bluuebunny/crossref_metadata_2025 huggingface dataset:
Angioedema Related to Angiotensin‐Converting Enzyme Inhibitors
Authors: Seidman Michael D. , Lewandowski Christopher A. , Sarpa J.R. , Potesta Eugene , Schweitzer Vanessa G.
Published: January 2017

Angioedema is a disorder characterized by well‐demarcated nonpitting edema involving the tongue, floor of the mouth, larynx, lips, and face. This condition can progress to upper airway obstruction and death. Angiotensin‐converting enzyme inhibitors (ACEIs), relatively new antihypertensive agents, act by blocking the formation of angiotensin II, a potent vasoconstrictor and stimulator of aldosterone formation. ACEIs also retard the breakdown of bradykinin, a potent vasodilator, which may lead to the edema seen in nonhereditary angioedema. These ACEIs include enalapril, Captopril, ilsinopril saralasin acetate, and a combination of ACEl with diuretics (for example, Capozide) From August 1987 to January 1989, we treated six patients with a nonhereditary form of angioedema related to ingestion of angiotensin‐converting enzyme inhibitors Symptoms developed in all patients within 12 hours after their initial dose of an ACEl They presented with shortness of breath and dysphagia associated with tongue and floor of the mouth edema. Two Of the six required intubation and monitoring in the surgical intensive care unit for 36 to 48 hours. Three required supportive treatment and observation in an intermediate care unit, and one received supportive care in the clinic and was discharged the same day. Specifically, treatment consisted of cessation of inciting agent, steroids, antihistamines, and epinephrine. If not otherwise contraindicated. Assays of C, esterase inhibitor levels and C4 were normal in all six patients; this was important in order to rule out hereditary forms of angioedema. These cases will be discussed, including a review of the literature, methods of diagnosis, pathophysiology and treatment of angioedema.
Extranodal Head and Neck Sinus Histiocytosis with Massive Lymphadenopathy
Authors: Naidu Rahul K. , Urken Mark L. , Som Peter M. , Danon Ardis , Biller Hugh F.
Published: January 2017

Sinus histiocytosis with massive lymphadenopathy (SHML) is a rare, benign, and frequently chronic disorder that was first described in 1969. It is characterized by painless cervical lymphadenopathy, low‐grade fever, leukocytosis, elevated erythrocyte sedimentation rate, and polyclonal hypergammaglobulinemia.1'2In 22% of patients, extranodal infiltration occurs in head and neck sites.3The purpose of this article is to present a case of SHML that had extranodal disease in the sinonasal cavities, pharynx, and subglottis.
First Place — Resident Basic Science Award 1991: Cell and Molecular Anatomy of Nicotinic Acetylcholine Receptor Subunits and Calcitonin Gene‐Related Peptide in the Rat Vestibular System
Authors: Wackym Phillip A. , Popper Paul , Ward Paul H. , Micevych Paul E.
Published: January 2017

In this report we demonstrate the pattern of calcitonin gene‐related peptide (CGRP) mRNA and immunoreactivity in the central and peripheral vestibular system of the rat, using a CGRP cRNA probe and a polyclonal CGRP antiserum. We present evidence that somata in all regions of efferent vestibular neurons contain CGRP based on the correspondence between in situ hybridization (mRNA) and immunohistochemistry (mRNA translation product). CGRP immunohistochemistry (CGRPi) and in situ hybridization confirm that CGRPi axons and terminals present in the vestibular neuroepithelium are efferent in origin. Immunoelectron microscopy revealed an extensive innervation of the afferent vestibular pathway by CGRPi terminals that was not limited to the primary afferent chalice, as previously reported by Tanaka et al. (Brain Res 1989;504:31–5). An efferent neuromodulator role of CGRP can be inferred from the distribution of terminals found on the primary afferent fibers, and type I and type II hair cells. In addition, we present evidence that nicotinic acetylcholine receptor (nAChR) subunit mRNA is expressed by primary afferent cell bodies. On the basis of these data, a hypothetical molecular mechanism of vestibular efferent modulation of the primary afferent pathway is proposed.
The Protective Effects of Tirilated Mesylate (U74006F) on Ischemic and Reperfusion‐Induced Cochlear Damage
Authors: Seidman Michael D. , Quirk Wayne S.
Published: January 2017

We have recently demonstrated that allopurinol, a blocker of free oxygen radical (FOR) production, and superoxide dismutase (SOD), a scavenger of FOR, protect the cochlea from damage associated with ischemia/reperfusion. The purpose of this present study was to determine if tirilated mesylate (U74006F), a potent inhibitor of lipid peroxidation, can also protect the cochlea from ischemia/reperfusion. Eleven Wistar‐Kyoto rats were randomly assigned to two groups: (1) a control group (6 animals) that was exposed to 15 minutes of cochlear ischemia by clamping the anterior‐inferior cerebellar artery (AICA), followed by 15 minutes of reperfusion, and (2) a drug‐treated group (5 animals) that received U74006F before ischemia/reperfusion. In the control group, the tone burstevoked compound action potential (CAP) recorded from the round window (RW) was abolished and cochlear microphonic (CM) was reduced. In contrast, the U74006F‐treated animals showed post‐reperfusion sensitivity in CAP, and less of a CM threshold shift. We interpret these results to indicate that U74006F lessens cochlear damage occurring as a result of ischemia/reperfusion and supports the hypothesis that FOR‐induced lipid peroxidation may be partly responsible for the cochlear damage that occurs from ischemia.
Hierarchical Immunosuppression of Regional Lymph Nodes in Patients with Head and Neck Squamous Cell Carcinoma
Authors: Wang Marilene B. , Lichtenstein Alan , Mickel Robert A.
Published: January 2017

