bluuebunny/crossref_metadata_2025 huggingface dataset:
Sinus Histiocytosis with Massive Lymphadenopathy
Authors: Bankaci Murat , Stool Sylvan E. , Morris Rebecca F. , Paradise Jack L.
Published: January 2017

— Sinus histiocytosis with massive lymphadenopathy (SHML) was found in two siblings, both of whom had retropharyngeal involvement. In one of the children the retropharyngeal swelling appeared to produce obstructive symptoms, requiring excision of the involved lymph nodes. These cases appear to constitute not only the first proven familial occurrence of SHML but also the only reported instances of retropharyngeal involvement. SHML is an uncommon disease of unknown etiology that must be distinguished from other diseases associated with marked lymphadenopathy, particularly as its course is generally benign and not altered by any known form of medical treatment.
Size of Bony Labyrinth of Human Infant and Adult Compared to That in Certain Animals
Authors: Tremble G. Edward
Published: January 2017

— Comparative anatomic studies of the bony labyrinths of humans and those of a full grown pony, zebra, grizzly bear, seal and domestic cow were performed. Fusible metal was injected into the labyrinths and the resultant casts were then measured. The similarities and differences were noted and discussed.
Cricothyroid Muscle in Respiration
Authors: Horiuchi Masatoshi , Sasaki Clarence T.
Published: January 2017

— Although the phonatory activity of cricothyroid muscle is well-known, its respiratory role often remains unrecognized. Recent data suggest this muscle plays a major role in the overall regulation of breathing by its control of expiratory resistance and flow. Cricothyroid contraction in expiration results in vocal elongation increasing glottic size. Such a mechanical effect reduces airway resistance and shortens expiratory duration. By such a mechanism, the rate of respiration may ultimately be modified using the larynx as the principal effector of this control. In this regard, cricothyroid expiratory activity is a pressure-sensitive evoked response influenced by afferent vagal stimuli. Its activity is triggered by a critical threshold of pressure-increase with respect to time, and its duration is directly dependent on the duration of positive subglottic pressure. The threshold of cricothyroid activation is reduced in hypercapnia and elevated in hypocapnic states.
Reconstruction of the External Ear Using Multiple Burow'S Triangles
Authors: Lucente Frank E. , Boyers Jerold E.
Published: January 2017

— Basal cell carcinoma of the auricle presents a challenge in both excision and reconstruction to the clinician. The following case report discusses and illustrates the use of controlled excision with assessment of margins and reconstruction using chondrocutaneous advancement flaps and multiple Burow's triangles.
Animal Model for the 4-kHz Tonal Dip
Authors: Clark William W. , Bohne Barbara A.
Published: January 2017

In humans, noise exposures produce permanent hearing losses which usually begin at 4 kHz. In chinchillas, a similar pattern of hearing loss was observed following exposure for 9 or 18 days to an octave band of noise with a center frequency of 0.5 kHz. Histopathological observations of cellular degeneration showed that this exposure produced different types of damage in the basal and apical turns of the cochlea. Behavioral measures of auditory function showed that damage in the basal turn was associated with permanent threshold shifts for one to several of the high frequencies. However, moderate losses of outer hair cells commonly appeared in the apical turn without permanent threshold shifts for low-frequency tones. These findings indicate that the pure-tone audiogram may not accurately reflect the condition of the organ of Corti after noise exposure.
Lymphomatoid Granulomatosis in a Child with Acute Lymphatic Leukemia in Remission
Authors: Cohen Seymour R. , Siegel Stuart , Heuser Eva , Landing Benjamin H. , Shen Susan , Isaacs Hart
Published: January 2017

Lymphomatoid granulomatosis, a tumor-like process of unknown etiology, produced progressively destructive disease of the larynx, trachea and bronchi in an eight-year-old girl with acute lymphoblastic leukemia of five years duration. The leukemia had been in remission for 4½ years at the clinical onset of the lymphomatoid granulomatosis. Whether this occurrence suggests that lymphomatoid granulomatosis is a type of neoplasm, or is associated with immunologic depression, cannot be stated. Fortunately rare, and of poor prognosis, the disorder may become more frequent with improved survival rate of patients with leukemia and other neoplasms.
Mondini Dysplasia
Authors: Schuknecht Harold F.
Published: January 2017

Mondini dysplasia is characterized by a short flat cochlea, large vestibule, wide, small or missing semicircular canals, and immature sensorineural structures. It may occur in association with anomalies of other organs or it may occur in isolation. In some cases the footplate of the stapes is defective, leading to spontaneous perilymphatic fistula and meningitis.
Eustachian Tube Function in an American Indian Population
Authors: Beery Quinter C. , Doyle William J. , Bluestone Charles D. , Cantekin Erdem I. , Wiet Richard J.
Published: January 2017

