bluuebunny/crossref_metadata_2025 huggingface dataset:
Microfissure in the Oval Window Area
Authors: Harada Takehiko , Sando Isamu , Myers Eugene N.
Published: October 2014

Examination of 331 human temporal bones revealed the presence of a microfissure in the oval window area in 25%. The youngest temporal bone in which the microfissure was observed was from a child eight years old and the oldest temporal bone was from an individual 102 years old. It appears that the microfissure in this area occurs extremely rarely before 10 years of age, that it begins to be observed after the age of 10, and that the incidence of this fissure increases sharply at about age 40. In 61% of the bones in which the microfissure was observed, it was present both superior and inferior to the oval window in almost the same vertical plane. In none of the bones, however, did it extend beyond the annular ligament to the footplate. The histological appearance of the microfissure in this area was quite similar to that of the microfissure between the posterior canal ampulla and round window niche, although the latter appeared to be wider in general. The histogenesis of the microfissure is still unknown, but upon careful analysis of the results of this study and literature review, the authors consider nontraumatic spontaneous fracture by mechanical stress to be the most probable explanation for its occurrence. Possible clinical significance of the microfissure is also discussed.
Association of a Thyroglossal Duct Cyst and a Dermoid Cyst in the Neck
Authors: Haar J. G. , Sadeghi M. H. , Boulos E. J. , Sheffer J.
Published: October 2014

The association of a thyroglossal duct cyst and a dermoid cyst in the neck is a very interesting pathological finding. Review of the literature could not establish any relationship between the two lesions, embryological or otherwise. To our knowledge no previous similar case has been reported in the literature.
Osteogenesis Imperfecta Tarda and Otosclerosis a Temporal Bone Histopathology Report
Authors: Sando Isamu , Myers David , Hinojosa Raul , Harada Takehiko , Myers Eugene N.
Published: October 2014

The histopathology of the temporal bones in a 59-year-old female with osteogenesis imperfecta tarda (OIT), complicated by otosclerosis, is presented. Advanced conduction and sensorineural deafness in the left ear and absence of a response to sound in the right ear had been recorded before she died and the temporal bones were acquired for histological study. Histopathological examination revealed a marked degree of porosity of the labyrinthine capsule, enlarged vascular spaces, and a deficiency in number and size of bony trabeculae in the marrow of the petrous apex. All layers of the otic capsule had been extensively replaced by otosclerotic material including the bony semicircular canals and the cochlear and vestibular walls. In the right ear, which had a profound hearing loss, the outline of the space which had been occupied by a piston prosthesis in the oval window was evident; in addition, a layer of new bone (labyrinthitis ossificans was present in the scala tympani in the region of the round window. In the left ear the stapedial footplate was otosclerotic with the base of the crura slightly displaced but fixed in the window. The severity of the OIT in this case was demonstrated by the patient's history of repeated fractures, marked porosity of the nonotosclerotic areas of the labyrinthine capsule, and possibly by the female's relatively early death at age 59. The unique features of the otosclerosis in this case were the extensive replacement of all layers of the cochlear and vestibular capsules and the relatively large areas of an osteoporotic type of degeneration in the more central areas of the otosclerotic bone While the etiology of otosclerosis remains unknown it is apparent that both the incidence and severity of the disorder as it occurs in association with OIT bear some as yet unknown but definite relationship to the pathologies occurring with OIT.
Changes of Nasal Epithelial Cells and Mucus Layer after Challenge of Allergen
Authors: Watanabe Kensuke , Watanabe Isamu
Published: October 2014

It has been reported that the normal epithelium of the anterior nares is covered by a mucopolysaccharide layer with a depth of approximately 0.8μ1. In the present study, a patient with an allergy to the Japanese cedar was found to develop a very thin mucopolysaccharide layer (0.05μ in depth) when the mucosal tissue was taken off before provocation. Adhering pollen particles could have readily come in contact with the plasma membranes of the epithelial cells. The epithelium of the nonciliated cells exfoliated in a relatively short period of time after provocation. Ten minutes after provocation, a thick mucus layer covered the exfoliated epithelial mucosa. Pollen particles could no longer be brought into contact with mucosa due to the mucus layer. On the other hand, no difference from the normal condition was seen before provocation in the middle and posterior nares where ciliated cells were located. However, at ten minutes after provocation, a large number of goblet cells appeared in place of ciliated cells, and mucus production was very much activated. Many signs appeared at this stage which suggested the impairment of ciliary beating. Specifically, there was swelling and damage of plasma membranes of cilia, bending of cilia, existence of extra cytoplasm around the microtubules in the cilia, and intrusion of mucus fluid between cilia. In the regions where ciliated cells were replaced by goblet cells, the exfoliation of epithelium could be noted, but it is generally difficult to find that ciliated cells are exfoliated even when the ciliary beating is impaired. Taking into account the above-mentioned results, it can be assumed that pollen particles penetrate the submucosa not only through the posterior nares where ciliary beating is impaired, but also through the anterior nares where epithelial cells are exfoliated.
Total Laryngectomy with Tracheopharyngeal Fistula (Neoglottis)
Authors: Calearo Carlo V. , Caroggio Angelo
Published: October 2014

