bluuebunny/crossref_metadata_2025 huggingface dataset:
Sound-Field Hearing Tests
Authors: Wolf R. V.
Published: January 2017

Facilities for sound-field testing of hearing and calibration procedures are described.
2. Results in Normal Subjects
Authors: Sills Andrew W. , Baloh Robert W. , Honrubia Vicente
Published: January 2017

A large number of variables were examined simultaneously for 43 normal subjects over the four irrigations of a caloric test. Care was used for every step of the testing procedure and data analysis to eliminate as much of the variance in the caloric responses as possible. The normality of each variable's distribution was examined using the Wilk-Shapiro W test and corrected if necessary by the best of several transformations. The means, standard deviation, and 95% confidence intervals of the resultant data were derived. Statistical tests of temperature, sidedness, and directionality were done on the variables and several important sources of variance were found and explained.
Further Observations on Posterior Ampullary Nerve Transection for Positional Vertigo
Authors: Gacek Richard R.
Published: January 2017

— An evaluation was made on ten patients with benign paroxysmal positional vertigo (BPPV) in whom transection of the posterior ampullary nerve was performed by the middle ear approach under local anesthesia. The undermost ear in the provocative test position was selected for surgery. All ten patients were relieved of positional vertigo by the procedure. Of the five patients who were relieved of BPPV by posterior ampullary nerve transection prior to 1974, the long-term follow-up on four revealed continued relief of vertigo. Five additional patients treated by this surgical procedure since 1975 have also experienced relief from BPPV, but a moderate sensorineural hearing loss occurred in one patient. Two additional patients with BPPV were explored surgically but the singular canal could not be located. Persistence of the vertigo in these two patients strengthens the conclusion that the posterior semicircular canal sense organ is largely responsible for BPPV.
Perilymphatic Oxygen Tension and Vasoactive Drugs
Authors: Yagi N. , Fisch U. , Murata K.
Published: January 2017

— The oxygenation of the perilymph in response to the intravenous injection of vasoactive drugs has been measured in 67 cats using the polarographic method. Of all drugs used, only angiotensin induced a significant raise of perilymphatic PO2. Histamine, 50% glycerol and 7% Na2CO3 reduced the perilymphatic PO2. Papaverine, furosemid, pyridylcarbinol, naftidrofuryl and low molecular dextran have no significant effect upon the perilymphatic oxygen tension. Rapid changes of systemic blood pressure were found to correlate with subsequent modifications of the oxygen tension in the perilymphatic space.
Temporal Bone Findings in Hemifacial Microsomia
Authors: Sekhar H. K. Chandra , Toktta Nobuhtro , Alexic S. , Sachs M. , Daly John F.
Published: January 2017

— The temporal bone findings in a case of hemifacial microsomia are described with photographs. The right facial hypoplasia was associated with anophthalmia and microtia on the same side. The right petrous bone was hypoplastic and showed total superior dehiscence of the internal acoustic meatus. The otic capsule was deformed with an underdeveloped cochlear modiolus grossly deficient in spiral ganglion population. The spiralling cochlear shell showed partial deficiency of the interscalar septum between the middle and apical coils. The cochlear duct was shorter than that on the normal side; the organ of Corti however was normal. The vestibular system did not show any structural abnormality except for the degeneration and reduction of the Scarpa's ganglion cells and nerve fibers. An additional interesting fact was that the facial nerve was totally absent in the temporal bone except for its nervus intermedius component.
Necrotizing Sialometaplasia
Authors: Spark Ronald P. , Duncan Donn G.
Published: January 2017

— Necrotizing sialometaplasia of the palate, an enigmatic pseudomalignant penetrating ulcer, is a benign lesion which heals spontaneously in three to ten weeks. Relative painlessness contributes to patient delay in seeking medical attention, and suggests that many cases are subclinical. Clinically, the patient age group and morbid gross appearance mimic malignant palatal tumors. Lack of awareness of this entity has led to the misdiagnosis of carcinoma in several previous cases. However, the histopathologic features of sialadenitis, focal lobular necrosis with mucosal ulceration and glandular squamous metaplasia, are distinctly benign. A typical case and literature review are presented.
Noninvasive Chronic Recording of Auditory Nerve Potentials
Authors: Wiederhold Michael L. , Martinez Serge A. , Paull Dana M. , Pierson Martha G. , Defries Hugh O.
Published: January 2017

A system is described which allows repeated, noninvasive recording of auditory nerve responses in the cat to transient acoustic stimuli using a closed acoustic system. N1 responses to clicks are recorded from a stainless steel ring electrode at the end of a hollow earbar, the tapered end of which is made of insulating plastic. Acoustic stimuli are generated by a dynamic earphone coupled to the earbar. A calibrated probe microphone is also incorporated into the earbar to measure sound pressure near the tympanic membrane. This allows better stimulus control than is available with tree-field systems. To facilitate insertion of the earbar, meatoplasties were performed on all animals. Responses recorded with this system in anesthetized cats are described and compared with those recorded at the round window. Good repeatability of measurements is described for an animal population of 20 domestic cats over a period of several months. For some of these animals, response amplitude varied from one session to another, but response latency, especially for condensation clicks, was consistent. By comparing statistics of multiple measurement of both N1 amplitude and latency for rarefaction and condensation clicks, it is concluded that the N1 latency vs click-level function for condensation clicks provides the most reliable measure of the cat's auditory nerve function.
Epidermolysis Bullosa Associated with Laryngeal Stenosis
Authors: Cohen Seymour R. , Landing Benjamin H. , Isaacs Hart
Published: January 2017

