niche. One hard-ball reference electrode is placed into the hypotympanum. An additional electrode wrapped around the lead wire assembly can be used as an alternative reference electrode. A specially designed insertion needle facilitates the placement and the fixation of the soft-ball electrodes.
Recurrent Adult Acute Epiglottitis: The Role of Lingual Tonsillectomy
Authors: Wilson Joseph F. , Coutras Steven , Tami Thomas A.
Published: October 2014

Acute epiglottitis is a life-threatening infection of the supraglottic airway that can occur at any age. Although it is traditionally described as a childhood infection, recent reports describe an increased recognition of this problem in adults. When appropriate and timely therapy is instituted, this condition is generally self-limited. Recurrent acute epiglottitis is exceedingly uncommon, and its treatment rarely is addressed. We encountered and treated a case of recurrent acute epiglottitis in an adult. After the third recurrence, careful consideration was given to possible pathophysiologic mechanisms and potential therapeutic options. Further recurrence was prevented effectively by performing a lingual tonsillectomy. Although this is an unusual condition, the cause of recurrent acute epiglottitis may be related to chronic lingual tonsillitis. Lingual tonsillectomy in these cases may help prevent further recurrent episodes.
Facial Nerve Paralysis with Benign Parotid Masses
Authors: DeLozier Howard L. , Spinella Martin J. , Johnson Glenn D.
Published: October 2014

Facial paralysis in the presence of a parotid mass has been associated classically with a presumed diagnosis of malignancy. However, isolated case reports have documented the occurrence of paresis or paralysis secondary to pathologically benign, nonneurogenic parotid lesions. These previous cases have been reviewed and three additional cases are described. Comparisons are made on age, sex, symptoms, physical findings, pathologic findings, and prognosis. Involvement of the seventh nerve may be explained on the basis of compression, especially in association with local inflammation. Although facial paralysis still should be considered indicative of a malignancy, it also may be caused by benign masses, particularly those associated with rapid enlargement and/or infection.
What Have Whole Organ Sections Contributed to the Treatment of Laryngeal Cancer?
Authors: Kirchner John A.
Published: October 2014

The study of whole organ sections of laryngectomy specimens has demonstrated the patterns by which cancer spreads from one part of the larynx and hypopharynx to another. These studies have also demonstrated the fibroelastic membranes and ligaments that form the boundaries of intralaryngeal compartments within which cancer is confined in its early stages. They thus have added support to the concept of partial laryngectomy for selected lesions and have illustrated the features of those types of laryngeal cancer that have not responded well to radiotherapy. Whole organ sections of laryngectomy specimens have allowed a more accurate interpretation of preoperative computed tomography and magnetic resonance imaging and have provided a reliable basis for clinical staging.
Long-Term Results of Ethmoid Surgery
Authors: Sogg Alan
Published: October 2014

This paper investigates the results of nonendoscopic intranasal ethmoid surgery on 146 patients who were followed up for 6 to 13 years. These patients are divided into four groups: 1) infection without allergy, 2) infection with allergy, 3) infection with polyps and no allergy, and 4) infection with polyps and allergy. These groups are evaluated as to the long-term results of surgical treatment with or without concurrent allergic desensitization. The great majority of patients benefited from the surgical treatment regardless of their allergic status. Postoperatively, the allergic patients had more subjective symptoms than those having only infection. A major conclusion was that the long-term benefit to the patient as a result of the operation performed by experienced hands does override the potential risks of ethmoid surgery.
Thickness of the Lateral Surface of the Temporal Bone in Children
Authors: Simms David L. , Neely J. Gail
Published: October 2014

The placement of implantable auditory prostheses in children has raised questions concerning the thickness of the temporal bone in the region of implantation. The purpose of this study is to describe the thickness at specific sites of the lateral surface of the temporal bone in children of different ages. One hundred twenty-five intact temporal bones from 83 children of known sex, race, and age between birth and 20 years were measured. Thickness was measured with a specially designed micrometer at specific locations from a fixed reference point by use of a surface projected grid for site identification. Thickness was plotted against age on scattergraphs for each site, and regression analysis revealed a bimodal linear relationship. Sites medial to the temporalis muscle were the thinnest; sites associated with the posteroinferior insertion of the temporalis muscle, along the supramastoid crest, were the thickest. However, wide interindividual variability was the rule.
Hyaluronan in Experimental Serous and Purulent Otitis Media
Authors: Laurent Claude , Tengblad Anders , Hellström Sten , Lilja Karin
Published: October 2014

