bluuebunny/crossref_metadata_2025 huggingface dataset:
Human Speech Development for an Implantable Artificial Larynx
Authors: Painter Colin , Fredrickson John M. , Kaiser Timothy , Karzon Roanne
Published: October 2014

An electromagnetic artificial larynx was implanted in two volunteer laryngectomees. Both patients were able to communicate well, but the voice quality still needed improving. Therefore, in this investigation, listener judgments were obtained of 22 different sound sources with a view to incorporating the preferred speech sound in a new version of the device. Electroglottograms were used as sound sources in a speech synthesizer and sentences were produced with different voice qualities for judgmental tests. The results of the listening tests showed a distinct preference for waveforms corresponding to a long completely open phase, a very brief completely closed phase, and an abrupt closing gesture. The optimum acoustic characteristics for the device will be used by electrical engineers to manufacture a new version of the artificial larynx with an improved voice quality.
Bronchoscopy in Diffuse Lung Disease: Evaluation by Open Lung Biopsy in Nondiagnostic Transbronchial Lung Biopsy
Authors: Chuang Ming T. , Krellenstein Daniel J. , Raskin Jonathan , Teirstein Alvin S.
Published: October 2014

Transbronchial lung biopsy through the flexible bronchoscope is used widely for the diagnosis of diffuse lung disease; however, a significant number of specimens obtained by the bronchoscopic 2-mm biopsy forceps will reveal nonspecific findings, eg, interstitial fibrosis or nonspecific pneumonitis. Such a report may be an accurate reflection of the presence of idiopathic pulmonary fibrosis or nonspecific pneumonitis, but may merely indicate that the true diagnosis has been missed. We retrospectively studied 38 patients with diffuse lung disease whose transbronchial lung biopsies yielded nonspecific abnormalities. Subsequently, these patients were subjected to open lung biopsies. Nineteen of the 38 patients (50%) had a specific diagnosis made by open lung biopsy. The diagnoses included bronchiolitis obliterans, alveolar proteinosis, metastatic carcinoma, lymphoma, tuberculosis, and bronchioloalveolar cell carcinoma. Although transbronchial lung biopsy is useful in the diagnosis of many diffuse lung diseases, it is not a replacement for open lung biopsy. When nonspecific findings by transbronchial lung biopsy do not correlate with the clinical picture, open lung biopsy should be performed.
Vocal Cord Paralysis Associated with Cystic Fibrosis
Authors: Zitsch Robert P. , Reilly James S.
Published: October 2014

The course of the left recurrent laryngeal nerve through the chest brings it in close proximity with the heart and great cardiac vessels. Diseases of the heart and the great vessels are known to cause vocal cord paralysis, probably by mechanical injury to the recurrent laryngeal nerve. Pulmonary artery hypertension and dilation occur in up to 80% of patients with cystic fibrosis. We report a case of a 23-year-old woman with cystic fibrosis and left vocal cord paralysis. We believe that sudden pulmonary artery expansion produced recurrent laryngeal nerve injury and vocal cord paralysis. This is only the second association of unilateral vocal cord paralysis and cystic fibrosis in the medical literature. The pathophysiology of the cardiovocal syndrome is discussed.
Risk Factors for Intubation Injury of the Larynx
Authors: Volpi David , Kuriloff Daniel B. , Lin Pi-Tang , Kimmelman Charles P.
Published: October 2014

The endolaryngeal structures are subjected to insult from prolonged endotracheal intubation. Factors that may exacerbate this injury include intubation technique, duration of intubation, tube geometry and constitution, frequency of reintubation, and patient-related factors such as concomitant medical diseases. The contribution of underlying medical disease to laryngeal intubation injury was studied prospectively by sequential endoscopy from the time of tracheotomy. Diabetes mellitus, congestive heart failure, and a history of stroke or tuberculosis increased the likelihood of severe laryngeal injury. The association of these disorders with severe laryngeal injury should lead to consideration of earlier tracheotomy in such patients.
Clinical Characteristics of Nosocomial Sinusitis
Authors: Humphrey Margaret A. , Simpson George T. , Grindlinger Gene A.
Published: October 2014

Paranasal sinusitis is an important source of sepsis and morbidity in head injury victims and requires aggressive pursuit and therapy. Of 208 head-injured patients, 24 developed paranasal sinusitis. The Glasgow Coma Scale score of the sinusitis patients was 7.1 ± 3.9. Nineteen patients were intubated nasotracheally, and five were intubated orally. Sinus air fluid levels, indicative of bleeding into the sinus, were seen on 17 initial computed tomographic scans. Maxillary sinus suppuration occurred in 23 patients; in 20 it was the initial sinus involved. Twenty-one patients developed polymicrobial sinusitis. Coexisting infections were common. In 15 patients with concurrent tracheobronchitis or pneumonia, organisms identical to those in sinus aspirations were recovered from the sputum. Seven patients had associated bacteremia. Meningitis in six patients shared a common pathogen with their sinusitis. Nonoperative management successfully resolved sinus infection in 19 cases. Five patients required open sinusotomy.
Airway Complications from Laryngoscopy and Panendoscopy
Authors: Hill Richard S. , Koltai Peter J. , Parnes Steven M.
Published: October 2014

