bluuebunny/crossref_metadata_2025 huggingface dataset:
Correlation of fine needle aspiration biopsy and ct scanning of parotid masses
Authors: Berg Howard M. , Jacobs Joseph B. , Kaufman David , Reede Deborah L.
Published: October 2006

Preoperative evaluation of parotid tumors still poses difficult problems for the head and neck surgeon. The complex anatomy of the parotid space leads to difficulty in localizing these tumors. In addition, physical examination will rarely determine whether a parotid lesion is benign or malignant. High resolution CT scanning with contrast and fine needle aspiration can provide enough preoperative information to enable the surgeon to counsel his patient concerning possible risks and the extent of surgery that may be indicated. We are able to determine tumor location, multiple or bilateral masses, associated adenopathy, and often specific tumor histology. Forty‐two parotid aspirates and 26 CT scans were reviewed and correlated with their postoperative pathology specimen. Parotid aspiration cytology was found to be a highly accurate and safe procedure for preoperative determination of parotid pathology. However, the CT scan was specific only in defining the anatomic localization and extent of a parotid mass.
Comparison of the microbiology of recurrent tonsillitis between children and adults
Authors: Brook Itzhak , Foote Perry A.
Published: October 2006

The microbial flora of recurrently inflamed tonsils removed from 25 children with recurrent episodes of tonsillar pharyngitis were compared to flora of tonsils removed from 23 adults suffering from similar illness. More bacterial isolates per tonsil were recovered in adults (10.2 per tonsil) than in children (8.4 per tonsil). The difference between these groups was due to a higher recovery rate in adults of Bacteroides melaninogenicus group (1.6 isolates per adult, 0.8 per child) and Bacteroides fragilis group (0.4 per adult, 0.2 per child). Conversely, Group A beta‐hemolytic streptococci were isolated in seven (28%) children as compared to their isolation in one (4%) adult. More isolates of beta‐lactamase‐producing organisms (BLPO) per tonsil were recovered in adults. Forty‐three BLPO were detected in 21 (91%) of the 23 tonsils removed from adults (1.9 isolates per patient) as compared to 31 isolates in 16 (64%) of the 25 tonsils removed from children (1.2 isolates per patient) (P=0.04). These findings suggest that the etiology of recurrent tonsillitis in adults may differ from that in children. The differences in the tonsillar flora may be due to the effect of many more courses of antimicrobials given over the years to adults and the changes in tonsillar tissue that occur in this age group.
Methylene blue infusion for intraoperative identification of the parathyroid glands
Authors: Gavilan Javier , Gavilan Cesar , Tomas Manuel D.
Published: October 2006

Identifying the parathyroid glands is of fundamental importance in thyroid and parathyroid surgery. We found that intravenous infusion of methylene blue was beneficial in intraoperative identification of the parathyroid glands in patients undergoing surgery for hyperparathyroidism as well as total and bilateral subtotal thyroidectomy. The technique is safe and easy to use, and it clearly reduces the operative time. We suggest that it be used routinely in thyroid and parathyroid surgery.
Sphenoid sinus mucocele masquerading as a skull base malignancy
Authors: Shikowitz Mark J. , Goldstein Mark N. , Stegnjajic Arsen
Published: October 2006

Mucoceles of the sphenoid sinus are rare. Only occasional reports have appeared in the medical literature since they were first described by Berg in 1889. The sphenoid sinus lies deep within the skull at the crossroads of 13 sensitive structures. The presence of a sphenoid sinus mucocele may be accompanied by a wide variety of signs and symptoms depending upon which of these structures are involved. The majority of these lesions are initially misdiagnosed as malignancies leading to increased patient morbidity and possible mismanagement.

We present two cases of sphenoid sinus mucoceles which presented with a variety of neurological signs and symptoms. The radiographic findings were felt to be consistent with skull base malignancies. The diagnosis was corrected only after surgical exploration of the sphenoid sinus revealed a mucocele.
Acoustic neuroma surgery: The results of hearing conservation surgery
Authors: Glasscock Michael E. , McKennan Kevin X. , Levine Samuel C.
Published: October 2006

Between the years of 1978 and 1986 attempts have been made to save the hearing in 47 patients with unilateral pathologically confirmed acoustic neuromas. The middle fossa approach has been used in 32 cases and the suboccipital approach in 15 cases. Our review demonstrates an advantage using the suboccipital approach to excise most of these tumors. The success rate is higher (47% vs. 31%) and complications fewer using the suboccipital route. Despite these findings the middle fossa approach may be preferable in selected tumors located laterally in the internal auditory canal.

In an effort to better select patients for hearing conservation surgery, an analysis of preoperative data (demographics, audiometry, evoked auditory response testing, and tumor size) was performed. Although certain guidelines have evolved to more accurately select hearing conservation surgery candidates, we are still unable to do so reliably. Preoperative auditory brain stem response testing, however, may evolve as a useful indicator for a successful hearing operation. The findings of our preoperative data analysis, surgical results, and complications are reviewed.
Anterior extraoral approach to the atlas and axis
Authors: Nachlas Nathan E. , McAfee Paul C. , Johns Michael E.
Published: October 2006

A transcervical extraoral approach was utilized to achieve exposure to the upper cervical spine in five patients, four of whom required bone graft placement. Excellent exposure was achieved in all patients, and the postoperative course was uncomplicated. The anterior extraoral approach is a reliable technique in treatment of pathology of the atlas and axis.
Presentation and management of postcricoid hemangiomata in infancy
Authors: Goldsmith Manning Miles , Strope Gerald L. , Postma Duncan S.
Published: October 2006

Phillips and Ruh (1912)1 were the first to describe a congenital hemangioma of the larynx. Sweetser2 subsequently classified laryngeal hemangiomata into infantile and adult types and noted differences in incidence, location, and symptoms. According to Sweetser, the infantile form is less common, is almost always subglottic, and presents with stridor which may be intermittent. The adult form is somewhat more common, is generally supraglottic, and often presents with hoarseness or dysphagia.