Our experience with the so-called “neoglottis” (according to Staffieri) after total laryngectomy is presented. The technique, described in detail, aims at giving the patient good speech by creating a tracheoesophageal fistula through which air passes. In the period from 1973–1979, 63 patients underwent the procedure. The functional results were satisfactory in 68% of the cases. The patient's voice is much more agreeable than the esophageal voice and sounds louder and less monotonous than a laryngophone voice. The spectrographic analyses confirm its resemblance to natural voice. An occasional passage of liquids into the trachea may occur, but is not prejudicial to either speech or swallowing. Some dysfunctional problems may arise early or late after the operation: they are continuous aspiration during swallowing and lack of phonatory function. In most cases, these problems are due to incorrect surgical technique; the possibilities and procedures of correction are described. In conclusion, we maintain that the “neoglottis,” which may be applied to nearly all cases of total laryngectomy, represents a worthwhile “phonatory” innovation in the field of mutilating surgery of laryngeal cancer.
A Multiple-Channel Cochlear Implant: An Evaluation using Nonsense Syllables
Authors: Clark Graeme M. , Tong Yit Chow , Martin Lois F. , Busby Peter A. , Dowell Richard C. , Seligman Peter M. , Patrick James F.
Published: October 2014

A study using nonsense syllables has shown that a multiple-channel cochlear implant with speech processor is effective in providing information about voicing and manner and to a lesser extent place distinctions. These distinctions supplement lipreading cues. Furthermore, the average percentage improvements in overall identification scores for multiple-channel electrical stimulation and lipreading compared to lipreading alone were 71 % for a laboratory-based speech processor and 122% for a wearable unit.
Wegener's Granulomatosis Long-Term Results of Treatment
Authors: Illum Peter , Thorling Karen
Published: October 2014

Seventeen patients with Wegener's granulomatosis are presented. The very complex clinical features are outlined. A recently suggested new classification (ELK-classification) is applied. Fourteen patients were treated with cytotoxic agents and steroids, 12 of these receiving 6-mercaptopurine. Of the ten patients still alive, eight are in remission with treatment withdrawn in three cases. The duration of the treatment is discussed. The results are largely satisfactory, but the course of the disease is still capricious. Progression to a higher step in the ELK-classification has been observed in several cases and a number of serious sequelae to the disease are recorded. The initial symptoms of Wegener's granulomatosis are varied and uncharacteristic, and it is important to bear this disease in mind when patients with a long course of apparently trivial infections or peculiar constellations of symptoms from several organs are encountered. Repeated biopsies from the respiratory tract are important in order to establish the diagnosis, but treatment should not be delayed in cases where only a tentative diagnosis can be made on the basis of a reasonably typical clinical picture, even with a negative histological response.
Compensatory Eye Movement and Gaze Fixation during Active Head Rotation in Patients with Labyrinthine Disorders
Authors: Takahashi Masahiro , Uemura Takuya , Fujishiro Takehisa
Published: October 2014

Compensatory eye movement and gaze fixation during active head rotation were studied in patients with unilateral and bilateral loss of vestibular function. Patients with bilateral lesions were asked to perform mental arithmetic tasks in the dark. Although compensatory eye movements of these patients corresponded to 38–46% of compensatory movements in normal subjects, the ability of patients with lesions to visually fix on a stationary target was markedly impaired. Visual fixation on moving targets attached to the head (head-fixed targets) was also measured and found to be good. For patients with unilateral lesions, in the early stages of the disease, findings during rotations to the intact side resembled those for normal subjects, while results of rotations to the affected side resembled those for patients with bilateral lesions.
Discrimination of Purulent from Nonpurulent Maxillary Sinusitis
Authors: Berg O. , Bergstedt H. , Carenfelt C. , Lind M. G. , Perols O.
Published: October 2014

For the rational treatment of sinusitis, it is essential to distinguish sinusitis of bacterial origin from that of other etiologies. In maxillary sinusitis, antral purulence indicates a significant amount of pathogenic bacteria, whereas the presence of bacteria seems to be of less or no relevance in nonpurulent sinusitis. Hence, from a therapeutic point of view one important diagnostic goal is the differentiation of purulent from nonpurulent sinusitis. In this respect clinical examination is fairly reliable. Sinus radiography cannot distinguish purulent from nonpurulent sinusitis and offers few advantages when deciding on antibiotic therapy. Antral aspiration offers the most comprehensive information on which to base a reliable diagnosis.
Customized Dilator for the Treatment of Subglottic Stenosis in Children
Authors: Pashley Nigel R. T.
Published: October 2014

A new instrument, a customized dilator for use in dilating subglottic stenosis in children, is described. It combines the desirable features of the bougie for use in the laryngeal subglottis and will be useful to any surgeon involved in the treatment of these difficult airway problems in children.
Congenital Tracheal Stenosis
Authors: Benjamin Bruce , Pitkin John , Cohen Douglas
Published: October 2014