A comparatively high prevalence of acute and chronic otitis media (OM) has been reported for the native American Indian population. The present study reports data on the function of the eustachian tube (ET) in 25 White Mountain Apache Indians ranging in age from 3 to 36 years. All study subjects had a history of OM and reported to the reservation clinic with tympanic membrane perforations and a dry middle ear (ME). The results of inflation-deflation tests on these subjects indicated that the Indians had lower forced opening pressures than had been measured in a group of Caucasians with perforations secondary to chronic OM. Of the 23 subjects studied, 67% equilibrated applied positive ME pressures and 38% equilibrate negative pressures by swallowing. During forced response testing, the passive resistance of the ET was found to be lower and the active resistance equivalent to that of a group of Caucasians with traumatic perforations and otherwise negative otologic histories. While the ET was predilated in these subjects by constant airflow, active swallowing further dilated the tube in 67% of the subjects, constricted the tube in 25%, and had no effect in 8%. This study indicated that the ET of the American Indian was functionally different from that of Caucasians previously studied and was characterized by comparatively abnormal, low passive tubal resistance which may be considered to facilitate ventilatory function and to impair protective function. The difference may account for the high prevalence of OM with perforation and the low incidence of cholesteatoma in this population.
Histopathological Study of Otitis Media with Effusion
Authors: Ishii Tetsuo , Toriyama Minoru , Suzuki Jun-Ichi
Published: January 2017

Thirteen temporal bones with otitis media with effusion (OME) taken from ten patients were studied. The effusions in the tympanum were histologically classified into serous and mucoid types. In the serous effusion, neutrophils were dominantly distributed and the mucosa and submucosa showed inflammatory signs. Few epithelial cells and lymphocytes were observed in the effusion of the mucoid type. Eosinophils were rarely seen in the effusions of both types. The presence of inflammatory process was a common finding in OME, particularly with serous effusion. A case, with an immunologic disorder suspected, showed an extensive proliferation of mucosa and unusually thick liquid in the middle ear. This histological feature of the case did not resemble those of other ears with mucoid type of effusion.
Lymphocyte Morphology in Middle Ear Effusions
Authors: Palva Tauno , Häyry Pekka , Ylikoski Jukka
Published: January 2017

Cytological studies were performed on 157 middle ear effusion specimens, 54 of which belonged to the serous and 103 to the mucoid category. The cytocentrifuged samples were stained with May-Gruenwald-Giemsa stain and divided into three groups on the basis of cellular pattern: granulocytic, lymphocytic-monocytic and mixed. The T-lymphocytes were counted after incubation for six hours using α-naphtyl-acetate esterase (ANAE) marker and counterstaining with toluidine blue. In 57 samples, reliable assessment of lymphocytes could not be made because the absolute number of white blood cells was small or the lymphocytes were less than 100. In the remaining 40 serous and 60 mucoid samples, lymphocytes were present in sufficient numbers. The mean percentages of ANAE-positive lymphocytes were 62% serous and 57% mucoid. The results indicate that there is no numerical defect of the T-cells in chronic middle ear effusions.
Screening for Middle Ear Disease in a School for the Deaf
Authors: Stool Sylvan E. , Craig Helen B. , Laird Margaret A.
Published: January 2017

During the 1977–78 academic year, a study was conducted at the Western Pennsylvania School for the Deaf (WPSD) to evaluate, in a population of profoundly deaf students: 1) the incidence of middle ear (ME) effusion; 2) the correlation between high negative ME pressure (HNP) and ME effusion; and 3) the effect of HNP (> −100 mm H2O) on auditory acuity. All 446 students at WPSD were screened three times (fall, winter, and spring) by both otoscopy and tympanometry and were then classified as belonging to one of five categories according to the status of their ME. Otoscopic, tympanometric, and audiometric evaluations were conducted monthly for 41 study-group students with HNP and 41 controls with normal ears. Tabulations of the incidence of ME conditions over the year-long period showed that 8% of the students had effusion, 21% HNP, 1% inactive disease, 26% residual disease, and 44% normal ME. The majority of severe ME problems occurred in children between the ages of two and eight years. HNP proved insufficient to predict the occurrence of an effusion in children aged 6 to 21 years. However, only 21% of the ears in which HNP was identified returned to and remained normal for the entire year, as contrasted with the initially normal or “controls,” of which 77% remained normal. In this profoundly deaf population, the correlation between HNP and threshold shifts proved difficult to document. A small but significantly greater fluctuation in threshold during the period of a year was noted, however, when the students with HMP were compared with the controls.
Acoustic Reflex as a Predictor of Middle Ear Effusion
Authors: Freyss Georges E. , Manac'H Yves , Narcy Philippe P. , Toupet Michel G.
Published: January 2017

The comparative efficacy of tympanometry and the acoustic reflex (threshold and supraliminal amplitude) in predicting the presence of fluid in the middle ear was studied just before myringotomy in 50 children (99 ears) prior to adenoidectomy. Impedance audiometry was carried out under a general anesthetic (ketamine and nitrous oxide) in 60%, and without anesthesia in 40% of the cases. The comparative efficacy of this test was assessed using objective criteria which were independent of the cut-off point between normal and abnormal groups. The prediction efficacy of acoustic reflex threshold and amplitude (Youden's index = 0.58) was superior to that of tympanometry peak amplitude and pressure (Youden's indexes = 0.29 and 0.36). The efficacy of the gradient was 0.41. Modifications due to anesthesia were not statistically significant for the whole group, but temporary abolition of the acoustic reflex at the start of anesthesia is probably related to the high percentage of false positives noted when the acoustic reflex is used alone in patients given a general anesthetic.
Tympanometry in Three-Year-Old Children
Authors: Fiellau-Nikolajsen M.
Published: January 2017