We present what we believe is the first reported case of a postcricoid hemangioma in an infant. A review of hemangiomata of the aerodigestive tract is presented and treatment is discussed.
Bone resorption in cholesteatoma: Epithelial‐mesenchymal cell interaction and collagenase production
Authors: Moriyama Hiroshi , Honda Yoshio , Huang Cheng Chun , Abramson Maxwell
Published: October 2006

Clinical evidence has shown that chronic otitis media with cholestentoma causes greater bone resorption than otitis media without cholesteatoma. What is the role of the epithelium and its products on the morbidity of cholesteatoma? We have studied the mechanism of collagenase production in cultures of rat epidermal cells and skin fibroblast‐like cells under various conditions. The epithelial cells significantly induced mesenchymal cells to produce collagenase. We conclude that interaction between epithelial cells and fibroblast‐like cells enhances production of collagenase. This enhancement of proteolytic activity may be crucial in the series of molecular events resulting in bone resorption associated with cholesteatoma.
Vestibular ototoxicity of gentamicin assessed by the recording of a short‐latency vestibular‐evoked response in cats
Authors: Elidan Josef , Lin John , Honrubia Vicente
Published: October 2006

The short‐latency vestibular‐evoked response (VsER) and the auditory brain stem response (ABR) were recorded with scalp electrodes in four cats before, during, and after systemic administration of gentamicin. The VsER was altered and later disappeared in three cats, and in one cat it became asymmetric, typical of a unilateral vestibular lesion. In all cats the ABR was unaffected and remained normal through the end of the experiment 4 months later. Histopathological examination of the temporal bones of three cats showed severe damage to the vestibular end‐organ, particularly in the summit of the cristae, but in lesser amounts in the hair cells on the slopes of the cristae and in the maculae. In one cat, the pathological condition was greater in one ear, corresponding to the asymmetry in the VsER records.

This new method of inducing and recording the VsER has been demonstrated by the present study to be an effective tool for experimentally assessing vestibular end‐organ and nerve function in animal models. Furthermore, these results indicate that the VsER is generated in the vestibular labyrinth, most probably by the cristae of the semicircular canals.
Cable grafting of the spinal accessory nerve for rehabilitation of shoulder function after radical neck dissection
Authors: Weisberger Edward C. , Lingeman Raleigh E.
Published: October 2006

From January 1981 through December 1985, 9 patients underwent radical neck dissection with sacrifice of the spinal accessory nerve for removal of metastatic cancer to cervical nodes followed by reconstruction of the spinal accessory nerve utilizing a cable graft from the greater auricular nerve.

Shoulder function on the operated side was assessed postoperatively using a subjective questionnaire, objective strength testing, and EMG recordings. The group that had cable grafts of the spinal accessory nerve were compared to a group who had modified radical neck dissection with preservation of the spinal accessory nerve, and to a third group that had classical radical neck dissection with sacrifice of the spinal accessory nerve and no cable graft reconstruction.

The group with cable grafts scored in a position intermediate between the modified neck dissection group and the classical radical neck dissection group on subjective and objective testing. Most of the patients with cable grafts demonstrated voluntary motor potentials in the trapezius muscle on postoperative EMG testing.

Cable grafting of the spinal accessory nerve sacrificed during radical neck dissection results in improved shoulder function in the postoperative period. Indications and contraindications for the use of this rehabilitative procedure are presented.
Congenital laryngeal atresia
Authors: Gatti William M. , Macdonald Eileen , Orfei Emilio
Published: October 2006

Laryngeal atresia is a rare congenital anomaly requiring immediate tracheotomy as a lifesaving measure. A case of subglottic laryngeal atresia is reported and correlated with laryngeal embryogenesis. Three types of laryngeal atresia are described. Although tracheoesophageal fistula is commonly associated with laryngeal atresia, one must be careful not to confuse a pharyngotracheal duct with a tracheoesophageal fistula. A disproportionate number of reported TE fistulas associated with laryngeal atresia may result if an accurate distinction between pharyngotracheal duct and TE fistula is not made.
Hearing results after cholesteatoma surgery: The iowa experience
Authors: Ragheb S. M. , Gantz B. J. , Mccabe B. F.
Published: October 2006

This study compared the hearing outcome of canal‐up and canal‐down mastoidectomies for removal of cholesteatoma in 455 ears. An intact canal wall procedure was performed in 92 patients while the remainder (N=363) underwent a canal‐down operation.

The hearing results for both procedures are dependent on the presence of the stapes superstructure. When the stapes superstructure was intact, 52% of the patients with canal‐up operations had an air‐bone gap of less than 20 dB. The corresponding figure for canal‐down cases was 37%. When there was no stapes superstructure, 54% of the canal‐up cases and 19% of the canal‐down cases obtained a similar ABG closure.

