bluuebunny/crossref_metadata_2025 huggingface dataset:
Acoustic Reflex Latency Test in the Evaluation of Nontumor Patients with Abnormal Brainstem Latencies
Authors: Clemis Jack D. , Sarno Cynthia N.
Published: October 2014

The acoustic reflex latency test (ARLT), an indirect measure of neural conduction time utilizing the electroimpedance method, was used to evaluate 43 highly suspect, nontumor patients who demonstrated abnormal latency results on brainstem electric response audiometry (BERA), false-positive for tumor. Normative values and criteria for tumor-positive ARLT results were established on a control group using a second generation test unit, comprised of dual impedance bridges and a digital signal averager, designed especially to perform the ARLT. When cut-off criteria for both absolute reflex latency and interaural latency difference (ILD) values were applied to this BERA false positive population, the ARLT correctly identified 93% of patients as having end-organ lesions. Differences in ARLT and BERA test results are attributed to differences in 1) method of measurement, 2) characteristics of the eliciting signal, and 3) generation of the response. These factors are discussed as sources of variability. Both ARLT and BERA are recommended as tandem procedures when screening for acoustic or angle tumors.
Labyrinthectomy versus Middle Fossa Vestibular Nerve Section in Menière's Disease; a Critical Evaluation of Relief of Vertigo
Authors: Glasscock Michael E. , Davis William E. , Hughes Gordon B. , Jackson C. Gary
Published: October 2014

Labyrinthectomy has been used for years in the surgical management of Menière's disease for the control of vertigo. The effects of this procedure are predictable and satisfying but residual hearing is sacrificed. With the advent of the middle fossa section of the vestibular nerve, it soon became apparent that it was possible to obtain relief from vertigo and at the same time preserve residual hearing. How do the two procedures actually compare as far as relief of vertigo, postsurgical ataxia, and recovery periods? The purpose of this paper is to evaluate the two procedures in regard to these three parameters. A series of middle fossa operations is compared to one in which the patients received a labyrinthectomy. Results and complications in both groups are covered in detail.
Attachment of the Tectorial Membrane Revealed by Scanning Electron Microscope
Authors: Lawrence Merle , Burgio Paul A.
Published: October 2014

Our present-day descriptions of the causes of many forms of sensorineural deafness are based on what is known about the morphology of the organ of Corti. Unfortunately, this information is still woefully inadequate for a complete interpretation of normal events within this structure. Nevertheless there has been no shortage of theories based, in part at least, on assumptions of what the unknown morphology might be. One of the least understood structures is the tectorial membrane, for which the extent and position have had many descriptions. A review of these reveals that the observations vary with the techniques used, and different techniques have various effects on the sticky gel of the tectorial membrane which is reported to be 90% water. Here is described a technique whereby the bulk frozen-hydrated tectorial membrane is viewed by scanning electron microscopy. In its natural living state the tectorial membrane is sealed to the Hensen's cells, protecting the reticular lamina from endolymph.
Immunopathological Study of the Larynx
Authors: Nakashima Tadashi , Komiyama Sohtaro , Makishima Kazumi , Takeda Kazuo , Hiroto Ikuichiro
Published: October 2014

Using immunofluorescent and histopathological techniques, we studied the distribution and secretory activity of the glands of the larynx from 55 humans. The cavity of the larynx was covered with secretory glandular cells with the exception of the true vocal cords, aryepiglottic folds and upper part of the laryngeal surface of the epiglottis. Immunofluorescent study revealed the presence of IgG and other immunoglobulins throughout the connective tissue ground in each laryngeal mucosa. The most striking was seen in the staining pattern of IgA. Diffuse fluorescence for IgA was observed not only in the submucosal or periglandular connective tissue area but also in the intraepithelial or submucosal glands. Secretory component synthesis was found mainly in each serous-type glandular epithelium or acinus. In the submucosal or periglandular area, IgA producing plasma cells were numerous. Our observations suggest that IgA, produced locally, is secreted via the glandular cells as secretory component — SIgA. Secretory activity of SIgA in these glandular tissues indicates that the larynx is possibly an immunologically active organ in the upper respiratory tract.
Pediatric Flexible Bronchoscopy
Authors: Wood Robert E. , Sherman James M.
Published: October 2014

We have utilized a prototype pediatric flexible bronchoscope to perform diagnostic and therapeutic procedures on pediatric patients ranging from 840 gm to 14 years of age. Flexible bronchoscopy, with appropriate instrumentation and careful attention to physiological requirements of the patient, is safe and effective in pediatric patients. The availability of new instrumentation promises to have as great an impact on pediatric pulmonology as the standard flexible bronchoscopes did on adult pulmonology. With this instrument, the indications for bronchoscopy may be considerably expanded.
Hemoptysis in Children
Authors: Tom Lawrence W. C. , Weisman Robert A. , Handler Steven D.
Published: October 2014

