bluuebunny/crossref_metadata_2025 huggingface dataset:
Delineation of Cochlear Glycogen by Electron Microscopy
Authors: Duvall Arndt J. , Hukee Margaret J.
Published: October 2014

Two techniques for the demonstration and identification of glycogen by electron microscopy were applied to the cochlear duct tissues of normal guinea pigs and chinchillas. A modified osmium tetroxide fixative (with potassium ferricyanide) has been described by De Bruijn to selectively stain the glycogen particle. Identification of the stained particle was effected by its selective removal from the tissue with amyloglucosidase, an enzyme specific in its degradation of the glycogen molecule. Glycogen particles were noted in several cell types within the cochlear duct, but concentrations were greater in outer hair cells of both species and in the stria vascularis of the chinchilla. The fact that amyloglucosidase completely eliminated these particles from the liver of both species as well as cochlear tissue, led to the conclusion that these particles are indeed glycogen.
Adenocarcinoma Originating in the Thyroglossal Duct
Authors: Widström Ake , Magnusson Per , Hellqvist Hakan , Hallberg Olle , Ruber Harald
Published: October 2014

Eighty-six cases of carcinoma of the thyroglossal duct have been reported in the literature, most of these being well-differentiated adenocarcinomas. Three new cases of the latter type are presented. Cases where carcinoma of the thyroglossal duct is suspected should be investigated with fine-needle biopsy, thyroid scintigraphy, skeletal and pulmonary X-ray, determination of TSH, T 3, PBI and blood serum calcium. The treatment of well-differentiated adenocarcinomas is a combination of surgical and medical procedures.
Laser Adapter for Tracheoscopy
Authors: Andrews Albert H. , Bailey Larry L.
Published: October 2014

This adapter makes it possible for the operating microscope to be used monocularly, to see axially down the CO2 laser beam, to use the aiming light and its joy stick-control. This makes the laser useful for upper tracheal lesions through a tracheoscope.
Antihistamines
Authors: Krausen Anthony S.
Published: October 2014

Antihistamines may be used to maximum benefit for the allergic patient if the physician adheres to four guidelines. These guidelines are based upon 1) an appreciation of certain structural and pharmacologic differences among antihistamines, and 2) an understanding of their mechanism of action. Around the clock administration is advisable, the dosage should be titrated for the individual patient, substitutions to another antihistamine should be to a different class of antihistamine, and the efficacy of any single antihistamine usually will diminish with prolonged use, either on the basis of true tolerance or because of psychic factors. There is good theoretical evidence why α-adrenergic sympathomimetics, employed as decongestants in combination with antihistamines, should not be given to allergic patients. Two newer drugs, disodium cromoglycate and beclomethasone, may provide symptomatic relief for allergic rhinitis patients. They may benefit the patient who does not obtain full symptomatic relief from antihistamines.
Histopathologic and Experimental Models for Sensory and Neural Deafness
Authors: Spector Gershon J.
Published: October 2014

Six selected cases with neonatal and fetal cochlear pathology are presented. Those denoting cochlear sepsis are: H. influenza purulent labyrinthitis, cytomegalovirus endolabyrinthitis, and aseptic meningitis and labyrinthitis. Those denoting cochlear neural aplasia are Goldenhar's syndrome, left-sided cardiac hypoplasia with partial basal turn neural aplasia, and cerebral cortical and ventricular hemorrhage with modiolar extension. These findings are compared to the fluorocitrate ototoxicity model for neural deafness in the guinea pig. This study suggests hypotheses for viral trophism in the inner ear and neural degeneration of the cochlea as mechanisms for sensorineural deafness.
Reversible Sensorineural Hearing Loss with Intravenous Erythromycin Lactobionate
Authors: Karmody Collin S. , Weinstein Louis
Published: October 2014

Three patients are presented who developed reversible sensorineural hearing losses during treatment with intravenous erythromycin lactobionate. A fourth patient treated with erythromycin gluceptate did not develop hearing loss. Ototoxicity with erythromycin lactobionate has been previously reported in only three patients, one of whom had medication orally. Withdrawal of the antibiotic resulted in prompt improvement in every case with return of hearing to pretreatment levels.
Exostosis of the Mandibular Coronoid Process
Authors: Michel Randall G. , Hudson William R. , Drawbaugh Edward J. , Baylin George J.
Published: October 2014

Abnormal enlargement of one or both mandibular coronoid processes may lead to a limited mandibular excursion. A case of unilateral coronoid process exostosis severely limiting mandibular function is described. A review of the literature pertinent to this uncommon abnormality is presented. The various entities of coronoid process osteochondroma, osteoma, exostosis, hypertrophy and developmental anomaly, all producing a similar picture of coronoid process enlargement are discussed. The proper use of the available radiographic techniques simplifies the diagnosis of these uncommon maladies, as long as a coronoid process abnormality is considered in the differential diagnosis of restricted mandibular movement.
Eye-Tracking and Optokinetic Nystagmus
Authors: Baloh Robert W. , Honrubia Vicente , Sills Andrew
Published: October 2014