A boy with epidermolysis bullosa developed progressive laryngeal obstruction after age six months, with tracheotomy necessary at age three years. By eight years, the larynx was completely occluded by web and scar. Stenosis recurred repeatedly over the next seven years, three to six months after each corrective procedure, but laryngeal patency has been better-maintained since age 15. Laryngeal stenosis, presumably secondary to epithelial detachment, although a rare complication of epidermolysis bullosa, can be serious and life-threatening.
Auditory Prostheses Research with Multiple Channel Intracochlear Stimulation in Man
Authors: Eddington D. K. , Dobelle W. H. , Mladejovsky M. G. , Brackmann D. E. , Parkin J. L.
Published: January 2017

Although single-channel electrode arrays implanted in the scala tympani of deaf patients are useful as an aid to lip reading and for distinguishing some environmental sounds, they do not transmit intelligible speech. However, multichannel electrode arrays, which take advantage of the cochlea's tonotopic organization, may be capable of generating the complex patterns of neural activity necessary for speech discrimination.

In this study, multichannel electrodes were implanted in the cochleas of four volunteers, with access to the connecting wires made through the skin via a percutaneous connector. The major portion of the data presented is from two of these subjects: one has been bilaterally deaf since birth and the other has been unilaterally deaf for 15 years. Preliminary results of experiments with two more recently implanted subjects are described as well as experiments with a fifth volunteer who was implanted with five electrodes by House in 1969.

Data on pitch and loudness discrimination as well as the effects of stimulation parameters on threshold, impedance, and electrode interaction are presented. Place pitch and periodicity pitch were observed in all five volunteers. The results of pitch-matching experiments with the unilaterally deaf volunteer were consistent with tonotopic maps of the cochlea, and experiments indicated that a pitch continuum may be achieved by combining place and periodicity pitch modulation.

Preliminary experiments in tune recognition with one subject demonstrate his ability to recognize simple melodies based on periodicity pitch cues.

These results, coupled with the finding that subjective sensations remain stable over the long-term, support the feasibility of providing artificial hearing with a multichannel cochlear stimulation system.
Familial Dysautonomia (Riley-Day Syndrome)
Authors: Tokita Nobuhiro , Sekhar H. K. Chandra , Sachs Mieczyslawa , Daly John F.
Published: January 2017

Familial dysautonomia, or Riley-Day syndrome, is inherited in an autosomal recessive fashion and occurs almost exclusively in Jewish families. This disorder is characterized by a smooth tongue devoid of fungiform papillae and of taste buds, and is clinically associated with poor taste discrimination. An unsteady gait and dizziness on change in position are also common presenting symptoms. This study reports the histopathological findings of eight temporal bones from four patients with documented familial dysautonomia. For the control series, 13 normal temporal bones were also studied. The most striking finding in the dysautonomic patients was an extreme paucity of geniculate ganglion cells ( P <0.001). A statistically significant reduction in the number of neurons was also found both in the superior and in the inferior divisions of the vestibular nerve ( P <0.001). The paucity of the geniculate ganglion cells correlates well with the impairment of the taste in dysautonomic individuals, since the afferent fibers leaving taste buds of the anterior two-thirds of the tongue run via the chorda tympani and have their cell bodies in the geniculate ganglion. Furthermore, the reduction in the number of Scarpa's ganglion cells observed in the dysautonomic patients studied here could account for a poor response to caloric test, positional vertigo and an unsteady gait in this condition.
Operating Ranges for Cochlear Implants
Authors: Pfingst Bryan E. , Spelman Francis A. , Sutton Dwight
Published: January 2017

The range of simple electrical stimuli that may be used for prosthetic stimulation via scala tympani implants was explored using psychophysical procedures in macaque monkeys. Biophysical considerations placed further limitations on the operating range. The operating range was dependent on stimulus waveform, electrode configuration, and the condition of the implanted cochlea and eighth nerve.
Frequency of Pathologic Changes in the Middle Ear
Authors: Rudin Rolf , Holmquist J.
Published: January 2017

One third of a total of 2,783 60-year-old males living in Gothenburg were examined to establish the frequency of pathologic changes in the middle ear. During 1973 to 1975, 767 men were examined. The eardrums were studied with otomicroscopy. Audiometric tests and x-ray of the mastoid cell system were performed. Pathologic changes were found in 37% of which 5% had chronic otitis. Hearing impairment was found in 95% of patients with chronic otitis. This group showed a significant reduction in mastoid cell area compared to males with normal tympanic membranes. There was a distinct relationship between low social class and small mastoid cell area and high frequency of noise injury.
Natural History of Otitis Media in the American Native
Authors: Wiet Richard J. , Stewart Joseph , Deblanc G. Bruce , Weider Dudley J.
Published: January 2017

