bluuebunny/crossref_metadata_2025 huggingface dataset:
Facial Nerve Reconstruction and its Prognosis
Authors: Sadé J.
Published: October 2014

This study of the functional end results of successful surgical repair of the traumatized facial nerve trunk shows more or less homogenous results, whether the procedure was end-to-end suture or grafting, and independent of the site of the lesion. The expected results are: 1) excellent tonus at rest; 2) the ability to close the affected eye to a useful degree when the other eye is closed; 3) some ability to close the affected eye in association with some mass action of the affected face; 4) in a small proportion of patients, the ability to produce a faint smile, but not to move the corner of the mouth, to smile fully or to whistle; and 5) though all patients seemed to be able to move their faces “en masse,” none could move isolated groups of muscles as a healthy person can. Thus, though appreciable results are obtained, important limitations of movements are inevitable. The reason for these uniformly deficient results stems from the fact that in the facial nerve the peripheral axons are not arranged in a separate specific compartmental fashion. Instead, they intermingle and are distributed among the various bundles which constitute together the main nerve trunk; each bundle will therefore represent the whole face and not one specific region of the face. The result of this intermingling is that when axons regrow after traumatic repair, they have scarcely any chance to be redirected to their original regional muscular plate, due to inevitable crossover phenomena during regeneration.
Frey's Syndrome - A Technical Remedyr
Authors: Sessions Roy B. , Roark David T. , Alford Bobby R.
Published: October 2014

The symptoms of Frey's syndrome are occasionally of sufficient magnitude to warrant curative treatment. In four patients, a fascia lata graft was placed under the involved skin in an attempt to offer permanent relief from the cutaneous discomfort suffered during eating. Two of these patients have excellent long-term results. The other two patients were lost to long-term follow-up but were asymptomatic several months following grafting.
Observations on the Primate Hyoepiglottic Complex
Authors: Tucker Gabriel , Tucker John A.
Published: October 2014

In the species presented, the orifice to the subhyoid air sac is found at the tuberculum (when the epiglottis attaches at the level of the ventricle); here also is noted the presence of a cartilaginous island(s) just anterior to the duct. When seen in coronal section along the axis of the duct, the glandular elements cluster around the sac in the anterior supraglottic subhyoid wedge, in preference to the area around the ventricles.
Vertigo of Delayed Onset after Sudden Deafness
Authors: Nadol Joseph B. , Weiss Alfred D. , Parker Stephen W.
Published: October 2014

An entity of episodic true vertigo of delayed onset following sudden and profound sensorineural hearing loss is described. Data on 12 patients and three case reports are presented. The latency between sudden deafness and the onset of the vertigo varied from 1 to 68 years. The vestibular symptoms are identical to the vestibular symptoms of Ménière's disease, and there is some evidence that endolymphatic hydrops in the previously deafened ear represents at least part of the labyrinthine pathology. Labyrinthectomy in the deaf ear was curative. Tentatively, this entity is best considered a variant of Ménière's disease.
Carcinomatous Encephalomyelitis with Auditory and Vestibular Manifestations
Authors: McGill Trevor
Published: October 2014

A clinical and pathological study of carcinomatous encephalomyelitis is presented. Attention is drawn to the various types of nonmetastatic paraneoplastic syndromes and their particular association with oat cell carcinoma of the lung. The feature of special interest in this study is the onset with otologic symptoms, sudden deafness in the left ear and vertigo, at a time when the neoplastic basis for the disease was not clinically evident. The most striking change in the left temporal bone is the almost total loss of cochlear neurons in Rosenthal's canal and degeneration of both divisions of the vestibular nerve. The organ of Corti and stria vascularis are normal throughout the cochlear duct. The vestibular sense organs are normal. The left cochlear nucleus is devoid of neurons, this neuronal loss is accompanied by a well developed astrocytic and microglial response similar to that in the medulla and spinal cord. This represents a carcinomatous sensory neuropathy involving the left VIII nerve with simultaneous involvement of the left cochlear nucleus. The pathogenesis of this condition still defies explanation, but there are some insights in the autoimmune sector.
Spastic Dysphonia
Authors: Brodnitz Friedrich S.
Published: October 2014

130 cases of spastic dysphonia are reviewed with special emphasis on the etiology of the disorder. An analysis of the circumstances surrounding the onset of the disease points strongly to a psychogenic origin of the disease in, at least, the vast majority of the cases.
Effect of Nicotine on Cochlear Function and Noise-Induced Hair Cell Loss
Authors: Bobbin Richard P. , Gondra Maria I.
Published: October 2014

Nicotine administered in high doses intravenously (1 mg/kg) and intracochlearly (10 mM) exhibited very little effect on guinea pig cochlear potentials. When administered chronically (1–20 mg/kg, i.p. for 20 days), nicotine demonstrated no effect on cochlear potentials or the number of observed hair cell scars monitored 21 days after the treatment was terminated. Neither chronic nicotine treatment (1–20 mg/kg, i.p. for 20 days) nor acute reserpine pretreatment (5 mg/kg, i.p. 24 hours before) altered the hair cell damaging effects of an intense pure tone (4 kHz, 126 dB SPL, 30 min). No nicotine ototoxicity was detected by the methods used in this study.
Effect of Anesthesia on Susceptibility to Acoustic Trauma
Authors: Rubinstein Moshe , Pluznik Nechama
Published: October 2014