Laryngoscopy and panendoscopy can cause airway complications. To determine the risk to the airway from reintubation following general anesthesia in otolaryngology patients, we examined recovery room and anesthesia records at the Albany Veterans Administration Medical Center covering a 10-year period. From this information we determined the incidence of recovery room reintubation and studied airway risk factors associated with otolaryngologic endoscopy. From 1975 to 1984, 10,060 surgical patients were intubated at the Albany VA Medical Center. Only 17 patients (0.17%) required reintubation. Of 1,365 otolaryngology patients intubated during the same period, 324 had laryngoscopy and 302 had panendoscopy. Significantly, four laryngoscopy patients (1.2%) and nine panendoscopy patients (3%) required recovery room intubation. Nine endoscopy patients needed reintubation within 1 hour of extubation. We conclude that the risk of postoperative airway compromise is significantly greater among patients who underwent diagnostic laryngoscopy and panendoscopy than among patients who had general anesthesia for other reasons.
Hereditary Congenital Laryngeal Abductor Paralysis
Authors: Isaacson Glenn , Moya Fernando
Published: October 2014

We discuss the cases of a mother and daughter with paralysis of laryngeal abduction at birth as an isolated symptom. These patients are compared with other known families with congenital abductor paralysis, and inferences are made about the cause and mechanism of the disorder. A plan of diagnosis and management is presented.
Treatment of Laryngeal Sarcoidosis with Intralesional Steroid Injection
Authors: Krespi Yosef P. , Husain Shaista , Mitrani Moises , Meltzer Charles J.
Published: October 2014

Laryngeal sarcoidosis presents with hoarseness, cough, and dysphagia. Shortness of breath due to upper airway obstruction may occur. Indirect laryngoscopy reveals mucosal edema and erythema, granulomas, and nodules. The supraglottic larynx is the most frequently affected area. Systemic corticosteroids can be used initially; however, with persistent symptoms and/or severe airway problems, intralesional steroid injections may be more effective, as in the six patients presented.
Pathology Consultation Laryngeal Involvement by Thyroid Disease
Authors: Batsakis John G.
Published: October 2014

Thyroid tissue or neoplastic derivatives therefrom in the larynx or trachea have their genesis in either ectopia or a direct invasion by carcinoma of the thyroid gland proper. The benign lesions are found preponderantly in patients from regions in which goiter is endemic, and they may represent as much as 7% of all benign tracheal tumors. Laryngotracheal invasion by thyroid carcinoma also has a frequency of approximately 7%, with all histologic types represented.
Recent Advances in Cochlear Blood Flow Measurements
Authors: Sillman Jonathon S. , Larouere Michael J. , Nuttall Alfred L. , Lawrence Merle , Miller Josef M.
Published: October 2014

Changes in blood flow to the inner ear have been thought to influence or underlie a number of cochlear diseases, including some forms of noise-induced hearing loss, sudden hearing loss, and Meniere's disease. Recently, important advances have been made in two technologies for the study of cochlear blood flow. The first is in the area of vital microscopic studies of cochlear microcirculation, and the second is based on the introduction of laser technology in the form of laser Doppler flowmetry. In this report, measurements are given of changes in cochlear circulation caused by carbon dioxide breathing, intravenous phenylephrine injection, systemic hemodilution, positive end expiratory pressure, and direct electrical stimulation of the cochlea. From these changes, we observe that cochlear blood circulation responds to systemic blood pressure alterations and is subject to local flow control mechanisms. Linearity and speed of response of the laser Doppler instrumentation also are shown. These advances show promise for contributing to our knowledge of control mechanisms of inner ear blood flow and for revealing the influence of various pharmacologic agents of potential clinical value.
Cochlea and Heart as End-Organs in Small Vessel Disease
Authors: Sidman James D. , Pulver Stephen H. , Prazma Jiri , Pillsbury Harold C.
Published: October 2014

Many studies have been done recently to determine the role of various stresses on the heart and peripheral vasculature. Although damage to coronary arteries and renal vessels has been well described, the ear as an end-organ in small vessel disease has been largely neglected. In a previous study, we examined the effects of noise, hypertension, and an atherogenic diet on the microvasculature of the cochleas in rats. The present study examines the effects of these stresses on the hearts of the same rats. The technique used to examine microvascular blood flow was the injection of unlabeled microspheres prior to killing. We found that the blood flow in the cochleas was reduced significantly in hypertensive animals exposed to noise or an atherogenic diet compared to that of normotensive or hypertensive control animals. The hearts of such animals, however, showed decreased myocardial blood flow only when compared to those of normotensive control animals, not when compared to those of hypertensive control animals.
Neurons of the Inferior Medullary Velum in the Cerebellopontine Angle
Authors: Terr Leonid I. , House William F.
Published: October 2014

The edge of the inferior medullary velum (tenia) is attached in part to the surface of several structures localized in the cerebellopontine angle, including the cochlear nuclear complex and the pontobulbar body. Since superficial layers of these structures contain numerous neurons, we examined the possibility that neurons are also present within the velum. On light microscopy, we found groups of neurons accumulated immediately under the pia mater covering the tenia. The number of groups in different specimens varied from one to three, and the groups were rounded or oval in shape. A bundle of fibers running from the main mass of the brain stem toward these groups was revealed with a myelin-staining technique. The majority of neurons in the groups were angular in shape. These findings may contribute to our understanding of the general and surgical anatomy of the cerebellopontine angle.
Hearing Preservation in Unilateral Acoustic Neuroma Surgery
Authors: Gardner Gale , Robertson Jon H.
Published: October 2014