The concentration of hyaluronan (hyaluronic acid; sodium hyaluronate; HA), a major component of connective tissue, was analyzed by a specific radioassay in tissue samples from normal rat middle ears and in tissue and effusions from middle ears affected by experimentally induced otitis media. In normal ears the pars flaccida of the tympanic membrane contained a considerably higher concentration of HA (60 to 200 μg/g) than the pars tensa and areas of the medial wall (2 to 7 μg/g). In purulent otitis media the pars flaccida contained less HA than in normal ears. The HA concentrations were lower in purulent (3 to 40 μg/mL) than in serous (20 to 190 μg/mL) effusions. The weight average molecular weight of HA in serous fluid was high (> 106) and comparable to that in lymph. It is inferred from the study that the subepithelial tissue and its matrix components, eg, HA, must be considered when attempting to understand the function of the middle ear normally and in otitis media.
Promotion of Patient Appointment Compliance in Indigent Pediatric Medical Care by Use of a Microcomputer
Authors: Kavanagh Kevin T. , Smith Theresa R. , Tate Nellie P. , Golden Gerald S. , Hinkle William G.
Published: October 2014

A computerized system for appointment scheduling, medical record keeping, medical billing, patient tracking, and epidemiologic data generation was developed and applied in an indigent pediatric otologic clinic. Functions used to augment appointment compliance are 1) notifying the referring physicians, agencies, and health department coordinators of failed appointments and sending medical information on the attended appointments, 2) listing patients who failed appointments, 3) production of mailings for failed appointments, 4) automatic rescheduling of failed appointments, and 5) automatic calculation of patient attendance ratios. The attendance ratio can be used to help identify patients for referral to social service workers and to implement rewards designed to promote medical compliance. The automatic rescheduling of failed appointments resulted in 21% of new patients and 30% of return patients above controls returning for a medical visit. The recalled patients had a much lower economic status than our average clinic patient, ie, the system was effective in reaching the target population.
Review of Neuroendocrine Carcinomas of the Larynx
Authors: Ferlito Alfio , Friedmann Imrich
Published: October 2014

Neuroendocrine carcinomas of the larynx are uncommon tumors of considerable scientific interest and clinical importance. They include typical carcinoid tumors, atypical carcinoid tumors, and small cell neuroendocrine carcinomas. This paper considers these neoplasms from a personal experience and reviews the relevant medical literature. About 200 cases of neuroendocrine carcinomas of the larynx have been reported. The diagnosis is based on light microscopy and is confirmed by ultrastructural evidence of neurosecretory granules. Histochemical and immunocytochemical investigations may support it. Paraneoplastic syndromes associated with laryngeal neuroendocrine carcinomas have been reported occasionally. The histogenesis, treatment, and prognosis of these lesions also are discussed.
Treacher Collins Syndrome: An Otologic Challenge
Authors: Jahrsdoerfer Robert A. , Yeakley Joel W. , Aguilar Eugenio A. , Cole Randolph R.
Published: October 2014

Patients with Treacher Collins syndrome have severe middle ear malformations that render operation difficult. We have evaluated 43 patients with Treacher Collins syndrome, on whom only 11 were operated. Computed tomography, the single most important study done preoperatively, routinely showed an underdeveloped temporal bone with islands of bone marrow and absent mastoid pneumatization. The middle ear space was often underdeveloped. Ossicular dysjunction was often noted in which the fused malleus/incus remnant was found 3 to 4 mm distant to the stapes. A common finding was severe dysplasia of the stapes-facial nerve complex that often made the middle ear malformation uncorrectable. Hearing results were much less predictable than in patients with isolated atresia/stenosis of the ear.
Delayed Airway Obstruction and Neck Abscess following Manual Strangulation Injury
Authors: Kuriloff Daniel B. , Pincus Robert L.
Published: October 2014

Few reports describing manual strangulation injury to the neck are found in the otolaryngologic literature. Since most victims sustain immediate fatal asphyxiation, brain anoxia, or cardiac arrest, they are usually examined by a forensic pathologist. When strangulation attempts are nonfatal, neck injuries can lead to delayed airway obstruction. If not managed in a timely fashion, these injuries can be fatal or cause permanent laryngotracheal sequelae. We describe a patient who 36 hours following manual strangulation developed acute upper airway obstruction and neck abscess necessitating tracheotomy, neck exploration, and drainage. Patients suffering this unique type of compression injury may present initially with deceptively benign symptoms and signs. We discuss the overall management of these patients, stressing the need for early imaging studies, endoscopic assessment, and continued airway monitoring in an intensive care unit.
Age-Related Morphologic Differences in the Components of the Eustachian Tube/Middle Ear System
Authors: Sadler-Kimes Deborah , Siegel Michael I. , Todhunter John S.
Published: October 2014