In an effort to ascertain whether differences in susceptibility to noise depend on general condition, awake and anesthetized guinea pigs were given a 4 kHz pure tone overstimulation under identical conditions. Cochlear hair cells were histologically examined four weeks after the noise exposure. The damage was localized in the upper part of the first turn and the lower part of the second turn. One fourth as much damage occurred in the anesthetized group. The distribution of damage in the four rows of sensory cells was different in the two experimental groups. In both groups of animals the damage was localized mainly to the outer hair cells, the first row sustaining the major damage.
Unilateral Endolymphatic Hydrops and Associated Abnormalities
Authors: Sando Isamu , Holinger Lauren D. , Balkany Thomas J. , Wood Raymond P.
Published: October 2014

A case of unilateral endolymphatic hydrops is presented in which several significant histopathological findings are observed in the affected inner ear and are absent in the opposite ear. Moderate endolymphatic hydrops is present in all cochlear turns on the involved side. Atrophic changes in the cochlear and vestibular end-organs, partial collapse and infolding of Reissner's and the saccular membranes, and collapse of the posterior canal membrane are also seen. There is also marked narrowing of the proximal rugose portion of the endolymphatic sac, associated with a flattened epithelial lining, dense fibrotic connective tissue, brown pigment deposition, and poor vascularity in a relatively narrowed and straightened vestibular aqueduct. Fibrosis, loss of vascularity, and brown pigment deposition are also observed in the bony channels surrounding die vestibular aqueduct.
Pigmented Lesion of the Middle Ear
Authors: Babin Richard W. , Benjamin Sanford P.
Published: October 2014

Melanotic lesions of the mucosal membranes of the head and neck have been reported infrequently. Malignant melanomas are reported with much more frequency than benign nevi in this region. The first reported case of a nevus of the middle ear mucosa is presented. The distinctions between this lesion, nevus of Ota, meningioma, Schwannoma, and hematoma are discussed. The malignant potential for this lesion is not known, but it appears low enough to obviate interval tympanotomy.
Ear-Cough (Arnold's) Reflex
Authors: Bloustine Stanley , Langston Lloyd , Miller Tom
Published: October 2014

A clinical survey of 688 patients revealed an incidence of Arnold's reflex in 1.74% of a general otolaryngology clinic population. There was no definite age, sex, or racial correlation found. The reflex was found unilaterally as well as bilaterally and in each canal quadrant, which is contrary to the previously described distribution of the nerve to the posterior and inferior parts of the canal. There was no predilection of a positive reflex with any particular ear disease.
Otolaryngological Manifestations of Arthrogryposis Multiplex Congenita
Authors: Cohen Seymour R. , Isaacs Hart
Published: October 2014

The important otolaryngological manifestations of arthrogryposis multiplex congenita (AMC), which heretofore have not been described in otolaryngological and other specialty journals, are reviewed. Thirty-seven patients with AMC were studied. Nine of these patients with neurogenic AMC, had otolaryngological manifestations. Six of these had Pierre Robin-like syndromes. Seven patients had severe dysphagia and aspiration pneumonitis. Five patients had voice changes, and three of these required tracheotomy to relieve laryngeal obstruction and prevent aspiration. Two of these patients were aphonic and had laryngeal paralysis. Three of the nine patients who had laryngeal examination showed supraglottic narrowing similar to laryngomalacia. Six patients with otolaryngological problems were autopsied, and two had pharyngeal biopsies. The histological examination demonstrated normal laryngeal and pharyngeal musculature. The cricoarytenoid joints were found normal in all the larynges examined. Central nervous system dysfunction rather than simple muscle weakness, caused the dysphagia and respiratory difficulties in patients with neurogenic AMC. Dysphagia with aspiration was the single most important cause of death in approximately 20% of patients with AMC. A tracheotomy and feeding gastrostomy appears essential for successful management of the otolaryngological complications of AMC.
Congenital Laryngeal Defects in the Adult
Authors: Montgomery William W. , Smith Stephen A.
Published: October 2014

Two types of congenital laryngeal defects in the adult are presented. The first case is a patient with a laryngeal cleft who became symptomatic at 42 years of age. Dysphagia, dyspnea, hoarseness and aspiration progressed in severity until surgery was necessary at the age of 48 years. The second case presented is a 21-year-old male with nonfusion of the thyroid laminae. He was asymptomatic except for persistence of a high-pitched voice after puberty. The case histories and radiographic studies are reviewed, emphasizing that the diagnosis of these defects was more difficult than their management. The surgical repair is described and illustrated. Briefly, this involved repair of the laryngeal cleft using techniques similar to those of a herniorrhaphy. The nonfusion of the thyroid laminae and resultant defective anterior glottis was repaired using bipedicled muscle flaps and a silicone keel.
Granular Cell Tumors of the Larynx
Authors: Coates Harvey L. , McDonald Thomas J. , Devine Kenneth D. , Weiland Louis H.
Published: October 2014

