bluuebunny/crossref_metadata_2025 huggingface dataset:
Temporal and perceptual characteristics of tracheoesophageal voice
Authors: Williams Sarah E. , Scanio Tom S. , Ritterman Stuart I.
Published: October 2006

This study compared the temporal and perceptual characteristics of tracheoesophageal voice produced in four different prosthetic/occlusion conditions: 1. using the Blom‐Singer duckbill prosthesis and digital occlusion of the tracheostoma; 2. using the Blom‐Singer duckbill prosthesis and valve occlusion of the tracheostoma; 3. using the Blom‐Singer low‐pressure prosthesis and digital occlusion of the tracheostoma; and 4. using the Blom‐Singer low‐pressure prosthesis and valve occlusion of the tracheostoma. Characteristics of speech produced in each condition were also compared to those of normal speech. Results revealed significant differences between normal speech and tracheoesophageal speech (in all prosthetic/occlusion conditions) for several temporal and perceptual parameters. In addition, important trends were noted among tracheoesophageal prosthetic/occlusion conditions.
Chondrosarcoma of the epiglottis with regional and distant metastasis
Authors: Jacobs Robert D. , Harris Jeffrey P. , Stayboldt Carla
Published: October 2006

Chondrosarcoma of the epiglottis is extremely rare and there are no previously reported cases of this neoplasm with regional or distant metastases. The first case of this entity and its histopathologic considerations are presented. Accurate grading of this malignancy is essential, since a more poorly differentiated pathologic condition in these tumors indicates aggressive biologic properties consequently leading to frequent local recurrences and metastasis. This is evident in the present case in which, despite being free of local or regional recurrence for 3 years following a supraglottic laryngectomy and bilateral neck dissections, the patient developed pulmonary metastases. We support the use of conservative laryngeal surgery and modified neck dissections for this disease rather than partial resections or debulking procedures, since the histopathologic condition may not be fully recognized without microscopic analysis.
Mucosal leishmaniasis in brazil
Authors: Zajtchuk Joan T. , Casler John D. , Netto Eduardo M. , Marsden Phillip D. , Grogl Max , Neafie Ronald C. , Hessel Craig R. , De Magalhaes Albino Vercosa
Published: October 2006

The clinical diagnosis and laboratory identification of Leish‐mania brazilicnsis braziliensis, a parasitic disease affecting the upper aerodigestive tract, is difficult. A retrospective computer‐assisted analysis of patient records was done after examination of 58 patients with mucosal leishmaniasis in an endemic area of L. braziliensis braziliensis in Bahia, Brazil during January 1987. Biopsies of clinically active and clinically inactive mucosal patients were examined for parasites using routine hematoxylin and eosin histopathology and a new technique for rapid detection of Leishmania amastigotes using a genus‐specific indirect immunofluorescent assay.

No amastigotes were found in specimens from seven patients with clinically inactive mucosal disease using immunofluorescent monoclonal assay techniques, whereas specimens from seven out of 14 patients with clinically active mucosal disease were positive. These results suggest that the immunofluorescent antibody technique is markedly superior in identifying the intra‐cellular amastigote in tissue sections of mucosal biopsies when compared to histopathology techniques or with other standard tests done in rural areas of Brazil.

Various clinical and laboratory test data of the entire group of patients were examined and the efficacy of treatment evaluated. The median interval of time noted between cutaneous and mucosal disease was 4.5 years. Relapse was noted in 31% of patients treated with a low dose of meglumine antimoniate (10 mg per kg of body weight). Patients treated with a high dose of meglumine antimoniate (20 mg per kg of body weight) had a relapse rate of 27.3%. A chi‐squarc statistical analysis revealed no significant difference (χ2 = 0.049) between the two groups. Patients were considered cured if mucosal granulations were clinically absent after 4.6 years.
A DNA linkage study of usher's syndrome excluding much of chromosome 4
Authors: Smith Richard J. H.
Published: October 2006