Tympanometric screening was performed in January 1976 and in August 1978 on 938 healthy three-year-old children (1,868 ears), constituting more than 95% of the total population of three-year-olds living in a Danish municipality at the time of testing. All children showing abnormalities were followed by tympanometry through the subsequent six months, or until spontaneous normalization had been ascertained. The study demonstrated a high prevalence and a common spontaneous recovery of secretory otitis media. In summer as well as in winter middle ear effusion was found in about 10% of all ears, or in every eighth child. Two thirds of the ears improved spontaneously, one third to complete normalization. Middle ear function, assessed by tympanometry, is extremely labile during the preschool years and must be evaluated from a dynamic point of view. This greatly restricts the predictive value of snapshots, such as screening results. Therefore, pending complementary information from long-term cohort studies, universal impedance screening of all preschool children should not be instituted.
Trimethoprim-Sulfamethoxazole in the Treatment of Otitis Media Secondary to Ampicillin-Resistant Strains of Haemophilus Influenzae
Authors: Schwartz Richard , Mann Ronald , Rodriguez William J. , Barsanti Ronald G. , Khan Waheed , Ross SydneY
Published: January 2017

Between August 1977 and January 1979, 16 children (7 males and 9 females) ranging in age from 5 to 38 months (mean age 18 months) were treated with trimethoprim-sulfamethoxazole (TMP-SMX) (40 mg/kg SMX per 24 hours) for otitis media caused by beta-lactamase strains of ampicillin-resistant Haemophilus influenzae. Fourteen patients had failed after antecedent ten-day courses of ampicillin (9 patients) or amoxicillin (5 patients) therapy. The remaining two patients received only five days of ampicillin before changing to TMP-SMX. Six of the isolates were nontypable, 3 were type B, 5 isolates were Haemophilus parainfluenzae, and 2 strains were unavailable for typing. Of 13 strains tested, 10 had a minimal inhibitory concentration (MIC) in excess of 3.12 μg/ml of ampicillin; the remaining 3 had an MIC of < 3.12 μg/ml. All 13 isolates were susceptible to 0.19 μg/ml TMP-SMX. Five of 16 children were symptomatic (irritable; fever of > 38.2 C); within three days of starting TMP-SMX treatment, they became asymptomatic. Fifteen of 16 patients (93%) responded favorably after ten days of TMP-SMX. Only one patient had H influenzae resistant to ampicillin (12.5 μg/ml) and sensitive to TMP-SMX (0.19 μg/ml) isolated from the middle ear at the end of ten days of TMP-SMX. At the end of TMP-SMX therapy, middle ear effusions were noted in ten patients; the fluid was sterile in the four patients who had a second tympanocentesis. There were two recurrences within one month of TMP-SMX therapy. No adverse clinical reactions were noted.
Adenoidectomy versus Tympanostomy in Chronic Secretory Otitis Media
Authors: Marshak Gabriel , Neriah Ziva Ben
Published: January 2017

Fifty-eight consecutive charts of children suffering from mucoid middle ear effusion proven by myringotomy who were followed for two years were reviewed. Half of the group underwent adenoidectomy and the other half, with similar age distribution, had tympanostomy. Only 20.7% of the adenoidectomized children had normal hearing and aerated middle ears during the two-year follow-up, whereas 59% had normal hearing following tympanostomy. Adenoidectomy had no additional beneficial effect on the cure rate obtained by tympanostomy, which proved to be more effective in all age groups, and in the nonallergic child. In the atopic child, however, both modalities yielded similarly poor results.
Surgery of the Mastoid in Ears with Middle Ear Effusion
Authors: Holmquist Jörgen , Jarlstedt Jan , Tjellström Anders
Published: January 2017

It has been demonstrated that in most ears with middle ear effusion the mastoid air cells may be involved as well. The mucosal changes and the secretion extends into all cavities of the ear including the mastoid air cells. In most ears insertion of a ventilating tube through the tympanic membrane is adequate for proper aeration of the middle ear as well as of the mastoid air cell system. The draining usually stops and the mucosa gradually changes into its normal condition. In a small percentage of these, the ear will continue to drain and the mastoid will not clear up. Antibiotics and decongestants fail to cure the ear. Surgical intervention of the mastoid may be indicated in the rare cases where conventional treatment fails to control the condition. The aim of this report is to 1) focus attention to the fact that the mastoid is an integral part of the middle ear cavity; 2) discuss the pathogenesis in stubborn ears with middle ear effusion; and 3) demonstrate the surgical procedure commonly used in our department in order to reestablish aeration of the mastoid air cell system. Early recognition and proper treatment of ears with middle ear effusion will hopefully reduce the incidence of stubborn cases and also decrease the number of those cases which end up with chronic otitis media and cholesteatoma. It is hoped that the screening programs involving school and even preschool children, as well as new preventative programs, will diminish the frequency of cases which need extensive surgery as discussed in this paper.
Support of Programs for the Communicatively Disadvantaged Child: Role of the Private Foundation
Authors: Terry Luther L.
Published: January 2017