Granular cell tumors of the larynx are relatively uncommon, always benign, and most commonly located in the posterior portion of the larynx. They are easily identified and should be differentiated from other lesions. A possible problem in the differential diagnosis is the presence of pseudoepitheliomatous hyperplasia, which overlies the granular cell tumor and which may mimic squamous cell carcinoma. Careful histopathologic differentiation is important because the laryngeal granular cell lesion should be managed conservatively, with transoral local excision usually being adequate. The histogenesis of these lesions remains in doubt, with a neural or epithelial derivation being the most likely possibility.
Verrucous Carcinoma of the Larynx Management by Radiotherapy and Surgery
Authors: Burns Hugh P. , Van Nostrand A. W. Peter , Bryce Douglas P.
Published: October 2014

Verrucous carcinoma is an unusual and distinct variant of well differentiated squamous cell carcinoma, and accounts for approximately 1 to 2% of all primary squamous cell carcinomas of the larynx. There has been considerable controversy regarding the role of radiotherapy in the management of these tumors, as they are said to be radioresistant, and in a number of instances “anaplastic transformation” has apparently occurred following such therapy. We have reviewed 18 patients with verrucous carcinoma of the larynx in which eight received surgical therapy alone, eight received radiotherapy alone, and two received combined therapy. We conclude that radiotherapy and surgery are equally effective in eradicating the disease. “Anaplastic transformation” of these tumors represents a small but nevertheless real risk following radiotherapy. Accordingly, our current therapeutic policy is to treat by surgical excision those smaller tumors which can be removed by conservation laryngectomy procedures, reserving radiotherapy for those large tumors which would require total laryngectomy if treated surgically.
Repair of Laryngeal Stenosis with Nasal Septal Grafts
Authors: Toohill Robert J. , Martinelli Dean L. , Janowak Michael C.
Published: October 2014

Autogenous nasal septal grafts were utilized in 18 dogs. The availability, method of transfer, placement, take, stability and long-term survival of these grafts are presented. Transfer of septal cartilage or composite grafts of nasal mucosa and cartilage to surgically created defects of cricoid and thyroid cartilage was performed on eight animals. Ten animals had composite grafts three months after stenosing procedures. Results were excellent in all grafts to the cricoid and subglottic areas. Grafts to the thyroid and glottic regions were characterized by severe resorption of Cartilage and fibrosis. Composite grafts to the glottic area were successful in improving the airway. Results are documented by microlaryngeal photographs and histologic sections. A literature review accompanies the presentation with emphasis on clinical utilization of composite nasal septal grafts. Twelve previously reported cases of repair by this method for laryngeal and upper tracheal stenosis are discussed. A patient with severe traumatic laryngeal stenosis successfully rehabilitated is added to this list and details the clinical value of these grafts.
Tracing the Tracheostomy
Authors: Frost Elizabeth A. M.
Published: October 2014

The evolution of tracheostomy can be divided into five stages. The first and longest period (covering roughly 3,000 years from 1500 BC to 1500 AD) begins with references to incisions into the “wind pipe” in the Ebers Papyrus and the Rig Veda. However, Alexander the Great, Asclepiades, Aretaeus and Galen are all recorded as having used this operation. Between 1546 with the writings of Brassarolo until 1883, the procedure was considered futile and irresponsible and few surgeons had the courage to perform it. The third period starts with Trousseau's report of 200 cases in the therapy of diphtheria in 1833. Tracheostomy became a highly dramatized operation for asphyxia and acute respiratory obstruction. In 1932 Wilson suggested its prophylactic and therapeutic use in poliomyelitis. Tracheostomy was then recommended for a large variety of assorted maladies. This started a tremendous period of enthusiasm. Finally, the present era starting in 1965 comes as a period of rationalization. Complications, indications and interrelation with endotracheal intubation are clearly outlined. Tracheostomy has found its place.
Percutaneous Jet Ventilation
Authors: Carden Edward , Becker Gary , Hamood Hassney
Published: October 2014

A method of ventilation utilizing an S-shaped cannula placed through the cricothyroid membrane and hooked up to a conventional jetting system is described. Its advantages are reduced morbidity, better ventilation, and an unobstructed view of the operating site for the surgeon. The system allows ventilation of the patient with oxygen prior to the induction, or at the end of anesthesia if necessary, and allows the surgeon to perform a tracheostomy in the usual manner if it is indicated. The system is not proposed as a routine method of ventilation during anesthesia for laryngeal surgery but is reserved for cases in which other methods would not perform adequately.
Tracheal Afferent Nerves
Authors: Traxel Roger M. , Prudlow William F. , Kampine John P. , Coon Robert L. , Zuperku Edward J.
Published: October 2014