Eye-tracking and optokinetic nystagmus (OKN) abnormalities in patients with focal lesions of the nervous system are reviewed. Patients with peripheral labyrinthine lesions can have deficits in smooth pursuit and OKN, but they are rapidly compensated after an acute lesion. By contrast, patients with large, cerebellopontine angle tumors have progressive impairment of pursuit and OKN as the tumor enlarges. Abnormalities of saccadic eye movements suggest intrinsic central nervous system (CNS) dysfunction. Saccade accuracy is severely impaired with cerebellar lesions, while brain stem disease frequently results in a slowing of saccade maximum velocity. Smooth pursuit and OKN abnormalities are common with all types of CNS lesions. The pattern of eye-tracking and OKN abnormality can be useful in anatomically localizing nervous system lesions.
Preservation of Cochlear Function after Extensive Labyrinthine Destruction
Authors: Bumsted Robert M. , Dolan Kenneth D. , Sadé Jacob , McCabe Brian F.
Published: October 2014

Four ears are presented with extensive destruction of the bony and membranous labyrinth with loss of caloric function but with retention of hearing. Fourteen similar cases described previously in the literature are reviewed. Our cases are unique in that hearing was preserved after surgical removal of the disease in the inner ear itself. We are unaware of any previous well-documented reports showing such extensive destruction of the pars superior portion of the labyrinth with the preservation of hearing. Possible explanations and theoretical implications are discussed.
Use of Quick Hardening Polymers in Congenital Neck Fistulae and Cysts: Operative Technique
Authors: Zakrzewski Jerzy
Published: October 2014

A detailed description of the use of quick hardening polymer to facilitate extirpation of congenital lateral and medial neck fistulae and cysts is presented.
In Vivo Observation of Tracheal Microcirculation in Dogs
Authors: Galoob Harry D. , Norris Charles W. , Toledo Pedro S.
Published: October 2014

Tracheal microcirculation was studied in six healthy anesthetized adult mongrel dogs. A transparent balloon was used to apply pressure to the tracheal mucosa during observation of the microcirculation. Pressures of microvascular occlusion were measured using an electrically calibrated silicone envelope placed on the observation balloon. The different vessel sizes were measured and classified using the operating microscope. Capillary occlusion pressures ranged from 10 to 40 mm Hg. Generalized and local tracheal dilation was observed and sequential measurements of tracheal diameter were performed. Progressive local and generalized dilation occurred. Capillary occlusion pressure was lower in the more dilated specimens. The lower than expected occlusion pressures are thought to be a result of the tracheal dilation and may be related to the administration of drugs or other factors.
Hearing Aids & Hearing Deterioration
Authors: Titche Leon L. , Windrem Emory O. , Starmer William T.
Published: October 2014

The literature contains articles which report that the deterioration of hearing is increased by the use of hearing aids, and others which show that there is no increase. The results of our experience with 261 patients over a ten-year period show that there is no increase in hearing loss in the aided ear which can be attributed to the use of a hearing aid.
Dilator Naris Muscle
Authors: Mann Douglas G. , Sasaki Clarence T. , Fukuda Hiroyuki , Suzuki Masafumi , Hernandez Juan R.
Published: October 2014

The human nose is an important organ of respiration which by virtue of its valvular influence becomes a significant effector of respiratory resistance over a wide range of ventilatory requirements. In man its effectiveness in this regard is related to its flow limiting segment (FLS) located at the limen nasi. Its passive valvular effect is additionally modified by active respiratory contractions of the dilator naris muscle (DNM) controlled through the VII cranial nerve by the brain stem respiratory center. Its behavior, quantitatively determined in human beings and experimental animals, is summarized. 1) In man, phasic DNM activity operates during eupneic nasal breathing and varies directly with ventilatory resistance. 2) The elimination of all measurable ventilatory resistance results in complete cessation of DNM activity. 3) Over time, reduced resistance produces difficulty in reestablishing dilator function once it is physiologically lost. 4) DNM respiratory activity is modified by pulmonary mechano-and pressure-receptors via afferent vagal pathways. The response of nasal dilators in valvular control, therefore, appears dependent on the physiologic integrity of the vagus nerves. It is our belief that nasal valvular control has not previously been appreciated in this context.
Organ Culture of the Mammalian and Avian Embryo Otocyst
Authors: Friedmann I. , Hodges M. Giselle , Riddle P. N.
Published: October 2014

The use of a chemically defined medium supplemented with serum has proved most suitable for the growth of the isolated embryonic otocyst in vitro. Complete differentiation of the cochlear duct and of the vestibular apparatus ensued and is described. The system is reliable for organ cultures of both the avian and mammalian otocyst and for the study of various lesions affecting the inner ear and middle ear.
Endolymphatic Sac Obstruction Biochemical Studies
Authors: Silverstein Herbert , Takeda Teiro
Published: October 2014

