bluuebunny/crossref_metadata_2025 huggingface dataset:
Changes in Spontaneous Activity and Cns Morphology Associated with Conductive and Sensorineural Hearing Loss in Chickens
Authors: Tucci Debara L. , Born Donald E. , Rubel Edwin W.
Published: October 2014

The effects of a conductive or mixed (conductive and sensorineural) hearing loss on anatomical and physiological properties of the chicken auditory system were examined. Animals used in the anatomical studies underwent either a columella (ossicle) removal, which produced a moderate conductive hearing loss, or an oval window puncture, which produced a severe mixed hearing loss, at 4 days posthatch. In a companion study, multiunit spike counts were obtained from 3-week-old chickens before, during, and after consecutive tympanic membrane puncture, columella removal, and oval window puncture. Tympanic membrane puncture and columella removal (conductive hearing loss) are not associated with either cell area changes in the nucleus magnocellularis or changes in spontaneous neuronal activity. Conversely, an oval window puncture (sensorineural damage) is associated with a cell area reduction of 20%, as well as a marked decline in activity within auditory nuclei.
Effects of Neutralizing Agents on Esophageal Burns Caused by Disc Batteries
Authors: Rivera Eugene A. , Maves Michael D.
Published: October 2014

The sequelae associated with ingested disc batteries that lodge in the esophagus may include tracheoesophageal fistula, esophageal perforation, stricture formation, or death. The focus of the current investigation is on whether medical therapy can arrest or lessen the severity of the injury during the time required to transport the patient to a center for treatment. A case of esophageal damage from the ingestion of a 1.5-v manganese dioxide disc battery in a 3-year-old boy is reported also. A two-phase study was completed in which the initial phase was an in vitro experiment to identify potable solutions that might neutralize the alkali contained in disc batteries. An in vivo study in 24 cats was undertaken to determine if bolus administration of these solutions would arrest or lessen the severity of the esophageal injury. None of the solutions tested demonstrated a significant difference in the degree of gross or histologic esophageal damage when compared to controls.
Nasal and Paranasal Sinus Surgery in Children with Cystic Fibrosis
Authors: Crockett Dennis M. , McGill Trevor J. , Healy Gerald B. , Friedman Ellen M. , Salkeld Lesley J.
Published: October 2014

Cystic fibrosis (mucoviscidosis; fibrocystic disease of the pancreas) is an inherited autosomal recessive disorder that results in generalized dysfunction of exocrine glands. Chronic pansinusitis with nasal polyposis occurs frequently in this disease. Polypectomy and sinus drainage procedures are often required in those cases refractory to medical therapy. Recurrence of nasal polyps following removal is common. Controversy exists regarding the timing and extent of surgery. The management of 40 children with cystic fibrosis who underwent nasal polypectomy, intranasal ethmoidectomy, and Caldwell-Luc procedures to treat extensive sinusitis and nasal polyposis forms the basis for this report. Follow-up data indicate that fewer recurrences and longer symptom-free intervals result when intranasal ethmoidectomy and Caldwell-Luc procedures are combined with polypectomy.
Giant Cell Arteritis and Polymyalgia Rheumatica
Authors: Ferguson B. J. , Allen Nancy Bates , Farmer Joseph C.
Published: October 2014

Patients suspected of giant cell arteritis or polymyalgia rheumatica are often referred to the otolaryngologist for temporal artery biopsy. These patients may initially present to the otolaryngologist with symptoms referable to the head and neck. a comprehensive review of these two interrelated disorders is provided, with emphasis on head and neck manifestations and features of obtaining the temporal artery biopsy specimen.
Extended Supraglottic Laryngectomy
Authors: Bocca E. , Pignataro O. , Oldini C. , Sambataro G. , Cappa C.
Published: October 2014

Extended supraglottic laryngectomy is a surgical procedure by which the boundaries of standard supraglottic laryngectomy are extended to include the base of the tongue and/or pyriform sinus and/or one of the arytenoids, according to the extent of epilaryngeal or extralaryngeal invasion by vestibular cancer. We report the results of 84 extended supraglottic laryngectomies performed by our group from 1970 to 1980. Besides the highly favorable 5-year cure rate (75%), full functional rehabilitation followed in all but three patients, who were therefore submitted to secondary total laryngectomy. Rehabilitation time is often somewhat longer than in standard supraglottic laryngectomy, especially when an ample resection of the base of the tongue is required. Combined resection of the base of the tongue, aryepiglottic fold, and one of the arytenoids may further lengthen the rehabilitation period. We believe that extended supraglottic laryngectomy should be performed more often, not only for actual invasion, but also for suspected invasion of extralaryngeal structures.
Secretory Iga and Serum Type Iga in Nasal Secretion and Antibody Activity against the M Protein
Authors: Kurono Yuichi , Mogi Goro
Published: October 2014

We studied IgA immunoglobulins in nasal secretions in order to clarify mucosal immunity of the nasal cavity and paranasal sinuses during chronic nasal infection. Secretory IgA and serum type IgA of 165 samples of nasal secretions were analyzed quantitatively by use of electroimmunodiffusion techniques, and the specific antibody activity of secretory IgA against the M protein of Streptococcus pyogenes was investigated by use of enzyme-linked immunosorbent assay. Results show that although the secretory IgA content in nasal secretions was elevated in chronic sinusitis, its specific antibody activity against the M protein was lower than that in normal subjects. This evidence suggests that nonspecific secretory IgA antibodies are predominantly produced in chronic sinusitis, and that mucosal immunity preventing the adherence of bacteria is impaired in the diseased mucosa.
Microbiology of Abscesses of the Head and Neck in Children
Authors: Brook Itzhak
Published: October 2014