Patients with head and neck squamous cell carcinomas (HNSCCs) manifest defects in cell‐mediated immune function. Previous studies in this laboratory have demonstrated regional alterations in the immunocompetence of draining lymph nodes (LNs) in HNSCC patients. In this investigation, we studied functional activity of lymphocytes from lymph nodes in different locations in the radical neck dissections (RNDs) from patients undergoing operations for HNSCC. Lymphocytes from nodes close to the primary tumor (“near” lymph nodes or NLN) exhibited a significant decrease in interleukin‐2 (IL‐2)‐activated cytotoxicity when compared to lymphocyes from distant nodes (“far” lymph nodes or FLN). In addition, co‐culture experiments suggested the existence of a soluble regulatory factor, produced by lymph nodes, that inhibited the development of lymphokine‐activated killer (LAK) cells in vitro. Further experiments with conditioned supernatants from the lymph node cells confirmed the presence of this soluble inhibitory factor. The inhibitory effect is significantly greater in NLNs than in FLNS. This hierarchical phenomenon suggests a regional network of immunosuppression in HNSCC patients. It is likely that tumor‐ and lymph node‐induced suppression plays a role in limiting the efficacy of current immunotherapy protocols in human beings. A greater understanding of mechanisms of local inhibition of immune function will aid in improving adoptive immunotherapy for treatment of cancers in human beings.
Direct Electrical Stimulation of the Cochlear Nucleus: Surface vs. Penetrating Stimulation
Authors: El‐Kashlan Hussam K. , Niparko John K. , Altschuler Richard A. , Miller Josef M.
Published: January 2017

Prosthetic stimulation of the cochlear nucleus (CN) has been used for rehabilitation of profoundly deaf patients who are not suitable candidates for cochlear implants. The goal of this article was to assess the relative effectiveness of surface vs. penetrating stimulation of the CN. Electrophysiologic and autoradiographic measures were used to study central auditory system activation elicited by direct stimulation of the CN. Eighteen pigmented guinea pigs, divided into three groups, underwent acute implantation of bipolar electrodes in the CN. One group was not stimulated and acted as a control (n = 7). Electrodes were placed on the surface of the CN in one test group (n = 4) and within the CN in a second test group (n = 7). Thresholds for electrically evoked middle latency responses (EMLR) were determined and input/output (I/O) functions were obtained. The two test groups were then pulsed with [14C]‐2‐Deoxyglucose (2‐DG) intramuscularly and stimulated for 1 hour with biphasic; charge‐balanced pulses having a total duration of 400 μsec, a repetition rate of 100/sec, and an amplitude of 200 μA. After stimulation, animals were killed and brains were harvested and prepared for autoradiography using standard techniques. Threshold current for EMLRs in the surface‐stimulated group had a mean of 67.5 ± 23.9 μA (range, 40 to 100 μA). Thresholds for in‐depth stimulated group had a mean of 11.4 ± 3.5 μA (range, 10 to 20 μA). The saturation level of the I/O function for the surface‐stimulated group had a mean of 287.5 ± 41.5 μA (range, 250 to 350 μA). The saturation level for the in‐depth stimulated group had a mean of 192.9 ± 49.5 μA (range, 100 to 250 μA). The dynamic range for the surface electrodes had a mean of 13.1 ± 2.7 dB (range, 9.9 to 15.9 dB), whereas the dynamic range for the penetrating electrodes had a mean of 24.5 ± 2.6 dB (range, 20 to 28.0 dB). Autoradiographs generated by CNS tissue from stimulated animals demonstrated no significant difference in metabolic activity of the CN between surface and in‐depth stimulated groups. However, there were highly significant differences in 2‐DG uptake in the contralateral superior olivary complex, contralateral inferior colllculus, and ipsilateral and contralateral lateral lemniscus, with greater uptake in in‐depth stimulated preparations. Electrophysiologic and autoradiographic data suggest that a penetrating CN prosthesis is capable of activating the auditory tract at a lower threshold, with a relatively wider dynamic range than a surface prosthesis. This probably reflects greater efficiency of neurostimulation by virtue of direct access to larger populations of second‐order neurons and avoiding current injection through surface pial layers.
The Cervical Sympathetic Nerves in Surgery of the Neck
Authors: Collins Sharon L.
Published: January 2017

The otolaryngologist–head and neck surgeon is aware that the cervical sympathetic nerves lie behind the carotid artery and should be avoided during neck surgery. To render this sketchy dictum more tangible, relevant anatomy and physiology of the autonomic supply to the head and neck is reviewed, as are aspects of site‐of‐lesion testing, with respect to Horner's syndrome. Examples of neck operations during which the cervical sympathetic chain—from the base of skull to the root of the neck—may be injured are illustrated.
An Implantable Tumor‐Window Chamber Model for the Study of Photodynamic Therapy
Authors: Stern Scott J. , Flock Stephen , Small Susan , Thomsen Sharon , Jacques Steven
Published: January 2017