Hemoptysis is uncommon in the pediatric age group. There is little mentioned regarding this problem in either the pediatric or the otolaryngologic literature. A review of the past ten years' experience at the Children's Hospital of Philadelphia identified 40 patients whose presenting symptoms included hemoptysis. Causes of the hemoptysis included tumor, infection, trauma, and foreign bodies, as well as a variety of other conditions. Based on these findings, a systematic approach to the diagnostic evaluation of the pediatric patient with hemoptysis has been developed. A thorough endoscopic examination of the upper aerodigestive tract is essential in most cases, and can have both diagnostic and therapeutic value. Particular attention is directed toward airway management in patients with massive hemorrhage. Close cooperation among the bronchoesophagologist, pediatrician, and anesthesiologist is mandatory for optimal care of the child with hemoptysis.
Foreign Bodies in the Larynx and Tracheobronchial Tree in Children
Authors: Rothmann Bruce F. , Boeckman Clifford R.
Published: October 2014

In a study of 225 patients with foreign bodies in the larynx, trachea and bronchi, 77 % were 36 months of age or less. The male-female ratio was 2:1. Food or food derivatives were the causative agent in 70% of the cases, with 38% due to a portion of nut. The foreign body involved the right and left bronchus with equal frequency. A choking episode followed by an audible wheeze (55 %) was the most common presenting complaint. Obstructive emphysema was demonstrated in 60 % and was best demonstrated by inspiration-expiration chest roentgenograms or fluoroscopy. A radio-opaque object was seen in 13 %. Two hundred ten foreign objects (93 %) were removed by endoscopy. Four patients required pulmonary resection for bronchiectasis and in three patients bronchotomy was performed. Five patients expelled the foreign body spontaneously, two patients were transferred to another hospital, and one foreign body was not recovered. There was no mortality.
Five-Year Retrospective Study with Special Reference to Management
Authors: Cohen Seymour R. , Herbert Wayne I. , Lewis George B. , Geller Kenneth A.
Published: October 2014

The charts of 143 patients with foreign bodies in the larynx and tracheobronchial tree who were admitted to the Childrens Hospital of Los Angeles during the period 1973 to 1978 were reviewed. Of these children 84 were male and 59 were female. One hundred were private patients and forty-three were clinic patients. Of these foreign bodies 60 were nut meat which is by far the most common foreign body of the tracheobronchial tree. All foreign bodies were successfully removed. One hundred twenty-six were discharged within the first 24 hours after admission and treatment. Fifty-one or 36% of these patients were discharged on the same day after the foreign body was removed. Sixty-two of the foreign bodies were in the left bronchial tree, while 55 were in the right bronchial tree. One hundred thirty-eight were endoscoped under general anesthesia using the apneic technique and five patients were treated with oxygen standby only because of severe respiratory obstruction. A detailed description of the use of apneic technique with profound muscle relaxation, the avoidance of preoperative medication and the team approach to ventilating the patients are all described. The advantage of general anesthesia, and the potential intraoperative and postoperative problems are reviewed. Of the total number of cases 13 % were between 4 and 11 months of age, 44% were between 12 and 23 months of age and 57% were over 23 months of age.
The Cricopharyngeus in the Neonate
Authors: Reichert Timothy J. , Faw Kenneth D.
Published: October 2014

The cricopharyngeus muscle in neonates and infants has not been well established. It is found, like other laryngopharyngeal structures in infants, to be relatively much larger than its counterpart in the adult but not large enough to correlate with the total length of reported sphincter function. It also varies significantly in size, and therefore probably does not contribute completely to the function of the upper esophageal sphincter. Its relationship to airway protection, regurgitation and respiration needs to be more thoroughly studied.
Experimental Otitis Media following Middle Ear Inoculation of Nonviable Streptococcus Pneumoniae
Authors: Lowell Seth H. , Juhn S. K. , Giebink G. Scott
Published: October 2014

The pathogenesis of otitis media is poorly understood, and the events leading to bacterial invasion of the middle ear cleft and resulting inflammation are a matter of conjecture. While Streptococcus pneumoniae is the most frequent microbe cultured from acute, purulent middle ear effusions, it is infrequently cultured from nonsuppurative serous and mucoid effusion. To explore the possibility that nonviable pneumococci persisting in the middle ear cleft might produce mucosal inflammation, a solution of heat-killed pneumococci was placed in the middle ear cavity of experimental animals. Mucoperiosteal pathology which followed inoculation included an active, early subepithelial inflammatory response, metaplasia of the lining epithelium and later new bone formation. Thus, nonviable pneumococci are capable of producing middle ear inflammation, and it is possible that persistence of whole nonviable organisms or subcellular components in either middle ear effusion or mucoperiosteum may lead to continued middle ear inflammation or nonsuppurative otitis media.
Papilloma of the Larynx and Tracheobronchial Tree in Children
Authors: Cohen Seymour R. , Geller Kenneth A. , Seltzer Sharon , Thompson Jerome W.
Published: October 2014

One hundred and forty cases of papilloma of the larynx and tracheobronchial tree are documented in the records of the Childrens Hospital of Los Angeles. The records of 90 patients were available and were reviewed intensively. The method of direct laryngoscopy with general anesthesia using apneic technique in most patients and intubation in some was an adequate method of treating patients with laryngeal papillomata. A general anesthetic was never used where obstruction was severe and the airway could not be controlled. The low incidence of papilloma of the tracheobronchial tree and an absence of parenchymal lung seeding in this series is attributed to the avoidance of a tracheotomy and fewer intubation anesthetics thus avoiding trauma to the trachea and bronchi. The immediate removal of the tracheotomy tube seems an alternative if the surgical procedure had been performed. In the patients in this series decannulation was accomplished in a very short period of time. The establishment of an airway seems to be a priority in the treatment of this disease and this can be accomplished by repeated endoscopic procedures rather than tracheotomy. Statistics are given, and prognosis based on the type of lesion and histopathology is documented.
Acquired Stenosis of the Upper Airway in Neonates an Increasing Problem
Authors: Papsidero Michael J. , Pashley Nigel R. T.
Published: October 2014