Specimens from 36 children with abscesses of the neck and 31 children with abscesses of the head were cultured for aerobic and anaerobic bacteria. Antimicrobial therapy was administered to 51 of the 67 patients (76%) prior to sample collection. In specimens obtained from neck infections, aerobic bacteria only were recovered in 24 (67%), anaerobic bacteria only in seven (19%), and mixed aerobic and anaerobic bacteria in five (14%). In abscesses of the head, aerobic bacteria only were recovered in 11 (35%), anaerobic bacteria only in eight (26%), and mixed aerobic and anaerobic bacteria in 12 (39%). Of a total of 52 isolates recovered from neck abscesses (1.4 per specimen), 34 were aerobes (0.9 per specimen), and 18 were anaerobes (0.5 per specimen). Of a total of 62 isolates recovered from head abscesses (2.0 per specimen), 20 were aerobes (0.6 per specimen), and 42 were anaerobes (1.4 per specimen). The most frequently recovered organism in neck infection was Staphylococcus aureus (20 isolates), and the most frequently recovered organism in head infection was Bacteroides sp (19 isolates). β-Lactamase activity was detected in 36 isolates recovered in 21 abscesses (46%). Correlation between the predisposing conditions and the bacteria recovered showed a higher recovery of anaerobes in patients with dental infection or manipulation, tonsillitis, and fetal monitoring. Staphylococcus aureus was associated with trauma. This study demonstrated the importance of anaerobic bacteria in abscesses in the head and neck, especially in infections originating from sites where these organisms are the predominant flora.
Localization, Frequency, and Severity of Endolymphatic Hydrops and the Pathology of the Labyrinthine Membrane in Meniere's Disease
Authors: Okuno Taeko , Sando Isamu
Published: October 2014

The localization, frequency, and severity of endolymphatic hydrops in 22 temporal bones of 16 individuals with Meniere's disease were studied histopathologically. Endolymphatic hydrops was more often observed in the pars inferior (22/22) than in the pars superior (13/22) of the temporal bone, and severe hydrops was observed most frequently in the saccule, followed by the cochlea, the utricle, and the three semicircular canals. In the cochlea, the most severe hydrops was observed in the apical turn, followed by the hook portion, the middle turn, and the basal turn. Clinically interesting observations regarding endolymphatic hydrops included bulging into the perilymphatic space of the vestibule. In 17 of 22 bones the saccular membrane bulged into the vestibule laterally and was attached to the footplate of the stapes. In two of 22 bones, Reissner's membrane in the hook portion of the basal turn of the cochlea bulged superiorly into the vestibule, occupying most of the perilymphatic space of the vestibule.
Cochleotoxic Effects of Spermine and Kanamycin
Authors: Yung M. W. , Wright A.
Published: October 2014

Aminoglycosides are organic bases that contain multiple amino groups. The ototoxic potential of these amine groups was studied using spermine, which is a polyamine with four amine groups (two amino and two imino). Twenty-four pigmented guinea pigs were studied. One-tenth milliliter of different concentrations of kanamycin A sulfate or spermine were given intratympanically. The temporal bones were removed 4 days after the injections, and the cochleas were examined using the scanning electron microscope. The damage to the hair cells was recorded in cytocochleograms. The results show that spermine is cochleotoxic when given intratympanically. Dosage of 50 μmol for kanamycin A sulfate and 5 μmol for spermine caused total damage of the outer hair cells in all ears. Lower dosage of kanamycin A sulfate (20 μmol) and spermine (1 μmol) did not cause any histologically discernible changes.
Adjunctive Measures for Successful Laryngotracheal Reconstruction
Authors: Gray Steven , Myer Charles M. , Miller Robert , Cotton Robin T.
Published: October 2014

The field of reconstructive surgery of the laryngotracheal complex has been the object of considerable enthusiasm in recent years. New surgical techniques, better surgical tools, and improved diagnostic skills all have contributed to a more confident approach to severe laryngotracheal stenosis. Just as the surgeon's judgment is crucial for a successful primary laryngotracheal reconstruction, so are his or her skill and judgment vitally important in managing the various problems that frequently are found following reconstructive surgery of the larynx and trachea. These problems, although seemingly minor, may prevent successful decannulation if not managed appropriately. This paper discusses the various problems that have been encountered while achieving decannulation following laryngotracheal reconstruction. An approach to such frustrating problems as suprastomal collapse, granulation tissue, and the inability to decannulate are presented.
Correlation of Tumor Volume with Local Control in Laryngeal Carcinoma Treated by Radiotherapy
Authors: Birt Derek , Jenkin Derek , Gilbert Ralph W. , Shulman Harry , MacKenzie Robert , Freeman Jeremy , Smith Charles
Published: October 2014