Twenty-one cases of congenital tracheal stenosis seen at the Royal Alexandra Hospital for Children 1971 through 1980 were reviewed with regard to the clinical features, associated anomalies, endoscopic findings and radiological evaluation. Congenital tracheal stenosis was usually a serious problem often associated with other major anomalies of the respiratory tract, esophagus, or skeleton. There was no set pattern of presentation. The presenting features included: persistent wheeze or stridor, atypical “respiratory distress,” and atypical “croup” or “bronchiolitis.” Documentation of the nature and extent of the stenosis by endoscopy and, if necessary, tracheobronchogram was important for prognosis and to direct treatment. Congenital tracheal stenosis must be considered in infants who present with atypical respiratory tract obstruction, especially where there is an H-type tracheoesophageal fistula, pulmonary hypoplasia or skeletal abnormalities such as hemivertebrae or a thumb abnormality.
Endoscopy in Esophageal Atresia and Tracheoesophageal Fistula
Authors: Benjamin Bruce
Published: October 2014

Between 1970 and 1979 152 infants born with the anomaly of esophageal atresia with or without tracheoesophageal fistula or of congenital tracheoesophageal fistula without atresia were treated at the Royal Alexandra Hospital for Children, Sydney. Recent developments in endoscopic equipment and new techniques of anesthesia allow detailed examination of the respiratory tract and esophagus with minimum trauma and maximum safety. Symptomatology relating to the airway and to the esophagus after surgical repair often occurs in patients who may have tracheomalacia, esophageal anastomotic stricture, esophageal reflux and sometimes recurrent or residual fistula. A definite diagnosis of tracheomalacia can be made by finding the typical triad of anteroposterior narrowing of the tracheal lumen, weakening of the semicircular-shaped cartilages and forward ballooning of the widened posterior membranous tracheal wall. Careful examination of the trachea and esophagus allows identification of an elusive recurrent fistula or an H-type fistula. As the primary results of surgery for esophageal atresia and tracheoesophageal fistula improve, long-term problems are becoming increasingly important. The role of the pediatric endoscopist is vital in the care of these patients.
Panendoscopy for Second Primaries in Head and Neck Cancer
Authors: Maisel Robert H. , Vermeersch Hubert
Published: October 2014

Four hundred patients with biopsy-proven squamous cell carcinoma of the upper aerodigestive tract were studied for evidence of a synchronous second primary tumor. The protocol of study included in most cases direct laryngoscopy, metal tube bronchoscopy, and esophagoscopy. Chest x-ray studies were performed on all patients and many had barium swallow x-ray studies. Asymptomatic second head and neck primary tumors were found only in the vallecula and esophagus among this series of patients. Metachronous second primary tumors were presented as early as one month after the original endoscopy and were located in areas which had been carefully examined by endoscopy and appeared asymptomatic to the examining physician at the time of the original evaluation. Based on this series of patients, we recommend careful indirect laryngoscopy and oral examination, direct laryngoscopy and esophagoscopy as well as a barium swallow for patients with clinically suspicious mucosal lesion of the upper aerodigestive tract. In view of our failure to discover a single lung carcinoma which was not evident from chest x-ray studies, we recommend bronchoscopy, which adds some morbidity to the endoscopic procedure, not be included unless a specific clinical suspicion is entertained. However, because of the important treatment implications which follow the diagnosis of a new squamous cell carcinoma of the upper aerodigestive tract, we feel it is imperative that the entire esophagus be evaluated in the course of the pretreatment exploration of the patient. Although few esophageal tumors were discovered, their implications in terms of surgical resection and debilitation without much likelihood of long-term patient survival has encouraged us to continue the above described procedure.
Limitations of the Blom-Singer Technique for Voice Restoration
Authors: Donegan J. Oliver , Gluckman Jack L. , Singh Jagdev
Published: October 2014

The loss of voice following total laryngectomy is a severe blow to a patient's functional and psychological well-being. Since the first laryngectomy numerous attempts at voice restoration have been attempted with only limited success. The tracheoesophageal puncture with insertion of the Blom-Singer valve is a major development in neoglottic reconstruction. Initial reports on the use of this technique have been very encouraging. Our initial experience has not been entirely satisfactory. The difficulties encountered include: 1) inability to manage the prosthesis in the home setting; 2) anatomical problems; 3) inability to produce fluent speech. While it is our impression that this new technique is the simplest and most effective method of voice restoration, it is not appropriate for all laryngectomees. Great care should be exercised in patient selection, and this may eliminate many of the difficulties encountered.
Further Experience with Voice Restoration after Total Laryngectomy
Authors: Singer Mark I. , Blom Eric D. , Hamaker Ronald C.
Published: October 2014

The current report describes a 40-month experience with 129 patients undergoing voice restoration by endoscopic tracheoesophageal puncture and use of a removable silicone valve. Successful acquisition of voice was achieved in 88% of patients with minimal complications. Observations of this group of laryngectomy patients suggest that esophageal voice is profoundly affected by the residual function of the pharyngeal constrictor musculature. Selective division of these muscles will enhance voice acquisition in a large number of failed esophageal speakers.
Voice Button Prosthesis Rehabilitation of the Laryngectomee
Authors: Panje William R. , VanDemark Duane , McCabe Brian F.
Published: October 2014