Otitis media is the leading reportable disease among the Indian and Eskimo population. In addition, its prevalence is more frequent in American natives than in Caucasians or Negroes. An attempt herewith is made to delineate the factors that account for the high prevalence of otitis media in the acute and chronic form. Secondly, the characteristic morbid complications of otitis media in this population are evaluated.
Effect of Surgical Alterations of the Tensor Veli Palatini Muscle onc Eustachian Tube Function
Authors: Cantekin Erdem I. , Phillips David C. , Bluestone Charles D. , Doyle William J. , Kimes Kyle K.
Published: January 2017

Previous studies in humans have indicated that functional obstruction of the eustachian tube (ET) is an important factor in the pathogenesis of otitis media with effusion (OME). This type of obstruction appears to be related to the structural properties of the tube, or to an inefficient active tubal opening mechanism, or both. In this study, functional ET obstruction was created in 22 rhesus monkeys ( Macaca mulatta) by surgically altering the tensor veli palatini (TVP) muscle using three different procedures: 1) complete excision of the muscle; 2) transection of the superficial muscle bundle; or 3) transposition of the muscle tendon medial to the hamular process. Prior to surgery, weekly tympanometry, pneumatic otoscopy, and otomicroscopic examinations were performed for a period of at least six months to document middle ear (ME) status. A minimum of four ET function tests were performed on each animal using the inflation-deflation and forced-response tests. Following surgery, these tests and examinations were continued for periods of up to one year. Postoperatively, the animals in which the TVP had been excised developed a sterile ME effusion which proved to be a chronic condition which persisted throughout the follow-up period. Eustachian tube function tests showed a complete absence of any active tubal dilation by swallowing. Animals that had the muscle transected developed abnormal ME pressures, or effusions, or both, which returned to normal in some ears, but which were recurrent or chronic in others. Eustachian tube function tests in these animals showed an initial loss of active tubal function which gradually improved, but not to normal levels, presumably as a result of healing of the muscle. In cases in which the muscle was transposed the ME pathology and ET dysfunction were similar after the surgery, but improved within a short period of time. These data suggest that alteration of the TVP muscle can create functional obstruction of the ET. The severity of ET obstruction depends upon the surgical procedure undertaken. The results of postoperative ET function tests were similar to those recorded from children with recurrent and chronic OME.
Observations of Middle Ear Pressures
Authors: Buckingham Richard A. , Ferrer Jose L.
Published: January 2017

Previous direct measurements of middle ear pressure in ears with serous otitis resulted in the range of from 0 to − 10 mm H2O pressure. To confirm these findings we attempted to quantify middle ear pressures by doing myringotomies in serous otitis patients through sterile saline solution. We compared the rate of aspiration of the saline in ears with serous otitis to the rate of aspiration of saline after an experimental myringotomy in an ear model in which known pressures were imposed. To record our findings we used motion picture photography. Layering a film of sterile oil suspension of oxytetracycline and hydrocortisone over dry tympanic membrane perforations resulted in the demonstration of a pulsatile positive pressure of about 6 mm water in many of the ears which we tested. The oil film often formed an external bubble which ruptured after several minutes. In some ears there was no change in pressure and in only a small percentage there was evidence of a decreased pressure by absorption of air in the middle ear during the period of observation. This positive pressure is unrelated to swallowing and suggests that the current theories of middle ear aeration via opening of the eustachian tube may not be valid. These findings were demonstrated with motion picture film.
Effect of Anesthetic Gases on Middle Ear Pressure in the Presence of Effusion
Authors: Gates George A. , Cooper J. C.
Published: January 2017

Halothane, randomly with or without nitrous oxide (N2O), was administered by face mask to 69 children (selected by tympanometric and otoscopic evidence of chronic otitis media with effusion) for pressure equalization (PE) tube insertion in one or both ears. Tympanograms were obtained from 127 ears prior to and soon after the induction of a satisfactory level of anesthesia. The effect of anesthesia was identical whether N2O was used or not: 85% (75/88) of ears with flat tympanograms (B) remained B (all contained fluid); 15% (13/88) became peaked and 62% (8/13) of those contained fluid. All but two ears with peaked tympanograms showed substantial increases in middle ear pressure (mean: 179 mm H2O, range: − 70 to + 550 mm H2O) regardless of the presence of fluid. We conclude the N2O is not responsible for aerating the middle ear in the usual surgical setting, and that assisted ventilation used in mask inhalation anesthetic techniques will inflate all normal middle ears, most ears with a peaked tympanogram regardless of fluid, and 15% of ears with a nonpeaked tympanogram. It is unlikely that inhalation of anesthetic gases is responsible for displacement of middle ear fluid down the eustachian tube within the time constraints of the usual operating room setting.
Negative Middle Ear Pressure
Authors: Lildholdt Torben
Published: January 2017