The individual fibers of the inferior laryngeal nerve and anastomosing branch of the superior laryngeal nerve arising from the upper five to six tracheal rings were studied. In 30 mongrel dogs using single and multifiber nerve preparations, afferent nerve activity was studied both in the intact trachea and in an isolated segment of trachea with artificial stimuli of graded pressure and flow. The adaptation rate, threshold, spontaneous firing frequency, maximum firing frequency, and rate of change in afferent discharge were recorded. Subsequently, these fibers were electrically stimulated to determine what reflex effects could be produced. Afferent nerve activity recorded from the upper trachea was found to be sensitive to tracheal pressure changes of 0.5 to 12 mm Hg. Nerve activity paralleled the frequency of pressure changes. Electrical stimulation of these fibers demonstrated reflex bradycardia, bradypnea and alteration of blood pressure. These data and that of other investigators indicate that upper airway mechano-receptors may be significant, not only in the initiation of upper airway protective reflexes, but also in the regulation of normal respiration.
Test-Retest Reliability in Clinical Electrocochleography
Authors: Bergholtz L. M. , Hoopeh R. E. , Mehta D. C.
Published: October 2014

The intratest test-retest reliability in clinical electrocochleography was studied by measuring the difference between amplitude of the test and retest and latency of the test and retest. Eighty-four comparisons were made in 40 patients with different types of hearing losses. The type of hearing loss and whether test and retest were performed in sequence or not did not affect the variability of the amplitude. The test and retest correlation between amplitudes was good. Small amplitudes mainly found near the action potential (AP) “threshold” showed less absolute variability than larger amplitudes found at higher intensities. The correlation between the intratest latencies was excellent. The latency showed less variability at higher intensities than near AP “threshold.”
Effect of Various Sensory Stimuli on Reflex Laryngeal Adduction
Authors: Suzuki Masafumi , Sasaki Clarence T.
Published: October 2014

Various types of sensory stimuli may influence reflex laryngeal adduction. The recurrent laryngeal nerve responses evoked by single shock and repetitive electrical stimulation of a number of sensory nerves have been neurophysiologically observed in twenty-five adult cats. Stimulation of major cranial afferents produces strong adductor responses. The magnitude of these evoked responses is approached only by stimulation of the splanchnic nerve in the abdomen. On the other hand, comparable stimulation of special sensory and spinal somatic sensory nerves produces rapidly attenuated evoked adductor responses. We postulate that while these latter adductor responses may be insufficient to produce strong glottic closure, they may effectively modify phonatory function of the larynx. We have, therefore, attempted to demonstrate the effects of various sensory elicitations upon reflex laryngeal adduction as they may compositely influence both protective and phonatory control of this organ system.
Clinical Significance of Asymmetrical Vocal Cord Tension
Authors: Isshiki Nobuhiko , Tanabe Masahiro , Ishizaka Kenzo , Broad David
Published: October 2014

The effects of asymmetrical tension on the vibratory pattern of the vocal cords were studied in two kinds of experiments: 1) high speed motion picture photography of artificial voice production in excised canine and human larynges, and 2) computer synthesis of voice and vocal cord vibration via a theoretical model incorporating the physiological parameters required for phonation. In both approaches the asymmetrically tensed vocal cords consistently vibrated in three distinct modes which depend partly on the rest positions of the vocal cords; Type I. For rest positions at or near closure, the two cords vibrate at the same frequency with glottal closure every period, and with the tense cord preceding the lax one in phase and with the line of contact moving toward the tenser cord during the closed phase. The voice produced is not hoarse; Type II. For wider rest positions glottal closure occurs irregularly, the vibrations become complex and less periodic, and the voice becomes hoarse; Type III. The glottis never closes and the vibrations become more periodic with reduced amplitude. Supplementary strobo-scopic observations suggest a procedure for diagnosing tension asymmetry and the implications for surgical treatment for disorders of vocal pitch are discussed.
Tetanus and Tracheostomy
Authors: Mukherjee Dilip Kumar
Published: October 2014

Forty-one patients with tetanus in different stages of the disease on whom tracheostomies were performed are discussed in this paper. Out of these, 21 died, giving a mortality rate of just over 50%, which is about equal with those reported from other centers. It was found that patients in Stage III of the disease referred for tracheostomy hardly ever recovered. Patients in Stage II on whom tracheostomy was performed early stood the best chance of survival and recovery. However, if the operation was delayed in Stage II patients, there was a much greater chance for complications to develop, mostly due to aspiration of secretions into the tracheobronchial tree with consequent bronchopneumonia. There were four deaths, all in Stage III patients undergoing tracheostomy, where no definite or conventional identifiable cause could be determined. There were three deaths due to “technical failure” in tracheostomized tetanus patients, which underlines the difficulties and technical problems encountered in satisfactorily maintaining a totally paralyzed patient without any means of communication.
Visual Suppression Test
Authors: Takemori Setsuko
Published: October 2014