Forty laryngectomy patients in Iowa have received a tracheoesophageal fistula and voice button prosthesis. The fistula was successfully completed in all patients using local anesthesia. Delayed insertion of the voice prosthesis, approximately a month after the fistula is created, appears to be helpful in establishing the respiratory muscle control needed to achieve tracheoesophageal speech. In addition, delayed insertion allows for longer fistula maturation, recognition by the patient that speech is formed by vibrations within the pharyngoesophageal segment, and improved ability to manage the fistula site by proper insertion of the stent. The tracheoesophageal fistula-voice button prosthesis technique has proved to be a relatively simple, uncomplicated, reproducible and inexpensive method of achieving effective speech in a majority of laryngectomy patients.
Chronic Nonsuppurative Otitis Media
Authors: Armstrong Beverly W. , Armstrong Robert B.
Published: October 2014

Experiences with tympanostomy tubes extending over a period of 29 years are compared with the computer-assisted analysis of a questionnaire that was submitted to 500 otolaryngologists. Ventilating tubes are being used by 99.4% of the respondents in the group and are estimated to achieve good to excellent results in 90% of patients treated. Appropriate use of tympanostomy tubes has significantly reduced the incidence of chronic ear disease. A comparison of prophylactic antibiotics and prophylactic ventilating tubes for the prevention of acute otitis media showed that 91 % of the participants in the survey found ventilating tubes to be more effective than antibiotics. Benefits from ventilating tubes far outweigh the small number of tube-induced complications.
Use of Tympanostomy Tubes in Otitis Media
Authors: Meyerhoff William L.
Published: October 2014

Tympanostomy tubes (TT) are frequently employed as treatment for otitis media (OM) although there is little clinical or experimental evidence of their efficacy. Potential detriments of TT include cost, risk of inhalation anesthesia, intraoperative complications, and tympanic membrane (TM) damage. Potential benefits include elimination of the conductive hearing loss (CHL), reduction in the occurrence of acute purulent OM, and avoidance of sequelae. The cost/benefit ratio of TT has never been accurately determined and morbid complications of inhalation anesthesia and the surgical procedure appear to be rare. There is evidence that TT significantly reduce the CHL of OM as well as reduce the incidence of recurrent acute purulent OM and help avoid sequelae. It is therefore determined that the risk of TT insertion for middle ear effusion (occasional TM changes) can be justified, in properly selected patients, by the benefits (immediate improvement in hearing and reduction in the incidence of recurrent acute purulent OM).
Recurrent Middle Ear Effusion in Childhood: Implications of Temporary Auditory Deprivation for Language and Learning
Authors: Sak Robert J. , Ruben Robert J.
Published: October 2014

Eighteen healthy, normal hearing (PTA≤15dB, better ear), neurologically intact, 8 to 11-year-old children who had documented histories of middle ear effusion (MEE) before the age of five years were evaluated by a battery of audiological, psychological, language and achievement tests. Each was compared to his/her non-MEE sibling who was tested at the same age. All the children (n = 36) tested in the bright normal range of verbal ability (WISC-R) and none had been diagnosed previously as learning disabled. Paired comparison of sibling data revealed that the effusion subjects had deficits in verbal ability, auditory decoding and spelling skills when compared with their control siblings. Significant strength in visual sequential memory in the MEE subjects suggests the availability of compensatory strategies for auditory deficits. Data analysis on the basis of sex and/or birth order differences could not explain the differences between siblings.
Current Clinical Methods, Indications and Interpretation of Eustachian Tube Function Tests
Authors: Bluestone Charles D. , Cantekin Erdem I.
Published: October 2014

Eustachian tube (ET) dysfunction is the most important factor in the pathogenesis of otitis media and related conditions. The importance of the function of the ET in relation to the middle ear-mastoid air cell system is compared to the critical role that laryngeal function has in its relation to the tracheobronchial-pulmonary system. However, because of its obscure location, the ET is not as easily assessed by clinical or laboratory methods as is the larynx, and therefore, its function is not as well understood. Most clinicians do not include ET function testing as part of their evaluation of patients with middle ear (ME) disease. Pneumatic otoscopy, the Toynbee test, tympanometry, the 9-step inflation-deflation tympanometric test, and the patulous tube test can be performed when the tympanic membrane is intact. The modified inflation-deflation test employing the pump-manometer of the electroacoustic impedance bridge can assess the function of the ET when the tympanic membrane is not intact. These tests are helpful in the diagnosis of the presence or absence of abnormal ET function; if a dysfunction is present, these tests help to determine whether or not the tube is obstructed (mechanically or functionally) or abnormally patent, and in some instances, the degree of the malfunction. Even though testing of the function of the ET in the clinical setting has severe limitations at present, and further research is needed, information can be gained which is useful in the diagnosis and management of ME disease. Failing to recognize and assess the function of the ET in relation to the ME and mastoid in selected patients is as irrational as ignoring the function of the larynx in patients with disease of the lower respiratory tract.
Pathomechanisms in Cell Metabolism: A Key to Treatment of Bell's Palsy
Authors: Stennert Eberhard
Published: October 2014

In light of current research the classic theory on the vicious circle of Bell's palsy has to be reconsidered. New findings through electron microscopy and biochemistry concerning the structure and metabolism of cells have presented aspects which have consequences for treatment of the disease. These aspects deal mainly with the pathomechanisms of cell metabolism whose interactions also cause a vicious circle, leading to a breakdown of microcirculation and ultimately to the death of the cells due to hypoxia and acidosis. It is therefore suggested that the aim of an effective therapy must be the early normalization of cell metabolism by improving microcirculation. A fitting treatment protocol is presented and the extraordinarily good results are discussed.
Metabolic Management in Menière's Disease
Authors: Proctor Bruce , Proctor Conrad
Published: October 2014