Inner ear fluids were studied biochemically in guinea pigs from 1 to 16 weeks after producing endolymphatic hydrops by obstructing the endolymphatic duct. Fluid collected from beneath the footplate showed changes of 50% of the animals indicating distension of the saccule. There was an increase in potassium concentration and decrease in sodium concentration of the collected fluid, indicating a traumatic mixing of endolymph and perilymph produced by rupture of the saccule during collection of the fluid. The smallest changes occurred at one week, and the greatest changes were found four months after endolymphatic sac obstruction. Similar findings were observed in studying inner ear fluids obtained from patients with Ménière's disease. Cochlear endolymph showed biochemical alterations after endolymphatic duct blockage. There was a two- to three-fold increase in sodium concentration and a decrease in potassium concentration with the total ionic concentration remaining approximately the same. Some guinea pigs showed similar changes in vestibular endolymph. This study indicates that in the guinea pig, endolymph obtained in the distended endolymph compartment has a slightly different sodium-potassium ratio as compared to the normal ear. In patients with Ménière's disease there may also be an elevation of endolymph sodium concentration. The significance of this change and hearing loss observed in experimental endolymphatic hydrops and Ménière's disease is open to speculation at the present time.
Experimental Alteration of Physiological State of Inner Ear Fluids
Authors: Juhn S. K.
Published: October 2014

Mechanisms of endolymphatic hydrops formation in the inner ear are not yet fully understood. The available knowledge of the composition and the function of inner ear fluids, of mechanisms for maintenance of microhomeostasis, and the possible factors responsible for hydrops formation were reviewed. The nature of the functional barrier systems of the inner ear was investigated by measuring the amount of intravenously or intracisternally injected test substances which entered the perilymph. Based on studies of the osmotic relationship between the blood and the perilymph, an hypothesis of hydrops formation is proposed. The hypothesis predicts an osmotic imbalance, resulting from an upset of the homeostasis between the fluid compartments and the tissues of the inner ear, as a factor responsible for endolymphatic hydrops formation. An osmotic imbalance can be induced by various experimental conditions including metabolic disorders. The results of animal experiments strongly suggest the necessity of further survey of metabolic imbalance in Ménière's patients.
New Insights into the Causes of Postoperative Aspiration following Conservation Surgery of the Larynx
Authors: Ward Paul H. , Berci George , Calcaterra Thomas C.
Published: October 2014

This study was conducted specifically to determine and document the various possible causes of postoperative aspiration. Such information may assist in better selection of candidates as well as provide insights that facilitate improvement of operative techniques for conservation surgery for cancer of the larynx. The major significant information derived from this study is the recognition and delineation of the part played by paralysis of the superior and recurrent laryngeal nerves as causes for aspiration following conservation laryngeal surgery.
Esthesioneuroblastoma: Diagnosis and Treatment
Authors: Cantrell Robert W. , Ghorayeb Bechara Y. , Fitz-Hugh G. Slaughter
Published: October 2014

Esthesioneuroblastoma is a nasal tumor which arises from cells of neural crest origin. It is a difficult tumor to diagnose clinically and histopathologically. First described in 1924, approximately 160 cases have been reported with over 125 of these in the last 15 years. This reflects an increased awareness of the tumor by physicians rather than an increased incidence. In the past 17 years, 12 cases of esthesioneuroblastoma have been treated at the Department of Otolaryngology and Maxillofacial Surgery of the University of Virginia Medical Center. Reviewing these cases and the literature leads us to make the following recommendations for diagnosis and treatment: The diagnosis of esthesioneuroblastoma can be made by 1) the clinician who suspects it in any patient with a nasal mass causing unilateral obstruction; 2) the finding of plexiform intercellular fibrils by light microscopy (rosettes and pseudorosettes are not as common as reported); 3) the finding of secretory granules and neurites by electron microscopy of the highly undifferentiated tumors; and 4) formaldehyde-fume-induced fluorescence. Combined therapy with preoperative irradiation followed by craniofacial resection of the tumor to include the cribriform plate is recommended. This treatment should result in a five-year survival in excess of 50% of patients.
Lingual Thyroid
Authors: Weider Dudley J. , Parker Willard
Published: October 2014

The literature on lingual thyroid is reviewed. The incidence is relatively rare and sex incidence is four or five to one in favor of females. The embryology and development of the thyroid gland is discussed and some evidence presented to suggest that the lateral thyroid primordia are not involved in the formation of functional thyroid tissue. The pathologic findings of lingual thyroid tissue are similar to that of cervical thyroid tissue, including goiter formation. Diagnostic measures include mirror examination, I-125 scan, and tomography. Thyroid function studies are helpful in evaluating the level of thyroid function. Treatment includes surgical removal, transplantation, I-131, and thyroid replacement. Since the first three methods usually require supplemental thyroid treatment afterward, it is believed that initial thyroid replacement is the treatment of choice since it is simple, safe, effective, and noninvasive. Four new cases are reported.
Current Concepts of Tumor Immunology III. Immune Therapy
Authors: Krause Charles J. , Nysather John O.
Published: October 2014

It is apparent that development of consistently effective methods of immunotherapy must await a more thorough understanding of the immune response to cancer. However, even those forms of immunotherapy which have been developed to date indicate a tremendous potential. It appears that immunotherapy may be most useful as an adjuvant to established forms of treatment. Surgery, radiation therapy and/or chemotherapy are used to remove all of the gross tumor, with immune therapy then employed to destroy the small foci of tumor which remain. As methods are developed which are effective in counteracting the immunosuppression of tumors, other means of immunotherapy may be found which are capable of destroying tumor cells while not affecting the adjacent normal tissue. Thus, the future of immune therapy holds great promise. As more is learned about the immune response to cancer, advances in therapy will certainly follow.
Salivary Bypass Tube
Authors: Montgomery William W.
Published: October 2014