In order to study both the anti‐tumor effects and early vascular events in photodynamic therapy, a useful animal model has been developed. A window chamber is surgically placed on the dorsum of the Fischer‐344 rat, and 500‐μm fragments of the rat mammary adenocarcinoma 13672 are placed under direct vision into the subcutaneous tissue. Implantation of the chamber has been successfully completed in more than 50 rats. The operative procedure Is straightforward and is accomplished in less than 1 hour. Using tumor fragments, tumor viability has been 60%. We have demonstrated obvious and reproducible neovascularization occurring as soon as 1 day after implantation. The application of this system to an experimental protocol comparing the photosensitizes dihematoporphyrin ether (DHE) and chloroaluminum sulfonated phthalocyanine (CASP) has yielded important information on early vascular events resulting from photodynamic therapy.
The Role of Autonomic Nervous System and Inflammatory Mediators in Nasal Hyperreactivity: A Review
Authors: Rubel Edwin W. , Bernstein Joel M.
Published: January 2017

The last decade has seen a marked increase in the number of otolaryngologists–head and neck surgeons who have been trained to perform rhinologic surgery. This includes both rhinoseptoplasty and endoscopic sinus surgery. A better understanding of the pathophysiology of rhinitis and sinusitis has also kept pace with this rapid expansion of surgical intervention. For example, significant advances have taken place in our knowledge of the local lmmune system in the nose, particularly in regard to mucosal and submucosal mast cells1 and the development of protective antibodies in the nasal mucosa against viral and bacterial infections.2 We have far more understanding of the complex innervation of the blood vessels and glands in the nasal mucosa and their receptors, and, most recently, a tremendous increase of scientific data has accumulated on the effect of neuropeptides on the nasal mucous membrane. It is imperative that rhinologic surgeons have an understanding and appreciation of the complex patterns of sensory and autonomic innervation of the nose to better evaluate the medical, allergic, and surgical treatment of acute and chronic rhinitis and sinusitis. This discussion will focus on recent advances in our understanding of the biochemical substances that are released by both the autonomic nervous system and the sensory nervous system in the nasal mucosa. The effect of these mediators on both vascular smooth muscle and the seromucinous glands of the nose will be considered. Finally, the dynamic interaction between the inflammatory mediators released by sensory nerves so‐called tachykinins— And the immune system and mast cell degranulation will be considered.
Surgical Management of Adenoid Cystic Carcinoma in the Parotid Gland
Authors: Casler John D. , Conley John J.
Published: January 2017

Although adenoid cystic carcinoma may be found in multiple sites in the head and neck as well as other glandular sites throughout the body, nowhere is management of the disease more controversial than in the parotid gland. Here the facial nerve is at risk from both the disease and the treatment. Seventy‐five cases of adenoid cystic carcinoma of the parotid were analyzed. Patients were placed in four groups, depending on the type of parotid surgery received as definitive therapy: (1) lateral lobectomy, (2) total parotidectomy, (3) radical parotidectomy without preoperative facial weakness, and (4) radical parotidectomy with preoperative facial weakness. Patients were assessed with regard to staging of the initial lesion, the status of surgical margins, and the use of postoperative radiotherapy. The incidence of local recurrence and distant metastases were also recorded. Survival statistics are presented for each group. Though associated with facial nerve sacrifice, radical parotidectomy appears to offer clear advantages in terms of long‐term disease‐free survival in patients with T2 and T3 lesions. The residual facial paralysis may be rehabilitated primarily or secondarily to reduce patient morbidity. Four of 16 patients (25%) with preoperative weakness achieved 10‐year survival when radical parotidectomy was used. Obtaining clear margins at the initial setting appears to offer improved survival.
An Investigation of the Potential for Laser Nerve Welding
Authors: Korff Marjorie , Bent Stephen W. , Havig Michael T. , Schwaber Mitchell K. , Ossoff Robert H. , Zealear David L.
Published: January 2017

Suture repair of a severed peripheral nerve is cumbersome, presents a focus for infection and neuroma formation, and does not always produce adequate stump alignment. An alternative form of repair is laser nerve welding, which is attractive because it does not introduce foreign material into the anastomotic site, it forms a circumferential seal, and it can be performed in difficult‐to‐reach areas. Laser repair has not been widely accepted both because the effect of laser irradiation on intact nerves is not well documented, and the anastomotic strength of the weld has been inferior to suture repair. In the first part of the present study, rat sciatic nerves were exposed and irradiated with increasing intensities from a Sharplan CO2 and KTP laser to document nerve damage as recorded by decreases in the peak compound action potential. A new technique of laser repair (S‐Q weld) was then developed that involved harvesting subcutaneous tissue from the adjacent dermis, wrapping it around the two opposed nerve stumps, and lasering it to the epineurium to effect a weld. The strength of the S‐Q weld (6.1 grams) was considerably greater than that produced by laser welding alone. The third phase of the study compared regeneration at 2 months in severed rat sciatic nerves repaired by either microsuture or S‐Q weld. Analysis of the compound action potential values indicated that the number of regenerating fibers after laser repair was greater than that after suture repair, although a significant difference could not be demonstrated. The rate of nerve dehiscence in the laser repair was unacceptably high, but the observed advantages of the techique indicate a need for further investigation.
Single‐Stage Management of Cholesteatoma
Authors: Hirsch Barry E. , Kamerer Donald B. , Doshi Sal
Published: January 2017