Preserving the posterior external auditory canal wall results in slightly better hearing function. However, when the stapes superstructure is intact, the difference in hearing function is not remarkable, and must be weighed against the potential for residual disease or recurrence associated with canal‐up procedures.
Epithelioid hemangioendothelioma (histiocytoid hemangioma) of the palate
Authors: Moran William J. , Dobleman Thomas J. , Bostwick David G.
Published: October 2006

The first case of epithelioid hemangioendothelioma involving the oropharynx is described. A 25‐year‐old woman developed a mass on the palate which was noted to enlarge during the first trimester of pregnancy. Biopsy revealed a cellular tumor initially considered to be of epithelial origin. Vascular differentiation of the tumor was confirmed, however, by positive lectin histochemistry for Ulex europaeus, by evidence of immunoreactivity for factor VIII‐related antigen, and by ultrastructural identification of endothelial features. The patient remains free of tumor 21 months after complete excision. Because of the potential for misdiagnosis, epithelioid hemangioendothelioma should be considered in the differential diagnosis of oropharyngeal malignancies. The effect of pregnancy on the development and growth of vascular tumors such as epithelioid hemangioendothelioma remains uncertain.
Radiation therapy in the treatment of chemodectomas
Authors: Konefal J. B. , Pilepich M. V. , Spector G. J. , Perez C. A.
Published: October 2006

Twenty‐six patients with chemodectomas were treated with radiation therapy from 1961 to 1983 and followed for at least 4 years. In 16 glomus tympanicum lesions treated primarily with radiation, long‐term control was achieved in all (follow‐up 4–24 years, mean 10.5). Fifteen of 16 had no clinical evidence of disease at time of death or last follow‐up, and one patient had recurrent but stable disease at 10 years and died of an unrelated illness 19 years after treatment. Eight of the glomus tympanicum lesions were referred for radiation therapy with persistent disease after multiple surgical procedures. Two had extensive skull and intracranial involvement at the time of radiation.

Six patients with glomus jugulare lesions were treated with radiation. Four achieved long‐term control, and two died of their disease. In addition, two glomus vagal and one carotid body tumor were treated with palliative intent. One glomus tympanicum lesion was treated with preoperative radiation and resection. Chemodectoma was the cause of death in 4 of 25 patients—3 from intracranial extension and 1 from lung and mediastinal metastases. All four patients were referred for radiation with metastases or extensive bone involvement at the skull base.

Radiation appears to be effective in achieving long‐term clinical control of chemodectomas. Adequately treated volume should bo determined with arteriography and/or contrast‐enhanced computer tomography, allowing for geometric margins. Doses in the range of 4,500 to 5,000 cGy delivered in about 5 weeks are recommended.
Cricothyroidotomy versus tracheotomy: An otolaryngologist's perspective
Authors: Cole Randolph R. , Aguilar Eugenio A.
Published: October 2006

A series of 655 elective cricothyroidotomies presented by Brantigan and Grow in 1975 has fueled a recent explosion in the number of cricothyroidotomies being performed for elective tracheal access.

This article reviews Jackson's classic 1921 paper on cricothyroidotomy, Brantigan and Grow's series, seven recent clinical series of elective cricothyroidotomies, and our experience.

Voice change is the most frequent complication of cricothyroidotomy occurring in up to 50% of cases. Chronic subglottic stenosis occurs in approximately 2% of cases. Contraindications to cricothyroidotomy include prolonged intubation, airway obstruction following extubation, and laryngeal pathology of any kind.
Jugular bulb position and shape are unrelated to temporal bone pneumatization
Authors: Orr James B. , Wendell Todd N.
Published: October 2006

The position and shape of the jugular bulb are undependable, and thus can add difficulty to temporal bone surgery. The present study addresses the hypothesis that position and shape of the jugular bulb correlate with the extent of temporal bone pneumatization. Systematic study was done in 25 unilateral cadaver specimens. Pneumatization was determined using both the classic Runström II radiograph, and computed tomography. Jugular bulb shape and position were determined by anatomic dissection and computed tomography. No association of jugular bulb shape or position, with pneumatization, was found. However, the dissection‐determined distance from the plane of the lateral semicircular canal to the roof of the jugular bulb (2 to 15 mm), had a good correlation (r = 0.70, p < .001) with the distance from the internal auditory canal to the apex of the jugular bulb (1.5 to 15.0 mm).
Migraine equivalent as a cause of episodic vertigo
Authors: Harker Lee A. , Rassekh Christopher
Published: October 2006

There are many transient neurologic disturbances associated with various types of migraine. Visual symptoms, such as scintillating scotomata are most common, but somatosensory, motor, cranial nerve, and brain stem symptoms also occur. Among the brain stem symptoms, vestibular manifestations are quite common and include nonspecific dizziness, disequilibrium, vertigo, and motion intolerance. Auditory symptoms are less common. These transient neurologic symptoms can precede the headache as an aura, can occur during the headache, or, uncommonly, can immediately follow the headache. It is also well documented that the neurologic symptoms can occur in the period between headaches, a situation termed “migraine equivalent.” Migraine equivalents usually occur in patients who have experienced typical migraine headaches earlier in life or who have migraine headaches at times other than when they experience equivalent symptoms. Rarely, typical migraine equivalent symptoms precede the development of the headaches by months or years, or occur in individuals who never develop headaches.