An analysis of 37 patients with laryngeal carcinoma (T2 or greater) treated with radical radiotherapy, with surgery reserved for failure, was performed to determine if tumor volume, alone or in association with other prognostic factors, accurately predicted the probability of local control. Patient records were reviewed retrospectively and the following data extracted: Age, sex, laryngeal region and number of sites involved by tumor, T and N categories, and success or failure of radiotherapy. Tumor volume for each patient was calculated from pretreatment computed tomograms by summing the products of the cross-sectional tumor area on each CT cut and the interval in millimeters between sequential CT cuts. The mean tumor volume for patients failing radiotherapy was 21.8 cm3, and the mean volume for patients primarily controlled by radiotherapy was 8.86 cm3. Tumor volume significantly predicted disease-free interval (p = .045) and outcome with radiotherapy (p = .02). The study suggests that tumor volume is a significant factor in determining the outcome of primary radiotherapy in advanced laryngeal carcinoma.
Unusual Pharyngeal Lesion Causing Dysphagia
Authors: Obana Kathryn K. , Fee Willard E.
Published: October 2014

A 58-year-old man was evaluated for a 42-year complaint of a pharyngeal foreign body sensation whenever he ate. Examination revealed normal anatomy at rest but diffuse hypopharyngeal distension with Valsalva's maneuver. His past history was remarkable for an infectious illness, possibly diphtheria. We speculate that this unusual case most likely represents a postdiphtheritic selective pharyngeal paralysis and present his case, radiographic findings, and a discussion of the differential diagnosis.
Vocal Nodules in Children
Authors: Benjamin Bruce , Croxson Glen
Published: October 2014

We reviewed 27 pediatric patients who had vocal nodules removed surgically in a 5-year period. Age of operation, duration of symptoms, indications for operation, and the results of removal are analyzed. The techniques of laryngoscopic assessment with telescopes and of microsurgical removal are described in detail. The 27 children had 53 nodules removed. Almost all had normal or improved voices as judged by the parents' answers to a written questionnaire. From the results of this series, microsurgical removal of vocal nodules in children is justified in selected patients.
Use of Botulinum Toxin to Lateralize True Vocal Cords: A Biochemical Method to Relieve Bilateral Abductor Vocal Cord Paralysis
Authors: Cohen Seymour R. , Thompson Jerome W.
Published: October 2014

Using the mongrel dog as an animal model, we studied the effectiveness of botulinum toxin (Oculinum) to lateralize the true vocal cord. This experiment was undertaken in order to determine whether the toxin can improve the airway in subjects with bilateral abductor vocal cord paralysis. The toxin was injected into the cricothyroid muscle to block neuromuscular transmission at the motor end-plate. Paralysis of the cricothyroid muscle was achieved and documented by electromyography and videotaped endoscopy. Paralysis of the cricothyroid muscle decreases the tension of the true vocal cord and allows the cord to take a more lateral position. In this preliminary report, the literature is reviewed, the effect of and action of the toxin are discussed, and the results of the experimental protocol, establishment of dose-response curves, and techniques of injection are presented. Preliminary data suggest that there is an increase in the airway by lateralizing the true vocal cord with this biologic substance, and that this method may have many applications in clinical medicine for the otolaryngologist-head and neck surgeon.
Malignant Laryngeal Epithelial Tumors and Lymph Node Involvement: Therapeutic and Prognostic Considerations
Authors: Ferlito Alfio
Published: October 2014

The relationship among various malignant epithelial tumors of the larynx, with or without their respective lymph node and visceral metastases, is discussed. The tumors considered include squamous cell carcinoma, verrucous squamous cell carcinoma, spindle cell squamous carcinoma, small cell carcinoma, atypical carcinoma, mucoepidermoid carcinoma, adenoid cystic carcinoma, and primary malignant melanoma. Other, rarer, malignant epithelial neoplasms of the larynx are only mentioned. The choice of therapy should be determined by tumor stage, oncotype, and patient status.
Conradi-Hunerman Syndrome
Authors: Hochman Marcelo , Fee Willard E.
Published: October 2014

Conradi-Hunerman syndrome, a variant of chondrodysplasia punctata, rarely presents with primary manifestations relevant to the head and neck surgeon. Usually, the disease is evidenced by malformation of the extremities, cataracts, cutaneous lesions, and an unusual facies. We have followed a child with Conradi-Hunerman syndrome for 7 years whose primary manifestation of the disease is respiratory compromise secondary to calcification of the laryngotracheobronchial tree. In addition, he has a conductive hearing loss thought to be secondary to ossicular chain fixation.
Selective, Histamine-Mediated Immunosuppression in Laryngeal Cancer
Authors: Richtsmeier William J. , Styczynski Peter , Johns Michael E.
Published: October 2014

Immunosuppression observed even in the earliest laryngeal cancers can be, in part, reversed with H2 histamine antagonists. In an effort to explain this, we tested whether histamine could evoke changes in endogenous antitumor lympholdne production using tonsil lymphocytes as test cells. We have observed that lymphocytes, treated in vitro with histamine, display a significant suppression of lymphokine production and mixed lymphocyte proliferation response following galactose oxidase treatment. Interferon gamma production was reduced to less than 2% of control value in the presence of histamine. In contrast, the lymphokine-activated killer cell activity induced by purified, natural interleukin-2 was not affected by similar concentrations of histamine. Histamine appears to exert its inhibitory effect by stimulating the production of a substance released by suppressor T cells. The suppressive effects observed could be reversed by concomitant or sequential treatment with cimetidine or ranitidine and not by H1 histamine antagonists, indicating that it occurs through an H2 histamine receptor. These experiments suggest that histamine may have a profound suppressive effect on the lymphocyte population studied.
Selection of Video Cameras for Stroboscopic Videolaryngoscopy
Authors: Yanagisawa Eiji , Godley Frederick , Muta Hiroshi
Published: October 2014