Surgical management of chronic otitis media with cholesteatoma can be performed in a single‐stage procedure, with revision surgery necessary because of recurrent disease or electively with unsatisfactory hearing results. We retrospectively reviewed 164 cases with cholesteatoma surgically managed from 1980 through 1986. In total there were 11 tympanoplasties, 36 canal wall‐up mastoidectomies, 81 canal wall down modified radical mastoidectomies, and 36 radical mastoidectomies. The recidivistic rate for cholesteatoma in patients available for 5‐year followup was 11% for tympanoplasties, 19% for canal wall‐up mastoidectomies, 5% for canal wall‐down modified radical mastoidectomies, and 0% for radical mastoidectomies. Hearing results were best in patients who required tympanoplasty alone, followed by those who underwent canal wall‐down procedures. Single‐stage management of cholesteatoma with modified radical mastoidectomy (canal wall‐down) required fewer revisions for recidivistic cholesteatoma and achieved better hearing results than canal wall‐up procedures. We conclude, therefore, that staging is not necessary, improved hearing may likely be achieved with a second procedure, but this is at the patient's discretion.
Effect of Head Orientation on the Diagnostic Sensitivity of Posturography in Patients with Compensated Unilateral Lesions
Authors: Barin Kamran , Seitz Curtis M. , Welling D. Bradley
Published: January 2017

Patients with compensated unilateral vestibular lesions often have no detectable abnormality on conventional posturography. The purpose of this study was to determine whether a change in head orientation could improve the diagnostic sensitivity of the test for these patients. Twenty‐four patients with known unilateral vestibulopathy and twenty‐four normal controls were tested on the EqulTest apparatus in four head positions: head centered, head tilted right, head tilted left, and head extended. The sensory organization test was performed for each head position, using a single trial for each sensory condition. The test sequence was randomized to account for simple order effects. The subject's equilibrium was quantified by a performance index and a composite score of all sensory conditions was calculated for each head position. Patients with unilateral vestibulopathy had more postural sway with the head tilted contralateral to the side of lesion. The difference between the mean composite scores for ipsilateral and contralateral head tilts was statistically significant (p < 0.05). When individual trials were compared, equilibrium scores were significantly different only for sensory conditions that required vestibular input. Head extension increased postural sway in both patients and controls. Equilibrium scores were significantly different for all sensory conditions in which the support was sway‐referenced. We suggest that the results of head extension in patients are similar to those found in normal individuals. However, equilibrium scores for right‐left head flits are sensitive to the side of lesion and can provide additional information for patients with unilateral vestibulopathy.
Transantral Revision of Recurrent Maxillary and Ethmoidal Disease following Functional Intranasal Surgery
Authors: Friedman William H. , Katsantonis George P.
Published: January 2017

Recurring disease in the maxillary sinus, despite inferior meatal antrostomies, has led to the widespread use of middle meatal antrostomy or simple decompression of the natural ostium of the middle meatus in attempts to restore function to the maxillary sinus. We have reported recurrent disease in the maxillary sinus in patients with stage III or stage IV hyperplastic rhinosinusitis in whom attempts at functional surgery of the middle meatus were unsuccessful in reversal of retrograde changes. One hundred patients who had previously undergone intranasal sphenoethmoidectomy with removal of the middle turbinate, decompression of the maxillary ostium, and removal of overt hyperplastic disease of the middle meatus underwent revision transantral ethmoidectomy. All recurrent or residual diseased mucosa was removed, including polyps, occasional mucoceles, and hyperplastic changes that occurred despite patency of a middle meatal maxillary ostium. In many of these patients the maxillary sinus was widely marsupialized secondarily into the posterior nasal vault. While the initial overall polyp recurrence rate after intranasal sphenoethmoldectomy in these patients was as high as 19.2%, the rate of polyp recurrence after transantral revision was less than 5% in from 18 to 48 months postoperatively. The experience in this series suggests that mucosal changes have played a primary role in unsuccessful treatment, independent of whether or not adequate functional egress for maxillary secretion, drainage, or ventilation has been created or restored. A brief review, statistical evaluation of patients, and overall evaluation of the relationship of ethmoid surgery to maxillary surgery are presented.
Laryngeal Amyloidosis: A Clinicopathologic and Immunohistochemical Review
Authors: Lewis Jean E. , Olsen Kerry D. , Kurtin Paul J. , Kyle Robert A.
Published: January 2017

The clinical nature of laryngeal amyloidosis has not been well established, and the natural history of the disease remains a controversial matter. To address these issues, we reviewed the clinicopathologic and immunohistochemical features of 22 cases (11 men and 11 women; mean age, 56 years) of laryngeal amyloidosis. Hoarseness was the most common symptom, and the most frequent site affected was the false vocal cords. Six patients had concomitant tracheal amyloidosis. Paraffin blocks were available for immunostaining in 20 cases. Nineteen cases were positive for amyloid P component. λ‐Light chains were detected in 12 cases and κ‐light chains in 5; three cases did not show definite light‐chain staining. Ten patients underwent repeated operations for persistent or recurrent respiratory tract disease. One patient died of progressive tracheobronchial amyloidosis, but systemic amyloidosis did not develop in any of the patients. Laryngeal amyloidosis is a form of localized amyloidosis characterized by monoclonal light‐chain deposition. Recurrent respiratory tract disease is not uncommon, but the usual clinical course is relatively benign.
Meta‐Analysis of Antibiotics for the Treatment of Otitis Media with Effusion
Authors: Rosenfeld Richard M. , Post J. Christopher
Published: January 2017

OBJECTIVE:

To reconcile conflicting reports of antibiotic efficacy for otitis media with effusion in children.