This paper reviews the principal English literature on hearing preservation in unilateral acoustic neuroma surgery. Seventeen case reports and 13 surgical series are included. In addition, we report ten cases of our own, two with successful hearing preservation. The purpose of this report is to study feasibility, success rate, and associated problems. Previous reports have been compared in terms of criteria that we have selected. A classification system similar to Silverstein's is used. The total number of cases under review is 621, with 221 reported successes. Cases limited to those having a unilateral acoustic neuroma, with valid supportive audiometry, were 394, with 131 successes. The approximate overall rate of success is 33%. There are five cases of hearing preservation with unilateral acoustic neuromas 3 cm or larger when supporting audiometric data are available, the largest being “4–5 centimeters.” Problems included mixing of unilateral acoustic neuromas with other types of tumors and failure to include comprehensive data, particularly audiometry. We conclude 1) that hearing preservation is a reasonable goal in unilateral acoustic neuroma surgery, although the number of available candidates is relatively small and 2) that intelligent selection of patients and high quality surgical technique are the keys to success.
Morphologic Effects of Glycerol and Urea on Cochlear Tissues of the Chinchilla
Authors: Wright Charles G. , Lee David H. , Meyerhoff William L. , Roland Peter S.
Published: October 2014

Glycerol and urea are used as test agents in confirming the diagnosis of endolymphatic hydrops. Although both substances act as osmotic diuretics, recent evidence suggests that they may have differing physiologic effects on the inner ear. This study was designed to compare the morphologic effects of urea and glycerol on cochlear tissues, using the chinchilla as an experimental model. Animals were given subcutaneous injections of glycerol (2 g/kg) or urea (1.2 g/kg) over periods of 3 hours, 4 days, or 1 week. Both agents were found to produce ultrastructural changes, including spiral ligament vacuolization, intracellular alterations of the stria vascularis, and increased numbers of Hensen's bodies in outer hair cells. These alterations appeared indicative of metabolic stress, but not toxicity. The morphologic findings provided no evidence that glycerol and urea affect the inner ear by fundamentally different mechanisms of action.
The Tricyclic Trimipramine in the Treatment of Subjective Tinnitus
Authors: Mihail R. Clifford , Fishburne Joseph , Crowley Joanne M. , Reinwall John E. , Walden Brian E. , Zajtchuk Joan T.
Published: October 2014

We examined 26 consecutive patients with subjective tinnitus. All subjects were treated with the tricyclic antidepressant trimipramine in a double-blind study, each subject acting as his own control. All subjects were evaluated with pure tone audiometry, site of lesion testing, and auditory brain stem evoked response. The tinnitus assessment consisted of frequency and intensity matching, the determination of masking levels, and a subjective evaluation of severity. Plasma levels of trimipramine were monitored at regular intervals, and the Zung and Millon inventories were administered at the beginning and end of each study period. Nineteen subjects completed the study. Within the trimipramine group, one reported complete disappearance of his tinnitus, eight reported improvement, three no change, and seven that tinnitus was worse. Within the placebo group, eight reported improvement, seven no change, and four that tinnitus was worse. The natural history of tinnitus is such that what has been observed may reflect the evolution of the disease itself, rather than the effect of treatment. We feel that while tricyclics may not have been shown to be effective, the placebo effect played a significant role in the results obtained.
Prospective Study of the Effects of Ventilation Tubes on Hearing after Radiotherapy for Carcinoma of Nasopharynx
Authors: Chowdhury C. R. , Tsao S. Y. , Ho J. H. C. , Au G. K. H. , Wright A. , Tung Y.
Published: October 2014

In patients with nasopharyngeal carcinoma, deafness sometimes occurs following radiotherapy. It is usually conductive, but may be sensorineural. Tinnitus is present frequently and usually is distressing. The role of ventilation tubes (grommets) in relieving these problems was assessed in a prospective randomized controlled trial of 115 patients. In the group with grommets, there was an improvement in hearing, with a reduction of the averaged air-bone gap (p< .01). This was not found in the control group without ventilation tubes, who developed a larger conductive loss (p< .01) and, in addition, a slight deterioration of the averaged bone conduction threshold (p< .01). Surprisingly, the group with grommets did not develop this sensorineural loss (p> .01). In addition, tinnitus was improved significantly by the insertion of ventilation tubes (p< .01). Neither necrosis nor stenosis of the external auditory meatus was found in either group.
Auditory and Vestibular Disorders Due to Barotrauma
Authors: Nakashima Tsutomu , Itoh Michio , Sato Masahiro , Watanabe Yusuke , Yanagita Noriyuki
Published: October 2014

In order to investigate auditory and vestibular disorders caused by barotrauma, 12 guinea pigs were exposed to compression and decompression between 1 absolute pressure (ATA) and 2 ATA in a pressure chamber. During the atmospheric pressure change spontaneous nystagmus occurred in two thirds of the animals. Auditory dysfunction that showed the difference between the right and left ears was confirmed by auditory brain stem response and Preyer's reflex in the animals with spontaneous nystagmus. Damage to the organ of Corti was the most significant cause for the auditory dysfunction. Though findings attributed to the rupture of the round window membrane were recognized in four ears, the rupture or hemorrhage of the round window membrane was not the direct cause of the auditory dysfunction. The significance of the round window membrane rupture is discussed.
Acute Effects of Irradiation on Middle Ear Mucosa
Authors: Ohashi Yoshihiro , Ikeoka Hiroshi , Nakai Yoshiaki , Koshimo Hiroyuki , Esaki Yusuke , Onoyama Yasuto
Published: October 2014