Five patients with migraine equivalent symptoms that include vertigo are presented. The vertigo was the dominant symptom in some cases and was accompanied by nausea and vomiting. Differentiation from peripheral labyrinthine disorders is difficult, but a personal or family history of migraine, the temporal association of the neuro‐otologic symptoms with other migraine equivalent symptoms, a characteristic pattern of occurrence of the symptoms, and a positive response to antimigrainous therapy are features that strengthen the diagnosis of a migraine equivalent phenomenon.
The head and neck sequelae of cervical intravenous drug abuse
Authors: Myers Ernest M. , Kirkland Levi S. , Mickey Robert
Published: October 2006

When peripheral veins sclerose, addicts desperately seek new and more dangerous injection sites. At Howard University Hospital, Washington, DC, a disturbing increase in intravenous head and neck complications has been observed. From 1982 to 1985, 30 patients demonstrating complications resulting from intravenous cervical injections were treated. Computed tomography is emphasized as the most helpful diagnostic modality. Its timely use enables physicians to formulate early diagnosis and precise surgical intervention. A suggested diagnostic and treatment protocol is presented as a guideline in the management of this potentially deadly phenomenon.
Statistical analysis of changes of pediatric nasal patency with growth
Authors: Hoshino Tadahiko , Togawa Kiyoshi , Nishihira Shigeki
Published: October 2006

The purpose of this study was to further investigate the changes of pediatric nasal patency with growth. The nasal patency of Japanese children aged 6 to 14 years was measured by active anterior mask rhinomanometry in terms of effective cross‐sectional area (ECSA).

The total nasal ECSA of the boys studied was larger than that of the girls of the same age groups. Total nasal ECSA was significantly correlated to age and height, as not transformed, and to weight as logarithmically transformed. Moreover, our study suggests that pediatric nasal resistance is inversely proportional to the second power of age, of height, and of body weight; however, it was concluded that the parameter of height was in itself sufficient to permit an approximate calculation of the total nasal ECSA in normal subjects.
Artificial reflex arc: A potential solution for chronic aspiration: II. A canine study based on a laryngeal prosthesis
Authors: Broniatowski Michael , Ilyes Laszlo A. , Jacobs Gordon B. , Nose Yukihiko , Tucker Harvey M.
Published: October 2006

Long‐term and repeated aspiration can result in pneumonia and eventually death. To avoid current techniques which divert or close off the incompetent larynx, the authors have recently described an artificial reflex arc (ARA), in hopes of providing a dynamic solution to this problem. With this concept, a segment of skin surface with intact sensory innervation is implanted into the pharynx in the path of the food bolus. Resulting neural impulses would be detected by a perineural electrode and then channeled to both recurrent laryngeal nerves via an electronic pacemaker to cause vocal fold adduction at the critical time during swallowing. A pilot study using a tubed cervical cutaneous surface has yielded promising results in the canine. In this current study, an alternate means for information pickup based upon use of a miniature strain gage is presented. Mechanical stimulation of the hypopharynx using this “sensory” detector resulted in synchronous laryngeal adduction of the vocal folds, as documented graphically and on videotape.
Hearing results and control of vertigo after retrolabyrinthine vestibular nerve section
Authors: Boyce Stephen E. , Mischke Robert E. , Goin Donald W.
Published: October 2006

To determine the effect of retrolabyrinthine vestibular nerve section (RVNS) on hearing, vertigo, and associated symptoms, we reviewed our experience in 48 patients. Of the 48, 39 responded to a questionnaire. Although RVNS appeared to have little effect on hearing in Meniere's patients, 91% of non‐Meniere's patients had significant and often delayed postoperative sensorineural hearing loss. Our results for vertigo control compared favorably to previous reports with 96% of Meniere's patients and 69% of non‐Meniere's patients reporting improvement.

Presently, we more frequently recommend RVNS as the primary procedure for the control of severe vertigo in Meniere's patients. Patients with vertigo from other causes must be carefully selected.
Anterior epitympanic cholesteatoma with facial paralysis: A characteristic growth pattern
Authors: Chu Felix W. K. , Jackler Robert K.
Published: October 2006

Epitympanic cholesteatoma may involve the facial nerve at several anatomic locations resulting in functional impairment. The most common site of nerve compression is the middle‐ear segment where the nerve is frequently devoid of bony covering. In five patients with facial palsy due to epitympanic cholesteatoma, a characteristic pattern of growth was recognized in which the cholesteatoma traversed the anterior epitympanum rather than taking the more common posterior route. Extension anteromedial to the head of the malleus leads to compression of the facial nerve in the region of the geniculate ganglion at the level of the middle cranial fossa floor. The most probable pathogenesis of this lesion is extension of disease along the embryologic course of either the saccus anticus or the anterior saccule of the saccus medius. Management of these lesions is surgical and may require, in addition to mastoidectomy with anterior and/or posterior atticotomy, middle fossa craniotomy and/or partial removal of the labyrinth for complete excision.
Management of obstructive sleep apnea: Comparison of various treatment modalities
Authors: Katsantonis George P. , Branham Gregory H. , Chambers Guy , Schweitzer Paula K. , Walsh James K.
Published: October 2006

From July, 1982 through March, 1986, 253 patients with moderate to severe sleep apnea (OSA) were treated and had polysomnographic assessment of treatment. The treatment modalities were: 1. uvulopalatopharyngoplasty (UPP), 2. nasal continuous positive airway pressure (CPAP), 3. tracheostomy, 4. medication (tricyclic antidepressants), 5. tongue retaining device (TRD), and 6. orthodontic device.