Visual suppression of caloric nystagmus was studied in normal adults and in 98 clinical cases in order to justify the application of the procedure as a clinical test. The maximum slow phase velocity during ten seconds in darkness and the slow phase velocity during ten seconds in light were taken from the recordings and measured. The mean values of these slow phase velocities were calculated and the mean slow phase velocity in darkness was assigned a value of 100%. The value which the slow phase velocity in light subtracts from the slow phase velocity in darkness, represents the visual suppression. It was determined that visual suppression of the slow phase velocity of caloric nystagmus was 48 ± 10% in 22 normal adults. This was caused by the visual fixation mechanisms. Cases in which lesions were diagnosed in the cerebellum, such as spinocerebellar degeneration and cerebellitis, showed reduced or abolished visual suppression. The lesion side can be determined by this test. Compensation following unilateral sudden loss of inner ear function can be measured by the visual suppression test.
Pseudocellulitis of the Orbit
Authors: Nadol Joseph B.
Published: October 2014

A case of retinoblastoma with secondary glaucoma, in which the initial clinical findings were indistinguishable from those of orbital cellulitis, is presented. Acute glaucoma, especially in childhood, may mimick suppurative disease of the orbit, and primary ocular pathology must be considered in evaluating apparent disease processes in other facial structures.
Pemphigus of the Air and Food Passages
Authors: Block Leslie J. , Holinger Paul H. , Caldarelli David D. , Pearson Roger W.
Published: October 2014

Pemphigus vulgaris is one among many bullous diseases which involve the mucous membranes of the oropharynx and the larynx. The pernicious nature and previous high mortality of this disease have been greatly reduced with early diagnosis and the appropriate use of corticosteroids and immunosuppressive agents. Thirteen patients with pemphigus vulgaris were seen at Rush-Presbyterian-St. Luke's Medical Center from 1970 through 1976. All patients had moderate-to-severe generalized eruptions and were biopsy-positive for pemphigus vulgaris. A moderate prednisone dosage of 80 to 120 mg/day in moderate-to-severe cases was utilized in 11 out of 13 patients. All patients were treated initially with prednisone only, and after control of the acute generalized eruptions was achieved, Cytoxan® was added to the regimen to allow reduction of the prednisone dosage. One patient in our series died as a result of disseminated herpes simplex, probably secondary to high-dose corticosteroid treatment. Mortality in our series was 7.6% This investigation suggests that lower prednisone doses of 80 to 120 mg/day, except in recalcitrant cases, may be efficacious in the treatment of pemphigus vulgaris, especially in conjunction with adjuvant immunosuppressive therapy.
Esophageal Papillomatosis
Authors: Nuwayhid Nizar S. , Ballard Edgar T. , Cotton Robin
Published: October 2014

An unusual case report of asymptomatic multiple esophageal papillomas associated with pedunculated hypopharyngeal papillomas that presented as laryngeal obstruction in a 21/2-year-old boy who underwent resection and irradiation of a retroperitoneal neuroblastoma at the age of nine months. Barium swallow and esophagoscopy confirmed the presence of multiple asymptomatic lesions involving the upper two-thirds of the esophagus. Biopsy confirmed the hypopharyngeal and esophageal lesions to be similar in nature.
Inhalation Injury
Authors: Fry Willard A. , Semerdjian Ronald A.
Published: October 2014

In the period from 1974 through 1976, there were 243 patients treated in the Evanston Hospital Burn Unit. Seventy-eight of these patients, representing 33% of the total admissions, sustained significant inhalation injury. The overall mortality of the Burn Unit for the three-year period was 19%. The mortality rate for patients sustaining inhalation injury was 42%. House fires were the most common cause of inhalation injury, and the history of sustaining a flame burn in an enclosed space is most important. Physical assessment emphasizes singeing of the nasal hairs, the presence of soot in the mouth and hypopharynx, and the finding of wheezing on auscultation of the chest. Elevated blood carboxyhemoglobin (HbCO) values can signal the extent of exposure. Our current policy is to perform flexible fiberoptic bronchoscopy on all patients with known or suspected inhalation injury immediately upon admission to the Burn Unit. Endoscopic findings are of great value in defining the degree of inhalation injury, in predicting the course of the individual patient, and in planning patient management. Intravenous amino-phylline is administered to those patients with wheezing. If gross ulceration, significant edema about the glottis, or large quantities of soot are noted on admission, then pharmacologic doses of corticosteroids are given intravenously for up to 48 hours. Tracheal intubation is performed if edema about the glottis threatens airway obstruction. Those patients who required ventilator support and/or tracheostomy did poorly. Major emphasis is placed on adequate respiratory support with vigorous care directed toward mobilizing tracheobronchial secretions. Nasotracheal intubation is preferred over tracheostomy, and such intubation can usually be performed with an adequate diameter tube to permit proper tracheobronchial toilet, if the flexible fiberoptic bronchoscope is used.
Pulmonary Migraine
Authors: Tucker Gabriel F.
Published: October 2014

Although it is not uncommon in bronchoesophagological practice to be consulted in cases of unexplained atelectasis, patients presenting with painful atelectasis are indeed rare. Three such cases will be described. The first case, previously unreported, for which Dr. M. E. Avery suggested the term “pulmonary migraine” is that of a 14-year-old Caucasian female with a history of recurrent “asthma,” chest pain, atelectasis and migraine headache. On investigation there was demonstrable spastic obliteration of the lumen of a lobar bronchus. Two similar cases are described.
Current Concepts of Tumor Immunology I. Basic Immunologic Concepts
Authors: Krause Charles J. , Nysather John O.
Published: October 2014