DATA SOURCES:

English‐language MEDLINE search (“antibiotics” and “otitis” media with effusion“) from January 1980 through December 1990. Current Contents 1990, consultation with experts, and references from review articles, textbook chapters, and retrieved reports.

STUDY SELECTION:

Randomized clinical trials with concurrent controls (placebo or no drug), and children with at least one ear not violated by tympanocentesis. Ten of the initial 82 articles were selected after blind review of the methods sections.

DATA EXTRACTION:

We independently evaluated each trial using 20 measures of internal and external validity, then extracted treatment and control responses for an end point of all affected ears free of effusion at the first posttreatment assessment.

DATA SYNTHESIS:

Pooled analysis of 1325 children yielded a rate difference of 22.8% (95% CI, 10.5 to 35.1) that was minimally affected by interstudy quality differences, and was unlikely to represent publication bias. Variations in trial outcomes were not attributable to chance, study design, or choice of drug, but were inversely related to the control group natural cure rate. Children with chronic bilateral effusions not related to a recent episode of acute otitis media tended to have lower natural cure rates, and a more favorable response to therapy.

CONCLUSIONS:

Antibiotics have a clinically and statistically significant impact on the resolution of otitis media with effusion. The association between outcome and natural cure rate has important implications for the design and interpretation of future trials.
Craniofacial Resection for Tumors Involving the Anterior Skull Base
Authors: Shah Jatin P. , Kraus Dennis H. , Arbit Ehud , Galicich Joseph H. , Strong Elliot W.
Published: January 2017

A consecutive series of 71 patients who underwent craniofacial resection between 1974 and 1990 for tumors that involved the anterior cranial base was reviewed. A variety of histologic diagnoses was present in this series. The most prevalent sites of origin included the nasal cavity, ethmoid sinus, and frontal sinus. Gross tumor removal was achieved in all patients, with 29 requiring orbital exenteration. Adjuvant radiation therapy was used in 25 patients. Two patients died of postoperative complications and 26 had complications that increased morbidity and length of hospitalization. Five‐year overall survival was 56%, with a median survival of 4.2 years. Local control was observed in 40 of 56 patients with negative margins and 9 of 15 patients with positive margins. There was no difference in survival between previously treated and untreated patients. Survival varied considerably among the various pathologic diagnoses. Survival was related to the extent of disease. Patients with either dural or brain invasion had significantly decreased survival compared to those with no dural invasion. The operative procedure is safe, with acceptable morbidity and mortality, and offers respectable survival in properly selected patients.
The Role of Scientific Research in Risk Assessment and Risk Management Decisions
Authors: Sexton Ken
Published: January 2017

Risk‐based decisions are an integral part of societal efforts to protect the public from the harmful health effects of environmental pollution. Scientific Information about the magnitude and extent of risks experienced by people and about the causes of those risks is a critical factor in setting priorities and choosing cost‐effective mitigation strategies. To be effective in strengthening risk assessment and risk management decisions, research must focus on developing four types of predictive tools: (1) methods to screen and characterize toxicity; (2) biologically based dose‐response models; (3) physiologically based pharmacokinetic models; and (4) Integrated human exposure models. This approach is the key to reducing the uncertainties currently associated with many environmental health problems.
Hearing: The Effects of Noise
Authors: Clark William W.
Published: January 2017

We live in a noisy world. The clamor and din of modern society has increased in variety, if not in prevalence and intensity, In the past decades, making noise America's most widespread nuisance. Excessive noise exposure annoys individuals, produces stress, Impairs the ability to communicate, Interferes with work and play activities, and, in high enough doses, produces permanent damage to the auditory system, which leads to significant hearing loss. Noise exposure associated with the workplace has been known to produce hearing loss for centuries. More than 20 years ago the U.S. Department of Labor promulgated regulations designed to protect the hearing of employees who work in noisy environments. However, these regulations failed to consider noise exposures outside the workplace, and recent evidence suggests that these exposures are potentially hazardous for millions of Americans. The most important sources of nonoccupational noise exposure are hunting and target shooting, listening to amplified music through headphones, and attendance at rock concerts. For each source, an assessment of risk of hearing loss is made.
The Impact of Pollution on the Voice
Authors: Sataloff Robert Thayer
Published: January 2017

Pollution is responsible for the presence of toxic substances and conditions throughout our environment. Inhalation of toxic pollutants may affect the voice adversely by direct laryngeal inJury, by causing pulmonary dysfunction that results in voice maladies, or through Impairments elsewhere in the vocal tract. Ingested substances—especially those that have neurolaryngologic effects—may also adversely affect the voice. Non‐chemical environmental pollutants such as noise may also be responsible for voice abnormalities. Most of the Information about the effects of pollution on the voice is anecdotal. Equipment and techniques that permit valid, reliable voice research have recently become available; and studies on the impact of pollution on communication, and specifically on voice, should be encouraged.
Pollution: The Nose and Sinuses
Authors: Leopold Donald A.
Published: January 2017