Thirty neonates with acquired airway stenosis were treated between 1975 and 1979 at the C. S. Mott Children's Hospital of the University of Michigan. Neonates surviving a period of ventilation are at risk of developing subglottic stenosis (8.3%). The stenosis is often severe. Children with respiratory distress syndrome and/or neurologic disorders were particularly prone to developing a stenosis (37 %). Following treatment, 43% were successfully decannulated and decannulation occurred in a biphasic pattern. Thirty-seven percent were still tracheostomy-dependent but had a voice and were developing normal speech patterns. The mean decannulation time was 92.5 weeks, confirming that acquired subglottic stenosis in the neonate is a serious problem with long-term disability.
Long-Term Stenting for Laryngotracheal Stenosis
Authors: Schuller David E.
Published: October 2014

The use of an inert stent as an adjunct to surgical procedures to correct laryngotracheal stenoses remains somewhat controversial. It is the purpose of this report to describe the use of long-term stents in seven patients with either acute or chronic laryngotracheal stenoses. The conclusion from this series is that stenting for prolonged periods of time represents a valuable adjunctive technique in the correction of the more severe airway reconstruction problems.
Silicone Tracheal Cannula
Authors: Montgomery William W.
Published: October 2014

This presentation is to introduce a silicone tracheal cannula which has been designed for use in selected cases instead of a tracheotomy tube. The design of the cannula was developed in the laboratory and has now been used clinically over a period of four years in 26 cases. Special features of the cannula include a one-size diameter which is suitable for all adults. An inner flange is shaped so as to conform with the inner aspect of the anterior wall of the trachea and to prevent rotation and anterior displacement of the cannula. The inner flange is angulated to allow for proper direction of the long axis of the cannula. An outer flange fits into one of a number of grooves and prevents posterior displacement of the cannula. Thus far the silicone tracheal cannula has been used in cases of sleep apnea, bilateral vocal cord paralysis in the position of adduction, intermittent glottic insufficiency, laryngeal carcinoma, chronic lung disease, and short-term necessity for a tracheotomy. Special equipment has been designed for ease of the surgical procedure required for insertion of the cannula. A oneway valve has been designed which is easily applied to the cannula. A variation of the silicone tracheal cannula has been designed for long-term use.
An Endoscopic Technique for Restoration of Voice after Laryngectomy
Authors: Singer Mark I. , Blom Eric D.
Published: October 2014

Reports of restoration of voice after total laryngectomy include diversion of exhaled pulmonary air through planned or spontaneous fistulae with a variety of modified tracheal cannulas and valves. Limitations of these techniques include aspiration, scar closure of the shunts, wound complications, and failure to achieve voice consistently. We report a two-year experience with an endoscopic method using a unique valved prosthesis eliminating complicated surgical reconstructions, aspiration, and stenosis. Fifty-four of 60 patients (90%) achieved fluent voices with one deglutition problem. Radiation therapy preceded voice restoration in 63% of the patients and radical neck dissection in 72%. The endoscopic procedure, hospitalization and period of speech therapy are short and constitute a cost-effective voice rehabilitation program. The results of this simple method and lack of complications are encouraging.
Evolution of the Clinically Negative Neck
Authors: Skolnik E. M. , Katz A. H. , Becker S. P. , Mantravadi R. , Stal S.
Published: October 2014

A retrospective study was done of 602 patients with primary squamous cell carcinoma of the upper aerodigestive tract and a clinically negative neck (N o) seen at the University of Illinois Hospital between 1960–1975. There was no uniform policy as to the treatment of N o neck during this period; therefore in many of the patients, cervical lymph nodes were treated with elective neck dissection and others were followed until they became positive clinically. It was this difference which formed the basis for this study. All the patients were treated surgically; the patients were placed into two groups depending on whether they had radical neck dissection at the same time as resection of the primary. Group 1 consisted of 149 patients and had surgery for the primary only. The 253 patients of group 2 had surgery for the primary and also had a neck dissection. Both groups were analyzed for recurrences in the cervical region. In group 1, 12.9 % of the patients developed either ipsilateral or contralateral metastases. Of the group 2 patients, 22% developed palpable nodal disease. The evolution of palpable nodal disease was analyzed by primary site, T-stage, and according to whether the tumor at the primary was controlled. Only 3% of the patients developed lymph nodes when the primary was controlled. The pathology reports of the neck specimens were studied to determine the relationship between a) positive node histology and b) number of nodes positive to the recurrence rate in the neck Our results showed a 23% failure rate for the histologically positive group and a 21% failure rate for the negative group. The number of positive nodes did not seem to affect the recurrence rate.
Blastomycosis of the Larynx
Authors: Suen James Y. , Wetzel William J. , Wetmore Stephen J. , Craig Robert D.
Published: October 2014