The current study utilized a three-dimensional computer graphics technique to analyze the size, shape, and positional associations of the eustachian tube (ET) cartilage and lumen, the levator veli palatini (LVP) muscle, and the tensor veli palatini (TVP) muscle. Older specimens 7 years and above (n = 13) were compared to young specimens less than 7 years (n = 4). Our results suggest that changes in ET function associated with age could result from size and shape differences in the ET cartilage and changes in the position of the LVP and TVP muscles.
Effects of Unilateral Loss of Vestibular Function on the Vestibulo-Ocular Reflex and Postural Control
Authors: Black F. Owen , Peterka Robert J. , Shupert Charlotte L. , Nashner Lewis M.
Published: October 2014

Long-term recovery from surgically induced unilateral loss of vestibular function was studied in 14 patients. Seven patients underwent surgical extirpation or section of the vestibular nerve, and seven patients underwent labyrinthectomy without vestibular nerve section. The vestibulo-ocular reflex (VOR) and postural control were evaluated preoperatively and monitored for up to 4 years postoperatively with use of pseudorandom rotation (combined sinusoidal frequencies from 0.009 to 1.5 Hz) and moving platform posturography. Immediately following surgery all patients showed minimal reductions in the VOR gain constant, but marked reduction in the time constant, and marked increase in slow eye velocity bias. Bias returned to normal values within about 10 days, but time constants never returned to normal values. Results of standard Romberg tests in these patients were normal throughout the preoperative and postoperative periods. However, all patients showed marked postural control abnormalities in tests of the ability to maintain balance in unusual sensory environments in the immediate postoperative period. Seventy-five percent of the patients eventually recovered normal postural control. Postural control returned to near baseline performance with a time course similar to that of the VOR bias. However, postural control also continued to improve after the recovery of VOR bias was complete.
Prospective Studies Evaluating the Standard Endotracheal Tube and a Prototype Endotracheal Tube
Authors: Santos Perry M. , Afrassiabi Ali , Weymuller Ernest A.
Published: October 2014

Two prospective studies were designed to evaluate laryngeal injury sustained with the standard endotracheal tube (ETT) and the relative safety of a new prototype ETT. The first study followed patients after prolonged intubation with the standard ETT. Potential patient host factors were recorded and correlated with subjective complaints and objective findings on fiberoptic laryngoscopy. Nearly all patients sustained laryngeal injury after prolonged intubation, although over two thirds experienced resolution. Nasogastric feeding tubes and larger-diameter ETTs were associated with true vocal cord (TVC) granuloma formation. Duration of intubation was associated with delayed TVC immobility. The mechanisms of TVC granulomas and immobility are probably different, as suggested by the different host factor associations and onset times. The second study compared the standard ETT with the prototype ETT in short-term intubations. The prototype ETT was associated with no complications in this setting and is considered relatively safe for further testing in the patient with prolonged intubation.
Sternomastoid Tumor of Infancy
Authors: Thomsen James R. , Koltai Peter J.
Published: October 2014

Sternomastoid tumor of infancy (SMTI) is the most common cause of neck mass in the perinatal period. We present seven children with this disorder, six studied prospectively. Ages at presentation ranged from 1 week to 4 weeks. Five had a history of birth trauma. Torticollis with facial asymmetry was seen in two. In six the diagnosis of SMTI was made clinically, and these patients were managed conservatively with massage and controlled stretching of the neck. Resolution of the neck mass, the torticollis, and the facial asymmetry occurred in all patients. Pathologic and radiographic findings are presented. We conclude that careful clinical assessment precludes the necessity of biopsy and emphasize the importance of conservative management of this transient problem.
Immune Response of the Endolymphatic Sac to Horseradish Peroxidase: Immunologic Route from the Middle Ear to the Inner Ear
Authors: Ikeda Minoru , Morgenstern Claus
Published: October 2014

Twenty guinea pigs were immunized with horseradish peroxidase (HRP) intradermally and challenged with 5 mg of the same antigen in the tympanic bulla. The appearance of immunoglobulin-producing cells (plasma cells) in the inner ear structure was examined immunohistochemically in frozen sections. Four to 10 days following antigen challenge, 5 of the 20 animals showed significantly increased plasma cells in the subepithelial connective tissue of the endolymphatic sac (ES). Those cells showed positive reactions, mainly with IgG followed by IgM. The cells that reacted positively with IgA were few. Some of these plasma cells were considered to contain the specific antibody against HRP. The results indicate the role of the ES as a local immune response region for the inner ear complex, as well as the existence of an immunologic route from the middle ear cavity to the inner ear, particularly to the ES.
Malignant Hyperthermia in the Otolaryngologic Patient: Prospective Anesthetic and Surgical Management of Eight Children
Authors: Dudley James P. , Reynolds Robert , Dubrow Terry J.
Published: October 2014