Interest in tumor immunology grew out of the study of host response to microbial infections during the second half of the 19th century. However, the growth of interest in transplantation during the 1950s and 1960s is largely responsible for the great surge of scientific investigation into tumor immunobiology which we are experiencing today. Tumor cells possess certain abnormal antigens in addition to their normal complement of transplantation antigens. These abnormal antigens evoke an immune response in the host, which involves both the humoral and the cell-mediated systems. Though the cell-mediated (thymus derived) system is generally conceded the most important role in tumor cell destruction, the humoral (bursal-equivalent derived) system also plays a role in host response which is presently less clearly understood. Certain aspects of the humoral response (blocking factors) actually appear to inhibit the host response against a tumor. This complex system of host immune response to tumor has been termed the immunosurveillance system.
Vertical Partial Laryngectomy for Glottic Carcinoma with Posterior Subglottic Extension
Authors: Biller Hugh F. , Som Max L.
Published: October 2014

Posterior subglottic extension of glottic carcinoma has been a contraindication for partial laryngectomy because of the proximity of the cricoid cartilage. Resection of the upper portion of the posterior aspect of the cricoid is necessary for adequate tumor resection but is complicated by persistent aspiration. This paper presents a method of reconstruction following partial posterior cricoid resection.
Complications of Laryngectomy and Neck Dissection following Planned Preoperative Radiotherapy
Authors: Cummings Charles W. , Chung Chung K. , Johnson Jonas , Sagerman Robert
Published: October 2014

One hundred sixty-nine patients with carcinoma involving the larynx treated with surgery, combined preoperative radiotherapy plus surgery, or failed curative radiotherapy with surgical salvage have been evaluated with respect to complications. Major complications occurred at approximately the same rate with all three modes of therapy. Major complications had generally a later onset and healed less rapidly in the preoperative radiotherapy group. Minor complications occurred more frequently in irradiated patients than in nonirradiated patients. When evaluating postoperative complications in irradiated patients the time interval must be extended beyond the immediate span because of delayed onset.
Long-Term Stenting in the Treatment of Subglottic Stenosis
Authors: Goode Richard L. , Shinn John B.
Published: October 2014

Long-term stenting (3 to 12 months) with silicone rubber stents was found successful in 12 of 14 cases (86%) with severe subglottic stenosis. A new silicone rubber stent is described that is suitable for long-term stenting in infants or adults.
Management of the Dying Patient with Head and Neck Cancer
Authors: Miller Daniel
Published: October 2014

The management of a patient with head and neck cancer and the psychological effect on the patient and his or her family is a subject frequently avoided in scientific assemblies. Yet, it is a fact that many physicians silently look for better understanding in themselves to be better able to understand the possible responses in patients and their respective families so that confrontations between all parties may be more comfortable for all concerned. I have tried to verbalize in this presentation such processes that affect the patient, his family and the physician himself so that we, as physicians, may better manage those unpleasant situations associated with the care of a patient with incurable head and neck cancer.
Transtympanic Electrocochleography in Patients with Syphilis and Hearing Loss
Authors: Ramsden Richard T. , Moffat David A. , Gibson William P. R.
Published: October 2014

Transtympanic electrocochleography was carried out on 18 syphilitic patients (30 ears were tested) most of whom were suffering from the late onset congenital form of the disease. A diphasic action potential with a large negative summating potential on the descending limb was found in 77.7% of ears; the cochlear microphonic potential was always of small amplitude. While these findings are not pathognomonic of syphilis, they are characteristic and may be explained on pathological grounds.
Experimental Animal Model of Subglottic Stenosis
Authors: Borowiecki Bernard , Croft Charles B.
Published: October 2014

An animal model of subglottic stenosis has been developed. The results of this pilot study show evidence to suggest that injury to the cricoid cartilage leading to perichondritis is the important factor in the development of subglottic stenosis.
Critical Look at the Classification of Maxillary Sinus Carcinomata
Authors: Harrison D. F. N.
Published: October 2014

All the classification systems at present adopted for use in carcinoma of the maxillary sinus suffer from both intrinsic inaccuracies and an apparent failure to relate T (extent of primary tumor) categories to clinical experience of the spread of these tumors. Three systems are critically analyzed in relation to personal experience of 86 patients with sinus carcinoma and a fourth system proposed as a compromise solution to this problem.
Blocking Effect of Radio-Contrast Media on Cochlear Depression
Authors: Hirashima Naoko
Published: October 2014

Furosemide injection was used in a total of 72 guinea pigs to induce a cochlear dysfunction similar to the sensorineural loss associated with sudden deafness. Prior to the furosemide administration, 38 of the animals were treated with an injection of one of four radio-contrast media; methylglucamine and sodium diatrizoate, sodium iothalamate, methylglucamine and sodium iodamide, and methlyglucamine diatrizoate. In the control animals, receiving only furosemide, both endocochlear potential (EP) and cochlear microphonic (CM) underwent a severe depression followed by recovery and subsequent secondary depression. Animals pretreated with one of the first three compounds showed little or no EP or CM depression. Animals pretreated with the fourth, methylglucamine diatrizoate, showed the same EP depression as the control animals. The possible mechanism for this blocking effect and its significance in the clinical treatment of sudden deafness is discussed.
Airway Management in the Premature Infant
Authors: Heroy James H. , MacDonald Mhari G. , Mazzi Eduardo , Risemberg Herman M.
Published: October 2014