Stroboscopic evaluation for the analysis of laryngeal function and disease has been reemphasized recently and its routine clinical use recommended. Many have found, however, that it is not always possible to obtain consistently satisfactory video images of stroboscopic laryngoscopy. The problem is related to the low intensity of the xenon light source during stroboscopy. The authors have tried many different video cameras available, along with the Brüel & Kjaer Rhino-Larynx Stroboscope type 4914, and two types of endoscopes (flexible and rigid). The cameras included 1) single tube camera, 2) single chip metal oxide semiconductors (MOS) solid-state camera, 3) single chip charge-coupled devices (CCD) solid-state camera, 4) three-tube camera, and 5) three-chip CCD camera. Currently available video cameras and their adaptability for stroboscopic videolaryngoscopy are discussed.
Vocal Ligametry
Authors: LeJeune Francis E.
Published: October 2014

In 1983, a report was made concerning experience with a technique of vocal ligament tightening in certain cases of dysphonia due to the ligament's stretching or lengthening. Since that time, efforts to measure the relative slackness or loss of tension of the vocal ligament have been partially successful. This report addresses the topics of consent forms; review of the local board of human procedures; and technical problems of instrument design, fabrication, and calibration. A large data base will be needed before true usefulness can be derived from these efforts. The author hopes to stimulate other workers in the field of phonosurgery to parallel these efforts and explore a field that is still relatively uncharted.
Side Effects and Toxicity of Interferon in the Treatment of Recurrent Respiratory Papillomatosis
Authors: Crockett Dennis M. , Lusk Rodney P. , McCabe Brian F. , Mixon Janis Horne
Published: October 2014

Twenty-six patients with recurrent respiratory papillomatosis have received interferon administered according to one or more of five experimental protocols currently ongoing or completed at the University of Iowa. Short-term side effects following interferon administration were common and included fever, headache, chills, fatigue, myalgias, and nausea. Two patients experienced neurotoxicity manifested as somnolence, confusion, or petit mal type or grand mal type seizures. Preliminary data show evidence for some growth retardation in patients receiving long-term interferon therapy. Laboratory evidence of toxicity in the form of decreased WBC, RBC, and platelet counts occurred in five patients, and increased liver enzymes occurred in 16 patients. Neither cardiovascular nor renal toxicity was noted.
Nasopharyngeal Carcinoma: The Dana-Farber Cancer Institute Experience with 24 Patients Treated with Induction Chemotherapy and Radiotherapy
Authors: Clark John R. , Fallon Rarbara G. , Chaffey John T. , Norris Charles M. , Balogh Karoly , Andersen Janet W. , Dreyfuss Arnon I. , Anderson Roger F. , Miller Daniel
Published: October 2014

Nasopharyngeal carcinoma traditionally has been treated with radiotherapy alone. Although the probability of cure for patients with stage I and II nasopharyngeal carcinoma is high, the probability of cure for patients with stage III and IV disease is poor because of a higher rate of local-regional and distant failure. Between February 1981 and August 1986, 24 patients with previously untreated, stage IV nasopharyngeal carcinoma were treated with two to four monthly courses of cisplatin-based combination chemotherapy prior to radiotherapy. A response to induction chemotherapy was recorded in 75% of patients (29% complete response and 46% partial) prior to radiotherapy. By actuarial estimate with a median follow-up of 42 months, the 2-year failure-free survival for all patients was 57%. In conclusion, induction chemotherapy has significant activity in nasopharyngeal carcinoma. The toxicity of this approach, as well as the influence of initial histopathology and response to chemotherapy on survival, will be discussed.
Myxomas of Soft Tissues and the Facial Skeleton
Authors: Batsakis John G.
Published: October 2014

Myxomas in the head and neck may be intraosseous or in soft tissues. In each site, their microscopic appearance and biologic activity are similar. Recurrences of myxomas are more the consequence of incomplete excision than intrinsic aggressiveness.
Association of Laryngeal and Pulmonary Malignancies: A Continuing Challenge
Authors: Strigenz Michael A. , Toohill Robert J. , Grossman Thomas W.
Published: October 2014

Over a 10-year period, 790 patients with squamous cell carcinoma of the head and neck were treated at The Medical College of Wisconsin Affiliated Hospitals and were followed for a minimum of 7 years. Of the 218 patients with index primary laryngeal tumors, 43 (19.7%) developed additional malignancies in the head and neck, esophagus, or lung. Secondary lung tumors were the most common, occurring in 23 patients (10.6%). Of the 218 patients with index primary laryngeal carcinoma, 113 were treated successfully and never developed a recurrence of the original tumor. Twenty-one second primary lung malignancies developed in this group of successfully treated laryngeal tumor patients. The occurrence of these pulmonary malignancies was distributed fairly evenly over time. Three patients developed second primary lung tumors more than 7 years after initial treatment. The appearance of a second primary malignancy in the lung had a devastating effect upon survival. None of our patients survived more than 2 years after detection of the lung lesion. The relatively high incidence and delayed onset of second primary lung tumors in this group call into question the concept of 5-year “cures.” Our challenge for the future should be the prevention and early detection of these second primary lung tumors.
Histopathologic Study of Carcinoma of the Hypopharynx: Implications for Conservation Surgery
Authors: Hirano Minoru , Kurita Shigejiro , Tanaka Hisashi
Published: October 2014