The nose and sinuses are constantly exposed to the huge quantities of gases needed to maintain life. Not only is the human nose well‐equipped to warm and humidify this inhaled air, but It is also uniquely able to clean much of it. Any material other than physiologic amounts of oxygen, nitrogen, carbon dioxide, and water that accompanies the airstream can be considered a pollutant, and this pollutant could potentially Injure the individual. The following discussion will review the defense mechanisms that allow the nose and sinuses to protect the lower airways. The effects of pollutants on the respiratory mucosa will then be described, including some recent trends in those effects. These trends include specific population consequences of Indoor and outdoor air pollution, and changes in risk for individuals in several occupations. Throughout these discussions, specific areas that would benefit from further research will be mentioned.
Age‐Related Vulnerability
Authors: Baum Bruce J.
Published: January 2017

This presentation considers the vulnerability of the upper alimentary and respiratory tracts to environmental insults during aging. A specific example, salivary gland secretion, is discussed. Available data suggest that while aging per se does not affect salivary performance adversely, It does appear to compromise the glands in such a way that older persons are more vulnerable to exogenous factors that can reduce secretory capacity and, consequently, diminish oropharyngeal health.
Second place — resident basic science award 1993: Mucociliary function and endothelins 1, 2, and 3
Authors: Amble Finn R. , Lindberg Sven O. H. , McCaffrey Thomas V. , Runer Thomas
Published: January 2017

Endothelins are recently discovered peptides that cause vasoconstriction and bronchoconstriction. The significance to the mucociliary system of endothelins (ET) 1, 2 and 3 in upper as well as lower airways has not yet been clarified. Effects of these active peptides were investigated, combining both in vitro and in vivo rabbit models of mucociliary activity from the maxillary sinus and the trachea. The studies were performed using computerized photometric microscopy. Immunohistologic staining procedures were used to determine the presence of endothelins in sinus and trachea epithelium. Significant effects on mucociliary activity were noted for ET‐1, −2, and −3 in vitro as well as in vivo. All endothelins were noted to accelerate mucociliary activity of both sinus and tracheal mucosa. The effects of endothelins were greater in the sinus than in the trachea. In vitro studies using the calcium blocker nifedipine and the cyclooxygenase inhibitor diclofenac indicated that the mechanism of action involves an intermediary prostaglandin pathway but is independent of release of intracellular calcium. These results were confirmed using ET‐1 in vivo. Immunohistochemical staining showed endothelin to be present in both maxillary and tracheal epithelium of the rabbit. We conclude that endothelins have significant mucociliary stimulatory effects and that the presence of endothelins in normal mucosa indicates a potentially important role in respiratory homeostasis as well as inflammatory conditions
First place — resident clinical science award 1993: A comparison of cocaine vs. lidocaine with oxymetazoline for use in nasal procedures
Authors: Tarver Cynthia P. , Noorily Allen D. , Sakai Connie S.
Published: January 2017

This study compared the degree of vasoconstriction and anesthesia obtained with cocaine vs. that obtained with a mixture of lidocaine and oxymetazoline (lido/oxy) in healthy, male volunteers. Blood flow was evaluated by laser Doppler flowmetry. Anesthesia was measured with Semmes‐Weinstein monofilaments, testing both sensation threshold and pain perception. A greater decrease in blood flow was seen after the administration of lido/oxy than after the administration of cocaine. Pain perception change was not significantly different between treatment groups at 10 minutes after removal of the medication‐soaked pledget, but lido/oxy caused a greater decrease in pain perception than cocaine after 50 minutes. No significant difference in sensation threshold change was seen between treatment groups. Lidocaine with oxymetazoline is, therefore, believed to be an effective alternative to cocaine for nasal procedures.
Second place — resident clinical science award 1993: Effect of otologic drill noise on abr thresholds in a guinea pig model
Authors: Suits Gregg W. , Brummett Robert E. , Nunley Jim
Published: January 2017

The Noise Generated By The Otologic Drill Has Been Implicated As A Cause Of Sensorineural Hearing Loss After Ear Surgery. However, Clinical Studies On This Subject Are Contradictory And Difficult To Interpret. Therefore A Guinea Pig Model Was Used To Study Whether The Level Of Noise Generated By The Otologic Drill Can Cause Threshold Shifts In The Auditory Brainstem Response (Abr). The Source Noise Was A Recording Obtained During A Human Cadaver Mastoidectomy Using A Microphone And An Accelerometer. Ten Female Topeka‐Strain Guinea Pigs Were Exposed To The Recorded Drill Noise For A Period Of 55 Minutes. Exposure Included Both Air‐Conducted Energy From A Speaker And Bone‐Conducted Energy From A Bone Vibrator Applied Directly To The Skull. Abr Threshold Measurements Were Taken Pre‐Exposure (Baseline), Immediately After Exposure, And At Weekly Intervals Thereafter For 3 Weeks. Three Control Animals Were Subjected To The Same Procedure Without The Sound Exposure. A Significant Threshold Shift (P > 0.0001) Was Seen For Each Frequency Tested (2, 4, 8, 16, 20, And 32 Khz) Immediately After Exposure To Noise In All Experimental Animals. Thresholds Returned To Baseline Within 3 Weeks. We Conclude That The Level Of Noise Generated By The Otologic Drill In Mastoid Surgery Can Cause A Temporary Threshold Shift In This Guinea Pig Model
Third place — resident clinical science award 1993: Effect of pentoxyfylline on myocutaneous flap viability in pigs
Authors: Armstrong Michael , Kunar Dario R. , Cummings Charles W.
Published: January 2017