In comparison to its support of life-threatening diseases, the Federal government has given little support to preventing and alleviating communicative disorders. The very fact that they are not life threatening, means that communicative disorders can remain an uncomfortable, costly, and debilitating factor throughout the lives of millions of children and adults. In view of the magnitude of the problem and the lack of Federal support, responsible leaders are going to have to turn to the general public for support. Foundations, corporations and individuals can provide support for training and organizing services. Such support may well provide them with an opportunity to assist in an area which has touched their families or them personally. Research, training and service programs for the communicatively disadvantaged child are urged to seek finanical support from private foundations.
Educational and Training Priorities for Clinicians and Researchers in the Area of Communication Disorders
Authors: Sooy Francis A.
Published: January 2017

Philosophical but practical current discussion of trends in education which could have a profound effect on the future of communicative sciences.
Frequency Analysis in Normal and Hearing-Impaired Listeners
Authors: Jesteadt Walt
Published: January 2017

Recent studies of frequency analysis in listeners with normal hearing and in those with sensorineural hearing losses are reviewed and compared with related physiological data. These studies suggest that it is now possible to obtain detailed audiological or psychoacoustic data for human listeners that closely parallel physiological data obtained in eighth nerve recordings from animals. Implications of these developments for future research with impaired listeners are discussed.
Orofacial Embryology, Anatomy and Physiology
Authors: Kuehn David P.
Published: January 2017

The orofacial region is intricately involved in shaping the speech signal that emerges from the speaker. Without this shaping, speech would be largely a communicatively indistinct blur. It is not surprising, therefore, that there is considerable interest in the embryology, anatomy, and physiology of this extremely important region of the body.
Laryngeal Development and Congenital Lesions
Authors: Tucker Gabriel F.
Published: January 2017

In considering laryngeal development, functional development and the comparative anatomical approach of Sir Victor Negus must be included in addition to classical morphological development; postnatal questions are considered in addition to embryological and fetal development.
Research Priorities in Language and Learning
Authors: Fletcher Paul
Published: January 2017

The paper reviews recent work in the area of linguistics applied to abnormal language development, specifically in the area of grammar. Particular attention is paid to the notion of linguistic profiling as a procedure for assessment and remediation, using information from normal language development research as a guide. It is suggested that in addition to the potential benefit of the continuing advance in knowledge of normal language acquistion for studies of language disorders, the study of the language of mothers to children could prove of considerable value to the speech and language pathologist.
Labyrinthine Segment and Geniculate Ganglion of Facial Nerve in Fetal and Adult Human Temporal Bones
Authors: Ge Xian-Xi , Spector Gershon J.
Published: January 2017

The later stages of development (15–40 weeks in utero) of the geniculate ganglion and labyrinthine segment of the facial nerve in the human fetus demonstrate minimal neuronal growth. The vascular supply is well established. The major changes occur in the perineural ossification pattern. The canal of the labyrinthine facial nerve segment ossifies first via the petrous apex and periotic capsule. The narrowest portion of the canal is at the geniculate ganglion in the earlier stages and at the fundus of the internal auditory canal at term. The geniculate ganglion area ossifies by means of two bony plates. The medial plate is a derivate of the periosteal growth of the petrous apex and the lateral plate is an extension of membranous bone from the squama. The major relationships to the middle ear do not change. The hiatus of the facial canal diminishes in size during gestation, but remains patent at birth.
Chemoprophylaxis for Surgery of the Head and Neck
Authors: Becker Gary D.
Published: January 2017

A prospective study of patients undergoing major head and neck cancer surgery was undertaken to 1) define the value of cefazolin prophylaxis in reducing the incidence of wound infection, 2) define the value of preoperative and intraoperative (perioperative) cultures in identifying the patient at high risk of wound infection and in predicting the bacteriology of subsequent wound infection, and 3) demonstrate the most common aerobic and anaerobic flora of infected wounds. Preoperatively, the neck skin, oropharynx and anterior nares were swabbed for aerobic cultures. An intraoperative wound culture was obtained after the mucosal defect was sutured and the wound irrigated with water and sent for aerobic culture. All infected wounds were cultured for aerobic and anaerobic flora. Cefazolin, 1 g, was given intramuscularly (IM) about two hours before the skin incision, and continued in 0.5 g doses IM or intravenously (IV) every six hours for four doses. Cefazolin prophylaxis significantly reduced the incidence of postoperative wound infection. Isolation of aerobic pathogens perioperatively was not correlated with a greater risk of wound infection and did not accurately predict the flora of subsequent wound infection. The most common pathogenic aerobes isolated from infected wounds were Staphylococcus aureus and β- Streptococcus not group A, as well as a variety of Gram-negative organisms. The most common anaerobic isolate was Bacteroides melaninogenicus.
Comparison of Cefaclor and Amoxicillin for Acute Otitis Media with Effusion
Authors: Mandel Ellen M. , Bluestone Charles D. , Ghorbanian S. Nasrin , Cantekin Erdem I. , Rockette Howard E.
Published: January 2017