This study describes variations in the occurrence of negative middle ear pressures during a 12-month period in an unselected group of 352 children, all about seven years old. During the year-long study, the children were screened several times in the field to measure middle ear pressure and hearing losses greater than 20 dB. The children that failed this field screening were transported to the Hearing Clinic of Vejle Hospital and their auditory acuity was measured by audiological procedures. Calculation of the cumulated incidence of negative middle ear pressure showed that a pressure of − 150 to − 250 mm H2O, otherwise purported to reflect pathology, occurred in 25% to 55% of the children at different times during the year. The prevalence of these negative middle ear pressures was such as to negate the term “pathology,” which is usually applied to such findings. Various negative pressures were found to occur as characteristics of the season of the year and were also found to occur more frequently bilaterally in boys. Conductive hearing losses of 10 to 20 dB were found in 7% to 44% of the children but were not found to be related to sex. The variability of middle ear pressure limits its value in predicting middle ear pathology and leads to a risk that children will be over-referred for further investigation and treatment of nonexistent middle ear problems if middle ear pressure is used as the sole prognosticator of middle ear pathology.
Secretory Otitis Media and Mastoid Pneumatization
Authors: Hussl Burkhard , Welzl-Mueller Kunigunde
Published: January 2017

The objective of this study is to correlate in children with chronic secretory otitis media the extent of pneumatization with morphological and functional end results after therapy. For this purpose we examined 82 children and adolescents (147 ears), who 5 to 8 years previously were treated with insertion of ventilating tubes for chronic secretory otitis media. We evaluated the morphological and functional end results with otomicroscopy, pure tone audiometry, tympanometry and stapedial reflex testing. Roentgenograms of the temporal bones in a lateral projection were taken initially in 96 ears and at time of control in 145 ears. We judged the size of the mastoid air cell system by visual estimation and classified the mastoids according to the extent of pneumatization into three groups: large, middle-sized and small (sclerotic). Twenty-five percent of the ears had sclerotic mastoids at time of control. Statistically significant correlations exist between arrested pneumatization (sclerotic mastoids), major morphological changes in the tympanic membranes and unfavorable functional results. Also the correlation between sclerotic mastoids and the number of tube insertions required in the course of the disease is statistically significant. But no correlation can be established between the physical properties of secretions and the extent of pneumatization. Arrest of pneumatization leading to a small mastoid air cell system constitutes an unfavorable prognostic factor for the final outcome of chronic secretory otitis media.
Study of Antibody Levels in Children with Purulent Otitis Media
Authors: Branefors P. , Dahlberg T. , Nylén O.
Published: January 2017

A series of episodes of acute otitis media were studied with reference to the bacterial findings in the nasopharynx and the specific antibody response in a group of children nine months to ten years of age, with previous frequent episodes of acute otitis media, Serum IgG, IgM and IgA antibody levels against five polysaccharide antigens, namely Haemophilus influenzae type b and Streptococcus pneumoniae types 3, 6, 19 and 23, were studied by means of an enzyme-linked immunosorbent assay. The selection of polysaccharide antigens was based on isolation frequency. The sera to be tested were tenfold serially diluted. An extinction of 0.2 over the base was taken as the end-point titer and expressed as in-log10. The results showed that most children including those under three years of age showed increasing homologous antibody titers at an infection, or had already initially very high antibody titers, especially of the IgG class. The titers reached levels of 104 to 105. In some cases, however, it could be shown that high serum antibody titers did not give protection against a new infection with the same serological type of bacteria. It was also demonstrated that most children, regardless of age, had IgG and IgM titers against the heterologous antigens. In some cases the levels were quite high (103 to 104). However, the IgA antibody levels were lower and in a considerable number of samples antibodies were not even detectable.
Sonometric Evaluation of Eustachian Tube Function Using Broadband Stimuli
Authors: Murti Krishna G. , Cantekin Erdem I. , Stern Richard M. , Bluestone Charles D.
Published: January 2017

New measurements of acoustical transmission through the eustachian tube (ET) have been obtained in a series of experiments directed toward the development of a clinical instrument to assess ET function behind an intact tympanic membrane (TM). Using a sound conduction method, a sound source was placed in one nostril, and the acoustical energy that was transmitted through the ET was measured by a microphone placed in the ear canal. The present study used a broadband noise as the acoustical stimulus, in contrast to the tonal stimuli employed in previous investigations. This stimulus was chosen because it is believed to reduce the variability in the data due to intersubject differences in the acoustics of the nasopharynx and ET, and to avoid any a priori assumptions concerning the specific frequencies that would be of greatest diagnostic significance. Averaged spectra of the sound transmitted to the ear canal were obtained for three experimental conditions: acoustical source present during subject swallowing, source present with no swallowing, and subject swallowing with source absent. A Bayesian classification scheme based on the statistics of these spectra was used in classifying subjects into one of two possible categories, normal and abnormal ET function. A comparison was made between sonometric classification and classification based on a tympanometric ET function test. Correlation between the two methods was 87.1%.
Hearing Loss in Relation to Physical Properties of Middle Ear Effusions
Authors: Wiederhold M. L. , Vap J. G. , Zajtchuk J. T. , Paggi R. E.
Published: January 2017