Blastomycosis is an uncommon fungal disease which may mimic carcinoma of the larynx. Physical examination may show a granular appearance early in the disease with progression to laryngeal fibrosis. Histologic examination usually shows pseudoepitheliomatous hyperplasia, microabscesses, and giant cells. The broad-based budding yeast organisms may be easily overlooked unless special stains are used. Two cases of laryngeal blastomycosis which were originally treated as carcinoma are reported.
Conservative Surgical Treatment of Chondrosarcoma of the Larynx
Authors: Cantrell Robert W. , Reibel James F. , Jahrsdoerfer Robert A. , Johns Michael E.
Published: October 2014

Chondrosarcoma of the larynx is a rare malignant tumor sometimes encountered by otolaryngologists. Since they are usually of low grade malignancy, total laryngectomy is indicated only in cases of high grade malignancy or where total excision by conservative (partial) laryngectomy is not feasible. This paper reviews chondrosarcoma of the larynx, discusses a patient who developed this tumor, and describes a method of conservative surgical excision and laryngotracheal reconstruction when the tumor involves the cricoid, the most common site of occurrence in the larynx.
Candida Laryngitis in Chronic Mucocutaneous Candidiasis its Association with Candida Esophagitis
Authors: Dudley James P. , Byrne William J. , Kobayashi Roger , Ament Marvin E. , Rosenblatt Howard M. , Stiehm E. Richard
Published: October 2014

Four patients with chronic mucocutaneous candidiasis (CMC) underwent esophagoscopy and microlaryngoscopy. Cultures were obtained by biopsy of the larynx and the esophagus. Three of the four patients with laryngeal disease proven by laryngoscopy and culture also had extensive esophageal disease. One patient with a normal larynx by examination and culture also had a normal esophagus. There appears to be a good correlation between the presence of laryngeal and esophageal disease.
Reciprocal Synapses at the Base of Outer Hair Cells in the Organ of Corti of Man
Authors: Nadol Joseph B.
Published: October 2014

Reciprocal synapses have been found between nerve terminals and the outer hair cells in the human organ of Corti. A single nerve ending of the nonvesiculated type may possess two types of synaptic specialization of opposite polarity. The first is typical of the “afferent” synapse with a presynaptic body in the hair cell and pre- and postsynaptic membrane thickening. The second consists of a small collection of presynaptic vesicles in the neural cytoplasm near the plasma membrane facing the hair cell and a subsynaptic cisterna within the hair cell cytoplasm. The second type of specialization is similar to the synapses seen in “efferent” endings. This suggests that both an afferent (hair cell to neuron) and efferent (neuron to hair cell) synaptic relationship may exist between an outer hair cell and a single nerve terminal.
Protease Inhibitors in Middle Ear Effusions
Authors: Carlsson Britt , Lundberg Christer , Ohlsson Kjell
Published: October 2014

As the presence of granulocytes in middle ear fluid in serous otitis media implicates a potential risk of extracellular release of granulocyte proteases, the main protease inhibitors in serum, α1-antitrypsin, α1-antichymotrypsin and α2-macroglobulin, were immunochemically quantitated in such effusions. The mean concentration of α1-antitrypsin was found to be higher in middle ear effusion and the mean concentration of α1-antichymotrypsin slightly lower than in plasma. On comparison with albumin, however, lower values than expected were found in the middle ear fluid for the two inhibitors. The high molecular weight α2-macroglobulin was significantly lower than in plasma. Furthermore a low molecular weight protease inhibitor, which is thought to be locally produced in the respiratory epithelium, was demonstrated in the effusion.
Chondrosarcoma at the Skull Base
Authors: Gay I. , Elidan J. , Kopolovic J.
Published: October 2014

A rare case of chondrosarcoma at the skull base is presented. Computerized tomography scan was very helpful in delineating the exact extent of the tumor. Chondrosarcoma is a slow growing malignant tumor which metastasizes very late. Usually it is radioresistant, but when surgery is not feasible, irradiation treatment is worth a trial.
Idiopathic Endolymphatic Hydrops and the Vestibular Aqueduct
Authors: Rizvi Syed S. , Smith Lee Eliott
Published: October 2014

The vestibular aqueduct (VA) and endolymphatic sac were examined topographically in 29 human ears with idiopathic endolymphatic hydrops. When compared with 34 control ears, there was found to be a slight but statistically significant reduction in the width ( P < 0.005) and length ( P < 0.05) of the vestibular aqueduct. A small hypoplastic endolymphatic sac was found in three of the ears with hydrops but was also present in one control ear. It would appear that a marked reduction in sac size is not a consistent feature in ears with endolymphatic hydrops.
Eye-Head Coordination during Optokinetic Stimulation in Squirrel Monkeys
Authors: Kubo Takeshi , Jensen David W. , Igarashi Makoto , Homick Jerry L.
Published: October 2014