A total of 38 specimens obtained by laryngopharyngectomy were subjected to a whole organ section study. Of the 38, 31 were pyriform sinus (PS), three were postcricoid (PC), and four were posterior wall (PW) carcinomas. The results were as follows. 1) The thyroid cartilage was involved much more frequently than the other laryngeal cartilages. 2) Joint involvements were infrequent. 3) The interarytenoid, thyroarytenoid, and lateral cricoarytenoid muscles frequently were invaded by PS carcinomas, whereas PC carcinomas frequently involved the interarytenoid and posterior cricoarytenoid muscles. 4) The recurrent laryngeal nerve (RLN) was involved in all PC T3 cases, but RLN involvement was rare in PS cases. 5) Involvements of the paraglottic space and periarytenoid region were closely related to fixation of the larynx on the affected side (hemilarynx) in PS carcinomas. 6) Neither hemilarynx fixation nor PS apex involvement was a reliable landmark for determining the exact extent of laryngeal involvement. 7) Conservation surgery could have been employed in 18 of the 38 cases.
Neural and Neuroendocrine Tumors of the Larynx
Authors: Stanley Robert J. , Weiland Louis H. , Scheithauer Rernd W. , Neel H. Bryan
Published: October 2014

Benign and malignant neural and neuroendocrine tumors of the larynx are uncommon enough that knowledge about them is sparse, coming from single case reports and literature reviews. We have reviewed the clinical behavior, pathologic findings, treatment, and outcome in 42 patients seen at one institution from 1907 to 1986. In some cases, electron microscopy or immunocytochemistry, or both, may be needed to reach the correct diagnosis. Treatment is largely determined by the histopathologic features, size, and location of the tumor. The most common sites are the supraglottic region and posterior larynx. Most tumors are treated by conservation surgery, including transoral excision; however, some are aggressive and require larger surgical procedures, including wide-field laryngectomy and complete neck dissection.
Complications of Laser Surgery for Recurrent Respiratory Papillomatosis
Authors: Crockett Dennis M. , McCabe Brian F. , Shive Cynthia J.
Published: October 2014

During an 8-year period, 66 patients with recurrent respiratory papillomatosis underwent 890 laser microlaryngoscopy procedures. A retrospective analysis of immediate and delayed complications occurring with laser microlaryngoscopy in the treatment of these patients revealed that complications secondary to anesthetic technique and laser methodology were remarkably low (0.3%). Delayed complications of tissue injury (36% of pediatric patients and 17% of adult patients) were more frequent and included anterior glottic webbing, interarytenoid scarring and arytenoid fixation, vocal fold fibrosis, and generalized endolaryngeal glottic stenosis. All patients were evaluated by direct visualization and recording at the time of the operative procedure, as well as by review of intraoperative photographs. A smaller group of patients underwent analysis of voice recordings and laryngeal stroboscopy. The frequency and severity of tissue injury was higher in the patients with more severe disease who underwent multiple operative procedures.
Endoscopic Surgical Management for Laryngomalacia
Authors: Kavanagh Kevin T. , Babin Richard W.
Published: October 2014

Laryngomalacia is the most common of the many causes of respiratory stridor in the newborn. It may be identified by fiberoptic nasopharyngoscopy in the nursery or office. Several anatomic mechanisms of supraglottic collapse have been reported in the literature. The most common is a narrowing of the supraglottic airway with blockage of the glottic opening by the redundant tissue of the aryepiglottic folds. Although surgery rarely is indicated, severe airway obstruction, necessitating surgical intervention, can occur. Resection of supraglottic tissue should be performed only as an alternative to tracheotomy. Surgical procedures ranging from tracheotomy to epiglottidectomy have been advocated. Direct visualization of the obstructing tissue by nasopharyngoscopy allows the planning of an appropriate surgical procedure. In a patient with lateral supraglottic collapse, deep resection of the epiglottis would be expected to weaken the support of the aryepiglottic folds and aggravate the airway condition. Similarly, resection of tissue along the aryepiglottic folds will be useful only if preoperative evaluation demonstrates the obstruction to be at this location.
Laryngotracheal Reconstruction for Subglottic Stenosis in Children
Authors: Maddalozzo John , Holinger Lauren D.
Published: October 2014

The experience with laryngotracheal reconstruction in 20 children in Chicago is reviewed. Nine of the 20 children (45%) operated upon had congenital subglottic stenosis. Ten (50%) had acquired stenosis. One child was classified as having combined types. All patients underwent laryngotracheal reconstruction with autogenous costal cartilage grafts. Eight patients had both anterior and posterior costal cartilage grafts with stent insertion. One had a posterior costal cartilage graft only. Sixteen of the 20 children (80%) have been decannulated. Midtracheal or lower tracheal disease concomitant with laryngotracheal stenosis is an indication that endoscopic management of severe subglottic stenosis is likely to fail. Early laryngotracheal reconstruction is indicated for patients with a high likelihood of failure of endoscopic management and for those with severe cricoid cartilage deformities. Our results support the use of laryngotracheal reconstruction as an alternative to conservative (endoscopic) management of severe subglottic stenosis in carefully selected patients.
Traumatic Innominate Pseudoaneurysm Rupture during Laryngeal Dilatation
Authors: Friduss Michael , Alessi David , Hoover Larry A. , Robertson John
Published: October 2014