Pollution in the bloodstream by abnormal amounts of metabolites (sugar, insulin, triglycerides and cholesterol) over an extended period of time will have an adverse effect upon the small blood vessels: the arterioles, capillaries and venules. If the microcirculation of the inner ear becomes afflicted, it may produce endolymphatic hydrops. Control of blood pollution can usually be achieved by intelligent dietary management; and, in the case of Menière's disease, the clinical relief is gratifying. Carbohydrate and lipid metabolism is complicated. If the new insulin-glucose tolerance test is used, it will detect many more cases of glucose intolerance. Fifty consecutive cases of Menière's disease were studied for abnormal levels of metabolites. Thirty-eight (76 %) of these cases had either an abnormal glucose tolerance test (using the Wilkerson point system) or at least borderline insulin levels: a) abnormal insulin levels, 35 cases; b) borderline insulin values, 3 cases; c) abnormal glucose tolerance with normal insulin values, no cases; d) both normal glucose tolerance and normal insulin production, 12 cases.
Revascularization of Skin Using a Myovascular Pedicle an Animal Model for Free and Myocutaneous Flaps
Authors: Sergeant R. , Panje William R.
Published: October 2014

Myovascular pedicles developed from the rat hind limb allowed for revascularization of groin skin. This result confirms previous work. The myovascularized skin could be used as a free flap or as an experimental animal model in the study of myocutaneous flaps.
Auditory Brainstem Responses as Indicators of Hearing Aid Performance
Authors: Kileny Paul
Published: October 2014

A procedure involving the utilization of auditory brainstem responses (ABR) to indicate effective amplification is reported. The procedure involves eliciting ABRs by clicks presented in sound field to the aided ear and the estimation of an aided ABR threshold. The method allows for the selection of the ear responding best to amplification in very young or uncooperative hearing-impaired patients. Case studies including electroacoustical analyses of the amplified click stimuli and aided ABRs are presented.
Humoral and Cell-Mediated Immunity in Peripheral Blood following Introduction of Antigen into the Middle Ear
Authors: Ryan Allen F. , Hartman M. Terry , Cleveland Patrick H. , Catanzaro Antonino
Published: October 2014

Serum levels of specific IgG and the sensitization of peripheral blood T-lymphocytes were measured in guinea pigs after single-dose antigenic sensitization by two routes-, intratympanic and intradermal injection. Keyhole limpet hemocyanin (KLH) served as the antigen. Intratympanic injection of antigen resulted in much lower levels of circulating anti-KLH IgC than intradermal injection. When KLH was conjugated with alum to produce nonspecific inflammation and serve as an adjuvant, the intratympanic route was considerably enhanced, but remained much less effective than the intradermal route. Development of an IgG response was also somewhat less rapid following intratympanic than following intradermal administration. Marked sensitization of circulating T-lymphocytes was seen after intradermal injection of alum-precipitated KLH. A much weaker, though still positive, response was seen after intradermal injection of KLH alone and with the intratympanic injection of alum-precipitated KLH. No T-lymphocyte sensitization could be detected after intratympanic injection of KLH alone. It was concluded that the afferent limb of both humoral (IgG) and cell-mediated immunity was operative in the middle ear. Therefore, the middle ear does not represent an immunologically “privileged” site. On the other hand, the afferent limb from the middle ear appears to operate less effectively and rapidly than that from the dermis. This observation is consistent with observations in other mucosal systems.
Nasal Cycle and Postural Variations in Nasal Resistance
Authors: Hasegawa Makoto
Published: October 2014

The relationship between the nasal cycle and postural variations in unilateral nasal resistance (UNR) was observed in ten normal subjects. During the nasal cycle, postural variations in UNR were notable in congested nasal chambers; UNR at 0° from a horizontal plane was found to be higher than at greater angles. Postural variations in UNR in constricted sides of nasal chambers, however, were very slight. This phenomenon was observed in all ten cases. For total nasal resistance, postural variations were small. (Total nasal resistance was strongly influenced by UNR in constricted sides.) The nasal cycle may be induced by alternative changes in the sympathetic tone to the nasal mucosa, probably regulated by the hypothalamus.
Indications of Congenital Palatal Incompetence before Diagnosis
Authors: Morris Hughlett L. , Krueger Lois J. , Bumsted Robert M.
Published: October 2014

Frequently the disorder of congenital palatal incompetence (CPI), in the absence of physiological evidence of clefting, is not discovered until after adenoidectomy. That is because the adenoidal pad served to mask the insufficiency of the velopharyngeal mechanism. Findings from this study indicate that early disorders in speech production, particularly nasalization of speech, is a useful predictor of CPI. Recommendations are made about methods for screening children before adenoidectomy or those suspected of having the CPI disorder.
Bone Resorption in Human Cholesteatomas
Authors: Bretlau Paul , Jørgensen Martin B. , Sørensen Christian H. , Dabelsteen Erik
Published: October 2014