By applying molecular genetic techniques to families in whom inherited forms of hearing impairment are segregating, it will be possible to identify and isolate genes that cause hearing impairment. This will increase our understanding of the biochemical and cytochemical processes associated with hearing, and ultimately could have therapeutic implications. To achieve this goal, DNA linkage studies must be done to localize defective genes to specific chromosome regions. Previous data had suggested that the gene causing Usher's syndrome was located on chromosome 4 in close proximity to the Vitamin D binding protein. A DNA linkage analysis of this chromosome does not confirm the linkage relationship and excludes much of chromosome 4 as the site of the Usher's syndrome gene.
Histopathologic consequences of surgical approaches to the singular nerve
Authors: Ohmichi Takuya , Rutka John , Hawke Michael
Published: October 2006

Selective sectioning of the singular nerve has proven successful in the relief of incapacitating benign positional vertigo (BPV), presumably on the histopathologic basis of posterior am‐pullary cupulolithiasis. Although the surgical techniques of transmeatal and the recently introduced retrosigmoid IAC approach have been well described, little has been written about the singular nerve's anatomical relationships determined histo‐logically for each surgical approach. The anatomical relationships of the singular nerve in both the transmeatal and retrosigmoid IAC approaches are discussed.

Histologic evidence presented suggests that other mechanisms may also be ultimately responsible for improvement in the symptoms of BPV following transmeatal surgery. Moreover, the high incidence of injury to the endolymphatic duct during retrosigmoid surgery raises questions about the exact role of the endolymphatic duct and sac in inner ear homeostasis.
The role of leucocyte elastase in malignant tumors of the head and neck
Authors: Zöller Elisabeth
Published: October 2006

An elevated concentration of leucocyte elastase in the extracellular compartment leads to an inactivation of plasma proteins as well as changes in tissue structure. The presence of raised plasma elastase values in tumors of the lower respiratory tract has been well substantiated. This study was undertaken to find out whether tumors of the upper respiratory tract show a similar pattern. Elevated plasma elastase values were found in all of the three tumor groups examined (hypopharyngeal, mesopharyn‐geal, epipharyngeal) with respect to the control group.

Thus, the investigation of leucocyte elastase using enzyme im‐munoassay techniques could play a significant ancillary role in the diagnosis of head and neck tumors.
The effect of recurrent laryngeal nerve stimulation on phonation in an in vivo canine model
Authors: Berke Gerald S. , Moore Dennis M. , Gerratt Bruce R. , Hanson David G. , Bell Theodore S. , Natividad Manuel
Published: October 2006

The present investigation was designed to examine the effect of variation in recurrent laryngeal nerve stimulation (RLNS) on vocal fold vibration. Photoglottography (PGG), electroglottog‐raphy (EGG), and subglottic pressure (Psub) were measured in seven mongrel dogs using an in vivo canine model of phonation. The PGG, EGG, and Psub signals were examined at three fundamental frequencies (F0) (100 Hz, 130 Hz, and 160 Hz) for RLNS, using a constant rate of air flow. Increasing RLNS, which caused activation of the intrinsic laryngeal muscles, produced a modest increase in F0, a marked increase in Psub, no change in the open quotient (OQ), and an increase in the closing quotient (CQ). Phase quotient (Qp), which describes the interval between opening of the lower and upper fold margins, decreased with increasing RLNS.
Sclerosing lesions of the temporal bone
Authors: Schrimpf Robert , Karmody Collin S. , Chasin Werner D. , Carter Barbara
Published: October 2006

Sclerosis of the mastoid portion of the temporal bone is often seen on radiographs of patients who have or have had chronic otitis media. Occasionally lesions are seen that cause sclerosis of the entire temporal bone. The otolaryngologist must be alert to the fact that these findings may signify important pathology beyond that of chronic otitis media and indeed may be indicative of life threatening problems in adjacent or distant areas. In this paper the differential diagnoses of sclerotic lesions of the temporal bone will be discussed. These include fibrous dysplasia, osteopetrosis, meningioma, ossifying fibroma and metastatic lesions to the temporal bone. Three representative cases with sclerotic temporal bones are presented. The first is a patient with a conductive hearing loss secondary to stenosis of the external auditory canal. He was found to have a fibrous dysplasia of the temporal bone. The second case is an elderly male with a draining ear and a facial nerve paresis. He was found to have adenocarcinoma of the prostate gland metastatic to the temporal bone. The third case is that of a woman with a meningioma who demonstrated a sclerotic temporal bone on routine radiographs of the skull.
Infectious facial and nasal cutaneous necrosis: Evaluation and diagnosis
Authors: Koopmann Charles F. , Coulthard Stanley W.
Published: October 2006