Malignant hyperthermia (MH) is a rare genetic myopathy whose hallmark is rise in body temperature. This hypermetabolic state is triggered by inhalational anesthetics and/or depolarizing muscle relaxants such as succinylcholine. Even the use of dantrolene may not be protective against the hypermetabolic crisis. Eight patients at risk for MH undergoing tonsillectomy, adenoidectomy, and/or myringotomy with ventilation tube insertion were anesthetized with nitrous oxide, barbiturates, opiates, tranquilizers, and nondepolarizing muscle relaxants without dantrolene and without complication. Cardiac monitoring and rectal temperatures were followed. In order to provide additional evidence, all eight patients had vastus lateralis muscle biopsies with subsequent caffeine-halothane contracture studies performed. The contracture study showed positive results in seven of eight patients studied, indicating MH-susceptible muscle. No anesthetic or operative complications were encountered. This study demonstrates that patients at risk of developing MH crisis can have otolaryngologic procedures performed relatively safely while undergoing appropriately selected anesthesia.
Goblet Cell Density in Nasal Polyps
Authors: Tos Mirko , Larsen Per L. , Møller Kim
Published: October 2014

The goblet cell density was determined in 29 nasal polyps from 22 patients by use of the periodic acid Schiff-alcian blue whole-mount method. The distribution of goblet cells was found to be extremely irregular, ranging from areas completely devoid of goblet cells to areas with a relatively high density. The median density varied from 280 cells/mm2 to 10,000 cells/mm2. The total median density for all 15 polyps located anteriorly in the nose was 3,450 cells/mm2, compared with 6,050 cells/mm2 for 14 posteriorly located polyps. The density was highest in pseudostratified, cylindric epithelium, although great variations occurred among the different areas with this type of epithelium. The goblet cell density may be influenced by several factors, such as the airflow, type and thickness of the epithelium, and whether the genesis of the nasal polyps is infectious or allergic, in addition to polyp growth, size, and age.
Histopathologic Study of the Perilymph-Suctioned Labyrinth
Authors: Hara Makoto , Nomura Yasuya , Saito Kogaku
Published: October 2014

A small amount of perilymph was suctioned from the scala tympani through the round window membrane of guinea pigs. The animals either were killed immediately after the suctioning or were kept alive for 1 to 3 months. For morphologic study, the conventional celloidin embedding method was employed, and the temporal bones were serially sectioned. Various kinds and degrees of changes in the membranous labyrinth were observed: Hydrops, collapse, and rupture. Loss of outer hair cells in the upper turns of the cochlea was noted in the 1- to 3-month recovery specimens. These findings are identical to those found in animals in which artificial perilymph was injected into the subarachnoid space in order to produce experimental perilymphatic fistula. After comparing morphologic changes of the membranous labyrinth following use of each method, we concluded that perilymph suctioning from the round window can be used as an animal model of perilymphatic fistula.
Minicricothyrotomy for Tracheobronchial Toilet
Authors: Ophir Dov , Konichezky Sergio
Published: October 2014

Thirty-six patients underwent percutaneous cannulation of the cricothyroid membrane, using a small endotracheal tube, for the purpose of repeated suction of secretions from the tracheobronchial tree. The duration of cannulation ranged from 4 to 62 days (average, 12 days). Twenty-eight patients were followed up for a maximum of 3.5 years (mean, 20 months). There were no immediate or delayed postoperative complications. Subglottic stenosis did not occur in any of the patients. Minicricothyrotomy is a relatively safe and simple and efficient technique for tracheobronchial toilet in patients with chronic lung disease and in the postoperative period.
Morphometric Analysis of Normal Human Spiral Ganglion Cells
Authors: Nadol Joseph B. , Burgess Barbara J. , Reisser Christoph
Published: October 2014