In vivo studies of different aspects of bone resorption in human cholesteatomas are described in the immunodeficient “nude” mice. Cholesteatoma membranes were transplanted into the middle ear cavities of the mice. After 21–28 days, growth of cholesteatoma tissue could be demonstrated in 8 of 13 animals. In 7 of these 8 animals bone resorption of the labyrinthine wall and ossicles could be demonstrated; resorption with acute inflammation was found in only two animals. The cellular mechanism in relation to bone resorption is discussed.
Biofeedback Rehabilitation in Seventh Nerve Paralysis
Authors: Corral-Romero Miguel Angel , Bustamante-Balcárcel Andrés
Published: October 2014

Patients with facial paralysis do not always attain satisfactory recovery through surgery or medical treatment. It was decided that patients could be reeducated by biofeedback training. The method was applied in ten patients; important improvements were achieved. It was concluded that this technique could be useful when the problem is of sufficient importance.
The Price of Preservation of Hearing in Acoustic Neuroma Surgery
Authors: Tos Mirko , Thomsen Jens
Published: October 2014

Translabyrinthine surgery for acoustic neuroma was introduced in Denmark in 1976, and the results of the first 100 operations are presented. Two deaths occurred, unrelated to the translabyrinthine surgery. Postoperatively, 75% of the patients had normal facial function, while function was reduced in 15% and abolished in 10%. The series represents 85% of all acoustic neuromas operated in Denmark, with 30 new neuromas being diagnosed each year, derived from a population of 5.1 million. The overall postoperative results are compared with the available results from suboccipital removals of acoustic neuromas, and are clearly in favor of the translabyrinthine approach. It is concluded that centralization of acoustic neuroma surgery is necessary, that all acoustic neuromas regardless of size can be removed by the translabyrinthine approach and that the discussion about the hypothetical preservation of hearing by applying the suboccipital approach is being made without solid grounds. To adduce the theoretical chance of preserving hearing in a very small percentage of patients as an argument in favor of the suboccipital approach appears quite irrelevant, and the price of attempting this with the suboccipital approach is too high.
Warthin's Tumor, a Multifocal Disease
Authors: Shugar Joel M. A. , Som Peter M. , Biller Hugh F.
Published: October 2014

Of all salivary gland neoplasms Warthin's tumor is the only lesion which is truly multicentric. The most common presentation of these multiple lesions is bilateral solitary masses. We present the first reported case of bilateral multiple tumors occurring simultaneously. The embryology of the salivary glands as it relates to the pathogenesis of this tumor is discussed. The differential diagnosis of the multinodular parotid gland is reviewed.
Early- and Middle-AER Components to Clicks as Response Indices for Neonatal Hearing Screening
Authors: Frye-Osier Helene A. , Goldstein Robert , Hirsch Judith E. , Weber Kathleen
Published: October 2014

Early- and middle-component-averaged electroencephalic responses (AER) to monotic clicks at 60, 40 and 20 dB normal hearing level were elicited from 18 carefully selected normal neonates. Grand-composite AERs of the responses from all 18 babies showed stimulus-related configurations at all three stimulus levels. AERs for individual babies were more frequently identified as stimulus-related when poststimulus activity beyond 10 ms was included in response-identification procedures than when only the first 10 ms was observed.
Malleus Handle Probe
Authors: Duncan R. Bruce
Published: October 2014

Manual probing of the malleus handle (MH) of 477 patients suggests a protective middle ear reflex with a variable tonic contraction of the tensor tympani muscle (TTM). The degree and type of MH retraction suggests three stages of progressive middle ear inflammation. Prediction accuracy of 250 myringotomy findings was 60% with impedance audiometry and 92% with MH probing. Mechanical pressure gauge readings (grams) of 202 ears correlated with finger pressure estimations. The TTM tendons were sectioned in ten children with persisting otitis media with effusion (OME) and seven obtained benefit. The three diagnostic methods, pneumatic otoscopy, impedance audiometry and MH probing, assess similar and separate perimeters and are complementary. Malleus handle probing alone detects attic loculation of OME, 54 of 954 ears (5.6%). It extends the diagnostic range to the TTM activities.
Alexander's Law: A Model and Resulting Study
Authors: Doslak M. J. , Dell'Osso L. F. , Daroff R. B.
Published: October 2014

Recently we developed an analog model to simulate Alexander's law in nystagmus secondary to dysfunction of a semicircular canal. Alexander's law is based on the observation that the amplitude of the nystagmus grows with increasing gaze in the direction of the fast phase and diminishes with gaze in the opposite direction. To investigate the assumptions made in the model, we conducted quantitative experimental studies on the effect of gaze on caloric-induced nystagmus in human subjects. A weak stimulus (water at 26.5°C and 240 ml/min) was administered for several minutes which caused the development of jerk nystagmus. Both the average slow phase velocity and frequency reached a steady state at about three minutes after the start of irrigation and remained stable until the flow of water was stopped. To investigate the effect of gaze, each subject was asked to hold gaze at various positions from center, to the right, to the left, and to repeat the cycle. Results indicated that the slow phase velocity of the nystagmus was greatest in the direction of the fast phase and decreased approximately linearly with gaze in the other direction in accordance with Alexander's law. Frequency was not a function of gaze. We speculate as to the biological advantages of the brainstem neural circuitry responsible for Alexander's law.
Familial Laryngeal Abductor Paralysis with Presumed Autosomal Dominant Inheritance
Authors: Morelli G. , Mesolella C. , Costa F. , Testa B. , Ventruto V. , Santulli B.
Published: October 2014