A double-blind randomized clinical trial was conducted comparing cefaclor and amoxicillin for the treatment of acute otitis media with effusion in 110 children (150 ears). Each child underwent unilateral or bilateral tympanocentesis and then randomly received a 14-day course of either amoxicillin or cefaclor. Of 57 children in the cefaclor group, only 3 children (5.3%) had persistent or recurrent symptoms during the 14-day course of treatment, as compared to 5 of 53 children (9.4 %) in the amoxicillin group, but this difference is not significant. After completion of the 14 days of therapy, 45 of 76 ears (59.2%) of the children in the cefaclor group were effusion-free, as compared to only 28 of 64 ears (43.7%) of the children in the amoxicillin group. When adjusted for age and race, this difference is statistically significant (p = .03). However, the difference between the effect of the two antimicrobials is not statistically significant in children. Cefaclor is a reasonable choice for antimicrobial therapy for acute otitis media with effusion, and from these study findings, it appears that cefaclor may be more effective than amoxicillin in resolving the middle ear effusion at the completion of 14-day therapy.
Etiology and Antimicrobial Therapy of Paranasal Sinusitis in Children
Authors: Shurin Paul A.
Published: January 2017

Paranasal sinusitis in children is discussed in terms of pathogenesis, diagnosis, etiology and antimicrobial therapy.
Etiology, Diagnosis, and Antimicrobial Treatment of Pharyngitis and Pharyngotonsillitis
Authors: Paradise Jack L.
Published: January 2017

This review focuses on clinically important aspects of the etiology, diagnosis, and antimicrobial treatment of pharyngitis and pharyngotonsillitis. Most episodes of throat infection are of viral etiology, and accordingly are not susceptible to antimicrobial drugs currently available. By contrast, streptococcal and other varieties of bacterial pharyngitis do call for appropriate antimicrobial treatment. The review encompasses a discussion of clinical, bacteriological, and serological diagnosis; an algorithm for decision-making about antimicrobial treatment that is based on both clinical findings and culture results; and a summary of treatment regimens, emphasizing the management of streptococcal throat infection.
Cefaclor in Management of Streptococcal Pharyngitis, Otitis Media, and Skin Infections
Authors: Kammer Robert B.
Published: January 2017

Cefaclor, a semisynthetic cephalosporin antibiotic for oral use, was studied by 62 clinical investigators in six countries in 3,084 adult and pediatric patients. The pooled data reveal that satisfactory clinical responses were obtained in 96% of the streptococcal pharyngitis cases, 93% of the cases of otitis media, and 97% of skin infections. Administration of this antibiotic was associated with a low incidence of adverse reactions, including 73 gastrointestinal and 34 hypersensitivity reactions. Of particular clinical interest were the outstanding results obtained in the treatment of otitis media.
Sinusoidal Harmonic Acceleration
Authors: Mathog Robert H.
Published: January 2017

The need for accurate and reliable diagnostic tests for the evaluation of vestibular function has stimulated investigation of rotational methods and more recently, an evaluation of harmonic angular acceleration. Initial studies, using these techniques in humans, demonstrated a linear input-output function from 0.24 to 0.04 cycles/s at 0.4 radians/s2, but a reduction in the increase of response with an increase of acceleration or a decrease of frequency from this range. Nystagmic responses were symmetrical in these same normal individuals. In patients with vestibular disease, input-output functions, as well as symmetry, were altered, and appeared related to the degree of pathology. Evaluation of the test system in animals, rendered ototoxic with streptomycin, showed a depression in response similar to caloric tests. All data suggested that harmonic angular acceleration provided a reliable and sensitive method for evaluation of vestibular function, and a useful and important confirmation to the other methods that are available for these evaluations.
High-Voltage Electron Microscopic Study of the Inner Ear: Technique and Preliminary Results
Authors: Takasaka Tomonori , Shinkawa Hideich , Watanuki Kozo , Hashimoto Sho , Kawamoto Kazutomo
Published: January 2017

The technique and some preliminary results of the application of high-voltage electron microscopy (HVEM) to the study of inner ear morphology in the guinea pig are reported in this paper. The main advantage of HVEM is that sharp images of thicker specimens can be obtained because of the greater penetrating power of high energy electrons. The optimum thickness of the sections examined with an accelerating voltage of 1,000 kV was found to be between 500 to 800 nm. The sections below 500 nm in thickness often had insufficient contrast, while those above 800 nm were rather difficult to interpret due to overlap of images of the organelles. The whole structure of the sensory hairs from the tip to the rootlet was more frequently observed in the 800-nm thick sections. Thus the fine details of the hair attachment to the tectorial membrane as well as the hair rootlet extension into the cuticular plate could be thoroughly studied in the HVEM. In specimens fixed in aldehyde containing 2% tannic acid, the attachment of the tips of the outer hair cell stereocilia to the tectorial membrane was observed. For the inner hair cells, however, the tips of the hairs were separated from the undersurface of the tectorial membrane. The majority of the rootlets of the outer hair cells terminated at the midportion of the cuticular plate, while most of the inner hair cell rootlets traversed the entire width of the cuticular plate and extended into the apical cytoplasm. These differences in ultrastructural appearance may indicate that the two kinds of hair cells play different roles in the acoustic transduction process. The three-dimensional arrangement of the nerve endings on the hair cells was also studied by the serial thick-sectioning technique in the HVEM. In general, an entire arrangement of the nerve endings was almost completely cut in less than ten 800-nm thick sections instead of the 50- to 100-ultrathin (ie, less than 100 nm) conventional sections for transmission electron microscopy. The present study confirms an earlier report that the first row outer hair cells in the third cochlear turn are innervated by nearly equal numbers of efferent and afferent endings, the average number being nine.
Monkey Model for IgE-Mediated Otitis Media with Effusion
Authors: Friedman R. A. , Doyle W. J. , Fagin J. , Bluestone C. D. , Fireman P.
Published: January 2017