A review of the literature reveals that pyogenic gangrenosum (ecthyma gangrenosum) is fatal to most patients, especially infants. In this article, the authors review the differential diagnosis of facial necrosis, present two cases of infants who succumbed to the systemic manifestations of the disorder, and a third case of survival in an adult with concomitant systemic lupus erythematosus and pyogenic gangrenosum. Finally, a brief discussion of Pseudomonas gastroenteritis, Pseudomonas septicemia, and pseudomembranous enterocolitis is presented.
Clinical update on rhinoscleroma
Authors: Shum Tony K. , Whitaker Clay W. , Meyer Paul R.
Published: October 2006

Rhinosclcroma is recognized more frequently now because of the recent influx of immigrants from endemic Central America. This chronic infectious disease presents with three overlapping clinical stages and can involve any part of the respiratory tract. A review of the clinical presentation leads to a patient evaluation plan consisting of physical examination and radiographic studies. A highly sensitive and specific method is introduced for identification of Klebsiella rhinoscleromatis in the biopsy specimen using the immunoperoxidase technique. A study of the immune status of the patient revealed general immunological competence except in effective phagocytosis of the organism by the Mikulicz cells. The choice of chronic antibiotic therapy should be guided by individual patient consideration with respect to age and sex. Repeat biopsies help determine the duration of antibiotic therapy. Relapses do occur and close observation is the key to long‐term follow‐up of the patient.
Principles of surgical management of midfacial carcinoma
Authors: Wodd Benjamin G. , Levine Howard L. , Bailin Philip L. , Tucker Harvey M. , Esposito Salvatore J.
Published: October 2006

A series of large, midfacial, squamous cell and basal cell carcinomas treated by the Departments of Otolaryngology and Dermatology (Cleveland Clinic Foundation) are reported. Most cases required total/partial resection of the external nose, upper lip, hard palate, nasal septum, and adjacent midfacial soft tissues. Emphasis is placed on the principles of preoperative and intraoperative management as it relates to intraoral prosthetic design and total margin control of the surgical specimen. The immediate and delayed reconstructive philosophy and techniques employed here are discussed in detail. Recurrence rates and free‐of‐disease survival times are also reviewed.
Fibrolipoma of the pyriform sinuses: Thirty‐seven year follow‐up
Authors: Jesberg Norman
Published: October 2006

Lipomas and fibrolipomas of the larynx and hypopharynx are rare. Indeed, by 1934 Birkett was able to report only 42 extrinsic and 5 intrinsic cases. Additional occurrences have been reported since then and it has been emphasized that these tumors although histologically benign ore clinically malignant.

A case of recurrent fibrolipoma of the pyriform sinuses requiring right transthyroid lateral pharyngotomy in 1951 and 1966 and left transthyroid lateral pharyngotomy in 1961 is reported. The patient has been followed by one observer for the last 35 years and is at present in her 84th year. There has been neither histopathological evidence of liposarcomatous transformation nor recurrence since 1966. Previous recurrences appeared on the contralateral side from first observance after 10 years and on the same side after 15 years.
Reflectance spectrophotometric studies on mucosal pathology of the upper airway
Authors: Ohyama Masaru , Furuta Shigeru , Kurono Yuichi , Yano Hiromi , Ogawa Kazuaki , Katsuda Kenji
Published: October 2006

Reflectance spectrophotometry analysis has been applied to the human nasal mucosa in vivo to determine the objective parameters of the colors of the mucous membrane, as well as to study the hemodynamics and enzymatic activities related to respiratory chain metabolism in the nasal mucosa. In 24 normal subjects, there were three main spectral peaks: the peak at around 500 nm (P1), the smallest at 560 nm (P2) and the highest one at 660 nm (P3). In 28 patients with nasal allergy, spectral P3 shifted remarkably toward the shorter wavelength at around 640 nm, compared to that of normal subjects. Additionally, the increment of the absorption band at P2 was also observed. These phenomena could be seen in the nasal mucosa of the subjects after use of decongestant spray.