Out of 262 premature newborn patients admitted with a diagnosis of respiratory distress, it was necessary to treat 70 with a ventilator. Of these 70, 25 eventually underwent tracheostomy. Indications for tracheostomy were that of an infant needing prolonged endotracheal intubation greater than one week. The procedure itself was easily performed and an overall complication rate of 7% was the result. Of the patients who underwent tracheostomy, 8% had significant complications. There was no death attributable to the treatment regime. We feel, therefore, that a combination approach starting with the endotracheal tube and progressing to tracheostomy when necessary, provided the best care for premature infants requiring intensive airway management.
Eustachian Tube Function Assessed with Tympanometry
Authors: Siedentop Karl H. , Loewy Arthur , Corrigan Rosemary A. , Osenar Stan B.
Published: October 2014

On 15 normal ears and 14 pathological ears of adults with intact tympanic membranes, Eustachian tube function was measured by using tympanometry in an effort to reproduce the results published by Holmquist. His method appeared to be a promising tool for clinical determination of Eustachian tube function. However, our results on normal ears were not significantly different from our results on pathological ears and were inconsistent with Holmquist's results. In contrast to Holmquist, 60% of our normal ears were unable to attain achieved negative middle ear pressures of —100 mm to —250 mm H2O. Our normal ears, as well as our pathological ears, required repeated swallows to normalize negative pressure. Tests in both our groups were not always repeatable even though recorded applied nasopharyngeal pressure was identical. Therefore, our findings do not substantiate this procedure as a useful, reliable clinical tool for measuring Eustachian tube function on ears with intact tympanic membranes.
Blood Vessels on Reissner's Membrane
Authors: Okano Yasumasa , Sando Isamu , Myers Eugene N.
Published: October 2014

The purpose of this paper is to investigate in detail the prevalence, localization, and course of the vessels in Reissner's membrane in the well-developed cochleae of individuals of various ages. 1) Of 181 prenatal and postnatal temporal bone specimens, 36 bones (19.9%) showed a total of 43 blood vessels along the surfaces of Reissner's membrane on the scala vestibuli side. In relation to age, 15 vessels were found in 12 out of 16 bones (75%) in the 15-week-old fetus group; 19 vessels were present in 15 out of 58 bones (25.8%) in the 0–1 year age group; 8 vessels were seen in 8 out of 55 bones (14.2%) in the 1–10 year age group; and only 1 vessel was found in 1 out of 52 bones (1.9%) in the 10–102 year age group. 2) Of the 43 vessels, 41 were present in the apical turn, and the remaining 2 vessels were located in the the upper half of the middle turn. 3) There were two types of courses followed by the vessels on Reissner's membrane. Among the 43 vessels observed, 3 vessels ran over the surface of the membrane all the way from the area near the spiral limbus to the vestibular crest. The remaining 40 vessels ran across the fluid space of the scala vestibuli, attached to the membrane somewhere between the spiral limbus and the vestibular crest, and then took their courses along the membrane up to the area of the vestibular crest. 4) The cause of death of the 22 postnatal individuals with vessels on Reissner's membrane was studied. Fifteen individuals expired from congenital anomalies of the heart, brain, digestive organ, lung, or kidney. Among these, congenital heart anomaly cases occurred with an extremely high rate (66.6%). 5) The vessels on Reissner's membrane appeared to occur as an element in the incomplete development of the cochlea. They seemed to be in the process of devascularization, mostly in the first decade, in both the congenital anomaly cases and the noncongenital cases.
Epiglottitis
Authors: Cohen Seymour R. , Chai John
Published: October 2014

One hundred and seventy patients with acute epiglottitis were admitted to the Childrens Hospital of Los Angeles between the years 1957 to 1977. No deaths occurred in any of these patients, all of whom were treated with tracheotomy to support and ensure the airway. The records of 147 of these patients were available for review. No serious complications occurred from tracheotomy in any of the patients in this study. Tracheotomy is a safe method for caring for the airway problem in epiglottitis in a setting such as is available at the Childrens Hospital of Los Angeles. The median range of total days with tracheotomy was five to six days, and the median range for total days of hospitalization was six to seven days. Complications were never severe and in the extreme, merely prolonged hospitalization by a few days. This highly lethal disease is curable with antibiotics and an artificial airway, and it is questionable whether conservative medical measures with observation should be acceptable. The establishment of an airway, whether by tracheotomy or endotracheal intubation, is mandatory in the treatment of this disease.
New Endotracheal Tube for Laser Surgery of the Larynx
Authors: Norton Martin L. , de Vos Paul
Published: October 2014