Partial necrosis of a skin flap can complicate reconstructive surgery. We performed a double‐blinded crossover study to determine if pentoxifylline improves perfusion and survival of a myocutaneous flap. Ten 20‐kg pigs were fed pentoxifylline (400 mg three times a day) or placebo for 1 week before and after raising a 5 × 30 cm panniculus carnosus flap on one flank. After 1 week of washout, each pig began the opposite drug treatment and the surgery was repeated on the opposite flank. Immediately after surgery, perfusion dermofluorometry and laser Doppler velocimetry demonstrated a significant increase in the perfusion of pentoxifylline‐treated flaps compared to control flaps. On postoperative day 7, the mean area of clinical necrosis was 39.7 ± 4.7 cm2 on the placebo sides and 30.1 ± 4.6 cm2 on the pentoxifylline sides (f = 2.21, p < 0.05). We conclude that pentoxifylline improves perfusion and survival of myocutaneous flaps in pigs. Clinical trials appear to be indicated on the basis of the findings of this experiment
Student research award 1993: Characteristics of cerumen in diabetic patients: a key to understanding malignant external otitis?
Authors: Driscoll Peter V. , Ramachandrula Anand , Drezner Dean A. , Hicks Tracy A. , Schaffer Scott R.
Published: January 2017

Malignant externa otitis is a potentially fatal disease in diabetic and other immunocompromised patients. Cerumen contains defense properties that protect the patient against infection. We tested the hypothesis that patients with diabetes mellitus have abnormalities in their cerumen that affect the environment of their external auditory canals and may predispose them to malignant externa otitis.
Diuretic and diet effect on menière's disease evaluated by the 1985 committee on hearing and equilibrium guidelines
Authors: Santos Perry M. , Hall Raelene A. , Snyder Jack M. , Hughes Larry F. , Dobie Robert A.
Published: January 2017

Fifty‐four patients, diagnosed with Menière's disease and treated with diuretics and a low‐salt diet, were evaluated retrospectively with the 1985 AAO/HNS Committee on Hearing and Equilibrium (CHE) guidelines for vertigo and hearing changes. The patient data base was also evaluated with other methods that helped determine the effectiveness of the 1985 AAO/HNS CHE guidelines. After 24 months of therapy, vertigo control was complete or substantial in 79% of the patients, limited or insignificant in 19%, and worse in 2% as evaluated by the CHE 1985 guidelines. Hearing improved in 35% of the patients, was unchanged in 29%, was worse in 22%, and could not be classified by CHE guidelines in 14%. Hearing was also evaluated by comparison of individual thresholds before medical therapy, and at 22 and 74 months after the start of medical therapy. We found a stabilization of low‐ and mid‐threshold frequencies, with an average rate of hearing loss approximating 0 dB/yr with 74 months of followup. The results of this preliminary study suggest that diuretics and a low‐salt diet may decrease the natural progression of sensorineural hearing loss in patients with Menière's disease. Compared with other methods of data analysis, the 1985 CHE guidelines lacked sensitivity to evaluate the hearing changes observed.
New dimensions for the vital storage of microsurgical free flaps: An experimental approach
Authors: Mayer Berndt , Von Baeyer Hans , Kaiser Uwe
Published: January 2017

A Revolutionary Circulatory System Has Been Developed To Nourish Big, Free Osteomusculocutaneous Flaps Extracorporally. Thus We Will Be Able To Transplant The Free Flaps To Defect Areas That Have No Sufficient Vascular Situation. In Respect To The Cold Storage Of Microsurgical Free Flaps, To Date Maximal Periods Of Ischaemic Tolerance Have Been Considerably Exceeded; The Maximal Period Is Currently 168 Hours. The Vitality Of The Flap Is Monitored Through Parameters Setting Forth The Consumption Of Oxygen Together With Histology And Electron Microscopy. The Oxygenation Of The Nutritive Medium Is Achieved Through An Aqueous Phase Gas Exchange.
Are thymus‐derived lymphocytes (t cells) defective in the nasopharyngeal and palatine tonsils of children?
Authors: Bernstein Joel M. , Rich Gary A. , Odziemiec Christine , Ballow Mark
Published: January 2017

The present study was conducted to evaluate the response of adenoidal T cells and B cells in the production of immunoglobulins. There appears to be a consistent inability of adenoidal T cells to turn on B cells to mature into immunoglobulin‐secreting plasma cells. This phenomenon did not appear to be due to suppressor activity of adenoidal T cells because T cells from other sources appeared to effectively result in adenoidal B cell maturation, even in the presence of adenoidal T cells. Both tonsils and adenoids appear to have defective IL‐2 production, in response to both mitogens and specific antigens. It is hypothesized that a cytokine(s) may be released in adenoids that downregulate IL‐2 production and result in immune suppression in the adenoids of children with recurrent otitis media and chronic sinusitis.
The effects of preoperative steroids on tonsillectomy patients
Authors: Volk Mark S. , Martin Pierre , Brodsky Linda , Stanievich John F. , Ballou Margaret
Published: January 2017