A silicone salivary bypass tube is introduced as an adjuvant to the therapy of the following clinical entities: advanced carcinoma of the pharynx complicated by stricture and/or pharyngocutaneous fistula, traumatic stricture of the cervical esophagus or tracheoesophageal fistula, a stricture of the hypopharynx or cervical esophagus following ingestion of a caustic material, and a stricture of the cervical esophagus following laryngoesophagectomy. The salivary bypass tube is described and illustrated in detail along with the technique for its insertion and removal. Examples of its usage are illustrated by x-rays.
Mucociliary Transport
Authors: Sackner Marvin A.
Published: October 2014

Our laboratory has developed bronchofiberscopic and roentgenographic techniques to measure tracheal, bronchial and nasal mucus velocities in humans and animals. We found that inhalation of specific antigen is associated with depression of tracheal mucus velocity in dogs who may or may not display bronchospasm and the mediator for this phenomenon might be SRS-A. Corroboration of the depression of tracheal mucus transport after ragweed inhalation has been obtained in susceptible asthmatic patients; prior inhalation of cromolyn blocks this reaction. Depression of tracheal mucus transport may be the earliest adverse manifestation of cigarette smoking in young subjects. Slowing of mucus transport in the bronchi occurs after suctioning with suction catheters; a newly designed suction catheter tip, the Aero-Flo®, displays less adverse effects on mucus velocity than standard end hole and side hole catheters. Nasal mucus velocity is enhanced by nasal decongestants, ingestion of hot fluids and exercise.
Aortic Arch Anomalies in Adult Disorders of Deglutition
Authors: Rowe Lee D. , Keane William M. , Lowry Louis D. , Fallenjad Manoucher
Published: October 2014

Congenital vascular anomalies of the aortic arch are unusual etiologies of dysphagia in the adult. Swallowing abnormalities associated with compression of the esophagus primarily occur at birth or in the immediate neonatal period. However, as the result of arteriosclerotic vascular disease or aneurysm formation, anomalies which were asymptomatic postnatally may produce dysphagia in the adult. A retrospective analysis of 59 cases with aortic arch anomalies presenting initially in adulthood revealed characteristic clinical signs and symptoms. An aberrant right subclavian artery with left aortic arch was the most frequently encountered abnormality. The embryologic development of each vascular anomaly is described and the value of selective arteriography with contrast esophagography is stressed. Patients with minimal swallowing impairment are treated with dietary management alone. Surgical division of the anomalous artery is indicated only when severe dysphagia is associated with progressive life-threatening anorexia and weight loss.
Diagnosis and Treatment of Carotid Body Tumors
Authors: Ward Paul H. , Jenkins Herman A. , Hanafee William N.
Published: October 2014

The diagnosis and management of carotid body tumors are discussed, including the importance of good arteriography which allows visualization of all major feeding vessels. These include the carotid bulb, internal and external carotid arteries and the often neglected but important vertebral and ascending cervical arteries. Emphasis is placed on the importance of establishing tourniquet control of the common, internal and external carotid arteries. Surgeons removing carotid body tumors should be experienced in arterial wall repair by means of vascular shunts, end-to-end arterial anastomosis, and vein graft replacement of a segment of arterial wall.
Management of Subglottic Stenosis in Infancy and Childhood
Authors: Cotton Robin
Published: October 2014

The management of mature subglottic stenosis secondary to endotracheal intubation in infancy and childhood remains a controversial issue. If treated similarly to congenital subglottic stenosis by tracheotomy and a “wait-and-see” period then there is a considerably higher mortality and morbidity for the acquired disease compared with the congenital. Eighteen children with severe acquired subglottic stenosis managed by surgical reconstruction are presented; 17 have been successfully extubated. The longest follow-up is 5½ years. No evidence of interference with laryngeal growth is evident.
Treatment of Radiation-Induced Tissue Injury by Hyperbaric Oxygen
Authors: Farmer Joseph C. , Shelton D. L. , Angelillo J. D. , Bennett P. D. , Hudson W. R.
Published: October 2014

Hyperbaric oxygen therapy appears to be a beneficial adjunctive treatment modality in the management of radionecrosis of bone and soft tissue in the head and neck. The mechanism of such wound healing enhancement appears to be related to oxygen stimulation of fibroblastic activity and neovasculation. In this pilot study, involving 13 cases of refractory mandibular radionecrosis treated with hyperbaric oxygen, complete healing of soft tissue disease with covering of exposed bone has been noted in seven cases 11 to 27 months posttreatment; transient healing was seen in three cases; moderate to marked improvement in soft tissue disease has been noted in three cases. Pain relief was marked in six cases, moderate in four cases, and slight in one case of the 11 patients with significant pretreatment pain. Radiographic improvement was slight to moderate in ten cases. Four of the five patients with pathologic fractures developed a firm fibrous union of the mandibular segments during or shortly after treatment. Three additional cases of head and neck radionecrosis of other sites have noted significant improvement in their lesions during treatment. Three other patients with radionecrosis of the foot, hip, and vagina have also been treated with good results only in the vaginal case. None of the 19 patients treated with hyperbaric oxygen developed persistent or significant complications.
Surgical Treatment of Acute Blunt Laryngeal Injuries
Authors: Olson Nels R.
Published: October 2014