Head and eye movements in the yaw plane were recorded during and after optokinetic stimulation in squirrel monkeys. 1) Phasic or tonic head deviations to the side of the ocular quick phase occurred in 94% of total recordings (n = 50) during the perstimulus period, and in 75% of recordings (n = 49) during the poststimulus period. Magnitude of mean head deviation was significantly different between perstimulus and poststimulus periods. 2) Head nystagmus associated with eye nystagmus was consistently observed in seven of nine squirrel monkeys during optokinetic stimulation. Squirrel monkeys are thereby less prone to display head nystagmus than either guinea pigs, pigeons or chickens. 3) Slow phase speeds of coupled head and eye nystagmus were subjected to statistical analysis. A highly significant negative correlation was found between slow phase head and eye speeds. The correlation coefficient was −0.81 at 60°/sec stimulus (n = 119) and −0.72 at 100°/sec stimulus (n = 131). The gaze speed, calculated by summing the head and eye speeds, was 59.1 ± 6.8/sec at 60°/sec and 92.2 ± 11.4 at 100°/sec stimulus. There was no significant difference between the gaze speed in a free head condition and the eye speed when the head was fixed.
Objective Evaluation of Earplugs for the Control of Water-Borne Infection
Authors: Johnson David W. , Maisel Robert H.
Published: October 2014

Eighty-two cotton, foam, and solid core stock and custom earplugs were evaluated objectively for water absorption and water penetration characteristics in order to determine their efficacy for control of water-borne infection in ears having open middle ear cavities. Cotton plugs, even when saturated with petroleum jelly, had poor consistency in resisting even minimal water pressure. Polymeric foam plugs, especially when saturated with petroleum jelly, appeared to inhibit water flow in conditions approximating actual ear protection use. No plugs evaluated, including custom elastomeric solid core plugs, inhibited water penetration in conditions approximating shallow surface dives. A clinical protocol for evaluation of potential earplugs for patient use is proposed on the basis of this study.
Leaking Labyrinth Lesions, Deafness, Tinnitus and Dizziness
Authors: Goodhill Victor
Published: October 2014

The remarkable integrity of the finely balanced membranous labyrinth is occasionally disrupted, resulting in fistulae of various types in a number of locations. Such leaking labyrinth lesions can be of congenital origin, due to various types of malformations. They may be caused by destructive diseases such as syphilis, by many variants of acute and chronic otomastoiditis, and sequelae of otosclerosis surgery, and finally, as results of a variety of traumatic disruptions of labyrinthine integrity. Deafness, dizziness, and tinnitus are frequent symptoms and sequelae may include meningitis and other intracranial complications. The clinical consideration of leaking labyrinth lesions must always be considered in otologic diagnoses.
Ultrasonic Analysis of Head and Neck Neoplasms Correlation with Surgical Findings
Authors: Baker Shan R. , Krause Charles J.
Published: October 2014

Ultrasonography of head and neck neoplasms is useful in the preoperative evaluation of patients. Inflammatory masses demonstrate high reflectivity in a homogeneous pattern and have diffuse borders. Similarly, lipomas show medium to high reflectivity and have a homogeneous pattern, but are well outlined. Mixed tumors of the major salivary glands have a characteristic heterogeneous pattern and are well outlined. Malignant lesions demonstrate low reflectivity in a homogeneous or heterogeneous pattern and have poorly outlined or diffuse borders. Cysts of the head and neck are well outlined and devoid of interior echoes.
Efferent Innervation of the Cochlea
Authors: Strutz Jürgen
Published: October 2014

The origin of the efferent innervation of the cochlea was investigated in the guinea pigs. Horseradish peroxidase (HRP) was injected into the cochlea and transported to the brainstem by retrograde axonal transport of the efferent fibers, showing the origin of the crossed and uncrossed olivocochlear bundles of Rasmussen. HRP-labeled neurons were found in various nuclei of the superior olivary complex bilaterally. Ipsilateral to the injected cochlea there were three times more cells than on the contralateral side. About 40% of the total number of labeled neurons, a remarkable quantity, occurred in the ipsilateral lateral superior olivary nucleus. Moreover, extraolivary origin of the efferent innervation of the cochlea could be demonstrated bilaterally in the ventral nucleus of the lateral lemniscus.
Sarcoidosis and Fluctuating Hearing Loss
Authors: Jahrsdoerfer Robert A. , Johns Michael M. E. , Thompson Edward G. , Cantrell Robert W.
Published: October 2014

Neurological manifestations of sarcoidosis occur in 5% of affected patients. Of the cranial nerves, the eighth nerve is the fourth most frequently involved. The central nervous system lesion is presumed to be a granulomatous meningitis that directly infiltrates the cranial nerves or causes them to be compressed from involvement of adjacent intracranial structures. Sensorineural hearing loss and vertigo usually occur in concert with other neurological findings, but may be the only presenting complaint. Sarcoidosis is not generally recognized as a cause of fluctuating sensorineural hearing loss. The fluctuating quality of the hearing loss has been noted by other investigators, but no patient has been previously reported with hearing fluctuation as the initial complaint. A chest radiograph and eye examination are mandatory. The diagnosis may be suspected from hilar adenopathy and uveitis, and confirmed by node biopsy. The hearing will usually improve on steroid therapy. Sarcoidosis represents yet another disease entity the otolaryngologist must consider in the differential diagnosis of fluctuating hearing loss.
Myositis Ossificans following Radical Neck Dissection
Authors: Shugar Martin A. , Weber Alfred L. , Mulvaney Thomas J.
Published: October 2014