The risk of combustion of endotracheal tubes during laser surgery of the larynx has been demonstrated. A new flexible metal endotracheal tube has been developed to obviate this risk. The laser beam is dispersed by the construction of the metal tube, thus assuring protection from both combustion and reflection.
Tinnitus: Diagnosis and Treatment
Authors: Pulec Jack L. , Hodell Susan F. , Anthony Philip F.
Published: October 2014

Few conditions are seen as commonly by the otologist and are more poorly understood than subjective tinnitus. Tinnitus has been reported in as high as 80% of patients seen in an otolaryngology practice. This symptom is especially marked in patients with a hearing problem and can be so severe that it becomes incapacitating. Careful diagnosis and classification of tinnitus is important for understanding of the problem. Identification of the frequency and intensity of masking, using a tinnitus analyzer, is useful in selecting the form of treatment. Analysis of the history, physical findings and the use of special electrocochleography and brain stem evoked response audiometry help to identify the site of lesion, which may be within the cochlea, cochlear nerve, cochlear nucleus, brain stem, midbrain or auditory cortex. Specific disease entities should be identified and treated. Lesions of the end-organ or cochlear nerve can be treated when necessary by translabyrinthine or middle cranial fossa section of the cochlear nerve. Tinnitus from cervical nerve lesions can be treated by rhizotomy. The use of a hearing aid or introduction of a sound with a tinnitus masker has been found to be 82% effective in suppressing tinnitus. Maskers can be combined with a hearing aid in some cases. The pathogenesis of tinnitus is discussed, but the method of action of tinnitus relief by auditory stimulation is still unclear. A thoughtful and complete examination with our new diagnostic tools and the judicious selection of therapy now makes it possible to give relief to the majority of patients suffering with disturbing tinnitus.
Noise-Induced Hearing Loss
Authors: Egami Tetsuya , Sando Isamu , Sobel John H.
Published: October 2014

The histopathology of a case of profound hearing loss which seemed to be induced by noise exposure (explosions and drillings in a gold mine) is reported. The patient's only residual hearing was 250 Hz at 90 dB SPL in the right ear. The major histopathological findings were as follows: Bilateral absence or collapse of Corti's organ was observed in the middle and basal turns of the cochlea; however, in the remaining area (approximately 6.0 mm in range in the apical portion of the cochlea) Corti's organ was well-preserved with a moderate loss in number or atrophy of the hair cells. Bilateral marked decrease of the cochlear nerve was noted in the middle and basal turns; however, the nerve was well-preserved in the remaining apical portion (approximately 6.0 mm in range) of the cochlea. These pathological findings were somewhat less severe in the right cochlea than in the left. In general, there was good correlation between the profound hearing loss and the extensive pathological findings in Corti's organ. The residual hearing in the right ear would seem to be explained by the less severe pathological changes found in the apical portion of the right cochlea than in the left cochlea. In addition to noise exposure, other possible etiological factors contributing to this hearing loss are discussed. These include diabetes mellitus and presbycusis.
Intercellular Fluid Pathways in the Organ of Corti of Cat and Man
Authors: Nadol Joseph B.
Published: October 2014

The intercellular junctions in the organ of Corti of cat and man were examined with the electron microscope. In contrast to the zone of tight junctions, or zonulae occludentes, which were present at the surface of cells lining the scala media, there was no tight junctional specialization among the cells of the tympanic lamina, perilymphatic lining cells of the scala vestibuli, basal processes of the supporting cells of the organ of Corti or cells of the spiral limbus and spiral ligament. These findings suggest the possibility of fluid continuity between the scala vestibuli and scala tympani all along the cochlear duct. Morphological evidence for an intercellular diffusion barrier was present only at the endolymphatic surfaces of the cochlear duct and between the processes of the basal cells of the stria vascularis in cat and man.
Effect of Environmental Co2, O2 and Ph on the Growth of Respiratory Epithelium in Vitro
Authors: Weisman Ziva , Sadé Jacob
Published: October 2014

Explants of rabbit tracheal epithelium were exposed to various CO2 and O2 levels and to different pH values for two weeks in organ culture. During culture the original explanted epithelium gradually changed from pseudostratified to stratified and there was a decrease in goblet cell density, and in the amount of PAS positive material in these cells. The changes in stratification were found to be independent of the pH of the medium or the CO2 level, but the proportions of ciliated cells and goblet cells were affected by the CO2/O2 ratio and by pH. Coordinated ciliary activity was preserved in most explants except for those cultured at high (80 and 95%) oxygen levels. A new growth of epithelium gradually covered the exposed connective tissue. This new epithelial growth developed the phenotypic expression of the original tissue; it gradually differentiated into ciliated cells and goblet cells. At increased CO2 levels and a high pH (7.7), differentiation into goblet cells increased fourfold, while differentiation into ciliated cells decreased. These findings suggest that high CO2 levels promote goblet cell differentiation. and thus increase the propensity for mucus secretion in unaerated epithelia. The correlation of these results with the fact that increased CO2 level present in the middle ear of patients with secretory otitis media may help to explain the large increase in the population of mucus-secreting cells in this disease process.