Reflectance spectrophotometric analysis will serve as a non‐invasive method of giving us useful information for a further understanding of the mucosal pathophysiology of the upper airway.
Hyperuricemia: A possible etiologic factor in chronic recurrent parotitis
Authors: Eilon Amos , Deutsch Elimelech , Zelig Silviu
Published: October 2006

Chronic recurrent parotitis is a common salivary gland disease. It is often associated with such clinical conditions as antecedent pyogenic infections, mumps, debilitation, intense fluid restriction and drugs.

A case of chronic recurrent parotitis in a patient with hyperuricemia is presented, the presumptive pathophysiology is discussed, and an interrelationship between these two entities is suggested.
Malignant hyperthermia
Authors: Nissen Rick L. , Yonkers Anthony J.
Published: October 2006

The true incidence of malignant hyperthermia is unknown, but the frequency has been estimated as high as 1/14,000 anesthetic events. Review of the literature reports mortality rates up to 70%. Without prompt medical intervention, it is a uniformly fatal disease. Thus, it behooves the physician to have an awareness of the syndrome and its features, so that early recognition and adequate treatment take place. This paper presents a review of the literature on the occurrence, pathology, symptoms and treatment of malignant hyperthermia.
Perioperative complications and risk factors in the surgical treatment of obstructive sleep apnea syndrome
Authors: Esclamado Ramon M. , Glenn Michael G. , Mcculloch Timothy M. , Cummings Charles W.
Published: October 2006

A retrospective review of 135 patients surgically treated for obstructive sleep apnea syndrome (OSAS) from 1982 to 1987 was performed to identify perioperative complications and potential risk factors. The incidence of complications was 13% (18/135). Airway problems comprised 77% (14/18) of these complications, resulting in one death. There were three postoperative hemorrhages and one postoperative arrhythmia. Comparison of the complication group versus the noncomplication group showed a statistically significant difference in the minimum oxygen saturation (66% vs. 79%) and apnea index (75 vs. 57) on the pro‐operative sleep study and in the amount of narcotic administered intraoperatively. Patients with intubation complications tended to be heavier, whereas patients with extubation complications received significantly more narcotic analgesia intraoperatively. Risk for a perioperative complication was not related to age, type of obstructive symptoms, medical problems, or concurrent septoplasty/tonsillectomy. A protocol for perioperative airway management is presented.
Tuberculosis of the larynx: Clinical aspects in 19 patients
Authors: Soda Antonio , Ganem Jose , Berlanga Diego , Sanchez Andres , Rubio Horacio , Salazar Margarita
Published: October 2006

Laryngeal tuberculosis continues to exist in spite of extensive tuberculosis eradication campaigns. We present 19 cases of laryngeal tuberculosis seen in our institution between 1982 and 1987. From the clinical findings it is clear that the localization of the lesions has changed since the preantibiotic era. Today the spread appears to be mainly via lymphatic and hematogenic routes, as opposed to the direct spread more common previously. The fibrosis caused by the lesions is incapacitating and frequently requires surgical correction.
Diagnosis of surgical sinusitis using nasal endoscopy and computerized tomography
Authors: Nass Richard L. , Reede Deborah L. , Holliday Roy A.
Published: October 2006

The ability to identify surgical sinus disease using diagnostic nasal endoscopy and coronal CT scanning of the paranasal sinuses is studied prospectively. Fifty consecutive patients with symptoms of chronic sinusitis lacking surgical indications by traditional work‐up comprise the patient population. Sixty percent had endoscopic or CT indications for surgery. There was a 90% correlation between endoscopy and CT examination with the combined work‐up being more accurate than either modality alone. Functional endoscopic sinus surgery was performed in 18 cases. There were no major complications. Approximately 89% of the postoperative group report significant improvement, with 55.6% reporting total relief of symptoms.