Allergic and other immune mechanisms have been suggested as important in the etiology and pathogenesis of OME, and both humoral and cellular components of the immune response have been identified in MEEs obtained from patients with OME. Yet, specific and direct documentation of an immune basis for OME has not been forthcoming. To establish a causal relationship between an immune hypersensitivity and middle ear pathophysiology, a provocative intranasal antigen challenge test has been designed using the nine-step inflation-deflation tympanometric test for ET dysfunction. These initial studies were undertaken by OMRC personnel in association with the allergy and immunology service. Subsequently, on the basis of the preliminary observations additional funding was obtained (NIAID AI 19262) to confirm and extend these studies to document antigen-induced ET dysfunction in allergic adults and children, and to establish a clinical relevance for antigen-induced ET dysfunction. Because questions concerning the etiology and pathogenesis required invasive techniques and are not suitable in humans, a monkey animal model has also been developed.

Our future plans will be to further develop the monkey model of OME employing IgE and other immune reactions in monkeys with normal ET function, or with compromised, surgically created ET function. The experimental MEE will be assayed for immune components, including IgA and its secretory piece; IgG, IgM, and IgE, total complement; C3, C4, and cells including polymorphonuclear leukocytes, eosinophils, and lymphocytes (both T and B cells). Since OME is mainly a disease of the young child, it is essential that age-related differences be explored in each aspect of our experimental model. The reversal and prevention of ET dysfunction and/or OME with several drugs, including cromolyn, steroids, and antihistamines, will be studied in humans and in the monkey model.
Cochlear Pathology following Experimental Ablation of the Vestibular Labyrinth
Authors: Schuknecht Harold F. , Gao Yin-Zao
Published: January 2017

A surgical procedure was performed on 24 cats in which the oval window was entered and the vestibular sense organs were ablated. The operation incited a severe reparative response in the vestibule, characterized by proliferation of fibrous tissue and bone and blockage of the longitudinal flow of endolymph. One inner ear became infected resulting in degeneration of the labyrinth. Of the remaining 23 ears, 20 showed cochlear endolymphatic hydrops (EH) and three did not. All three ears without cochlear EH (as well as two ears with cochlear EH) had fistulae of their endolymphatic systems. The findings are consistent with the concept that fistulization of the membranous labyrinth prior to the blockage of longitudinal flow will prevent the formation of EH. Similarly, fistulization occurring after the onset of EH should arrest its progression. These observations are relevant for surgical procedures designed to control intractable vertigo caused by EH.
Inner Ear and Renal Diseases
Authors: Arnold Wolfgang
Published: January 2017

Certain conditions (Alport's syndrome, kidney transplantation, dialysis) are followed by a progressive inner ear hearing loss. On the other hand, pharmacological substances that act on the transport mechanisms of the tubular epithelium may also produce inner ear disturbance. Experimental data on the possible pathomechanisms are discussed in reference to results reported in the literature.
Vocal Efficiency and Aerodynamic Aspects in Voice Disorders
Authors: Tanaka Shinzo , Gould Wilbur J.
Published: January 2017

The variation of vocal efficiency for the mean values for normal subjects was investigated in patients with laryngeal disease. The relative contributions of mean flow rate and intrapulmonic pressure to the variation of efficiency were explored to explain aerodynamic aspects in voice disorders. Vocal efficiency was determined by use of expressions involving simultaneous values of sound pressure level, mean flow rate, and intrapulmonic pressure. The intrapulmonic pressure was noninvasively obtained by plethysmographic and pneumotachographic methods. Values of vocal efficiency were generally abnormally low for the types of larynges studied. An aerodynamic-biomechanical classification of laryngeal disease was inferred from the data: 1) large chink of glottis, associated with high flow rate; 2) mass on vocal fold, associated with high values of both flow rate and intrapulmonic pressure; and 3) high stiffness of vocal fold, associated with high values of intrapulmonic pressure.
Goblet Cells in the Laryngeal Mucosa in Benign Diseases of the Larynx
Authors: Nielsen K. O. , Bak-Pedersen K.
Published: January 2017