A morphometric analysis of the human spiral ganglion was performed at an ultrastructural level. Cells of the basal, middle, and upper middle turns were evaluated by serial section. The following parameters were evaluated: Myelinization, area, diameter, circumference, and degree of roundness of the cell body and nucleus; diameter of the axon and dendrite in their initial segments; and process configuration. Analysis of variance suggested there were at least two types of cell bodies within the human spiral ganglion, best delineated by the dimensions of the cell body and nucleus and the ratio of diameter of the initial segments of axonic and dendritic processes. Myelinization and degree of roundness were relatively unimportant differential parameters. Cluster (multivariate) analysis of the six most important differential parameters suggested the possibility of five subgroups among the groups of large and small cells. For the middle and upper middle turns, cluster analysis suggested that there may be as many as three groups of cells based on morphometric analysis. These results are discussed in relation to other morphologic and physiologic data in the mammalian spiral ganglion.
Immunohistologic Findings in Otosclerosis
Authors: Schrader Martin , Poppendieck Joerg , Weber Benno
Published: October 2014

The cause of otosclerosis is still unclear. Between 1981 and 1988 we obtained 186 biopsy specimens of otosclerotic bone during the course of stapedectomies. Serial sections of the specimens were examined histologically (H & E) and immunohistologically (peroxidase-antiperoxidase technique) for immunoglobulin G, immunoglobulin M, and C1q and C3 complements. Active otosclerotic foci were found in 61 cases, 43 of which had IgG deposits. IgM antibodies were absent. In specimens with inactive otosclerosis, IgG and IgM were not evident. C1q and C3 complements were demonstrated together with IgG, but sometimes also in the mucosa independent of the phase of the otosclerosis. Our findings suggest that an immunologic process may be important in the pathogenesis of otosclerosis.
Quantitative Distributions of Aspartate Aminotransferase and Glutaminase Activities in the Guinea Pig Cochlea
Authors: Wiet Gregory J. , Rubio Javier A. , Godfrey Donald A. , Ross C. David
Published: October 2014

Distributions of aspartate aminotransferase and glutaminase activities in the guinea pig cochlea have been examined with use of quantitative microchemical techniques to evaluate their roles in cochlear energy metabolism and neurotransmission. Other enzyme activities analyzed were those of choline acetyltransferase and malate dehydrogenase. It is concluded that aspartate aminotransferase activity appears to be especially concerned with cochlear energy metabolism, while glutaminase activity may function in transmitter metabolism in the guinea pig cochlea. Neither enzyme shows a clear association with the olivocochlear bundle.
Time-Related Changes in the Guinea Pig Cochlea after Acoustic Overstimulation
Authors: Fredelius Lars , Bagger-Sjöbäck Dan , Johansson Bo , Wersäll Jan
Published: October 2014

Forty-eight female pigmented guinea pigs were used to study the development of the morphologic and electrophysiologic changes occurring during a 4-week period after exposure to a 3.85-kHz pure tone at an intensity of 120 dB sound pressure level for 22.5 minutes. The morphologic results suggest an alteration in the permeability of ions between the inner ear fluids through gradual development of holes in the reticular lamina.
Otitic Candidiasis in Children: An Evaluation of the Problem and Effectiveness of Ketoconazole in 10 Patients
Authors: Cohen Seymour R. , Thompson Jerome W.
Published: October 2014

The purpose of this paper is to report a group of children with recurring ear infections in whom persistent otorrhea was found to be due to monilial ( Candida) infection of the middle ear. Some of the patients had associated mastoid disease. A review of the literature reveals few reports of otitis media and/or mastoiditis due to Candida infection. Ten patients who had persistent otorrhea were found to have monilial infection as a cause of the ear disease. None of the patients were immunosuppressed or immunocompromised. Nine of the 10 patients (one was lost to follow-up) were treated with antifungal medication, and the effectiveness of ketoconazole therapy is evaluated. None of the children in this series had systemic candidiasis. The probable causes of the problem of yeast infection of the ear are explored and appear to be related to the use of multiple broad-spectrum antibiotics and local antibiotic-steroid ear drops.
Correction of Glottic Insufficiency by Collagen Injection
Authors: Remacle Marc , Marbaix Etienne , Bertrand Bernard , Hamoir Marc , van den Eeckhaut Johan
Published: October 2014

Thirty-nine patients were treated with GAX collagen for vocal fold augmentation. The objective results were evaluated by measurement of the maximum phonation time, the phonatory quotient, vocal frequency analysis, and laryngostroboscopy. These results are as good as those with Zyderm Collagen II (ZCI). Avoidance of useless overcorrection, better resistance to collagenase, and less induced hypersensitivity differentiate GAX from ZCI.
Detection of Specific IgA Antibodies to Varicella Zoster Virus in Serum of Patients with Ramsay Hunt Syndrome
Authors: Hadar Tuvia , Tovi Ferit , Sarov Batia , Sidi Jack , Sarov Israel
Published: October 2014