Hearing loss was measured in cats after ligation of the eustachian tube (ET) on one side to produce middle ear effusions. Auditory nerve responses to broad-band clicks were recorded from the ear canal. Plots of N1 response amplitude and latency versus click sound pressure level (SPL) were constructed. Hearing loss was determined as the average displacement along the SPL axis of the latency plot, relative to a previously recorded control series. Viscosity of effusion was measured with a cone and plate viscometer. Specific gravity was measured using a 1 cc pycnometer. Middle ear pressure was assessed tympanographically. After ET ligation, all cats developed negative middle ear pressure within three days and flat (type B) tympanograms within seven days. Hearing loss also developed early and became maximal at about three weeks. Tympanocentesis yielded either thin fluid or glue-like effusions in nearly equal numbers. The data indicate there is not a significant difference between the amount of hearing loss associated with thin fluids or with glue. Viscosity is not clearly related to the duration of time the fluid is present in the middle ear. There is a significant positive correlation between the amount of hearing loss and the volume of fluid present in the middle ear. Thus, the amount of hearing loss appears to depend only on the volume of effusion and is not significantly dependent on other physical properties of the fluid.
Impedance Screening for Children
Authors: Bess Fred H.
Published: January 2017

Two sets of recommendations for impedance screening have been generated recently for use with preschool and school age children. One set of these recommendations, developed in Nashville, purports that it is premature to mass-screen on a routine basis for the detection of middle ear disease. These recommendations do encourage, however, the screening of special populations of children considered at risk for otitis media. This paper offers support for Nashville recommendations and suggests that there is a critical need for additional research before we begin to screen in mass. Areas in need of further research and clarification included the use of impedance as a screening tool, natural history and medical management of middle ear disease, and the educational and linguistic complications of middle ear disease. Hence, while the potential value for screening is recognized by the Nashville recommendations, they also recognize the need for more study of the procedure and the disease.
Inner Ear Pathology and Otitis Media
Authors: Paparella Michael M. , Goycoolea Marcos V. , Meyerhoff William L.
Published: January 2017

Insidious inner ear complications of otitis media have been and are being studied in our laboratory. The purpose of this paper is to review these studies, coordinate, capsulize and highlight the results with emphasis on the transport role of the round window membrane.
Diagnostic and Therapeutic Studies in Childhood Serous Otitis Media
Authors: O'Shea John S. , Lancenbrunner David J. , Pezzullo John C. , McCloskey David E. , Regan J. Barry
Published: January 2017

Fifty-five children with their first recognized episodes of serous otitis media were followed over a three-month period. The efficacy of an antihistamine-adrenergic combination (diphenhydramine and pseudoephedrine), the comparative value of various diagnostic studies of middle ear function, and the prognostic importance of information obtained at the first visit were assessed. Compared double-blindly to a placebo, the pharmaceutical preparations did not appear to influence the clinical course, although more drug patients experienced lethargy or relief of symptoms not directly concerned with middle ear function (mainly upper respiratory congestion). The color and extent of motility of the tympanic membrane, but no other pneumatic otoscopic findings, were related to audiometry, whereas tympanometry correlated with the amount of motility and the presence or absence of visible fluid behind the membrane. The patients with the most severe hearing losses or with visible middle ear fluid at their initial visits improved the most, and those who began to be followed in the summer the least. The last finding may be due to a general but unexplained deterioration of childhood serous otitis media during the fall.
Use of a Short Course of Prednisone for Treating Middle Ear Effusion
Authors: Schwartz Richard H. , Puglese Joseph , Schwartz Daniel M.
Published: January 2017

This report presents findings of a double-blind crossover prospective study involving the use of a short course of prednisone for the treatment of otitis media with effusion (OME). Subjects were 41 children with persistent OME for three weeks or more despite the use of antimicrobial and/or decongestant therapy. Pulverized prednisone tablets (5 mg) or lactose powder (placebo) were packed in unmarked gelatin capsules and placed in identically coded vials. The dosage schedule was 1 mg/kg/day for the first two days in a divided dose; 0.75 mg/kg/day for the next two days; followed by 5–10 mg/kg/day as a single morning dose for the remaining three days. In addition, all children received concomitant sulfisoxazole suspension of 50 mg/kg/day twice daily. Results for 40 children treated with steroids either initially or following crossover revealed that 70% demonstrated resolution of OME via pneumo-otoscopy and 64% via tympanometry. In addition, we examined the relationship between the ability to resolve effusion with corticosteroids and six variables: 1) duration of OME prior to entry into study, 2) month of year at entry into study, 3) bilateral versus unilateral disease, 4) child's sex, 5) prior use of ventilating tubes, and 6) personal or family history of allergy. The results of these comparisons are discussed.
Mucosal Immune System: Implications in Otitis Media with Effusion
Authors: Bernstein J. M. , Ogra Pearay L.
Published: January 2017