Pieces of mucosa were removed from the subglottis, the entrance into the sinus of Morgagni, and from the ventricular fold in 82 patients with benign diseases of the larynx. The goblet cells in these specimens were studied morphologically and quantitatively by an elective staining method and a whole mount technique. In 38 patients, the clinical and histological findings indicated an inflammatory disease in the form of chronic laryngitis or laryngeal edema. In 44 patients, the diagnosis was a nonmalignant tumorous lesion, such as papilloma, polyp, or cyst. These findings were compared with a similar study of goblet cells in normal larynges. In the inflammatory group as well as in the tumor group, the goblet cell density in the subglottis and ventricular fold proved to be lower than in normal larynges, but significantly lower only on the ventricular fold. This finding is assumed to be a result of the increased turbulence of the respiratory air, due to the disease process in the glottic fissure, which causes a greater contact surface between the mucosa and the respiratory air. In the close vicinity of the tumorous lesion there was a reduced, but not significantly reduced, goblet cell density, possibly caused by a tumor-initiated metaplasia to an epithelium poor in goblet cells. There were no morphological differences in goblet cells between the two disease groups and the normal larynges.
Benign Lesions of the Nose, Oral Cavity, and Oropharynx in Children: Excision by Carbon Dioxide Laser
Authors: Crockett Dennis M. , McGill Trevor J. I. , Healy Gerald B. , Friedman Ellen M.
Published: January 2017

The carbon dioxide laser was used to treat a group of pediatric patients with benign lesions of the upper aerodigestive tract exclusive of the larynx Prior to development of the CO2 laser, excision of these lesions by conventional means often resulted in incomplete removal, significant bleeding, and postoperative edema resulting in airway obstruction. The CO2 laser, with its unique properties of precise excision, hemostatic effect and minimal postoperative edema, has become the instrument of choice in the removal of these lesions.
Anterior Commissure Laryngoplasty for Adjustment of Vocal Fold Tension
Authors: Tucker Harvey M.
Published: January 2017

An anterior commissure laryngoplasty with placement of a tantalum splint has been employed to adjust vocal fold tension in nine cases. As originally described, the procedure was designed only to tighten flaccid vocal folds. The technique has been modified, however, to allow loosening of tension in tight vocal folds. All nine cases have been successful, at least to some extent, and have shown no significant complications. The details of the procedure and a general discussion of selection and management of patients are included. This procedure may provide relatively safe and effective adjustment of vocal pitch as well as strengthening the voices of patients with flaccid vocal folds.
Endoscopic Management of Selected Early Vocal Cord Carcinoma
Authors: Ossoff Robert H. , Sisson George A. , Shapshay Stanley M.
Published: January 2017

Twenty-five previously untreated patients with selected early midcordal squamous cell carcinomas have been treated by endoscopic excisional biopsy with the carbon dioxide laser and followed for a minimum of 3 years. Twenty-four of the 25 patients are alive and free of disease, and one patient died of local and regional recurrence 2 years after attempted endoscopic excision followed by partial laryngectomy. Indications, contraindications, advantages, and complications associated with this treatment option for patients with early glottic carcinoma are discussed.
Magnetic Resonance Imaging Findings and Correlations in Spasmodic Dysphonia Patients
Authors: Schaefer Steven , Finitzo Terese , Ross Elliott , Close Lanny , Reisch Joan , Freeman Frances , Cannito Michael , Maravilla Kenneth
Published: January 2017

A sample of 19 spasmodic dysphonia (SD) patients was selected from a larger population of such patients to undergo magnetic resonance imaging (MRI), auditory brain stem response (ABR) testing, speech analysis, and extensive physical examination. Six patients had abnormal spin-echo MRI findings, ranging from infarcts within the basal ganglia to demyelinating lesions within the supralateral angles of the lateral ventricles. A weakly positive correlation was noted between the abnormal MRI findings and an abnormal ABR. The lack of a significant correlation between the MRI findings and other predictors of brain stem and midbrain disease, and the current spatial resolution limitations of MRI, suggest that we are visualizing the associated lesions rather than the actual foci of SD. The range of MRI findings is consistent with the concept that SD is a voice disorder in a heterogeneous patient population.
Paraglottic Laryngitis in Association with Epiglottitis
Authors: Healy Gerald B. , Hyams Vincent J. , Tucker Gabriel F.
Published: January 2017

Infection of the supraglottic larynx is a well-recognized clinical entity in both adults and children. The anatomical relationships of the various components of the larynx have been studied extensively, especially as they relate to the spread of malignant disease. However, the relationship of these spaces and compartments in inflammatory disease has not been heretofore appreciated. This report describes for the first time histologic evidence that infection of the supraglottic larynx may spread to the paraglottic space, thus causing compromise of the glottic region. This potential carries significant implications for planning the appropriate therapeutic measures.
Management of the Cleft Larynx and Tracheoesophageal Clefts
Authors: Evans John N. G.
Published: January 2017

The anomaly of posterior laryngeal cleft and the more extensive laryngotracheoesophageal cleft is extremely rare. Twenty-one cases of cleft larynx are reviewed. A new, simpler clinically oriented classification of the clefts is proposed, and the difficulty in establishing the precise diagnosis is stressed. Stridor is the commonest presenting symptom in type 1 clefts, and aspiration on feeding, recurrent pneumonia, and abnormalities of cry suggest type 2 clefts. Type 3 clefts present with severe aspiration cyanosis and incipient cardiorespiratory failure. Aspiration reflux and persistent stridor are extremely common postoperative problems and are responsible for the delays in decannulation in spite of apparently successful operative closure of the clefts.
Hydroxyapatite Ceramic as Middle Ear Implant Material: Animal Experimental Results
Authors: Grote Jan J. , van Blitterswijk Clemens A. , Kuijpers Wim
Published: January 2017