A complete endoscopic sinus work‐up can often identify surgically correctable sinusitis despite normal routine rhinoscopic and plain‐film examination. It is. therefore, warranted in those patients with a suggestive history.
Steroids in rhinoplasty
Authors: Scott Griffies W. , Kennedy Kevin , Gasser Charles , Fankhauser Charles , Taylor Robert
Published: October 2006

A prospective double‐blind randomized pilot study was performed to test the benefits of steroids versus placebo in controlling edema and ecchymosis in rhinoplasty within the immediate postoperative period. Thirty consecutive patients who underwent rhinoplasty with osteotomies were entered into the study. Sixteen patients received 10 mg of intravenous dexnmethnsone before the procedure and 14 patients received placebo. All rhino‐plastics were performed by residents under the supervision of staff otolaryngologists. A 4‐point scale was used to assess the extent of periorbital edema and ecchymosis at 24 hours pustop‐eratively. A one‐time bolus of 10 mg of dexamethasone was beneficial in decreasing edema and ccchymosis in rhinoplasty. This benefit was demonstrated statistically (p &It .005). No complications were attributed to the administration of dexamethasone.
Olfactory function following late repair of choanal atresia
Authors: Gross‐Isseroff Ruth , Ophir Dov , Marshak Gabriel , Ganchrow Judith R. , Beizer Michael , Lancet Doron
Published: October 2006

Results of olfactory function tests (threshold determination and odor identification) in three cases of bilateral and one case of unilateral choanal atresia are reported. All four patients underwent successful repair of choanal atresia at relatively advanced ages (8 to 31 years). Test results showed that patients who had suffered from bilateral atresia had permanent olfactory deficits, while the patient who had suffered from unilateral atresia appeared to have normal olfactory acuity. Although these results should be interpreted with caution due to the small number of cases examined, they suggest the possibility that early sensory exposure might be needed for the normal development of central olfactory functions in analogy to the visual system.
Gadolinium‐DTPA‐Enhanced magnetic resonance scanning in cerebellopontine angle tumors
Authors: Wayman John W. , Dutcher Paul O. , Manzione James V. , Kido Daniel K. , Nelson Curtis N.
Published: October 2006

Magnetic resonance (MR) imaging has quickly emerged and already replaced computerized tomography (CT) in the evaluation of cerebellopontine angle (CPA) lesions, although even MR scanning may occasionally yield equivocal results. We recently studied six patients with a new MR image‐enhancing contrast, gado‐linium‐DTPA (Gd‐DTPA). All patients were suspected of having CPA pathology, and the standard MR scan was either negative, equivocal, or left unanswered questions regarding confirmed lesions. The Gd‐DTPA‐enhanced MR scan confirmed tumors or added useful information in five of six patients.
Rigid endoscopic repair of paranasal sinus cerebrospinal fluid fistulas
Authors: Maggiano Holly , Papay Francis A. , Dominquez Steven , Levine Howard L. , Lavertu Pierre , Hassenbusch Samuel J.
Published: October 2006

The advent of functional transnasal endoscopic sinus surgery has brought new opportunities in the repair of difficult cerebro‐spinal fluid leaks of the paranasal sinuses. The following four case reports illustrate the repair of cerebrospinal fluid leaks with the use of rigid transnasal endoscopy for enhanced angled visualization and illumination. A description of surgical techniques and instrumentation involving transnasal endoscopy in repair of sphenoidal and ethmoidal cerebrospinal fluid fistulas is reported. A discussion of etiology, diagnoses, and conservative versus surgical management of cerebrospinal fluid rhinorrhea is presented.
Simultaneous auditory stimuli shorten saccade latencies
Authors: Konrad Horst R. , Rea Chuck , Olin Bruce , Colliver Jerry
Published: October 2006