Myositis ossificans traumatica is an uncommon disorder in which there is posttraumatic bone formation in muscle and other soft tissues near bone. The lesion is exceedingly rare in the head and neck. A case is presented in which myositis ossificans of the platysma occurred following radical neck dissection. Because recurrence may follow excision of the abnormal bone, removal is recommended only if there are significant symptoms associated with the lesion. If surgery is indicated, it should be delayed for 6 to 12 months following the initial trauma to allow for maturation of the lesion.
Prehistoric Trephination of the Frontal Sinus
Authors: Canalis Rinaldo F. , Hemenway William G. , Cabieses Fernando , Aragon Roberto
Published: October 2014

Two examples of prehistoric trephination of the frontal sinus are presented. Both specimens were collected in Peru during the second decade of this century and are currently preserved at the Museum of Man in San Diego. One of the skulls represents trephining by incision and the other by scraping. Both show signs of healing indicating that the operated individuals survived the procedure. No definite clues as to the indications for surgery were found in one of the specimens. Trauma involving the frontal sinus appears to have been the reason for trephination in the other.
In Vitro Cultivation of the Fetal Guinea Pig Inner Ear
Authors: Davis Gustave L. , Hawrisiak Mary M.
Published: October 2014

Fetal guinea pig inner ears, gestational age from 21 to 54 days, were cultivated in vitro and then observed with light and electron microscopes. Early 21-day gestation otocysts developed cartilaginous capsules from differentiating mesenchyme and discrete neurosensory structures from endolabyrinthine epithelium. Coiling of the cochlea occurred. Older, differentiated inner ears showed progressive increase in size and development of the labyrinth. The 26-day gestation cochlea, maintained for 12 days in vitro, doubled in size with development comparable to the 37-day gestation in vivo control. The large size of the guinea pig inner ear resulted in varying degrees of necrosis. However, the well-defined growth and development of the guinea pig fetal inner ear in vitro indicates the efficacy of the technique and suggests that similar success would be forthcoming with other animals used in audiologic research, such as chinchilla and hamster.
Ototoxicity of Intracisternal Gentamicin in Cats
Authors: Parrish Katherine L. , Tachibana Masayoshi , Norris Charles H. , Domer Floyd R. , Guth Paul S.
Published: October 2014

The intrathecal administration of gentamicin has been used to treat bacterial meningitis. However, the influence of this route of administration on the well-known ototoxic activity of gentamicin is unknown. This route of administration should facilitate access to the inner ear and should increase the ototoxic liability. The possible ototoxic and neurotoxic effects of intrathecally administered gentamicin (0.5, 1, 2, 4, 6, 10 mg/day) in cats were evaluated. Hearing thresholds were obtained by a noninvasive technique prior to and on the 7th and 21st days after the initiation of a seven-day dosage regimen. Histological examination of the organ of Corti was routinely done. Additionally, the vestibular organs of one animal on the 4 mg/day regimen were examined. The concentrations of gentamicin in the cerebrospinal fluid were also determined. The data indicate that the 2 mg/day dose may be very close to the threshold dose for ototoxicity when gentamicin is given by intracisternal administration.
Effect of Increased Perilymphatic Pressure on Endocochlear Potential
Authors: Nakashima Tsutomu , Ito Akikazu
Published: October 2014

A study was done to determine how increased fluid pressure in the inner ear influences cochlear blood flow. Hydrostatic pressure was applied to the scala vestibuli or scala tympani in guinea pigs. Endocochlear potential, which is sensitive to the lack of oxygen, was measured through the round window membrane or through the stria vascularis. Cochlear blood flow was confirmed by intravenous injection of India ink. When the perilymphatic pressure was raised to a relatively high level, endocochlear potential decreased, in a similar way as in response to anoxia, because of the cessation of the cochlear blood flow. This change was completely reversible upon applications of pressure for brief periods of time. We consider that the cochlear blood flow ceases when the fluid pressure reaches the level of intracochlear arterial pressure.
Chronic Effects of Phasic Middle Ear Pressure Changes
Authors: Miller J. M. , Axelsson A. , Potter W.
Published: October 2014

In an attempt to better define the mechanisms of barotrauma, middle and inner ear pathology was studied in guinea pigs three weeks following exposure to a brief, sudden middle ear pressure change. Findings included tympanic membrane perforations (particularly dependent upon high negative pressure exposures), vascular hemorrhage (primarily dependent upon high positive pressure exposures), serosanguineous effusions (predominantly dependent upon infection) and serous effusion (dependent upon negative pressure exposure). Round window perforations were common in high pressure animals with infection. Other inner ear membrane changes were infrequent or minimal. Lymphatic hemorrhage was observed as a function of exposure. The clinical implications of these findings and possible mechanisms underlying these changes are discussed in terms of our previously reported study of the immediate effects of such pressure chance.
Otolaryngic Osteopathology in 14th Century Mid-America
Authors: Gregg John B. , Steele James P. , Ferwerda Helen , Zimmerman Larry , Gregg Pauline S.
Published: October 2014

Over 486 people were massacred and buried communally at the Crow Creek Village Site, South Dakota, about 1350 AD. Osseous pathology in the craniofacial area of the victims' skeletons is reviewed and compared to data from other indigenous skeletal populations past and present. The Crow Creek mastoid x-rays are analyzed and compared to four other studies which span over 1000 years of Dakota Territory history. Findings regarding external auditory canal exostoses in the different groups are compared. Unusual findings in the craniofacial area are assessed. Insight into longitudinal epidemiology in one portion of the U.S. is possible through this study.
Carbon Dioxide Laser Treatment of Metastatic Melanoma of the Trachea and Bronchi
Authors: Andrews Albert H. , Caldarelli David D.
Published: October 2014