The best management of acute laryngeal fractures is an approach which promotes healing by primary intention and does not require the use of a lumen keeper or core mold. This presenentation outlines the theoretical considerations and practical steps which make it possible to achieve these goals. The basic emphasis is on proper diagnosis, good surgical exposure and proper wound management. Also included are some ideas about the special anatomical and physiological characteristics of the larynx which make it difficult to obtain primary healing. The material presented is a synthesis of pertinent basic laryngologic research, wound healing theory and clinical experience.
Facial Nerve Repair in Cerebellopontine Angle Surgery
Authors: Brackmann Derald E. , Hitselberger William E. , Robinson Jerald V.
Published: October 2014

Facial nerve continuity was restored during cerebellopontine angle tumor removal in nine cases. The distal facial nerve was rerouted from the stylomastoid foramen into the cerebellopontine angle. Direct suture was accomplished in seven cases while two required interposition of a greater auricular nerve graft. There was excellent return of facial function in eight of the nine cases. Overall results are superior to nerve substitution techniques. The facial nerve should be inspected for continuity following tumor removal. If one is not certain the nerve is intact, the proximal facial stump should be identified at the brain stem and facial nerve continuity reestablished. A nerve substitution procedure should be resorted to at a later time only when the proximal facial stump is not identifiable.
Ewing's Sarcoma of the Mandible
Authors: Bernstein Paul E. , Bone Robert C. , Feldman Philip S.
Published: October 2014

Ewing's sarcoma of the mandible occurs rarely; there have been less than 50 reported cases in the past 30 years and none of these have been in the otolaryngologic literature. They usually present in the second decade of life with pain and swelling of the soft tissue overlying the mandible. The diagnosis can only be made by an adequate mandibular biopsy, although x-rays and clinical presentation are helpful. Current treatment consists of radiation therapy and sequential adjuvant chemotherapy.
Intralabyrinthine Schwannoma
Authors: DeLozier Howard L. , Gacek Richard R. , Dana Sidney T.
Published: October 2014

Two cases of unsuspected intralabyrinthine schwannoma are reported and the literature is reviewed. The mean age of the patients was 56 years, with the most common symptoms being hearing loss, dizziness, and tinnitus. All patients demonstrated a profound sensorineural hearing loss with low discrimination scores, and recruitment was elicited in two patients. A radiographic evaluation was negative in all but one case. Five of the six patients had a preoperative diagnosis of Ménière's disease. Transcanal labyrinthectomy was employed to remove tumor in all patients. This review suggests that a patient, presenting with symptoms of atypical Ménière's disease and negative radiographic evaluation, should alert the surgeon to the possibility of an intralabyrinthine schwannoma.
Width of the Internal Auditory Canal
Authors: Olivares Francisco Pérez , Schuknecht Harold F.
Published: October 2014

Vertical and horizontal measurements were made of the widths of the internal auditory canals of 435 histologically prepared temporal bones. The mean vertical width, measured at the porus acusticus, was 3.68 mm (range 2.10 to 5.26 mm), and the mean horizontal width, measured in the middle region of the canal, was 3.72 mm (range 2 to 5.8 mm). The 144 ears selected for study because they exhibited slowly progressive sensorineural hearing loss showed a distribution of canal widths similar to that of the group as a whole. Histological examination of the internal auditory canals failed to show any type of soft tissue lesion which might have contributed to narrowing of the canals. The study provides no anatomical or histological evidence for the existence of a small internal auditory canal syndrome.
Anatomical Effects of Sudden Middle Ear Pressure Changes
Authors: Axelsson A. , Miller J. , Silverman M.
Published: October 2014

Acute middle ear (ME) and inner ear changes following brief unilateral phasic ME pressure changes (up to ± 6000/mm H2O) were studied in the guinea pig. Middle ear findings included perforation of the tympanic membrane, serous and serosanguinous exudate and hemorrhage of tympanic membrane and periosteal vessels. Changes were related to magnitude of applied pressure. Perforation and hemorrhage were more commonly seen with negative rather than positive pressure. Air bubbles behind the round window were seen with positive pressures. Occasional distortion, but never perforation of the round window, was noted. Hemorrhage of the scala tympani was observed with both positive and negative pressures; scala vestibuli hemorrhage was found with negative ME pressure. In some instances pressure direction and magnitude related changes were seen in the contralateral ear.
Inhibition of Labyrinthine Nystagmus by Visual Fixation: Effects of Ablation of Visual Cortex and Superior Colliculi
Authors: Liebman Emil P. , Toglia Joseph U.
Published: October 2014

A study was conducted to destroy two specific areas of the cat's visual system in order to determine if these lesions would affect the visual inhibition of calorically-induced vestibular nystagmus. The occipital visual cortex was removed in eight cats and the superior colliculi were removed bilaterally in nine cats. Postoperative vestibular testing revealed no significant change in the electronystagmography tracings and response to visual fixation. These findings suggest that, in cats, the visual inhibition of labyrinthine nystagmus is not dependent upon the integrity of the visual cortex or superior colliculi. The hypothesis is brought forward that the visual inhibition of the vestibular nystagmus is merely a reflex of the brain stem to light stimulus, mediated via the cerebellum.
Evaluation of Computerized Tomography, Cinelaryngoscopy, and Laryngography in Determining the Extent of Laryngeal Disease
Authors: Ward Paul H. , Hanafee William , Shallit Joel , Mancuso Anthony , Berci George
Published: October 2014