The etiology of Gerhardt's syndrome is uncertain. With the present work the authors present a hereditary form of this syndrome, which was found in three subsequent generations with autosomal dominant transmission.
Pathogenesis of Vocal Cord Polyps
Authors: Kleinsasser Oskar
Published: October 2014

Polyps of the vocal cords are a separate entity occurring nowhere else in the larynx or in the human body. Gelatinous and telangiectatic, but mainly transitional types of polyps can be discriminated. Histological, histochemical and electron microscopic investigations on a series of polyps show that an alteration of the permeability of blood vessels may be of importance, allowing the extravasation of edema fluid, fibrin or erythrocytes. Following this, reactive processes develop with the formation of labyrinthine vascular spaces. This process is very similar to the organization of a thrombus. Since polyps occur mainly in people who use their voices very intensively, and develop at the site of maximum muscular and aerodynamic forces exerted during phonation, vocal cord polyps are considered a sequela of a phonotrauma.
Endoscopic Rehabilitation of the Airway in Laryngeal Paralysis
Authors: Kirchner Fernando R.
Published: October 2014

This paper deals with the three most commonly encountered laryngeal problems that are related directly or indirectly to laryngeal paralysis. These problems are compromised airway secondary to excessive injection of Teflon paste, abductor paralysis of the vocal cords and posterior commissure laryngeal webs.
Laryngeal Paralysis in Children
Authors: Cohen Seymour R. , Geller Kenneth A. , Birns Jeffrey W. , Thompson Jerome W.
Published: October 2014

The charts of 100 children with laryngeal paralysis were reviewed. The patients in this study had either unilateral or bilateral abductor vocal cord paralysis. The literature and pathophysiology are reviewed. A statistical analysis of each group of patients according to etiology is reported. The follow-up, progress and recovery are detailed. The need for observation and conservative therapy is reinforced by the tendency for spontaneous recovery. Suggestions regarding treatment are given.
Tracheostomal Stenosis following Total Laryngectomy
Authors: Myers Eugene N. , Gallia Louis J.
Published: October 2014

Stenosis of the tracheostoma after laryngectomy is an infrequent but often distressing postoperative complication. Recognition of possible predisposing factors will allow appropriate preventive measures in preoperative planning, surgical technique and postoperative care. We describe a surgical technique which can be utilized to correct tracheostomal stenosis or can be used at the time of initial stomal construction. Our method emphasizes mobilization of the tracheal stump, extensive excision of subcutaneous fat, excision of redundant skin and creation of a posterior-superior skin flap which is interdigitated into a vertical posterior tracheal incision. Our method is compared to other techniques described in the literature.
Singular Neurectomy Update
Authors: Gacek Richard R.
Published: October 2014

The results of a poll revealed that 96 singular neurectomies have been performed by ten surgeons in this country. Eighty-eight of these (91.7%) resulted in complete relief of benign paroxysmal positional vertigo (BPPV). In seven patients (7.3%) there was a sensorineural hearing loss as a result of this procedure. The average hospital stay for patients having this procedure ranged from 2–6 days, and the return to work time ranged from 1 to 3 weeks. These results indicate that singular neurectomy is an effective selective vestibular ablation procedure for BPPV and that the risks and disability are comparable to other routine middle ear procedures. The causes for failure of this procedure to relieve positional vertigo are a) misdiagnosis of BPPV and b) failure to recognize the singular nerve in the middle ear. Knowledge of the pathophysiology of the disorder and of the anatomical variation in the location of the singular canal will reduce these causes of failure.
Anatomic Specificity of Central Vestibular Signs in Posterior Fossa Lesions
Authors: Kumar Arvind , Mafee Mahmood , Torok Nicholas
Published: October 2014

The reliability of central vestibular signs such as decruitment in signifying retrolabyrinthine lesions has been well established. This study was initiated to determine if this and other central vestibular signs, individually or collectively, indicate involvement of specific anatomic structures in the posterior fossa. Forty-six patients with morphologic lesions defined by computerized tomography (CT), pneumo-CT or autopsy were studied. Oculomotor signs showed a statistically significant correlation with lesions of the archicerebellum. The other central vestibular signs did not show any correlations.
What Can Be Done for the Recruiting Ear?
Authors: Schiff Maurice , Sandlin Robert E.
Published: October 2014

Probably one of the greatest problems in hearing aid fitting is to try to adapt hearing amplification to the recruiting ear. Sound is not loud enough, and then it is too loud. Microchips have permitted hearing aids to be smaller and smaller. However, they still remain either linear output- or input-compression types. Log-linear amplification permits the “smart aid” to automatically decrease the gain as the input power of speech or noise increases. This together with a patented low-frequency signal processor permits maximum discrimination with minimal violation of the patient's threshold of discomfort. This is a considerable step in ameliorating the major problem of the recruiting ear.
Lyophilized Partial Ossicular Replacement Allografts
Authors: Smith Mansfield F. W. , McElveen John T.
Published: October 2014