The ontogeny of the mucosal immune system as it relates to the development of lymphoid tissue in the respiratory tract and the gastrointestinal tract has been studied quite extensively over the past few years. It is apparent now that the bronchus-associated lymphoid tissue and gut-associated lymphoid tissue are the major sources of immunocompetent precursor B lymphocytes. After the induction of antigens in the respiratory tract or the gastrointestinal tract, precursor lymphoid cells in these sites are preferentially activated to undergo significant proliferation. Such antigen-sensitized cells eventually migrate to other mucosa sites, such as mammary glands, genital tract, conjuctiva, etc. Recent evidence has suggested that the immunocompetent tissue observed in the middle ear cleft during otitis media with effusion may function as an extension of the mucosal immune system in the upper respiratory tract. The implications of these observations relative to middle ear disease are discussed.
Animal Models for Studying Pneumococcal Otitis Media and Pneumococcal Vaccine Efficacy
Authors: Giebink G. Scott , Berzins Ilze K. , Quie Paul G.
Published: January 2017

The natural history of experimental pneumococcal otitis media (POM) was studied in chinchillas following direct inoculation of Streptococcus pneumoniae into the middle ear cavity and following nasal colonization with S pneumoniae. POM was induced in over 75% of animals whose middle ears were inoculated with fewer than 1.5 × 102 S pneumoniae of types 3, 6A, 7F, 18C and 23B. Following nasal inoculation of pneumococci, fewer than 10% of animals spontaneously developed POM. However, after brief application of negative (−25 mm Hg) pressure to the middle ear cavity of colonized animals, greater than 50% of animals developed POM. Bacteriologic results suggested that POM induced by nasal colonization was less severe than that induced by direct middle ear inoculation, yet serum pneumococcal antibody responses were similar. These findings demonstrate the combined roles of nasopharyngeal colonization with pathogenic bacteria, compromised middle ear ventilation and immunologic response in the pathogenesis of otitis media. To determine whether pneumococcal capsular polysaccharide vaccine was effective in preventing experimental POM, 23 chinchillas were vaccinated with type 7 pneumococcal vaccine. Fourteen animals seroconverted with at least a twofold rise in serum antibody, and nine did not seroconvert. Following intranasal inoculation of type 7 S pneumoniae and application of bilateral negative middle ear pressure, only one (7%) of the vaccinated seroconverting animals and four (44%) of the nonseroconverting animals developed POM. Twenty-six of 42 (62%) unvaccinated animals developed POM. Protection was associated with high levels of serum antibody prior to nasal inoculation, and higher antibody levels were found in sterile middle ear effusions than in effusions with pneumococci. These findings suggest that vaccination with pneumococcal capsular polysaccharide may be effective for preventing type-specific pneumococcal otitis media in infants and young children.
Experimental Otitis Media in Chinchillas
Authors: Lewis Daniel M. , Meadema Samuel J. , Schram James L. , Lim David J.
Published: January 2017

Otitis media was induced in chinchillas by intrabullar injection of type 3 Streptococcus pneumoniae. It was found that the severity of a primary infection was related to the dose of bacteria injected, and animals that had recovered from a primary infection were resistant to reinfection with type 3 S pneumoniae. Middle ear effusions from infected animals contained antibodies to type 3 pneumococcal polysaccharide, whereas the sera of these animals lacked this antibody, suggesting that resistance to reinfection was due to local immune mechanisms. This idea was tested by immunizing chinchillas by various routes. Animals immunized with formalin-killed type 3 S pneumoniae by intramuscular injection (to stimulate the systemic immune system) or by intranasal inoculation (to stimulate the secretory immune system) were found to be susceptible to infection with type 3 pneumococcus, while animals immunized by inoculation of bacterial suspension directly into the middle ear were resistant to infection. In addition, we found that ampicillin treatment of a primary infection blocks the development of resistance since antibiotic-treated animals were susceptible to reinfection with the type 3 pneumococcus. These results indicate that chinchillas develop an immunity to pneumococcal otitis media following recovery from primary infection and that this immunity is mediated primarily by local immune mechanisms rather than systemic immune responses.
Problems of the Communicatively Disadvantaged an Overview
Authors: Bordley John E.
Published: January 2017

The article traces the attitude of various cultures through the centuries toward the hearing and speech handicapped. It outlines the early efforts to develop rehabilitative techniques for such handicaps, and describes a number of the pioneers in the field of education for the “deaf and dumb.” The emergence of the opposing philosophies for training the hearing handicapped, the oral school and the signing school, and the influence these two had on the development of education for the deaf is described. The part played by basic research and the development of new instrumentation during the past 50 years in the solution of many of the problems of disordered communication is reviewed. Finally, the philosophic aims are described that led to the establishment of the Boys Town Institute for communicatively handicapped children.
Communication Disorders: Investigator Training and Support Needs
Authors: Lawrence Merle
Published: January 2017