Endotracheal hemorrhage from the innominate artery is, fortunately, a rare problem encountered by the otolaryngologist. We present a patient with a tracheal–innominate artery fistula secondary to delayed rupture of a traumatic innominate artery aneurysm. The differential diagnosis of innominate artery hemorrhage is discussed, as is the management of this potentially lethal event. We propose, as the treatment of choice, cessation of hemorrhage through the use of a cuffed endotracheal tube, followed by ligation of the innominate artery using cardiopulmonary bypass. These techniques were used in this patient with a successful outcome.
Hypodermic Needles: An Unusual Tracheobronchial Foreign Body
Authors: Nussbaum Moses , Nash Michael , Cohen Jason , Cho Hyun , Pincus Robert
Published: October 2014

Case reports of foreign bodies in the upper aerodigestive regions and descriptions of the various methods used to retrieve them have been recorded in the medical literature since ancient times. Sharp, penetrating foreign bodies are most dangerous and may cause acute complications if they perforate the air and food passages. Recently, the authors encountered nine cases of hypodermic needles in the tracheobronchial tree. Seven of the nine needles were removed endoscopically without complications and two were expelled by the patients.
Multiple Otopathologic Disorders
Authors: Paparella Michael M. , Schachern Patricia A. , Goycoolea Marcos V.
Published: October 2014

Temporal bones (1,383) from 713 patients were studied systematically for multiple pathologic lesions. Eleven percent (152 temporal bones) were found to have more than one pathologic finding. Males (60.5%) had multiple diseases more commonly than did females (37.7%). The most frequently occurring findings were otitis media (71.1%), otosclerosis (43.4%), endolymphatic hydrops (38.8%), labyrinthitis (25.0%), and cancer (24.3%). We conclude that multiple coexisting pathologic conditions can have coincidental or causative relationships. The otolaryngologist should consider multiple pathologic conditions when diagnosing and treating diseases of the ear.
Diagnosis of Retrocochlear and Central Vestibular Disease by Magnetic Resonance Imaging
Authors: Valvassori Galdino E.
Published: October 2014

Magnetic resonance imaging has become the study of choice for the diagnosis of retrocochlear and central vestibular disease. Three groups of lesions, each characterized by a specific site of origin, have been recognized: 1) petrous apex lesions such as congenital cholesteatomas and cholesterol granulomas involving the eighth cranial nerve within the internal auditory canal; 2) cerebellopontine angle tumors, mainly acoustic neuromas and meningiomas; and 3) CNS disease involving the brain stem and the central auditory and vestibular pathways such as tumors, multiple sclerosis, infarcts, and hemorrhage.
Cholesteatoma in the Pediatric Age Group
Authors: Edelstein David R. , Parisier Simon C. , Chute Patricia , Ahuja Gurpreet S. , Wenig Shula , Juarbe Charles , Kaye Steven M.
Published: October 2014

The diagnosis and management of cholesteatoma in children remains controversial. In the past 15 years, the senior author (S.C.P.) has treated 320 patients with cholesteatoma. Patients 18 years and younger composed 40% (125) of the overall group and are the basis for this report. The patient data were compiled using the history, physical examination, audiograms, radiographs, patient questionnaires, surgical findings, and postoperative observations. The surgical treatment selected was determined by the extent of disease, the configuration of the mastoid, and a clinical assessment of eustachian tube function. A middle ear tympanotomy approach was used in 17% of the patients, a canal wall up procedure in 31 %, and a canal wall down procedure in 52.3 %. The average clinical follow-up was 3.9 years, with the range being from 3 months to 13.5 years. Hearing was maintained or slightly improved in a majority of cases. Residual disease occurred in 8 % of patients, and recurrent disease in only 3 %.
Spinal Accessory Nerve Function following Neck Dissection
Authors: Zibordi Francesco , Baiocco Federico , Bascelli Cristina , Bini Artilio , Canepa Alfredo
Published: October 2014

Spinal accessory nerve (SAN) function was evaluated by electromyography (EMG) and muscle testing in 36 patients who underwent neck dissection with SAN preservation. The results emphasized that SAN function was relatively good after conservative neck surgery. Muscle testing findings showed better function than did EMC findings. After surgery the trapezius muscle functioned more efficiently than the sternocleidomastoid (SCM) muscle probably because of the more traumatic surgical handling of both the SCM muscle and its SAN branch. In order to obtain the functional advantages of SAN preservation, the authors suggest that the conservative procedure in radical neck dissection be used whenever warranted by oncologic diagnosis.
Pathology Consultation Sialadenosis
Authors: Batsakis John G.
Published: October 2014

Sialadenosis, characterized by a uniform hypertrophy and hyperplasia of the acinar parenchyma of salivary glands, is associated with a variety of systemic diseases or functional disorders. Present evidence relates the clinical and morphologic changes in the salivary tissues to a neuropathic alteration of the autonomic innervation of the salivary acini.
Antenatal Diagnosis of Congenital Deafness
Authors: Isaacson Glenn
Published: October 2014

Advances in the field of antenatal diagnosis have made possible the detection of profound sensorineural hearing loss prior to birth. Fetal motion in response to sound and auditory evoked potential testing can determine the presence of fetal hearing in the third trimester of pregnancy. Imaging modalities including ultrasound, computed tomography, and magnetic resonance imaging hold promise for the diagnosis of some forms of congenital deafness in the second trimester fetus. The methods by which congenital deafness soon may be diagnosed and the implications for the otologist are discussed.
Reduction of Salivary Flow with Scopoderm Tts
Authors: Talmi Yoav P. , Zohar Yuval , Finkelstein Yehuda , Laurian Nelu
Published: October 2014