A prospective study of over 100 cases comparing computerized tomography (CT) and correlating these studies with photographic motion picture studies of the larynx, conventional tomography and contrast laryngography has been performed. The authors give illustrative examples of cases in which the CT scan has been documented as providing equal and oftentimes greater information concerning not only tumors, but also cystic lesions and traumatic lesions. With the newer technology, the reduced radiation (which is less than one half that of conventional tomography), and the decreased expense (now comparable to that of laryngography alone), eliminates the need for conventional laryngography and tomography examinations. The incorporation of motion picture documentation of the lesions allowing future comparative studies between the original lesion and the CT are recommended for a more accurate retrospective classification and assessment of therapeutic results.
Trends and Profiles in Stapes Surgery
Authors: Bellucci Richard J.
Published: October 2014

Stapedectomy has become recognized as the procedure of choice in the surgical treatment of clinical otosclerosis. Based on results obtained in stapes surgery performed in 1977, profiles were established for hearing improvement, vertigo, tinnitus, chorda tympani injury and temporary threshold shift of high tones. Tympanometric and stapedial muscle reflex tests in cases of proved clinical otosclerosis also are discussed. The profiles indicate that stapedectomy performed on a regular basis and under ideal conditions is highly successful for the improvement of hearing. The incidence and probable causes of complications are presented and discussed. This study reveals, however, that the number of new patients with otosclerosis has decreased steadily since its peak in 1964. Should the number of surgical cases continue to diminish, it may be impossible for the practicing otologist to maintain sufficient expertise for the performance of an occasional stapedectomy. Also, it may become impossible to provide sufficient experience in otosclerosis surgery for all trainees in otolaryngology.
Change in the Force-Summed Pressure Measurements of the Upper Esophageal Sphincter Prelaryngectomy and Postlaryngectomy
Authors: Welch Richard W. , Gates George A. , Ricks Phillip M. , Luckmann Kenneth F. , Drake Samuel T.
Published: October 2014

The pharyngoesophageal high pressure zone (PE-HPZ) was measured prelaryngectomy and postlaryngectomy with a new force-summing probe that accounts for sphincter pressure asymmetry. A total of 31 patients were studied six times each. Postoperatively, pressures dropped from 130 ± 24 mm Hg to 66 ± 9 mm Hg. After a standardized, intensive laryngectomy rehabilitation program, 12 of 19 postoperative patients acquired acceptable esophageal speech and 7 did not. Speakers and nonspeakers were found to have nearly identical PE-HPZ pressures (speakers = 70 ± 10 mm Hg, nonspeakers = 59 ± 18 mm Hg). Differences in sphincter length or relaxation likewise did not discriminate between these two groups. We conclude that PE-HPZ pressure is not a critical determinant of the acquisition of esophageal speech.
Establishment of a New Cell Line from Maxillary Sinus Carcinoma
Authors: Nakashima Tadashi , Makishima Kazumi , Hiroto Ikuichiro
Published: October 2014

We succeeded in deriving a long-term tissue culture cell line from human maxillary sinus carcinoma. This cell line, designated as MC, was passaged 100 times in vitro over a period of 18 months. The cells are globular in shape, grow as single cells in the culture medium, and the mean population doubling time is about 12 hours. The plating efficiency rate in soft agar is 78% and chromosomal analysis revealed the modal chromosome number to be between 47 and 51. These MC cells were transplanted into five nude mice, all of which developed a tumor after a latency period of 5 to 8 days and died within 39 days. Complete autopsy of all mice revealed no metastasis. Histopathological findings of the original and the transplanted tumor tissues showed a remarkable similarity.
Acute Gram-Negative Bacillary Infections of Middle Ear and Mastoid
Authors: Ostfeld Ervin , Rubinstein Ethan
Published: October 2014

Thirty-three patients with acute purulent otitis media and mastoiditis caused by Gram-negative bacilli are presented. The main features of the disease include: predilection for young male infants, a high rate of complications that include sepsis, mastoiditis and osteomyelitis of the base of the skull. Patients that are diagnosed early respond well to drainage and ventilation of the infected middle ear combined with in vitro effective antibacterial therapy. Patients that receive prior inappropriate antibacterial therapy tend to have prolonged courses and require mastoid surgery. It is suggested that early myringotomy and bacterial cultures be performed in all patients with acute middle ear infections.
Comparison of the Anatomy of the Eustachian Tube in the Rhesus Monkey (Macaca Mulatto) and Man
Authors: Doyle William J. , Rood Stewart R.
Published: October 2014