Varicella zoster virus (VZV)–specific IgG and IgA antibody titers were determined in serial serum samples of 23 patients with Ramsay Hunt syndrome by the immunoperoxidase assay. Varicella zoster virus–specific IgG antibodies were found in the first serum samples of all the patients. In 80% of 20 patients in whom a serum sample was available within 5 days after the onset of the disease, VZV-specific IgA antibodies were detected. The second serum sample was VZV-specific IgA–positive in all of the patients. While all the healthy age- and sex-matched control subjects had VZV-specific IgG antibodies, VZV-specific IgA antibodies were detected in a low titer (dilution = 2) in only three of the subjects. By using VZV-specific IgA antibody titers of ≥ 2 and ≥ 4 by the immunoperoxidase assay as a “cutoff” for younger and older patients with Ramsay Hunt syndrome, respectively, an early diagnosis of the disease can be obtained in 89% of the younger and in 64% of the older patients by a single serum sample.
Effect of Arachidonic Acid on the Inner Ear Blood Flow Measured with a Laser Doppler Flowmeter
Authors: Umemura Kazuo , Nakashima Mitsuyoshi , Takiguchi Yoshiharu , Nozue Michihiko
Published: October 2014

The present study was undertaken to clarify the effect of arachidonic acid (AA) on the inner ear blood flow of rats as measured with a laser Doppler flowmeter. With the rats under anesthesia with sodium pentobarbital, the middle ear was approached ventrally and a laser Doppler probe was positioned over the lateral wall of the cochlea. Drugs were administered via the subclavicular artery. The dose range of each drug was determined so as not to affect the systemic blood pressure. The AA (20 to 70 μg) increased the inner ear blood flow dose-dependently; this effect was abolished by indomethacin (5 mg orally). Both prostaglandin E2 (PGE2; 1 to 50 ng) and CS-570, a PGI2 analogue (12.8 to 25.6 ng) caused a dose-dependent increase in the inner ear blood flow. The response of PGI2 was shorter than that of PGE2. On the other hand, a stable thromboxane A2 (STA2; 30 to 80 ng) decreased the inner ear blood flow dose-dependently. Administration of PGF2α (0.2 to 3 μg) showed no effect on the inner ear blood flow. These results indicated that the effect of AA was mediated mainly via PGI2 and PGE2.
Laryngeal Chondrosarcoma: Incidence, Pathology, Biological Behavior, and Treatment
Authors: Nicolai Piero , Sasaki Clarence T. , Ferlito Alfio , Kirchner John A.
Published: October 2014

Chondrosarcoma is the most common mesenchymal tumor of the larynx and approximately 200 cases have been collected in the world medical literature. It is less aggressive in the larynx than elsewhere: Cervical or distant metastases are rare (8.5%), and although local recurrences are not uncommon, they are not catastrophic. A retrospective study was made on eight cases of laryngeal chondrosarcoma. Three cases had originally been diagnosed as idiopathic vocal cord paralysis, possibly because of early involvement of the cricoarytenoid joint or the distal portion of the recurrent nerve. This fact emphasizes the need for accurate laryngeal computed tomography in cases of vocal cord paralysis of unknown origin. Surgical excision is the treatment of choice for laryngeal chondrosarcoma, and conservative techniques may sometimes be appropriate. Supraglottic laryngectomy may be the technique of choice in the rare cases of epiglottic involvement.
Middle Ear as a Gas Pocket
Authors: Sadé Jacob , Luntz Michal
Published: October 2014

An analysis of 45 adult ears that underwent a modified radical mastoidectomy for cholesteatoma and remained with an intact unper-forated pars tensa is described. 1) While in practically all these ears some air was present behind the tympanic membrane, its amount varied considerably. 2) The air present behind the tympanic membrane was always in communication with the eustachian tube. 3) The regions in the middle ear devoid of air presented a deep atelectasis that was found predominantly in the posterior-superior part of the middle ear. Topographically the regions of air and atelectasis corresponded to the distribution of ciliated and flat epithelia in the middle ear, respectively. The presence of air in the middle ears obliges us to view these ears as being aerated gas pockets. The aeration difference between such an atelectatic ear and one in a physiologic state is probably a difference of degree. This difference can result from reduction in aeration through the eustachian tube or from excessive absorption of gases into the circulation, or from deficient normal diffusion of carbon dioxide or nitrogen from the circulation into the middle ear, or from a combination of these factors. The analogy with the respiratory system is emphasized.
Sensitivity and Specificity of the Head-Shaking Test for Detecting Vestibular System Abnormalities
Authors: Jacobson Gary P. , Newman Craig W. , Safadi Ibrahim
Published: October 2014