Single field, fixed irradiation of bilateral tympanic cavities using 200-kV x-rays was administered to five guinea pigs. The irradiation dose was 30 Gy. They were killed immediately after irradiation, and bilateral middle ear mucosa was examined for ciliary activity and epithelial structure. Significant deterioration of the ciliary activity in the middle ear mucosa was observed, proximal as well as distal to the eustachian tube. Electron microscopy showed various changes in the irradiated middle ear mucosa. The most conspicuous findings were hyperreactivity in secretion, vacuolation of ciliated cells, and stomal edema.
Human Leukocyte Antigen-A, -B, -C Tissue Types in Patients with Middle Earcc Cholesteatoma
Authors: Felding Jens Ulrik , Pedersen Christian Brahe , Lamm Lars U.
Published: October 2014

Two series of consecutive, nonrelated patients with middle ear cholesteatoma verified by operation were tissue typed for human leukocyte antigens (HLAs) in order to demonstrate any associations. The first series (102 patients) showed only a possible increase of HLA-B8 and HLA-A2. Because HLA-B8 is one of the antigens most often involved in associations with organ-specific autoimmune diseases, and because of the close relationship between HLA-B8 and HLA-DR3, the second series (48 patients) was tissue typed for these two antigens. This second series showed a similar increase of HLA-B8/DR3, but the difference was not statistically significant.
Carbon Dioxide Laser Surgery in Otorhinolaryngology: Pulsed Beam versus Continuous Wave Beam
Authors: Grossenbacher Rudolf , Sutter Rudolf
Published: October 2014

According to various authors, the use of the carbon dioxide laser beam in pulsed form has the following advantages: Better cutting action at the same mean power as that of the continuous laser, and less tissue damage at the edge of the cut. To date, however, there are no conclusive tests that demonstrate that pulsed operation of the CO2 laser has clear advantages over continuous operation. This study compares the effects of a pulsed laser and a continuous laser on freshly removed human palatine tonsils and skeletal muscle tissue. The depth of thermal tissue damage was measured microscopically. It was observed that the depth of damage at the edge of the cut tissue decreased with increasing power density with both the pulsed laser and the continuous laser. With comparable power densities, however, pulsed operation unexpectedly produced somewhat deeper damage at the edge of the cut than did the continuous operation. The results obtained indicate that the pulsed CO2 lasers available today have no advantages over the continuous mode CO2 lasers for otolaryngologic surgical applications.
Comparison of the Intrasubject Repeatability of Auditory Brain Stem and Middle Latency Responses Elicited in Young Children
Authors: Kavanagh Kevin T. , Crews Patricia L. , Domico William D. , McCormick Virginia A.
Published: October 2014

The auditory brain stem response (ABR) and middle latency response (MLR) were studied in 48 young children (96 ears). The responses were elicited using low intensity stimuli (30-dB nHL clicks) and simultaneously were recorded on a dual time base. Both the ABR and MLR were elicited in 70 ears. In 12 ears, just one response was recorded (ABR in eight ears and the MLR in four ears). In 14 ears, neither response was recorded. Test-retest analysis on the same subject demonstrated that the ABR was more repeatable and easier to identify than the MLR. The test-retest difference was determined for the amplitude and latency of the ABR and MLR waveforms. The test-retest latency difference for wave Pa was found to be 3.6 times larger than for wave V. The normalized test-retest amplitude difference for Pø-Na, Na-Pa, and Pa-Nb was found to be two to three times larger than for wave V. These data support the conclusion that the ABR, rather than the MLR, should be used to measure hearing in young children. The authors also advocate using minimal high pass (HP) filtering when recording the ABR in a sedated or sleeping child. Muscle artifact was not found to be a problem. The authors suggest the use of minimal HP filtering so that phase-shift distortion is minimized and a larger response amplitude can be recorded.
Effects of Bacterial Endotoxin on Ciliary Activity in the Tubotympanum
Authors: Ohashi Yoshihiro , Nakai Yoshiaki , Ikeoka Hiroshi , Esaki Yusuke , Koshimo Hiroyuki
Published: October 2014

The discovery of endotoxin in effusion of otitis media with effusion (OME) has suggested the possibility that bacterial endotoxin may be involved in the pathogenesis and development of OME. In this study, we investigated the direct effects of lipopolysaccharide (LPS), possessing the major part of endotoxin activity, on the ciliary activity in the tubotympanum. The study shows that LPS deteriorates ciliary activity in a dose-response fashion and that even low levels can, with extended exposure, cause dysfunction of cilia. It can be postulated that endotoxin in middle ear effusions aggravates the condition of mucociliary dysfunction, thus leading to chronic OME.
Statistical Correlations among Supraglottic Cancers
Authors: Robbins K. Thomas , Gray Lincoln , Michaels Leslie
Published: October 2014