Uvulopalatopharyngoplasty was performed in 98 patients. The patients were categorized according to post‐treatment improvement in the apnea/hypopnea index (A+HI) and severity index (SI) into good, moderate, and poor responders. There were 37 (37.7%) good, 33 (33.6%) moderate, and 28 (28.5%) poor responders in this group. Twenty‐four patients underwent tracheostomy. Eighteen (75%) patients continue to have their tracheostomies without complications (mean follow‐up time 32 months). One hundred thirty‐eight patients were evaluated with CPAP. Of the 100 patients who began home CPAP use, 53 continue to use CPAP successfully at 18 months. Medical treatment (tricyclic antidepressants) was used in 35 patients. The response to this modality was generally poor.

Six patients were fitted with TRD. The compliance to this device was poor, although two have had significant improvement in their apnea. An orthodontic appliance was used in two patients with one responding successfully.
Sigmoid sinus involvement in middle‐ear infection
Authors: Amirmajdi Nematollah Mokhtari
Published: October 2006

It was thought that sigmoid sinus Involvement from middle‐ear infection would become a rare clinical entity with the introduction of antibiotics. However, this problem is otill prevalent.

Twelve hundred eighty cases of mastoid surgery were performed at Ghaem Medical Center and the author's private clinic between January 1978 and December 1985 in Mashad, Iran. In sixteen cases, surgically proven sigmoid sinus involvement was due to a bone eroding process of chronic ear infection. The pattern of the clinical picture is different than in the preantibiotic era.
Benign paroxysmal positional vertigo as a complication of postoperative bedrest
Authors: Gyo Kiyofumi
Published: October 2006

Seven cases of benign paroxysmal positional vertigo (BPPV) after operation were reported, occurring between the fourth, and 14th postoperative day. In three of the seven cases, the condition occurred when the patients first arose from bed after 5 to 6 days of postoperative bedrest. In two cases, BPPV occurred when patients moved their head while maintaining strict bedrest. In the other two cases, it occurred 1 to 4 days after patients had been released from bedrest. The cause of BPPV was considered to be postoperative bedrest which might have facilitated the deposition of precipitate on the cupula of the posterior semicircular canal. The prognosis was good, and all the patients recovered within 20 days.
The nasolabial musculocutaneous flap: Clinical and anatomical correlations
Authors: Hagan Warren E. , Walker Leon B.
Published: October 2006

The location of the facial artery beneath the facial mimetic muscles of the nasolabial groove allows surgical development of a true musculocutaneous flap. This report of 20 surgical flaps and six cadaveric dissections highlights the nasolabial musculocutaneous flap with its direct muscle perforating arteries which nourish the overlying skin. The absence of any flap's ischemic failure emphasizes the durability of the flap for various midface and oral reconstructive situations. Inferiorly‐based flaps are preferable on the basis of discussed anatomical findings. The musculocutaneous flap is especially suited for circumferential interruption of cutaneous blood supply as in the “V‐to‐Y” and island pedicle flaps.
Phototherapy with the argon laser on human melanoma cells “sensitized” with rhodamine‐123: A new method for tumor growth inhibition
Authors: Castro Dan J. , Ward Paul H. , Saxton Romaine E. , Fetterman Harold R. , Castro Donna J.
Published: October 2006

Laser photodynamic therapy of superficial malignancies is a promising new approach that will become clinically useful when fluorochromes with high tumor specificity and low toxicity to normal tissues are identified. We recently reported that the mitochondrial dye, Rhodamine‐123 (Rh‐123), at nontoxic doses, is an effective sensitizing agent for argon laser treatment of human squamous carcinoma and melanoma cells in vitro. We now report the complete inhibition of in vivo tumor development by human M24 melanoma cells transplanted subcutaneously into nu/nu mice after exposure to 1μg/ml of Rh‐123 for 1 hour and treatment with an argon laser at nonthermal temperatures of 38 to 40 °C. Significant in vivo growth was observed for all control tumors. These results demonstrate that Rh‐123 enhances the tumoricidal effects of the argon laser at nonthermal temperatures and provides evidence that effective photodynamic therapy may be possible in vivo with the new fluorochrome Rhodamine‐123.
Acceptability ratings of tracheoesophageal speech
Authors: Pindzola Rebekah H. , Cain Blanche H.
Published: October 2006

Thirty‐one naive listeners rated the intelligibility and acceptability of tracheoesophageal, esophageal, and normal laryngeal speech of 15 adult speakers. Intelligibility was measured using a multiple‐choice word test while acceptability was rated on a seven‐point equal‐appearing interval scale. Judgments were made on the features of fluency, pitch/quality, speech rate, inflection, and overall acceptability. Tracheoesophageal speech was found not to differ significantly from normal speech in intelligibility, rate, and inflection, but was less acceptable for fluency, pitch/quality and overall acceptability. Tracheoesophageal speech was more acceptable than esophageal speech for all features measured.
Long‐term observations on ceramic ossicular replacement prosthesis (corp)
Authors: Yamamoto Etsuo
Published: October 2006