The head-shaking nystagmus (HSN) test has been reported to be a sensitive screening test for the presence of peripheral and central vestibular system disease. Previous investigations have utilized few subjects who were drawn from well-defined patient populations. The purpose of the present investigation was twofold: First, to determine the prevalence of HSN in a large unselected population of dizzy patients seen in an otology and neurotology practice, and second, to determine the sensitivity and specificity of this evaluation in the detection of vestibular system abnormalities as reflected by results of electronystagmography and rotary chair testing. The results of the investigation have suggested that the HSN test has a 27 % sensitivity and an 85 % specificity. The HSN test yields an acceptable number of false positives (15%) and an unacceptably large number of false negatives (73%).
Evoked Vertex and Inferior Colliculus Responses to Electrical Stimulation of the Cochlear Nucleus
Authors: Shore Susan E. , Wiler James A. , Anderson David J.
Published: October 2014

Evoked potentials were recorded from the vertex and the inferior colliculus in guinea pigs in response to electrical stimulation of the cochlear nucleus complex. The stimuli consisted of 80-μs biphasic pulses, ranging from 20 to 5,000 μA. The effect of electrode location (nerve root area, surface, and in-depth dorsal cochlear nucleus) on the evoked response was assessed by measuring amplitudes, latencies, and thresholds as a function of stimulating current levels. Stimulation of the nerve root area resulted in the shortest latencies, the largest amplitudes, and the lowest thresholds, whereas the surface of the dorsal cochlear nucleus was the least effective stimulating site.
Early Supraglottic Cancer
Authors: DeSanto Lawrence W.
Published: October 2014

Early supraglottic cancers (T1 and T2) are treated today with several dissimilar programs. Operation or irradiation alone, combined irradiation and operation, and irradiation with operation for salvage are the options. This study analyzed the effectiveness of operation alone in a group of 94 patients with early lesions. There were no local failures in the group. The only cause of failure was recurrence in the neck and distant metastasis in 15 % of patients. Comparisons were made of effectiveness of treatment with regard to local and neck failure, voices retained, frequency of retreatment, and determinate survival to the alternate treatment programs. No differences were found in regard to survival with any of the contemporary programs. There are differences in terms of retreatment frequency, voice preservation, and cause of failure between programs. Conservation surgery is preserving voices today. Combined therapy seems of little value in the early cancers.
Transcutaneous Intrafold Injection for Unilateral Vocal Fold Paralysis: Functional Results
Authors: Hirano Minoru , Tanaka Yasumasa , Tanaka Shinzo , Hibi Seishi
Published: October 2014

This paper presents the technique of transcutaneous intrafold silicone injection and the functional results of 44 procedures in 42 patients. The injection is given under local anesthesia with the patient in a supine position. The needle is inserted through the cricothyroid space. The location of the needle as well as the effect of injection is monitored by means of a fiberscope connected to a television camera and screen. The preoperative and postoperative vocal function was multidimensionally evaluated with the use of a test battery consisting of the maximum phonation time (MPT), mean airflow rate (MFRc), fundamental frequency (FO) range and sound pressure level (SPL) range of phonation, pitch perturbation quotient (PPQ), amplitude perturbation quotient (APQ), and normalized noise energy (NNEa). In the majority of the patients, MPT, FO range, and SPL range increased and MFRc, PPQ, APQ, and NNEa decreased postoperatively. In the overall evaluation based on the test values of these parameters, the result was excellent for 16 procedures, good for 16, fair for 7, and poor for 5. The most frequent cause of failure was an insufficient amount injected.
Endoscopic Laryngeal Surgery for Rilateral Midline Vocal Cord Orstruction
Authors: Rontal Michael , Rontal Eugene
Published: October 2014

There are a number of treatment regimens for bilateral laryngeal paralysis, ranging from tracheostomy to external microscopic approaches. None has become the standard because of their unpredictable results and/or the need for an external approach. Recently, the use of micro-trapdoor flaps and suturing done via a laryngoscope has shown a possibility of correcting the airway problem, allowing a predictable result, with a completely endoscopic approach. This paper presents our experience with a group of 10 patients who had at least one treatment attempt that failed and were treated by endoscopic laryngoplasty. Eight have been decannulated.
Responses to Rubella, Tetanus, and Diphtheria Vaccines in Otitis-Prone and Non-Otitis-Prone Children
Authors: Prellner Karin , Harsten Göran , Christenson Brith , Löfgren Bengt , Heldrup Jesper
Published: October 2014