A prospective, randomized, double‐blind study to determine the postoperative efficacy of steroids in tonsillectomy was performed in 49 children. A single dose of intravenous dexamethasone or placebo was administered after each child was anesthetized. Postoperatively each child was examined for objective signs of trismus (measured by interincisor distance), temperature elevation, and weight loss, as well as for subjective signs of mouth odor, oral intake, pain, level of activity, and analgesic usage. There were no statistical differences noted in any of the variables compared in the two groups and the complication rates were also similar
Hypersensitivity to latex in health care workers: Report of five cases
Authors: Rosen Arie , Isaacson David , Brady Mary , Corey Jacquelynne P.
Published: January 2017

Concern about transmission of acquired immunodeficiency syndrome and hepatitis has greatly increased the use of latex gloves. Latex allergy is a newly emerging problem with potential life‐threatening sequelae among health care personnel. Patients are also at risk. We report on five cases of latex allergy in health care workers who were using latex gloves for variable lengths of time before their allergic reaction. All workers had a significant history of reactions to other allergens, including inhalants and food. Each individual had at least one systemic symptom that was directly attributed to latex exposure. Reactions to latex ranged from severe contact urticaria (all cases), bronchospasm (three cases), angioedema (two cases), and rhinorrhea (one case) to anaphylactic reactions that required immediate attention in three cases. Levels of specific IgE to latex (as measured by in vitro enzyme immunoassay) and total IgE were elevated in all five patients (total IgE > 100 kU/L). Long‐term treatment included avoidance of latex, administration of antihistamines, and desensitization to other, nonlatex allergens. Health care workers should have increased awareness of latex allergy. At risk are health care workers with a history of other allergies and those with atopic dermatitis or eczema. In vitro testing may be useful, especially in persons with skin conditions such as eczema or urticaria or for persons with a history of systemic reactions to the latex allergen as reported in these five cases
Double‐blind, placebo‐controlled trial of rehabilitation for bilateral vestibular hypofunction: Preliminary report
Authors: Krebs David E. , Gill‐Body Kathleen M. , Riley Patrick O. , Parker Stephen W.
Published: January 2017

Vestibular rehabilitation (VR) is increasingly popular, but few data exist to support enthusiasts' claims of efficacy in improving functional abilities of patients with bilateral vestibular hypofunction (BVH). A double‐blind, controlled study of eight subjects (mean, 64 ± 12 years; seven females, one male) with bilateral vestibular hypofunction was conducted. Subjects in group A Received 8 weeks of VR followed by 8 weeks of home VR exercises, whereas those in group B Received 8 weeks of control treatment (isometric strengthening exercises) followed by 8 weeks of VR. At the end of 8 weeks, group A walked 8% faster and, during paced gait and stair‐climbing, with greater stability, evidenced by a 10% larger maximum moment arm and a 17% decreased double‐support duration during gait and stair stance. Group B improved less than 1% during the control treatment. Self‐reported Dizziness Handicap Inventory scores did not differ significantly between control and active VR. All subjects improved compared with baseline tests at the 16‐week post‐test on both functional testing and on the Self‐reported Dizziness Handicap Inventory scale. We conclude that in this small sample, VR effectively improved functional, dynamic stability during locomotion, but even strengthening exercises result in self‐reported symptomatic improvement.
Results of revision stapedectomy for conductive hearing loss
Authors: Prasad Sanjay , Kamerer Donald B.
Published: January 2017

Revision stapedectomy operations performed over a 13‐year period (1977 to 1990) for a conductive hearing loss are reviewed in terms of intraoperative findings and hearing results. All operations were performed in a conventional manner without use of laser techniques. A management algorithm based on intraoperative findings is described. Results are compared with previously reported series. The 66 cases include 20 males and 46 females, ranging in age from 8 to 73 years. Mean time between original and revision stapedectomy was 12.5 years. Prostheses encountered at time of revision included wireloop (29), Robinson (18), polyethylene (14), other (3), and two were not found. The most common cause of failure was displacement of the prosthesis. Incus erosion was found in 48% of wireloops, 35% of polyethylene, and only 11% of the Robinson prostheses. Revision resulted in closure of the pure‐tone average (PTA) air‐bone gap to within 10 dB in 46% and to within 15 dB in 76%. Sensorineural hearing loss (> 10 dB) occurred in 5 cases (7.6%), and a decline in speech discrimination (> 10%) occurred in 17%. Three of four cases requiring drillout had gap closure to within 10 dB. Findings suggest that our management technique produces results comparable to other large reported series. Drillout at the time of revision can be recommended
Detection of largyneal sensory‐evoked potentials (lseps) in the cat
Authors: Fukuyama Tsuyako , Umezaki Toshiro , Shin Takemoto
Published: January 2017

We previously reported on evoked potentials elicited by electrical stimulation of the superior laryngeal nerve at an appropriate site on the dural surface as a reflection of activities in the brain stem and cortex in anesthetized cats. This evoked potential was called the laryngeal sensory evoked potential (LSEP). In this study we attempted to establish a less invasive procedure for measuring LSEP. The procedures were recording on the scalp using chloride‐coated silver disk electrodes and stimulation by insertion of a bipolar platinum hooked wire electrode into the laryngeal mucosa. Evoked potentials could be detected using these less invasive procedures. The response morphologies and relative timing of LSEP components were quite similar for each method in a given cat. However, the amplitudes were slightly lower and the latencies were slightly prolonged with the less invasive techniques. These results suggest that this LSEP method might be applicable to human beings as a noninvasive method for evaluating the function of the laryngeal sensory pathway