Hydroxyapatite is the main constituent of the mineral matrix of bone. The behavior of porous and dense hydroxyapatite ceramic implants was studied in normal rat middle ears, after induced infection, and in an in vitro assay by light and electron microscopic techniques. All implants were integrated into the middle ears without signs of extrusion, and their mucosal coverings did not appear to differ fundamentally from those of normal ears. The porous hydroxyapatite became filled with fibrous tissue and bone that showed normal morphology, and there was direct bonding of the bone to the implants. Minor biodegradation was established for the porous implants. Hydroxyapatite did not affect cultured middle ear mucosa significantly in vitro. Induced infection failed to show any adverse effect on the behavior of the implants. These observations suggest that hydroxyapatite is very useful for reconstructive ear surgery.
Rheological Properties of Middle Ear Effusions from Children with Otitis Media with Effusion
Authors: Sakakura Yasuo , Hirata Keisuke , Majima Yuichi , Matsubara Takashi , Takeuchi Kazuhiko , Hamaguchi Yukiyoshi , Miyoshi Yasuro
Published: January 2017

Freshly harvested middle ear effusions (MEE) were collected from children with otitis media with effusion. Both elasticity (G′) and viscosity (η′) of the MEE were determined by an oscillating sphere magnetic rheometer and compared with transportability of the MEE on mucus-depleted frog palates. A maximum value of transport was obtained at G′ of about 20 dyne/cm2 (at 1 Hz), and below this value there was a significant positive correlation between the transport rate and log G′. Above 20 dyne/cm2, the negative correlation between the transport rate and log G′ was significant. This shows there is a sharp increase in transport with increase in G′ up to 20 dyne/cm2, and at the higher value of G′ there is a slow decrease in transport with increasing G′. A similar significant correlation between the transport rate and log η′ was observed.
Cochlear Implant after Radical Mastoidectomy
Authors: Scrivener B. P. , Gibson W. P. R.
Published: January 2017

We discuss special conditions that must be fulfilled when a cochlear implant is placed in an ear with a preexisting mastoidectomy cavity. The most important factor is the provision of a sound soft tissue lining. A successful case in which a two-stage procedure was used is described.
Current Spreading and Speech-Processing Strategies for Cochlear Prostheses
Authors: White R. L. , Van Compernolle D.
Published: January 2017

It is well known that current spreading in the cochlea causes a blurring at the excitable neural tissue of spatial details when the electrode array is stimulated. This paper describes techniques for compensating for current spreading by computing the pseudoinverse of the spreading function and applying a stimulation pattern to the electrode array, which produces the desired current pattern at the neural tissue. Specific examples are given assuming several current spreading functions, and the limits of applicability of the techniques in the domain of severe current spreading are explored.
Characterization of Mechanical Properties of Single Electrodes and Multielectrodes
Authors: Patrick J. F. , MacFarlane J. C.
Published: January 2017

Over recent years there has been increasing awareness of the potential damage to the fragile structures of the cochlea that could be caused by the insertion of intracochlear electrodes. Temporal bone histologic studies from chronically implanted human patients have shown that intracochlear electrodes can cause significant insertion trauma. This paper describes how the mechanical properties of the electrode array can influence insertion trauma, and compares the properties of solid wire electrodes with those of a tapered electrode array. The maximum force that can be applied by the tip of the solid wire electrode is 25 times what can be applied by the tapered electrode array, whereas the tapered array is ten times more flexible. These differences in mechanical properties suggest that evidence for insertion trauma should be assessed on an electrode-by-electrode basis.
Middle Ear Infection Postimplantation: Response of the round Window Membrane to Streptococcus Pyogenes
Authors: Cranswick N. E. , Franz B. K-H. , Clark G. M. , Shepherd R. K. , Bloom D. M.
Published: January 2017

The seal of the implanted round window membrane to resist Streptococcus pyogenes invasion from the middle ear was investigated in 12 cats. Results showed that the implanted round window membrane is able to form a barrier for S pyogenes starting 1 week postimplantation. Under normal conditions S pyogenes did not pass through the round window membrane, nor through the gap that existed between the membrane and the prosthesis. Mechanical disruption of the round window seal, however, and severe inflammatory response to S pyogenes caused the infection to extend into the inner ear.
Effects of Cochlear Prostheses on Vestibulo-Ocular Reflexes to Rotation
Authors: Mangham C. A.
Published: January 2017

This study addresses the following questions: What is the effect of implant surgery on the vestibulo-ocular reflex (VOR)? Does activation of the prosthesis affect the VOR? We studied the VOR elicited by rotary stimuli in 12 patients, six with a House 3M device, five with a Nucleus device, and one who sequentially had both devices. Nine of the 12 patients had VOR responses to rotation. Four of the nine had a decrement in the VOR associated with surgery and mild symptoms of dysequilibrium that lasted up to 1 week after surgery. No one had vestibular symptoms nor a decrement in the VOR during stimulation of the prosthesis at comfortable loudness. Rotational vestibular tests can quantify the VOR in some but not all cochlear prosthesis patients. The present surgical technique for implantation of scala tympani electrodes may cause a permanent reduction in the VOR to rotation in some patients.