The purpose of this study was to quantify the extent to which the presence or absence of cancer in endoscopically evaluable regions of the supraglottic larynx predicted occurrence in a region less easy to visualize but of critical importance to the nature of treatment. Histologic findings from 32 specimens were subjected to two separate statistical analyses. In the first analysis, the presence of cancer on the floor of the ventricle was the best predictor of tumor below this level. The combination of variables with the best correlation was cancer on the floor of the ventricle and in the vestibular folds. In the second analysis, involvements of the deep structures in the aryepiglottic folds and in the infrahyoid epiglottis were the only significant predictors of tumor extending to the preepiglottic space. The results suggest that such statistical analyses may provide guidelines for selection of treatment.
Clinical Nasal Obstruction and Objective Respiratory Mode Determination
Authors: Drake Amelia F. , Vig Peter S. , Keall Heather , Krause Charles J.
Published: October 2014

Nasal obstruction represents a considerable portion of the symptoms addressed by the otolaryngologist. It has received widespread interest in the orthodontic literature as well, because of the presumed relation between nasal obstruction and facial growth, especially vertical maxillary excess. The range of normal variation in oral versus nasal breathing has not been defined. This study attempted to correlate patient symptoms with respiratory mode. A sample of 20 symptomatic adult subjects presenting with nasal obstruction was compared to a control sample of 20 asymptomatic adults by means of SNORT (Simultaneous Nasal and Oral Respirometric Technique). Nasal resistance was significantly different between the two groups, but percent nasality (that proportion of the total volume of air breathed nasally) was a more consistent and significant finding. The relevance of these results to both clinical and basic physiology is discussed.
Tracheotomies: A 10-Year Experience in 319 Children
Authors: Crysdale William S. , Feldman Robert I. , Naito Kensei
Published: October 2014

A retrospective analysis was made of 319 patients having tracheotomies at the Hospital for Sick Children in Toronto between 1976 and 1985. In comparison to a similar study at the same institution completed 15 years earlier, the average number of tracheotomies per year has declined by half, because almost no tracheotomies are now done in patients with epiglottitis and tracheitis. Tracheotomies for children with CNS disorders and craniofacial anomalies are relatively more frequent. The average duration of tracheotomy is almost 1 year (339 days). Complications occurred in 30% of patients, but tracheotomy-related mortality was less than 1%.
Upper Aerodigestive Tract Manifestations of Cicatricial Pemphigoid
Authors: Hanson Ronald D. , Olsen Kerry D. , Rogers Roy S.
Published: October 2014

Cicatricial pemphigoid is a chronic mucosal blistering disorder with a predilection for subsequent scar formation. Many physicians may be unaware of the various presentations and sequelae of this uncommon disease. This report of the largest series to date focuses on the upper aerodigestive tract manifestations of this disease. During the years 1975 to 1985, 142 patients with cicatricial pemphigoid were seen at the Mayo Clinic. There were 93 women and 49 men; the age range was 21 to 92 years. Mucosal lesions occurred most often in the mucous membranes of the oral cavity and conjunctiva. Involvement of the pharynx, larynx, and esophagus was less common. Stenosis of the nasopharynx or larynx necessitated surgical repair in several persons and caused obstructive sleep apnea in two. The otolaryngologist can make an important contribution to the early recognition, diagnosis, and management of the complications of cicatricial pemphigoid.
Near-Fatal Complication of Tracheal T-Tube Use
Authors: Calhoun Karen H. , Deskin Ronald W. , Bailey Byron J.
Published: October 2014

Stenosis of the larynx and trachea is an unfortunate sequel to many thermal injuries. Numerous surgical techniques have been developed for correction of such problems, many involving use of a tracheal T-tube. We report a serious complication attributed to the use of such a tube. Factors contributing to this complication are analyzed and methods for avoiding similar near-catastrophes discussed.
Major Congenital Ear Malformations: Surgical Management and Results
Authors: Lambert Paul R.
Published: October 2014

Fifteen patients with major congenital aural atresia underwent operations using an anterior (trans-atretic bone) approach. Facial nerve monitoring was used in all cases and there were no instances of facial nerve injury. Postoperatively, two thirds of the patients had speech reception thresholds of 30 dB or better; the air conduction threshold (averaged for 500, 1,000, and 2,000 Hz) improved at least 25 dB in 80% of the patients and at least 30 dB in 60% of the patients (follow-up, 10 to 29 months). Minor revision surgery was necessary in three patients. On the basis of this series, several conclusions were made. First, one of the most important factors in proper patient selection is the degree of middle ear development on computed tomography, both in terms of size and ossicular formation. Second, every attempt should be made to keep the ossicular chain intact (versus use of a prosthesis), as this appears to optimize hearing results. Third, embryologic considerations and surgical experience predict a mobile stapes in the majority of major atresias. Lastly, facial nerve abnormalities are to be expected, especially in patients with significant microtia, but facial nerve monitoring will help minimize the risk of facial nerve injury.
Ventral Cleft of the Larynx in an Adult
Authors: Schild Joyce A. , Mafee Mahmood F.
Published: October 2014

Congenital clefts of the larynx are rare and usually found dorsally. This case report describes a patient with a partial anterior nonfusion, or ventral cleft, of the thyroid cartilage. This was first noted on computed tomography of the larynx used for delineation of carcinoma and was confirmed by horizontal whole mount histologic sections of the resected larynx. The thyroid cartilage suggested arrested fusion of the laminae in the middle to late embryonic period. This patient had an adult form of this rarely reported anomaly and the first, to our knowledge, detected with CT scan.
Detection of Gastroesophageal Reflux in the Head and Neck: The Role of Scintigraphy
Authors: Kuriloff Daniel B. , Goldfarb Richard , Chodosh Paul , Ongseng Fukiat
Published: October 2014