There are very few “simple problems” left in the area of communication disorders, but that does not mean that there are unsolvable problems. However, in pursuit of these, present day research often requires extensive technical procedures which require teams of investigators trained in different areas. Among these should be the otolaryngologist, but, in this country, there are few involved and there is a paucity of disease-oriented research. In the 1950s and 1960s, the NIH training grant provided funds for bringing doctor of philosophy researchers into clinical departments to set up laboratories and work intimately with the medical doctor. Basic research training is still essential during residency and the number of postresidency fellowships ought to be increased. The familiarity with clinical problems introduced into the research effort should improve the possibility for the conduction of disease-oriented research in addition to the present day emphasis on basic research.
Pathology of Congenital Deafness
Authors: Bergstrom LaVonne
Published: January 2017

The pathology of congenital hearing loss is as varied as the etiologies. Severe external ear anomalies, such as microtia, and middle ear defects have a significant incidence of accompanying inner ear aplasias, more often of the vestibular than of the cochlear end-organs. Classic inner ear aplasias are discussed, including Michel, Mondini, Alexander and Scheibe. A case illustrating close resemblance between a genetically induced Scheibe malformation and rubella inner ear deformities is presented. A variety of ear disorders acquired during intrauterine or neonatal life, including cytomegalic inclusion disease, hypoxia, erythroblastosis fetalis and later-onset genetic disorders are also discussed. Illustrative case histories are presented as well as priorities for future investigations into the pathology of congenital and genetic hearing loss.
Chronic Otitis Media and Cholesteatoma
Authors: Proud G. O.
Published: January 2017

Cholesteatoma may arise because of a number of events, but serous otitis media appears to be the precursor in the majority of instances. Whether one enters into conservative, simple excision of the keratotic mass or a more extensive modified radical mastoidectomy or radical exteriorizing procedure will depend upon whether the cholesteatoma is in a very small “pearl-like” mass, confined to a limited area, or whether it is dispersed to the point where total eradication is all but impossible.
Behavioral Methods in Pediatric Audiology: Past, Present, Future
Authors: Matkin Noel D.
Published: January 2017

A pediatric audiologic test battery consisting of both behavioral conditioning approaches and electrophysiological techniques has been developed and refined during the past decade. At present, a high rate of success can be anticipated in identifying and describing various degrees, types and configurations of pediatric hearing loss. Further, progress has been seen in the development of a battery of materials which are linguistically appropriate for assessing the utilization of residual auditory function among young hearing-impaired children. It is obvious, however, that clinical research is still needed to assure expansion and refinement of existing materials and techniques used for discrimination testing. Further, methodology must be developed for objective analysis of a youngster's auditory response behaviors if additional handicapping conditions are to be identified at an early age. Finally, a major challenge in the future is to analyze through systematic clinical investigation the potential contribution that can accrue with the administration of central audiologic test procedures designed both to identify and to classify various auditory-based language and learning disabilities.
Impedance Audiometry
Authors: Lidén Gunnar
Published: January 2017

After a review of the development of acoustic impedance measurements, the principles of tympanometry, static compliance and measurements of the middle ear reflexes are described. The interpretation of tympanometry is done by analyzing three essential features: pressure, amplitude and shape. The influence of high probe tones on the shape of the tympanogram and the possibility of analyzing the stiffness-mass relationship are pointed out. Impedance screening has supplemented tone screening on 5,886 seven-year-olds in five separate investigations from 1972 to 1978. In the last and most conclusive investigation on 1,027 children, the otologist found 6% pathological ears. Stapedius reflex threshold testing (ipsilateral stimulation), criterion level 110 dB SPL rated 7.8% of the ears as abnormal. Tympanometry resulted in 6.5% pathological ears and tone screening at 0.5 kHz 1.9%. Based on these results the following screening procedure is recommended: tone screening at 0.5 and 4.0 kHz supplemented by tympanometry. A middle ear pressure of ≤ — 150 mm H2O, or a flat tympanogram and/or tone screening levels ∓20 dB HTL at 0.5 kHz and/or 4.0 kHz are considered at indicative of ear pathology. Children failing the screening test should have a repeat test after four to six weeks at school and only those who do not pass at this time should be referred to an otologist.
Electrophysiologic Audiometry
Authors: Worthington Don W. , Peters Jon F.
Published: January 2017

The utility of the brainstem evoked response (BER) as a test of peripheral auditory sensitivity in infants and young children is discussed. Two cases are presented to illustrate the application of this technique in multiply handicapped children.
Vestibular Testing in Children
Authors: Cyr David G.
Published: January 2017