Scopoderm transdermal therapeutic system (TTS) is a form of application permitting programmed release of scopolamine through the skin into the bloodstream. Scopoderm TTS is indicated for prevention of nausea and vomiting associated with motion sickness. The most common side effect associated with its use is dryness of the mouth. We have been using Scopoderm TTS for reducing salivary flow in patients with sialorrhea or with difficulties in swallowing normal amounts of salivary secretions. Good results were achieved with minimal discomfort from adverse effects. We recommend the use of Scopoderm TTS in selected cases of sialorrhea and drooling, preoperatively and postoperatively in patients undergoing surgery of oral, laryngeal, and pharyngeal lesions.
Aural Pain Resulting from Acoustic Reflex
Authors: Painton Stephen W. , Shaw Michael B.
Published: October 2014

We present an unusual case of physical discomfort, as opposed to objective or subjective tinnitus, caused by a unilateral acoustic reflex. The cause of the discomfort was identified audiologically by the use of acoustic impedance audiometry. The dull pain that was elicited upon contraction and relaxation of the stapedius muscle was eliminated with sectioning of the stapedial tendon. No explanation of the mechanism for the pain is suggested at present.
High Frequency Audiometry in Prospective Clinical Research of Ototoxicity Due to Platinum Derivatives
Authors: van der Hulst R. J. A. M. , Dreschler W. A. , Urbanus N. A. M.
Published: October 2014

The results of clinical use of routine high frequency audiometry in monitoring the ototoxic side effects of platinum and its derivatives are described in this prospective study. After demonstrating the reproducibility of the technique, we discuss the first results of an analysis of ototoxic side effects in 75 patients (150 ears). Significant differences in the pattern of hearing loss were registered for the different platinum treatment groups (cisplatin 20 mg/m2, cisplatin 50 mg/m2, and carboplatin 350 mg/m2). In the groups receiving cisplatin 50 mg/m2 and carboplatin 350 mg/m2, 42% and 25%, respectively, of the investigated ears proved to be undamaged, versus 9% undamaged in the group receiving cisplatin 20 mg/m2 (p< .01). Ototoxic hearing loss started mainly (46% to 70%) in the higher frequencies (10,000 to 18,000 Hz) and developed into a broader-range hearing loss (1,000 to 18,000 Hz) during treatment in 13% to 43% (p< .01). The onset of hearing damage was influenced by the patient's age (p< .001) and the existence of a troubled otologic history (p< .05). The study demonstrates the important role of high frequency audiometry in early detection and monitoring of ototoxic damage.
Adductor Spastic Dysphonia: Heterogeneity of Physiologic and Phonatory Characteristics
Authors: Davis Pamela J. , Boone Daniel R. , Darveniza Paul , Carroll Raymond L. , Harrison Gordon A.
Published: October 2014

Physiologic and phonatory characteristics of 23 subjects with adductor spastic dysphonia were studied, including examination of the laryngeal appearance by fiberoptic nasoendoscopy, neurologic examination, and measurement of phonatory airflow and speaking fundamental frequency. These characteristics displayed considerable heterogeneity among the subjects investigated. Three patterns of laryngeal appearance during phonation were observed: Vocal fold adduction, associated ventricular fold constriction, and approximation of the laryngeal inlet. Eight of 13 subjects demonstrated some neurologic abnormality. For the majority of subjects, the airflow demonstrated marked variability during sustained phonation; for different subjects, this variability was observed to be associated with either an oscillatory or irregular airflow pattern. The modal speaking fundamental frequency for the women and men with adductor spastic dysphonia was not significantly different from that for age- and sex-matched controls.
Immunologic Responses against Lipopolysaccharide of Hemophilus Influenzae in Patients with Acute Sinusitis
Authors: Harada Teruhiko , Sakakura Yasuo
Published: October 2014

The serum antibodies against Iipopolysaccharide of Hemophilus influenzae were measured in acute and convalescent phase sera from 30 patients with acute maxillary sinusitis using enzyme-linked immunosorbent assay. Levels of antibodies in the maxillary antral secretions were also measured. In convalescent phase sera from 15 patients with acute sinusitis due to H influenzae, there was a threefold, 1.5-fold, and threefold increase in the geometric mean titers of IgG, IgM, and IgA, respectively. In antral secretions, titers were significantly higher (p< .01) in culture-positive patients than in culture-negative patients for all antibodies. These data indicate that the immune system has the ability to respond systemically and locally with specific antibodies against lipopolysaccharide of H influenzae.
Comparison of the Microbiology of Group a and Non-Group a Streptococcal Tonsillitis
Authors: Brook Itzhak , Yocum Paula
Published: October 2014

We studied the microbial flora of tonsils removed from 20 children who suffered from recurrent group A β-hemolytic streptococcal (GABHS) tonsillitis and 20 who had tonsillar hypertrophy following recurrent non-GABHS tonsillitis. Similar polymicrobial aerobic and anaerobic flora were recovered from the cores of the tonsils in each group. β-Lactamase-producing bacteria (BLPB) were recovered more often in the group with GABHS. This difference was due mostly to the lower incidence of β-lactamase-producing strains of Branhamella catarrhalis and Bacteroides sp in hypertrophic tonsils following non-GABHS tonsillitis. β-Lactamase-producing Staphylococcus aureus was found with equal frequency in both groups. These findings demonstrate that although BLPB are recovered more often in recurrently inflamed tonsils following GABHS infection, BLPB also can be found in hypertrophic tonsils following non-GABHS tonsillitis.
Clinical Investigations of Adductor Spastic Dysphonia
Authors: Hartman David E. , Abbs James H. , Vishwanat Balaji
Published: October 2014