Patients with gastroesophageal reflux (GER) present to the head and neck specialist with a myriad of nonspecific complaints that may be manifestations of pharyngoesophageal or upper airway involvement. Numerous diagnostic tests for GER have been used in the past with varying success. In the present study, gastroesophageal scintigraphy using 99 mtechnetium-sulfur colloid was used to evaluate 28 patients with head and neck manifestations of GER. The role of gastroesophageal scintigraphy as an accurate and noninvasive method of detecting GER is discussed in the context of other current diagnostic modalities.
Relapsing Polychondritis
Authors: Batsakis John G. , Manning John T.
Published: October 2014

Inflammatory destruction of cartilages, presumably on an autoimmune basis, characterizes relapsing polychondritis, a disease of varying severity and outcome. The otolaryngologist–head and neck surgeon is often the first physician contact, because the preponderance of signs and symptoms are in the head and neck, ie, auricular and nasal chondritis, ocular and auditory manifestations, and laryngotracheobronchial involvement.
Implantation of a Recurrent Laryngeal Nerve Stimulator for the Treatment of Spastic Dysphonia
Authors: Friedman Michael , Grybauskas Vytenis T. , Toriumi Dean M. , Applebaum Edward L.
Published: October 2014

Spastic dysphonia, a rare speech disorder, is characterized by strained phonation with excessively adducted vocal cords. Recurrent laryngeal nerve section, botulinum toxin injection into the vocalis-thyroarytenoid muscle complex, and other techniques have been used to treat this disorder. We have used percutaneous electrical stimulation of the recurrent laryngeal nerve with good results. Previous dog studies demonstrated the relative safety of an implantable recurrent laryngeal nerve stimulator. In this study, we directly stimulated the recurrent laryngeal nerve and vagus nerve in a dog without change in cardiorespiratory status. A Medtronic peripheral nerve stimulator was implanted in a patient with abductor spastic dysphonia. The cuff electrode was positioned around the recurrent laryngeal nerve and stimulation resulted in improvement in her voice. Extensive cardiopulmonary monitoring did not reveal any adverse response to stimulation and there was no discomfort to the patient. On the basis of the good results of this preliminary study, further study with long-term follow-up is under way.
Contractile Properties of Canine Thyroarytenoid Muscle Reinnervated from the Ansa Cervicalis
Authors: Rice Dale H. , Cooper Donald S.
Published: October 2014

In an attempt to obtain data on the contractile properties of vocal fold muscle reinnervated from the ansa cervicalis, we severed the recurrent nerve and connected its distal stump to the ansa cervicalis by an end-to-end anastomosis in a series of dogs. Each dog was allowed to heal for 5 months. Then the section of the thyroid cartilage on which the vocal fold muscle inserted was detached, connected to an isometric force transducer, and activated by indirect stimulation successively on both the operated and unoperated sides. A series of twitch contractions was recorded from each side. In two dogs no contractile response was obtained. In the three others, the twitch contraction time was increased significantly, by 23% to 60%. In two of three dogs, the operated muscle was significantly weaker than the unoperated muscle. The reinnervated thyroarytenoid muscle changed its speed in the direction of the donor sternothyroid muscle.
Vestibulospinal Findings in Two Syndromes with Spontaneous Vertigo Attacks
Authors: Norré Marcel E. , Forrez Gabriel , Beckers Ann
Published: October 2014

The influence of vestibular dysfunction upon the vestibulospinal reflex (VSR) in two common peripheral syndromes was investigated by two types of posturographic examination: “static” posturography, recording and analyzing the postural sway in stance, and “kinetic” posturography, recording the stepping in place test. The influence of the dysfunction was examined outside the attacks, ie, between attacks and not during or immediately after an attack, in patients with Meniere's disease and in others with a sudden vestibular loss syndrome, “neuronitis.” However, in both syndromes the influence of the dysfunction was obvious only in some patients; this indicates that central adaptation intervened in the other patients. In this way, central compensation related to the VSR was assessed and compared with compensation for the vestibulo-ocular reflex assessed by the rotation tests. Discordance was shown in a number of cases, ie, a number of cases showed compensation for one reflex, but not for the other. Comparison of the results of both posturographic methods also showed discordance. Normal performance in the walking test could not always be correlated with normal performance in the standing test and vice versa.
Mona Lisa Syndrome: Solving the Enigma of the Gioconda Smile
Authors: Adour Kedar K.
Published: October 2014

The Mona Lisa smile is presented as a possible example of facial muscle contracture that develops after Bell's palsy when the facial nerve has undergone partial wallerian degeneration and has regenerated. The accompanying synkinesis would explain many of the known facts surrounding the painting and is a classic example of Leonardo da Vinci as the compulsive anatomist who combined art and science.
Natural History of Treated T1N0 Squamous Carcinoma of the Glottis
Authors: Kaiser Timothy N. , Sessions Donald G. , Harvey Joseph E.
Published: October 2014