An occasional patient with metastatic or recurrent malignant disease develops intraluminal masses in the trachea and/or the main bronchi. The accuracy of the application, absence of bleeding, slight reaction, and rapid healing make the CO2 laser applied through the open bronchoscope a valuable palliative treatment for the relief of obstructive dyspnea. This patient is reported because he demonstrated the reduced bleeding which occurred with the bronchoscopic CO2 lasing as compared to bronchoscopic forceps removal.
Esophageal and Hypopharyngeal Injuries in Patients with Cervical Spine Trauma
Authors: Pollock Richard A. , Apple David F. , Purvis John M. , Murray Herdon
Published: October 2014

The authors review their recent experience with four patients referred to the Shepherd Spinal Center, Atlanta, with cervical spine fracture dislocation and quadriplegia. The patients were subsequently found to have tears of the hypopharynx or the esophagus as a complication of their injury. Unexplained fever, swelling of the neck, dysphagia or leukocytosis in the patient with acute cervical spine injury suggest, the authors urge, the possibility of esophageal or hypopharyngeal perforation. The authors review the kinematics and pathophysiology of cervical fractures and provide clues to early detection and management of perforation of the hypopharynx or esophagus, including the use of radiographic study and endoscopy.
Incendiary Characteristics of Endotracheal Tubes with the Carbon Dioxide Laser
Authors: Treyve Edward , Yarington C. Thomas , Thompson Gale E.
Published: October 2014

The ignition characteristics of the American Hospital, Portex®, polyvinyl chloride, and red rubber tracheal tubes commonly available have been evaluated using a standard carbon dioxide laser. The added hazard of the increased combustibility of the impregnated line on endotracheal tubes and the hazard of commonly utilized anesthetic or lubricating materials are discussed. The safety limits which, experimentally, indicate levels of energy and laser burst time which seem to preclude the hazard of ignition are outlined. The potential danger of postburn bronchiolitis is noted, along with appropriate treatment.
Surgical Repair in Hypopharyngeal and Cervical Esophageal Cancer
Authors: Harrison D. F. N.
Published: October 2014

Most recent publications dealing with surgical repair following pharyngolaryngectomy or pharyngolaryngoesophagectomy appear to be based upon limited surgical experience of the most differing operations now available. An up to date review of 162 patients, including 68 gastric “pull up” procedures, has the advantage of being a personal series as well as a critical evaluation of each technique based upon personal evaluation.
Duplication of the Esophagus
Authors: Mikaelian Diran O. , Simonian Simon , O'Keefe John J.
Published: October 2014

Two patients with tubular esophageal duplications and the embryologic development of the esophagus are presented. The several theories in the formation of the esophageal duplications have been reviewed. As of yet, no definite explanation can be advanced for this developmental anomaly.
Use of Videotape in Diagnosis and Treatment of Cancer of Larynx
Authors: Konrad Horst R. , Bussen John , Hopla Dan M. , Griswold Frederick C.
Published: October 2014

Sophisticated endoscopic techniques coupled with new developments in medical videotaping have made this combination a clinically useful technique in the diagnosis and management of laryngeal cancer. Preoperative tapings in the physician's office and taping at laryngoscopy and biopsy allow for better assessment and permanent record of size and location of lesion, location of biopsies, and physiologic impairment of laryngeal function. All personnel participating in treatment including radiotherapists, surgeons, pathologists, radiologists, chemotherapists, and speech therapists can clearly see the lesion and contribute more usefully to decisions regarding treat ment. Videotaping during and after radiotherapy and chemotherapy and after partial laryngectomy can aid in assessing response to treat ment, provide a permanent record for comparison, and aid in detecting treatment failure or recurrence. Finally, these techniques aid our educational process for future physicians by permanently and objectively recording the appearance of lesions, treatment, and outcome. (The presentation included actual videotape material used in the processes described.)
Epiglottic Laryngoplasty for Complicated Laryngeal Stenosis
Authors: Sobol Steven M. , Levine Howard , Wood Benjamin , Tucker Harvey M.
Published: October 2014

The technique of epiglottic laryngoplasty, previously described for reconstruction following near total laryngectomy for glottic carcinoma, has been used in selected patients with severe glottic and subglottic stenosis. Our experience in four patients suggests that it is useful for 1) laryngeal stenosis in which there is loss or collapse of the external cartilaginous framework, and 2) laryngeal stenosis which is refractory to the usual forms of therapy. The technique is a technically simple, one-stage procedure which provides its own endolaryngeal mucosal lining, as well as autogenous cartilaginous support. It has been successful in restoring adequate airway and preserving voice without interfering with deglutition or laryngeal competence in most patients.
Juvenile Nasopharyngeal Fibroma
Authors: Acuña Ricardo Tapia
Published: October 2014

The large number of cases of nasopharyngeal fibroma seen in Mexico gives Mexican otolaryngologists considerable experience with this disease. This report includes studies on 322 patients seen by the author. It is important to recognize that nasopharyngeal fibroma is not just a tumor, but a disease with particular characteristics, such as prevalence among young males. Clinically it is quite different from other tumors of the pharynx, nose or accessory sinuses.
Treatment of Carcinoma of the Epiglottis
Authors: Nadol Joseph B.
Published: October 2014