Long‐term observations on the ceramic ossicular replacement prosthesis (CORP) were performed. Extrusion rates were 8.3% for CORP‐P and 5.2% for CORP‐T, with most extrusions occurring within 2 years. Hearing results were satisfactory. Air‐bone gaps at 1 year were within 10 dB in 44.8% with CORP‐P and 31.2% with CORP‐T. At 3 to 5 years, air‐bone gaps were within 10 dB in 42.2% and 33.3%, respectively. It was found that the short‐term results were maintained even for the long period. Unsatisfactory hearing gains were caused mainly by the displacement or extrusion of CORP which could be prevented by fixation with the cartilage plate, deepening of the base of CORP‐P, fixing of the base of CORP‐T with the fascia, and additional fixing with the malleus handle and chorda tympani nerve.
Motions of the posterior pharyngeal wall in swallowing
Authors: Palmer Jeffrey B. , Tanaka Enchi , Siebens Arthur A.
Published: October 2006

The motions of the posterior pharyngeal wall during swallowing were studied in four asymptomatic males using a new method for videoradiography. Radiopaque markers of 4 mm diameter were affixed to the pharyngeal wall by suction. Ventrodorsal and axial components of motion were measured frame by frame. Large axial motions occurred during the pharyngeal stage of swallowing. Cephalad displacement of each marker occurred early and was followed by caudad motion. Within the pharyngoesophageal segment, there were cephalocaudal motions measuring as much as 25 mm. A late caudad motion beyond the reference position was observed in this segment in two participants. This late motion may play a role in passing the bolus through the pharyngoesophageal segment. The findings support the concept of an “engulfment” mechanism in pharyngeal kinesiology.
Pediatric upper airway obstruction due to ectopic thyroid: Classification and case reports
Authors: Chanin Louis R. , Greenberg Lyon M.
Published: October 2006

Few clinical situations can be as frightening, challenging, and as rewarding as stabilizing the airway of a child. Most causes of pediatric upper airway obstruction are well recognized, often discussed in the literature, and commonly encountered in practice. However, ectopic thyroid (i.e., thyroid tissue found in places other than its normal location) may be an unusual cause of pediatric upper airway obstruction with which the clinician may not be familiar. The resulting airway obstruction may be slow or rapid in onset, total or partial, and the relationship of the thyroid to the airway may be clear or obscure.

Two cases of obstructing ectopic thyroid are presented which demonstrate the spectrum within which this form of airway obstruction may occur. One case is the first reported example in the English literature of pediatric intratracheal thyroid. A review of the literature is also presented.

Four types of ectopic thyroid (lingual, sublingual, thyroglossal, and intralaryngotracheal) are illustrated and discussed in relation to their effect upon the pediatric upper airway. The authors also review the developmental anatomy of the thyroid and present two major theories regarding the development of intralaryngotracheal thyroid. The possible etiologies of the other ectopic forms are also discussed.
Beta‐lactamase‐producing bacteria in head and neck infection
Authors: Brook Itzhak
Published: October 2006

We have summarized our experience in recovery of beta‐lactamase‐producing bacteria (BLPB) in head and neck infection (UNI). These HNI include conjunctivitis, serous and chronic otitis media, cholesteatoma, chronic mastoiditis, chronic sinusitis, adenoiditis, recurrent tonsillitis in children and adults, peritonsillar abscess, and retropharyngeal abscess.

Beta‐lactamase‐producing bacteria were found in 262 (51%) of 513 patients with HNI; 72% had aerobic BLPB and 57% had anaerobic BLPB. The infections, where these organisms were most frequently recovered, were adenoiditis (85% of patients), tonsillitis in adults (82%) and children (74%), retropharyngeal abscess (71%), and chronic otitis media (57%). The predominant BLPB were Staphylococcus aureus (49% of patients with BLPB), the Bacteroides‐melaninogenicus group (28%), the Bacteroides fragilis group (20%), Pseudomonas aeruginosa (13%), Hemophilus influenzae (5%), and Branhamella catarrhalis (3%). The high incidence of recovery of BLPB in head and neck infections may have important implications on the antimicrobial management of these infections.
Perilymphatic fistula in children with preexisting sensorineural hearing loss
Authors: Pappps Dennis G. , Simpson L. Clark , Godwin George H.
Published: October 2006

Progression of preexisting sensorineural hearing loss (SNHL) in infants and children has been considered an indication for fistula exploration: is this approach warranted? On exploring 36 middle ears in 26 such children, we found a perilymphatic fistula (PLF) in four ears (11%). Although there was radiographic evidence of inner‐ear deformity in one half of these children, a definite fistula was found in only four of 18 radiographically abnormal ears explored (22%). Even in the four patients with a history of an “event” that could implicate a fistula such as exertion or barotrauma, a fistula was found in only one.