The records of 373 patients with T1N0 squamous carcinoma of the glottis were examined. Of these, 271 underwent initial hemilaryngectomy; 102 had full-course irradiation for cure. While the overall survival rates of the two initial therapies were similar, failure of the initial treatment modality was approximately twice as frequent in the irradiated patients (34.4%) as in the patients undergoing hemilaryngectomy (16.9%). The effect of this difference in initial failure rate on quality of life and on cost of overall therapy will be discussed.
Chemically Induced Esthesioneuroepithelioma: Ultrastructural Findings
Authors: Vollrath Michael , Altmannsberger Michael
Published: October 2014

Tumors of the olfactory epithelium of rats were induced with two different nitrosamines: 2,6-dimethylnitrosomorpholine and N-nitrosopiperidine. Both carcinogens yielded identical tumors consisting of small, undifferentiated, neuroblastic cell elements without specialized cell contact. Cell processes contained microtubuli, centrioles, and neurosecretory granules. Two kinds of rosettes were encountered frequently: Neuroblastic Homer Wright rosettes consisted of undifferentiated cells, surrounding a minute lumen filled with amorphous material; and Flexner rosettes showed a higher degree of maturation. Inside their central lumen, cell processes with characteristic features of olfactory sensory cells (basal bodies, cilia, centrioles, microtubuli) could be demonstrated. The stem cell of this tumor is most likely the undifferentiated light basal cell inside the olfactory epithelium, since its ultrastructural appearance and its cytoskeleton are alike. At least under neoplastic conditions, this stem cell may likewise differentiate into epithelial cells, since transition to squamous cell carcinomas has been observed. In view of their overwhelming similarity to their human counterpart, the induced tumors are most likely to represent esthesioneuroepitheliomas.
Effect of Prostaglandin E2 and Bacterial Endotoxin on the Rate of Dye Transport in the Eustachian Tube of the Chinchilla
Authors: Bakaletz Lauren O. , Griffith Stephen R. , Lim David J.
Published: October 2014

To determine the effects of various biologic agents on the rate of fluid transport in the eustachian tube of the chinchilla, we have established an in situ method of measuring dye transport in which the bulla remains intact. The normal rate of dye transport from an injection site in the superior bulla to the nasopharyngeal orifice of the eustachian tube was 130 ± 10 seconds. Inhibition of ciliary activity with the local anesthetic bupivacaine resulted in a saturable delay of transport (> 15 minutes), while exposure to the β-adrenergic stimulator isoproterenol caused a significant increase in transport rate (79 ± 7 seconds). Two inflammatory mediators commonly found in chronic middle ear effusions were also tested for their effect on fluid transport by the mucociliary apparatus. Bacterial endotoxin reduced transport rates at high concentrations, while prostaglandin E2 had no effect at any concentration tested.
Protease Inhibitors in Middle Ear Effusions from Experimental Otitis Media with Effusion: Kinetics of α1-Antitrypsin and α2-Macroglobulin Levels
Authors: Hamaguchi Yukiyoshi , Juhn Steven K. , Sakakura Yasuo
Published: October 2014

Alpha 1-antitrypsin (α1-AT) and alpha 2-macroglobulin (α2-M) were measured by both immunochemical and functional assays in paired plasma and middle ear effusions (MEEs) from experimental otitis media models (serous otitis media [SOM], purulent otitis media [POM], and SOM + POM). The MEE/plasma ratio of α1-AT in SOM was significantly higher than that in POM (p< .01) because of the high α1-AT level in POM plasma. The ratio of both antitryptic activity and trypsin-binding activity in POM was significantly higher than that in SOM + POM (p< .01, < .05), and significantly lower than that in SOM (p< .01). The majority of both inhibitors in SOM exist as the free state, and the reaction between proteases and inhibitors in POM and SOM + POM is more active than that in SOM. It is concluded that both α1-AT and α2-M appear to play an important role in the protection of middle ear mucosa by forming protease-inhibitor complexes to reduce proteolytic damage in POM and SOM + POM models.
Acute Effects of Sulfur Dioxide Exposure on the Middle Ear Mucosa
Authors: Ohashi Yoshihiro , Nakai Yoshiaki , Koshimo Hiroyuki , Ikeoka Hiroshi , Esaki Yusuke
Published: October 2014

A variety of atmospheric pollutants are known to depress mucociliary function in the respiratory system. Since the mucociliary function in the middle ear is similar, and the middle ear may be invaded by atmospheric pollutants, we decided to investigate the possible contribution of sulfur dioxide to middle ear effusion. Guinea pigs were exposed for 24 hours to 300 ppm of sulfur dioxide or air. Immediately after exposure, ciliary activity and epithelial structure were examined close to the tympanic orifice (proximal site) and more distal to it (distal site). In the animals exposed to sulfur dioxide, no effusion was found in the tympanic cavity. Ciliary activity was reduced only in the distal site. Electron microscopy demonstrated hypersecretion in the proximal site and severe pathologic changes in the distal site. Although the normally functioning cilia in the proximal site may prevent retention of surplus secretions in the ear, sulfur dioxide may promote middle ear effusion when combined with other detrimental factors, because it stimulates mucus secretion in the proximal site and impairs ciliary function in the distal site.
Brain Stem Auditory Evoked Potentials in Jaundiced Gunn Rats
Authors: Shapiro Steven M. , Hecox Kurt E.
Published: October 2014