One hundred five cases of primary squamous cell carcinoma of the epiglottis were reviewed and the results of treatment compared. The cure rate by radiation therapy for epiglottic carcinomas, both suprahyoid and infrahyoid, was poorer than previously reported cure rates for all supraglottic carcinomas (p<0.01). This may be due to unsuspected anterior extension of infrahyoid tumors into the preepiglottic space and thyroid cartilage. The cure rate (five years with no evidence of disease) for suprahyoid lesions was superior to that of infrahyoid lesions for all stages of primary size and nodal metastases and for all treatments. It is suggested that initial staging of primary epiglottic carcinomas should include the designation of suprahyoid or infrahyoid. The role of xeroradiography as an adjunct to staging and the implications for treatment are discussed.
Hypothyroidism following Treatment for Head and Neck Cancer
Authors: Vrabec Donald P. , Heffron Timothy J.
Published: October 2014

One hundred ninety-six head and neck patients were studied to determine the effects of radiation therapy and surgery on thyroid function. Serum thyroid-stimulating hormone (TSH) levels were obtained as a screening test for primary hypothyroidism. Elevated TSH levels were found in 57 of the 196 patients (29.1%). The highest incidence of abnormal TSH values (66%) occurred in the group treated with combination radiation therapy and surgery, including partial thyroidectomy. TSH levels rose early in the posttreatment period with 60% of the abnormal values occurring within the first three posttreatment years. Posttreatment thyroid dysfunction was twice as common in women (48.6%) as in men (25.4%). When serum thyroxine levels by radioimmunoassay (T4RIA) were correlated with the elevated serum TSH levels, a similar pattern was seen with 65% of the patients in Group 3 having a decreased T4RIA level indicating overt hypothyroidism. Pretreatment levels of thyroid function including thyroid antibody studies should be established for all patients. Serial TSH levels should be done every three months during the first three posttreatment years and semiannually thereafter as long as the patient will return for follow-up care. All patients treated with combination radiation therapy and surgery who develop elevated TSH levels should be treated with thyroid replacement therapy. Patients receiving radiation therapy alone should receive replacement thyroid therapy if they develop a depressed T4RIA value or a pattern of gradually increasing TSH levels.
Laryngeal Complications of Nasogastric Tubes
Authors: Sofferman Robert A. , Hubbell Richard N.
Published: October 2014

The association of bilateral vocal cord paralysis with relatively short-term nasogastric tube use is represented in four case histories. A prospective study of the effects of nasogastric tubes on the normal human larynx discovered arytenoid edema in approximately one third of patients. A literature review, possible pathophysiologic mechanisms to explain the condition, and basic medical management are described.
Documentation in Pediatric Laryngology
Authors: Benjamin Bruce
Published: October 2014

Endoscopy in pediatric laryngology continues to develop and broaden its horizons. The need for documentation of the various pathological conditions has become more apparent. The upper lateral airways radiological study together with endoscopic photography allows permanent objective documentation of the changes occurring in any part of the upper respiratory tract from the nose and nasopharynx to the bronchi and segmental openings. This combination of radiological study and single frame color photography is the most convenient means of studying the pathology, natural history, and results of treatment as well as for clinical research and teaching in training programs.
Bilateral Vertical Partial Laryngectomy for Bilateral Vocal Cord Carcinoma
Authors: Biller Hugh F. , Lawson William
Published: October 2014

This paper presents a technique of partial laryngectomy for tumors involving both vocal cords. The resection includes both vocal cords, adjacent cartilage and one arytenoid. Staged reconstruction consists of rotating the remaining posterior border of the thyroid cartilage 90° in order to obtain adequate anteroposterior length. A temporary laryngostome is formed. The results in four patients, followed for a minimum of three years, are presented.
Tracheoesophageal Puncture for Alaryngeal Voice Restoration
Authors: Wood Benjamin G. , Rusnov Melinda G. , Tucker Harvey M. , Levine Howard L.
Published: October 2014

Thirty-two tracheoesophageal punctures (TEP) were performed on 30 patients by The Cleveland Clinic Foundation Department of Otolaryngology and Communicative Disorders. In all cases, the Blom-Singer duckbill prosthesis was utilized for alaryngeal voice restoration. Ninety-three percent of patients were able to produce significantly better voice following TEP when compared to their preoperative mode of communication. The preoperative orientation/evaluation format, surgical technique, success-failure ratios, and possible factors affecting successful TEP voice restoration are examined.
Role of Chemotherapy in the Multidisciplinary Approach to Advanced Head and Neck Cancer: Potentials and Problems
Authors: Ervin Thomas J. , Karp Daniel D. , Weichselbaum Ralph R. , Posner Marshall R. , Fabian Richard L. , Miller Daniel
Published: October 2014

Chemotherapy as initial treatment for advanced squamous carcinoma has received much recent attention. Despite sparse experimental data supporting its usefulness, such chemotherapy is now used for a variety of advanced malignancies. This experience is conceptually reviewed, with special emphasis on squamous carcinoma of the head and neck. Factors which influence treatment results, such as drug dosage, radiation treatment planning, and surgical resection, will require careful analysis in the evolution of the multidisciplinary approach to advanced head and neck cancer.