Delayed immunologic maturation — Among other things based on a selective lack of antibodies against some acute purulent otitis media (AOM)–associated pneumococcal types — has been proposed in children with recurrent AOM (rAOM). To further elucidate the immunologic response in these children, we compared the antibody responses to diphtheria, tetanus, and rubella vaccinations in 13 children with rAOM and 29 children without AOM. The children took part in a prospective study from birth to the age of 3 years. The antibody response to the rubella vaccine was significantly lower in the children with rAOM. The responses to tetanus and to diphtheria did not differ between children with and without rAOM. Thus, the results indicate that in addition to the known lack of antibodies against pneumococcal polysaccharide antigens, a lower antibody response against at least one protein antigen may exist in otitis-prone children.
Hydrocortisone Delay of Tissue Repair of Experimental Tympanic Membrane Perforations
Authors: Spandow Odd , Hellström Sten , Schmidt Sten-Hermann
Published: October 2014

The effects of topically applied hydrocortisone on experimental tympanic membrane (TM) perforations in rats were evaluated by otomicroscopy and light microscopy. Standardized TM perforations, occupying the whole upper rear quadrant, were performed, and a 2% hydrocortisone suspension (CORT) was applied once daily for 10 consecutive days. Application of CORT caused a delayed healing pattern, and even at 1 month only 2 of 12 perforations had healed. The keratinizing squamous epithelial cells of the TM appeared hypertrophic, whereas hyperplasia, characterizing a nontreated healing TM perforation, was less prominent. The connective tissue layer of the CORT-treated TM was invaded by abundant inflammatory cells, mainly polymorphonuclear leukocytes. Also, when applied to an intact TM, CORT caused hypertrophy of the epidermal cells and an inflammatory reaction within the TM.
Morphologic and Biochemical Study of Vascular Permeability of the Middle Ear Mucosa in Experimental Otitis Media
Authors: Sakagami Masafumi , Juhn Steven K. , Harada Teruhiko , Arndt J. Duvall
Published: October 2014

The vascular permeability of the middle ear mucosa of chinchillas was examined by light and electron microscopy using horseradish peroxidase (HRP). Two kinds of experimental otitis media were used: Serous otitis media (SOM) produced by eustachian tube obstruction and purulent otitis media (POM) produced by inoculation with Streptococcus pneumoniae type 7F. Normal mucosa showed no leakage of HRP. In SOM, vessels were dilated and tortuous, but they did not show HRP leakage. In POM, vessel leakage of HRP was extensive. Biochemically, we measured the middle ear effusion–to-serum ratio of both albumin and α2-macroglobulin by an immunodiffusion method. The ratios of the two marker proteins for vascular permeability were significantly higher in POM than in SOM. This suggests that POM increases vascular permeability to a higher degree than SOM, and morphologic findings in the middle ear mucosa correlate with the biochemical composition of the middle ear effusion.
Sulcus Vocalis: Functional Aspects
Authors: Hirano Minoru , Yoshida Tetsuji , Tanaka Shinzo , Hibi Seishi
Published: October 2014

The vocal function of 126 patients with sulcus vocalis was evaluated with the use of a test battery of multidimensional evaluation items. Of the 126 patients, 31 had a unilateral sulcus and 95, bilateral lesions. The results were as follows. 1) The majority of the patients had a mild degree of hoarseness with a breathy quality. 2) An incomplete glottic closure, a small vibratory amplitude, and a small mucosal wave were frequently observed in the stroboscopic examination. 3) The maximum phonation time, fundamental frequency range, and sound pressure level range of phonation were decreased, whereas the airflow during phonation was increased. 4) The pitch perturbation quotient, amplitude perturbation quotient, and normalized noise energy were increased. 5) Abnormal test results were more frequent and more marked for bilateral lesions than for unilateral lesions.
Management of Sharp and Penetrating Foreign Bodies of the Upper Aerodigestive Tract
Authors: Holinger Lauren D.
Published: October 2014

The aspiration or ingestion of a foreign body into the upper aerodigestive tract is a common accident that befalls children and adults alike. Sharp and pointed objects pose special problems. The basic principles of their extraction were meticulously developed by Chevalier Jackson, whose concepts of the mechanical problems encountered and demonstrations of their solutions are responsible for keeping morbidity and mortality figures at a minimum. The principles of evaluation and management of sharp and penetrating foreign bodies of the upper digestive tract are described.
Ventilation Tube Duration versus Design
Authors: Moore Philip J.
Published: October 2014

Two ventilation tube designs were simultaneously compared in children in order to determine their relative rates of extrusion. The results show a twofold difference between the extrusion of the Shepard compared to the “Sheehy” or collar-button pattern of tube. Subjected to statistical analysis, these findings are highly significant.