Bilirubin encephalopathy causes potentially preventable brain damage and hearing loss. The site of auditory dysfunction is controversial, despite pathologic studies showing damage to brain stem auditory nuclei in humans and experimental animals. We studied the effects of bilirubin toxicity on the auditory system of homozygous jaundiced Gunn rats by use of brain stem auditory evoked potentials. Small but statistically significant abnormalities were found for wave latencies, interwave intervals, and amplitudes.
Transmucosal Electrical Stimulation of Laryngeal Muscles
Authors: Sanders Ira , Wu Bei-Lian , Kraus Warren M. , Aviv Jonathan E. , Morel Bruce , Biller Hugh F.
Published: October 2014

A new technique is described that enables discrete activation of individual laryngeal muscles by electrical stimulation across overlying mucosa. In 15 dogs, we defined six distinct motor points by transmucosal stimulation at 3 mA while observing the resulting characteristic position of the arytenoid and true vocal cord. Five dogs were then paralyzed with succinylcholine in order to simulate bilateral vocal cord paralysis. Application of a 3-mA stimulus at each motor point yielded no motion of the cords, but when the current was increased to 20 mA, characteristic responses were elicited. In five other dogs, botulinum toxin was injected directly into laryngeal muscles. Stimulation was used in an attempt to quantify the degree of neuromuscular blockade. In the last group of five dogs, we simulated cricoarytenoid arthritis by scarifying the joint. The extent and nature of the joint's impairment could be demonstrated by stimulation. Transmucosal stimulation appears promising as a clinical technique for correlating particular vocal cord movements and thresholds of activation with specific laryngeal disorders. Additionally, such a technique may be useful in clarifying how each laryngeal muscle acts upon the cricoarytenoid joint.
Effect of Naproxen, a Prostaglandin Inhibitor, on Acute Otitis Media and Persistence of Middle Ear Effusion in Children
Authors: Varsano Izhak B. , Volovitz Benjamin M. , Grossman Josef E.
Published: October 2014

Prostaglandins are thought to be of importance in the pathophysiology of otitis media with effusion (OME), and the possibility of reducing the frequency and persistence of this condition by using prostaglandin inhibitors has been suggested. In a double blind manner, naproxen was administered to children with acute otitis media, in addition to amoxicillin, and its influence on the subsequent occurrence and persistence of middle ear effusion was evaluated. Eighty-one children participated in the study. No significant difference was found in the number of patients with tympanograms consistent with OME in the two groups. After 10 days of treatment, 63% in the naproxen and 58% in the placebo group, and after 30 days, 41% and 59%, respectively, had type B tympanograms. Similarly, there were no differences between the two groups with respect to other parameters studied (duration of otalgia, fever, otoscopic findings). No side effects related to naproxen were observed.
Gastroesophageal Reflux and Posterior Laryngitis
Authors: White A. , Heading R. C. , Wilson J. A. , von Haacke N. P. , Pryde A. , Maran A. G. D. , Piris J.
Published: October 2014

Esophageal acid exposure was assessed by 23-hour ambulatory pH monitoring and compared with a biopsy of the posterior larynx and proximal esophagus in 97 patients with hoarseness, burning pharyngeal discomfort, or globus sensation. Patient results were compared with normal acid exposure times obtained in 54 control subjects. In 24 patients there were laryngeal abnormalities but both esophageal biopsy results and acid exposure times were normal. Laryngeal disease was found in association with prolonged acid exposure time or esophagitis in only 17 of the 97 patients (17.5%) studied. Recent reports appear to have overestimated the importance of acid reflux as a cause of posterior laryngitis.
Audiometric Results of Torp and Porp Middle Ear Reconstruction
Authors: Mair I. W. S. , Pedersen S. , Laukli E.
Published: October 2014

The results of 70 middle ear reconstructions using either total or partial ossicular replacement prostheses are presented, the mean observation period being 45 months. Twenty-seven of the prostheses (39%) were extruded, this occurring as late as 72 months after surgery, and four (6%) were removed at reoperation. The surgical results when assessed by the magnitude of the air-bone gap are comparable to those of other series in the literature. However, postoperative air conduction thresholds remained high, and 23 % of the patients are using hearing aids. The average air-bone gap for the frequencies 0.5, 1, and 2 kHz does not provide information on patients' everyday hearing level, and should no longer be employed as an index for assessing the functional results of middle ear surgery.
Facial Nerve Electroneurography with Implanted Electrodes Experimental Study in the Rabbit
Authors: Frankander Leif , Thomander Lars , Bagger-Sjöbäck Dan
Published: October 2014

Facial nerve function was evaluated with permanently implanted electrodes for registration of electroneurography in an experimental model. The test-retest reproducibility was analyzed under normal conditions, as well as after facial nerve section. The mean observed intraindividual variation obtained at different sessions was 4%. We believe that the method is well suited for studies of experimental facial palsy.
Dimensions of and Vibrations in the round Window Membrane in Cats
Authors: Fukaya Takashi , Nomura Yasuya
Published: October 2014

The shape and size of the round window membrane and its vibratory pattern were investigated in cats by use of an optical displacement meter and time-averaged holography. The round window membrane is convex toward the scala tympani and appears to be almost elliptic in shape. The major and minor axes of the membrane are 2,273 and 1,934 μm. The mean degree of convexity is 1,975 μm. Under vibration the area of maximum displacement occurs anteriorly-superiorly at low frequency. As frequency is increased, the maximum displaced area shifts posteriorly-superiorly, then breaks up into several segments.