There are a number of possible causes for progression of a preexisting SNHL, and surgical exploration of the middle ear should not be recommended on the basis of progression alone. Instead, exploration for a suspected PLF should be strongly considered when there is also a history of an “event,” and/or radiographic evidence of inner‐ear abnormalities. Even under these conditions, one should be aware that fistulae are not likely to be found.
Comparison of complications following frontal sinus fractures managed with exploration with or without obliteration over 10 years
Authors: Wilson Brian C. , Davidson Bruce , Corey Jacquelynne P. , Haydon Richard C.
Published: October 2006

Two hundred twelve patients were treated for facial or skull trauma at the West Virginia University Hospital between the years 1977 and 1987. Sixty‐she of these patients had frontal sinus or nasofrontal duct trauma. Follow‐up information was obtained on 64 of these patients through clinic visits, chart review, questionnaires to patients and physicians, and telephone calls to the patients. Follow‐up greater than 1 year was obtained on 52 patients. Sixty‐four patients were managed either with a frontal sinus obliteration or with an open exploratory procedure. The incidence of complications occurring in the past 10 years after each of these procedures is compared. Because the indications for each procedure vary somewhat, data is presented on fracture etiology, associated injuries, specific fracture location, fracture displacement, severity of injury, and associated cerebrospinal fluid leaks.
Utilizing angiogenic agents to expedite the neovascularization process in skin flaps
Authors: Hom David B. , Baker Shan R. , Graham Linda M. , Mcclatchey Kenneth D.
Published: October 2006

The revascularization of a skin flap after flap transposition is an important step in flap survival. This study investigates the efficacy of certain angiogenic agents to expedite the neovascularization process and to increase the viability of skin flaps. Eighty‐four island skin flaps were designed on the auricles of 42 New Zealand White rabbits to achieve 90% necrosis over a 7‐day period. Thirty‐six flaps were treated with Endothelial Cell Growth Supplement (ECGS) or Endothelial Cell Growth Factor (ECGF) at several concentrations topically or immersed in Gelfoam. The remaining flaps were used as normal saline controls. Flap viability and peripheral neovascularization were documented by polar planimetry, angiography, and histological analysis.

The flap viability of the ECGS‐Gelfoam(r)‐treated flaps was 100% greater than their normal saline‐Gelfoam controls (p = .021). Flap angiograms demonstrated increased vascular ingrowth among the treated flaps compared to the controls. This study suggests that angiogenic agents can expedite flap neovascularization and have the potential to increase flap viability.
Cochlear hypoxia and the compound action potentials
Authors: Hildesheimer Minka , Muchnik Hava , Rubinstein Moshe
Published: October 2006

A relatively restricted area, including the ear, was perfused in guinea pigs with hypoxic blood having a pO2 of 10, 20, and 30 mm Hg, respectively. The changes induced to the cochlear action potentials were analyzed and the results compared with those obtained in a previous study in which the guinea pigs were rendered hypoxemic by ventilating them with air entrapped in a closed circuit from which the CO2 was continously absorbed. The changes induced to the cochlear action potentials by both methods were very similar. However, while using the territorial model for inducing hypoxia, 75% of the animals showed a threshold shift at a blood pO2 of 20 mm Hg and with the general model all the animals showed a threshold shift at 25 mm Hg blood pO2. In other words, if the hypoxic condition affected the whole body, other factors such as a slight, but continuous tendency to acidosis with significant increase in blood lactic acid concentration could join the oxygen deficit in affecting cochlear function.
Evoked accelerometry: A sensitive and accurate method for evaluating facial nerve function using a portable device
Authors: Zealear David L. , Korff Marjorie , Herzon Garrett D.
Published: October 2006

A new electrodiagnostic technique has been developed which can be used to monitor facial nerve function. The technique has been termed “evoked accelerometry” (EAC) and is administered by a portable DC powered device. In performing a test, the device stimulates the facial nerve and then measures the evoked muscular response by a small accelerometer sensor affixed to the face with suction. The magnitude of the response is displayed as a digital readout on the device meter. The degree to which a reading is subnormal indicates the extent of nerve degeneration. In a study of normal participants the stimulus‐response characteristics of the EAC technique were found to be similar to those of ENoG, indicating the clinical efficacy of the technique. However, evoked accelerometry was found to be more sensitive than ENoG (i.e., detectable response of 0.3% to 0.6% vs. 1.8% to 5.2%) and more accurate than ENoG (average error of 6.8% v.s. 13.9% to 20.7%).
Retropharyngeal abscess in children: A retrospective and historical analysis
Authors: Thompson Jerome W. , Reddk Phyllis , Cohen Seymour R.
Published: October 2006

The charts of 65 pediatric patients with the diagnosis of retropharyngeal abscess were reviewed. These represented a 36‐year experience with the disease. The findings were compared with those documented at the turn of the century and were also compared with findings over the last four decades. The data suggests that retropharyngeal abscess may be occurring later in childhood and may not always be preceded by a major detectable infection. Classic diagnostic findings of retropharyngeal bulge and neck stiffness were present in less than half of the patients. Gram‐negative and anaerobic organisms are being documented on culture more frequently than in the past. We theorize that liberal use of oral antibiotics prior to admission may have brought about these changes.
The membrane rupture theory of meniere's disease — is it valid?
Authors: Brown Dale H. , Mcclure Joseph A. , Downar‐Zapolski Zbigniew
Published: October 2006

The Membrane Rupture Theory states that the acute attack of Meniere's disease occurs when endolymph, with its high potassium ion concentration, escapes into the perilymph and surrounds the first‐order neuron. Initially, this causes partial depolarization of the nerve and an increased resting discharge, followed by complete depolarization. Clinically, one would expect an initial irritative nystagmus (toward the affected side) followed by a paralytic nystagmus (toward the unaffected side). To confirm this, the guinea pig perilymphatic space was perfused with an artificial endolymph solution. The results confirmed an irritative/paralytic sequence of nystagmus that differs from the pattern of spontaneous nystagmus observed with ENG monitoring during the acute attack of Meniere's disease. Early in the attack, one observes a paralytic nystagmus followed by a secondary nystagmus beating toward the affected side (similar to an irritative nystagmus) as the patient recovers. This raises questions about the validity of the Membrane Rupture Theory.
Vasculae decompression of the cochlear nerve in tinnitus sufferers
Authors: Meyerhoff William L. , Mickey Bruce E.
Published: October 2006