Vestibular evaluation in the pediatric population has in the past taken several forms. For the most part, the pediatric vestibular evaluation has been more subjective than objective. One of the primary reasons for this has been the obvious difficulties encountered in trying to conduct a standard, adult electronystagmography (ENG) procedure on a pediatric patient population not capable of performing in a manner conducive to a good ENG recording. The purpose of this paper is to suggest certain modifications of the standard adult ENG battery for use with young children and infants. Discussion consists of modifications in the areas of various ocular movement tests including sinusoidal pursuit, calibration, optokinetics and gaze testing. In addition, procedures relative to peripheral vestibular output from perrotational and caloric stimulation are discussed. Topics also include the use of a closed-loop caloric irrigator and simultaneous caloric irrigation as viable alternatives to standard, alternate water irrigation when testing the vestibular output of a young child or infant.
Advances in Sensory Aids for the Hearing-Impaired: Visual and Vibrotactile Aids
Authors: Pickett J. M.
Published: January 2017

An informal sketch is given of the background and current status of research on electronic aids designed to convert speech into visual or tactile patterns in order to alleviate problems of speech reception and speech production by the hearing-impaired. The functions and problems of the major types of such aids are briefly described and literature references are given.
Perceptual Evaluation of Velopharyngeal Competency
Authors: Philips Betty Jane
Published: January 2017

Eight public school speech/language pathologists estimated velopharyngeal competence on the basis of perceptual evaluation of speech characteristics of 24 subjects. These evaluations were made from tape-recorded speech samples. After orientation to a system for scoring speech characteristics associated with velopharyngeal incompetence they reevaluated the same 24 subjects. The evaluations were found to improve significantly with orientation and to correlate well with experts' live evaluations as well as evaluations based on instrumentation which included telefluorography, manometric and pressure-flow data. It was concluded that speech/language pathologists, who by nature of their education and training have expertise in identification of speech deviations, can apply their skills effectively in identifying velopharyngeal incompetence. Further it was suggested that orientation to a system for weighing speech characteristics related to velopharyngeal competency can improve their estimates.
A Review of Histopathology
Authors: Paparella Michael M.
Published: January 2017

From a histopathological survey of 12 ears (7 cases) of Mondini's deformity and deafness, the following conclusions or interpretations are drawn: 1) Mondini's bony deformity diagnosable by polytomography does not necessarily indicate Mondini's deafness or x-ray diagnosis of Mondini's deafness cannot be specifically relied upon. 2) The pars superior (semicircular canals and utricle) may be absent (aplastic) or the canals may be enlarged leading to interesting questions regarding vestibular physiology in such patients. 3) Enlarged endolymphatic duct and deficient utriculoendolymphatic valve are commonly found associated with absence of endolymphatic hydrops or collapse suggesting an operational longitudinal flow. 4) One and one-half or fewer (instead of 2 1/2) cochlear turns are characteristic; however, end-organ of Corti lesions (aplasia) may be present or absent leading to interesting speculations for further research regarding auditory function, especially in those cases with normal-appearing sensory structures. 5) Mechanisms of hearing loss in Mondini's deafness can be variably explained on the basis of inner ear or middle ear pathology including dysgenesis of the end-organs and associated neural elements sufficient to cause sensorineural hearing loss, aplasia of the oval or round windows which might explain manifest “sensorineural hearing loss” in the presence of normal-appearing organs of Corti and aplasia or infection of the middle ear causing a conductive loss which can be superimposed upon a sensorineural hearing loss.
II. Standardization of the Eye-Tracking Test
Authors: Umeda Yoshio
Published: January 2017

Standardization of the eye-tracking test, especially of the target velocity, is required for the purpose of comparing abnormalities of eye-tracking patterns recorded in different clinics. In consideration of the results of several good reports on target velocities, we have the following remarks: 1) The maximum velocity of a target which normal subjects can follow without delay of the eye movement is about 20°/sec. 2) When pursuit eye movements of normal subjects are registered with the aid of an electronystagmograph, the eye-tracking patterns will remain normal at target velocities of up to 45°/sec. 3) In order to detect abnormalities of pursuit eye movement with the aid of an electronystagmograph, the target velocity should be as fast as possible, but not exceeding 45°/sec. As an instrument for the examination of pursuit eye movements, for reasons outlined in the text, the Umeda circular eye-tracking test apparatus (amplitude 40°, frequency 0.33 Hz, and target velocity 42°/sec) is ideal. The target amplitude and technical problems in making the apparatus also are discussed.
Thyroid Disease: A Guide for the Head and Neck Surgeon
Authors: Bumsted Robert M.
Published: January 2017

Head and neck surgeons are involved in the diagnosis and therapy of thyroid disease with increasing frequency. The surgical techniques utilized for the management of thyroid disease are well known by most head and neck surgeons and will not be discussed in this paper. It is the head and neck surgeons' knowledge of the physiology, medical disorders, and the proper evaluation of the patient with thyroid disease that is most open to criticism. This paper reviews thyroid physiology, basic tests used to assess thyroid function in health and disease, thyroiditis, thyroid carcinomas, and nodules of the thyroid gland. The signs, symptoms, laboratory findings, and the methods of medical and surgical therapy are discussed for each of these disorders. The supplement is not intended to provide expertise, but will provide a general and basic knowledge of thyroid disease.