The primate nasopharynx-eustachian tube-middle ear complex is being used to model both the normal and pathologic functions of the human eustachian tube by several researchers. An extensive search of the literature has indicated little detailed information on the primate eustachian tube/middle ear system. This study was undertaken to define the anatomical characteristic of the system in the Rhesus monkey ( Macaca mulatto) and to determine the limits on the use of the monkey as a model of human eustachian tube function. Although the direct application of morphologic data to explain the function of a system is tenuous, the data on the Rhesus monkey eustachian tube appears to be consistent with that published for other mammals. The tensor veli palatini muscle appears to be the only muscle to act directly on the tube and effect tubal dilation. The muscle is attached to the lateral membranous tubal wall along its extrabullar extension. The muscle has an inferior attachment to the posterior hard palate and thus possesses a vector directed inferolaterally; contraction would appear to pull the membranous wall inferiorly and laterally, resulting in the tubal dilation. The eustachian tube relationships of the salpingopharyngeus, levator veli palatini, and internal pterygoid muscles are described. Their possible role in primate tubal function is minimal at best.
Obliterative Fibrotic Middle Ear Disease in Systemic Vasculitis
Authors: Hill James H. , Graham Malcolm D. , Gikas Paul W.
Published: October 2014

A case of bilateral oliterative fibrotic middle ear disease occurring in a patient suffering from leukocytoclastic angiitis is presented. Following a brief discusion of middle ear involvement in systemic vasculitis the pathologic picture and differential diagnosis are considered. Biopsy of unexplained obliterative fibrotic middle ear tissue is recommended.
Laryngeal Ventricle Historical Features
Authors: Canalis Rinaldo F.
Published: October 2014

The author reviews some of the salient historical features related to the anatomical description of the laryngeal ventricle and its saccule. The paper is based on a translation of Morgagni's original work published in 1719. This information is presented along with a short biographical note of Morgagni's life. Only original sources were used and photographs of the original illustrations are included.
Neoglottic Reconstruction following Total Laryngectomy
Authors: Leipzig Bruce , Griffiths Ceri M. , Shea John P.
Published: October 2014

A technique of primary neoglottic reconstruction for surgical restoration of voice following total laryngectomy is described in detail. This technique has been performed on 30 patients at the University of Texas Medical Branch, and our results are reported. Twenty (67%) of these patients are speaking with their neoglottises after one year. Indications for neoglottic reconstruction are discussed, based on a review of the problems and complications which we have experienced. Relative contraindications to the procedure are extension of tumor beyond the anatomic boundaries of the larynx, patients with poor pulmonary reserve, or those with significant esophageal reflux incompetence. Radiotherapy is not a contraindication to neoglottic reconstruction. It does predispose the patient to increased morbidity with spontaneous closure of the neoglottis, as well as aspiration, occurring occasionally. Other problems which are discussed include aspiration, postoperative wound infection, and patient compliance with the procedure. Results to date have been very encouraging, meriting further investigation of this one-stage vocal rehabilitation.
Laryngeal Regulation of Airway Resistance I. Chemoreceptor Reflexes
Authors: McCaffrey Thomas V. , Kern Eugene B.
Published: October 2014

The resistance of the larynx to airflow was measured during hypercapnia, hypoxemia, and stimulation of peripheral chemoreceptors by sodium cyanide and phenyl diguanide in 15 dogs anesthetized with α-chloralose (80 mg/kg). Laryngeal airway resistance (R1 x) was obtained by measuring the pressure difference between the subglottic region and the mouth while a constant flow of humidified air was passed through the larynx. During spontaneous respiration, R1 x varies with the phase of the respiratory cycle: R1 x is high during expiration (mean ± SEM = 0.79 ± 0.19 cm H2O/L/sec) and falls just before inspiration (0.49 ± 0.14 cm H2O/L/sec) and remains low until the end of inspiration. Hypercapnia, hypoxemia, and chemoreceptor stimulation each stimulated respiration and simultaneously decreased R1 x during both inspiration and expiration. Chemoreceptor stimulation with phenyl diguanide (100 μg/kg) and sodium cyanide (100 μg/kg) produced similar decreases in R1 x whether injected into the right atrium or left ventricle, indicating that these agents are not stimulating pulmonary receptors. The decrease in R1 x during stimulation of chemoreceptors will decrease the work of ventilation. This study suggests that the control of ventilation involves the active regulation of the resistance of the laryngeal airway.
Cineradiographic Analysis of Eustachian Tube Function Experimental Study
Authors: Honjo Iwao , Okazaki Nobuhiro , Ushiro Koichi , Kumazawa Tadami
Published: October 2014

In order to determine the effect of muscular contraction upon the opening processes of the eustachian tube, cineradiography of four monkeys' tubes during stimulation of the tensor and levator veli palatini muscles was carried out. Levator stimulation produced no opening of the tube except a dilation of the pharyngeal orifice. On the other hand, tensor stimulation produced a consistent opening of the tube by outward displacement of the tubal wall along its entire cartilaginous part. A marked time lag in the movement of the tube between its proximal (isthmic) and distal (pharyngeal) parts was regarded to be important in the clearance function of the tube.
Chevalier Jackson Lecture Esophageal Stenosis in Children
Authors: Aprigliano Flavio
Published: October 2014

Congenital anomalies that can produce esophageal stenosis as well as acquired diseases of the esophagus in children are described. The infant and child who refuse to accept solid foods must be submitted to roentgenologic and endoscopic examination. Dysphagia is sometimes difficult to recognize in infants and children. Endoscopic treatment alone or associated with surgery is successful in many cases if well indicated and precisely done.
High Incidence of Pulmonary Symptoms in Infants Evaluated for Esophageal Disease
Authors: Rothstein Fred C. , Halpin Thomas C.
Published: October 2014