An estimated 40 million Americans suffer from tinnitus, and approximately 20% of these sufferers feel that the quality of their life is significantly impaired by this symptom. Despite thorough evaluation, the underlying etiology in the majority of these patients remains obscure or conjectural. Most of these patients will, however, benefit from consultation and avoidance of caffeine, nicotine, and salt, while others require biofeedback, amplification, masking, and even psychotherapy. On rare occasions, physicians are presented with a patient complaining of unilateral tinnitus of undetermined etiology who, in spite of a thorough evaluation and all conventional therapies, continues to be severely handicapped by that symptom. Early findings suggest that these patients may be suffering from vascular loop compression of the cochlear division of the eighth cranial nerve. When patients are carefully selected, retrosigmoid decompression of that vascular loop has provided gratifying relief.
Pseudotumor of the head and neck masquerading as neoplasia
Authors: Weisman Robert A. , Osguthorpe J. David
Published: October 2006

Four unusual cases of pseudotumor, which had clinical and radiographic findings suggesting neoplasia, are presented. One involved the maxillary sinus, destroying the lateral wall, and extending to the infratemporal fossa and the orbit. The second presented as an enlarging lacrimal gland tumor with ipsilateral parotid adenopathy, and the third as a large parapharyngeal mass that was diagnosed as a lymphoma on aspiration cytology. The fourth case documented the rare occurrence of a congenital pseudotumor, manifesting as proptosis in a neonate and thought to be a fibrosarcoma on frozen section study. Aggressive pseudotumors must be distinguished from malignancy to avoid unnecessary surgery or irradiation. Some cases can be distinguished from neoplasms by their dramatic response to oral steroid therapy, and others by characteristic features on CT or MRI. Due to the diverse cellular proliferation, aspiration cytology is infrequently helpful and diagnosis can be difficult on frozen section study. An approach to the diagnosis and management of pseudotumors is detailed.
Paeanasal sinus disease with intracranial extension: Aspergillosis versus malignancy
Authors: Sarti Edward J. , Blaugrund Stanley M. , Lin Pi Tang , Camins Martin B.
Published: October 2006

Aspergillus is a fungus with world‐wide distribution and a common endogenous contaminate of the upper respiratory tract. It has become an increasingly recognized pathogen in the paranasal sinuses. In its pathologic state it presents in one of several forms that may represent a continuum of the disease: allergic, noninvasive, invasive, and fulminant. The progression and prognosis of this disease depends on the location and immunologic status of the patient.

This case represents the fourth reported case of a nonimmunologic compromised patient with intracranial extension of aspergillosis. The patient presented with unilateral pansinusitis and radiographic evidence of orbital and anterior cranial fossa invasion. This case illustrates the difficulty of establishing the diagnosis of invasive aspergillosis and differentiating it from neoplastic entities. Radiographs and photomicrographs will be presented to establish this premise.
Clinical and laboratory characteristics of focal laryngeal dystonia: Study of 110 cases
Authors: Dds Andrew Blitzer, , Briny Mitchell F. , Fahn Stanley , Lovelace Robert E.
Published: October 2006

Spastic dysphonia is a syndrome often, producing a strain‐strangle voice. We have previously classified most of these patients as having focal laryngeal dystonia, a disorder of central motor processing. In a study of 1,280 cases of dystonia registered at the Dystonia Clinical Research Center at the Columbia‐Presbyterian Medical Center, we found 110 patients who had vocal cord involvement.

These patients had historical information evaluated for age of onset (mean 34.6 years), duration of symptoms (mean 13.8 years), sex (1.4:1 female to male) family history (positive in 23%), and primary (66%) and secondary (34%) etiology; neurological evaluation for other dystonic involvement (25% with segmental cranial involvement, 23% with generalized dystonia) or tremor (irregular 23%, regular 6% on EMG).

Treatment options were evaluated and included speech therapy, psychotherapy, biofeedback (with limited success), systemic medication (limited success except in abductor cases), nerve section (with late failure rate), and the use of botulinum toxin (improvement in all 34 injected patients).
Site of upper airway obstruction in patients with idiopathic obstructive sleep apnea
Authors: Chaban Roman , Cole Philip , Hoffstein Victor
Published: October 2006

We developed a technique to determine the site of upper airway obstruction in patients with idiopathic obstructive sleep apnea (OSA). This technique is based on the analysis of inspiratory airflow pressures at various levels of the pharyngeal airway during sleep. Pharyngeal pressure was measured by a moveable Millar catheter pressure transducer. The catheter's position in the airway was localized radiographically. Ten patients with OSA were tested: five patients were found to have upper airway obstruction at the level of the soft palate, and five had upper airway obstruction at the base of the tongue. We concluded that measuring airway pressures at multiple sites along the airway is useful in localizing the site of obstruction in patients with OSA, and may have important implications in terms of the patient's response to surgical treatment.