This report deals with the use of partial ossicular replacement allografts (PORAs) in the stable ear, ie, a middle ear free of any residual or recurrent disease process such as fluid, cholesteatoma or infection. PORAs have been used by Shinn and Smith at the Ear Medical Clinic of Santa Clara Valley between July 1978 and December 1981; they are used to span the distance between the malleus and the head of the stapes or tympanic membrane. Lyophilized ethylene oxide sterilized PORAs have been available through the Northern California Transplant Bank, San Francisco, since July 1978. Twenty-four of 32 PORAs (75%) used in stable ears closed the air-bone gap within 10 dB. Of the eight ears that did not have satisfactory functional hearing, it was evident within one year and there was no further deterioration noted up to four years. There was no evidence of PORA extrusion or erosion.
Midfacial Necrotizing Diseases
Authors: Batsakis John G.
Published: October 2014

Necrotizing and apparently nonhealing disease of the upper aerodigestive tract can be the result of a host of underlying causes. Exclusion of specific agents and malignancy masquerading as so-called nonhealing granulomas is mandatory. This done, four disorders enter the differential diagnosis; Wegener's granulomatosis, non-Hodgkin's lymphoma, polymorphic reticulosis and idiopathic midline granuloma. Given representative biopsy material, the first three have sufficient specific diagnostic features that separation is possible. Such identification is important because of the varying responses to therapy.
Congenital Hereditary Bilateral Abductor Vocal Cord Paralysis
Authors: Grundfast Kenneth M. , Milmoe Gregory
Published: October 2014

Congenital hereditary bilateral abductor vocal cord paralysis has been found in a father, his son and daughter. Though the disorder was previously believed to be inherited in a sex-linked manner, it now appears that there is an autosomal dominant variant. The vocal cord paralysis was associated with swallowing difficulty during infancy in all three of the family members. Although both the son and daughter required tracheostomies during the neonatal period, both manifested improvement of vocal cord movement during infancy so that decannulation was possible before 14 months of age. Localized delay in neurologic maturation is suspected as the etiology.
Anatomic Abnormalities in Obstructive Sleep Apnea
Authors: Wilms Dale , Popovich John , Fujita Shiro , Conway William , Zorick Frank
Published: October 2014

Both muscular hypotonia and anatomic abnormalities have been implicated in the pathogenesis of the obstructive sleep apnea syndrome (OSAS). The upper airways of 25 patients with OSAS were evaluated to determine potential sites of obstruction. Significant airway compromise was found in all patients with some patients having multiple sites of airway narrowing.
Anesthetic Gas Scavenger for Use during Open Rigid Bronchoscopy
Authors: Steward David J. , Fearon Blair
Published: October 2014

A simple, effective method of scavenging waste anesthetic gases from an open-end bronchoscope by the use of a standard anesthesia t-piece is described.
Tracheobronchial Obstruction from Metastatic Distant Malignancies
Authors: Shapshay Stanley M. , Strong M. Stuart
Published: October 2014

Tracheal or endobronchial metastases from distant primary malignancies are rare. Hemoptysis, dyspnea and cough are common nonspecific presenting symptoms. Renal, breast, thyroid and colon cancers are the most common malignancies associated with tracheobronchial metastases. Since 1979, five patients with tracheobronchial metastases from distant sites have been treated by the otolaryngology service at the Boston University Medical Center. Patients with advanced tumors previously treated by conventional modalities were referred for palliation of airway obstruction. Satisfactory palliation without significant morbidity was achieved in four out of five patients utilizing a CO2 surgical laser through a rigid bronchoscope system. Four patients died from advanced cancer, 1 to 18 months after laser surgery. Although tracheobronchial metastasis from extrathoracic malignancy is associated with a poor prognosis, palliation of airway obstruction can be achieved in most patients with endobronchial or tracheal tumor.
Nystagmus of Paroxysmal Positional Vertigo
Authors: Katsarkas A. , Outerbridge J. S.
Published: October 2014

During attacks of paroxysmal positional vertigo in 12 patients, nystagmus in different gaze positions was observed visually and recorded by electronystagmography (eyes open, fixating). Visually observed eye movement was similar in all cases, with oblique (upward and horizontal) and rotatory (clockwise during leftward movement) components in the fast phase; rotation dominated on ipsilateral gaze (toward the lower ear) and oblique movement dominated on contralateral gaze. However, ENG recordings showed greater variability and were often inconsistent with visual observation; the horizontal component often reversed with change in gaze position, and dissociated eye movements, as well as down-beating nystagmus, were sometimes seen. More sophisticated measurement and strict attention to gaze position is required to resolve these discrepancies.
Autonomic Innervation of the Middle Ear
Authors: Uddman R. , Kitajiri M. , Sundler F.
Published: October 2014

The distribution of nerve fibers in the middle ear mucosa and eardrum of the cat and guinea pig was studied using immunocytochemical and histofluorescence techniques. Nerve fibers containing noradrenaline, vasoactive intestinal peptide, substance P, enkephalin or immunoreactive avian pancreatic polypeptide were demonstrated in the middle ear mucosa. After extirpation of the superior cervical ganglion, nerve fibers containing noradrenaline and avian pancreatic polypeptide disappeared while fibers containing vasoactive intestinal peptide, substance P and enkephalin seemed to remain unaffected.