Of 62 children (1–24 months of age) evaluated for esophageal disease, 22 were found to have pulmonary symptoms of apnea, pneumonia, wheezing, cyanosis, cough and stridor. Upper gastrointestinal series showed free gastroesophageal reflux in 10 of 22 infants; 3 were thought to have stricture. Acid-reflux test was positive in 13 of 15 and correlated with the presence of esophagitis in 12. In addition to esophagitis, endoscopic examination found two foreign bodies and an esophageal stricture unrecognized during fluoroscopy. Endoscopic grasp biopsy was inadequate in most infants for the histologic evaluation of esophagitis. However, suction biopsy correlated well with endoscopically diagnosed esophagitis. In infants where medical therapy failed and symptoms were life-threatening, a Nissen fundoplication resulted in excellent resolution of symptoms. In children who present with prolonged and often life-threatening symptoms, esophageal dysfunction should be evaluated by rigorous testing.
Laryngology and the Numbers Game
Authors: Lucente Frank E.
Published: October 2014

Numbers play a great role in our practice of laryngology, and when used appropriately can be extremely valuable. However, careless or uncritical use may cause them to be an impediment or detriment to clinical practice and teaching. Examples of problems which arise with numbers are readily found in the areas of tumor staging (TNM system), the scientific literature, resident training and communications with third-party agencies. Consideration of these examples reminds us of the need to evaluate our use of numbers frequently.
Extended Partial Laryngectomy
Authors: Sessions Donald G.
Published: October 2014

This report details the diagnosis and treatment of a patient with a large T3 N0M0 laryngopharyngeal cancer by combined surgical excision and planned postoperative irradiation therapy. Surgical excision included a horizontal subtotal supraglottic laryngectomy combined with a vertical hemilaryngectomy and partial pharyngectomy. The patient was reconstructed with a free sternocleidomastoid muscle graft. The results and implications of this therapy are discussed.
Airway Obstruction in a Hemophiliac Child
Authors: Stanievich John F. , Marshak Gabriel , Stool Sylvan E.
Published: October 2014

The hemophiliac patient is in constant danger of death from hemorrhage. The danger of bleeding into the submucosal areas of the upper aerodigestive tract, however, does not primarily lie in the blood loss but rather is due to compression and edema of the upper airway. The treatment of choice, in addition to the direct treatment for the specific clotting factor deficiency, is elective nasotracheal intubation, since in most cases this interstitial bleeding, resulting in airway compromise, recedes in four to five days.
Elemental Composition of the Developing Inner Ear
Authors: Anniko Matti , Wroblewski Romuald
Published: October 2014

The elemental composition of the inner ear fluid-filled compartments has been analyzed using the x-ray energy dispersive technique (CBA mouse). Special attention has been focused on the maturation of endolymph. A few days before and after birth the relative peak intensity of potassium (R k) in the vestibular endolymphatic compartment was slightly surpassing that in the cochlear part of the labyrinth. From the fourth day after birth (DAB) a rapid increase occurred concerning the R k. The highest R k was found in the endolymphatic space in the basal part of the cochlea followed by that in the vestibular endolymph. The lowest R k was measured in endolymph of the apical part of the cochlea. These obvious differences were abandoned already on the sixth DAB. A mature composition of endolymph was reached on the eighth DAB. The present technique does not allow analyses of differences between cochlear and vestibular endolymph with regard to minimal shifts.
Study of Ventilation Testing with Electronystagmography
Authors: Wilson William R. , Kim Jin W.
Published: October 2014

Provocation tests such as head shaking and positional tests, as well as hyperventilation, have been used routinely by many laboratories to elicit nystagmus during an electronystagmogram. We added oxygen testing to this routine battery and compared the results with hyperventilation and other forms of provocative testing. Hyperventilation and oxygen testing are unique in that they probably affect the vestibular system by changing the levels of oxygen and carbon dioxide supplied. Hyperventilation in theory would decrease available oxygen, while oxygen testing would cause an increase. In a study of two groups totaling over 700 patients, we found that oxygen testing is only occasionally positive (2.5%) and is of little practical value. Hyperventilation testing is positive 8% of the time but rarely alone, and has no localizing value. When hyperventilation and oxygen tests are both positive, the nystagmus may be in opposite directions. In 6 of 18 patients with acoustic neurinomas, hyperventilation produced transitory direction-changing nystagmus.
Temporal Bone Findings in a Patient with MÖbius Syndrome
Authors: Saito Haruo , Kishimoto Seiji , Furuta Mutsuhiro
Published: October 2014

Temporal bone findings in a case of Möbius syndrome are presented. The most striking pathological feature of the case is that the facial nerves ended in the horizontal segment in the temporal bones on both sides. This finding gives direct evidence that the site of nerve lesion in Möbius syndrome is in the peripheral nerve. Despite the disappearance of the facial nerve in the horizontal segment, a neural element reappeared in the vertical segment of the fallopian canal, and moreover, the chorda tympani was found to cross the tympanic cavity in the normal position. This finding suggests that fibers of the chorda tympani sometimes take an alternative pathway via Arnold's nerve.