Spastic (spasmodic) dysphonia (SD) may coexist with or reflect certain neurologic or psychogenic illnesses. The present study of four patients with adductor SD (ASD) revealed several consistent clinical findings and characteristics that could be differentiated, while other findings were not distinguishable. Oscillographic and spectral analyses suggested voice tremor as a component of the dysphonia in all ASD patients studied. Clinical neurologic and otolaryngologic findings were nonconfirmatory regarding a disease process or state.
Acquired Ultrastructural Alterations of Respiratory Cilia and Clinical Disease
Authors: Ballenger John J.
Published: October 2014

Efficient cleansing of the upper and lower respiratory surfaces by the mucociliary apparatus is essential to health. Failure of the cleansing allows contaminants prolonged residence on the mucosal respiratory surfaces and thus penetration into the mucosa and possibly inauguration of disease. For some years, genetic ultrastructural ciliary alterations have been recognized, with symptoms dating from early life. It is only in recent years, however, that evidence has shown that ultrastructural ciliary alterations can be acquired later in life and that these alterations in turn lead to a deterioration of efficient ciliary cleansing. A discussion of the intrastructure of the normal mammalian cilium will be given, as well as a listing of the genetic ciliary diseases and their characteristic morphologic alterations. A more complete review will be made in regard to acquired ciliary defects, their cause, the ultrastructural changes, and the relation to clinical disease.
Hearing Impairment in Relation to Viscoelasticity of Middle Ear Effusions in Children
Authors: Majima Yuichi , Takeuchi Kazuhiko , Hamaguchi Yukiyoshi , Morishita Atsuhito , Hirata Keisuke , Sakakura Yasuo
Published: October 2014

Both dynamic viscosity (n′) and elasticity (G′) of middle ear effusion were measured with an oscillating sphere magnetic rheometer and compared with the degree of conductive hearing loss in 65 ears of 40 children. There was a significant correlation between n′ and the magnitude of the air-bone gap at 500 and 1,000 Hz, but there was no significant correlation between G′ and the magnitude of the air-bone gap at 2,000 or 4,000 Hz. No significant correlation was noted between G′ and the magnitude of the air-bone gap at 500,1,000, 2,000, or 4,000 Hz. These results indicate that the n′ of middle ear effusion has an effect on the amount of hearing impairment at frequencies below 1,000 Hz.
Dysphonia Caused by Forestier's Disease
Authors: Gay Isaac , Elidan Joseph
Published: October 2014

A case of diffuse idiopathic skeletal hyperostosis (Forestier's disease) causing dysphonia as the presenting and only symptom is reported. The dysphonia is attributed to the mass effect in the hypopharynx and the mild pressure on the larynx. The bony mass anterior to the vertebral body is demonstrated by CT scan for the first time in the literature on Forestier's disease.
Relationship of Eustachian Tube Bony Landmarks and Temporal Bone Pneumatization
Authors: Todd N. Wendell , Martin W. Stephen
Published: October 2014

Anatomic and functional differences of the eustachian tube have been suggested as etiologic factors in patients with otitis media. We studied eustachian tube lengths and vectors of the tensor veli palatini muscle in 25 unilateral specimens from adult human cadavers. The extent of temporal bone pneumatization, as determined by computed tomography and plain lateral radiographs, was used as an indicator of prior otitis media. Increased length of the cartilaginous eustachian tube was associated positively (r=.53, p<.01) with volume of pneumatization. However, neither the length of the bony eustachian tube nor the vector of maximum pull of the tensor veli palatini muscle was associated statistically with the extent of pneumatization. It may be that the longer cartilaginous eustachian tube is more protective of the middle ear.
Reversible Conductive Hearing Loss in Mice
Authors: Hood Linda J. , Webster Douglas B.
Published: October 2014

Fibrin tissue adhesive was injected into the right ears of four 7-week-old CBA/J mice. Auditory brain stem responses (ABRs) were used to monitor changes in auditory sensitivity over the next 26 days, after which the middle ears and cochleas were examined histologically. Mean maximum ABR threshold shifts were as great as 36 dB, and were larger for higher frequencies than for lower. Maximum shifts occurred between 1 and 8 days; by 26 days, thresholds had returned to intensity levels observed before injection.
In Vitro Electrophysiologic Studies on Nasal Airway Receptors of the Rabbit
Authors: Hoshino Tadahiko
Published: October 2014

Rabbit nasal airway receptors were investigated electrophysiologically in vitro. Cold receptors, warm receptors, and mechanoreceptors were found in the nasal membrane. The cold receptors showed a maximum static discharge at 28°C, and the warm receptors at 38°C. These thermoreceptors were activated constantly at temperatures between 18°C and 40°C. The mechanoreceptors were seen to adapt rapidly to gentle mechanical stimulation and were activated easily by repeated stimuli. Air blown directly at the nasal membrane did not activate the mechanoreceptors. It was concluded that nasal airflow sensation is due mainly to the activation of cold or warm receptors in the nasal airway, rather than the stimulation of mechanoreceptors.