Eye movement responses induced by vestibular, smooth pursuit, and optokinetic stimulation are largely dependent on the velocity of the stimulus. Saccade latencies, on the other hand, are a function of the anatomic and physiologic components of the reflex. By producing an audible click simultaneously with the movement of a visual target used to stimulate a saccadic eye movement, the saccade latency is significantly shortened. This does not appear to be due to alerting. It is probably due to an auditory input to the superior colliculus which decreased threshold for initiating a saccadic eye movement. Twenty normal participants were tested with or without the click stimulus. Latencies were significantly shorter when the click stimulus was presented simultaneously with the eye movement. The anatomic pathways in this reflex are reviewed in the presentation. This study provides further information on sensory interaction in saccade reflexes and emphasizes the need to control stimulus conditions during saccade testing.
The large vestibular aqueduct syndrome
Authors: Jackler Robert K. , de la Cruz Antonio
Published: October 2006

It has long been known that abnormally large vestibular aqueducts may accompany congenital malformations of the cochlea and semicircular canals. Recently, enlargement of the vestibular aqueducts as the sole radiographically detectable inner ear anomaly has been recognized as a distinct pattern of congenital inner ear malformation. Patho‐genesis of the large vestibular aqueduct syndrome probably stems from an early derangement in the embryogenesis of the endolymphatic duct. This anomaly appears to be relatively common in children with sensorineural hearing loss and is probably significantly underdiagnosed. Hearing loss is typically bilateral and progressive, with stepwise rather than fluctuant hearing decrements often triggered by relatively minor head trauma. A review of 17 patients (33 ears) revealed an average hearing level at presentation of 57 dB with a speech discrimination score of 66%. Considerable variability exists in hearing level among affected ears, ranging from normal hearing (4%) to profound deafness (39%). In 12 patients (23 ears) with an average long‐term follow‐up of 7.3 years, the hearing loss progressed by an average of 25 dB, with a drop of 29% in speech discrimination over the period of observation. An endolymphatic to subarachnoid shunt was performed on seven ears in an effort to stabilize hearing. Four of these ears had a substantial immediate postoperative drop in hearing. For this reason, endolymphatic sac surgery is not recommended for patients with this deformity.
Effects of preoperative embolization on glomus jugulare tumors
Authors: Murphy Terrence P. , Brackmann Derald E.
Published: October 2006

The charts of 35 patients were reviewed retrospectively to determine the effects of embolization on glomus jugulare tumors. Eighteen patients underwent embolization; 17 did not. All tumors were removed with a type A infratemporal fossa approach. The charts were evaluated for operative blood loss, operative time, length of hospitalization, new postoperative cranial nerve deficits and recurrence of tumor. Embolized patients had significantly less operative blood loss and operative time. Embolization did not affect length of hospitalization or reduce the incidence of new postoperative cranial nerve deficits. The surgeon's experience also plays a central role in reducing operative blood loss and operative time. The potential risks of embolization must be considered in the treatment regimen of glomus jugulare tumors.
1989 Ogura Memorial Lecture: Mediastinal Dissection
Authors: Sisson George A.
Published: October 2006

As I prepared this talk, I realized what an honor it is for me to have been selected the Joseph H. Ogura lecturer. It gives me double pleasure and comfort to accept. Joe Ogura was a long‐time, close friend and an inordinately respected role model.

Joe and I shared many stimulating and productive moments, and I was on the receiving end most of the time. He was a true scholar. Early in his career, he initiated basic laryngeal surgeries whereby voice was preserved. These conservation cancer surgeries so stimulated me that I performed six supraglottic operations while still a young upstart in Syracuse, New York. His detailed, well‐illustrated descriptions of this innovative work awakened world interest and changed the treatment of laryngeal carcinomas. I worked closely with Dr. Joe for many years, as a founding member of the American Society of Head and Neck Surgery, as a travelling companion for the National Cancer Institute Head and Neck Cancer cadre, and as a confidante, during which time he convinced me to become Department Head at Northwestern Medical School in Chicago. For that, I shall ever be grateful

The mediastinal dissection was introduced in 1962 to manage an otherwise uniformly fatal problem in head and neck oncology: stomal recurrence of laryngeal, squamous cell cancer. The morbidity and mortality rates continued to be high and the survival rates low, but they were an improvement over those of other treatment plans.

Since then, refinements of the ablative techniques and major advances in the reconstructive techniques have significantly decreased morbidity and mortality rates. The most recent data indicate a 45% survival rate at 42 months. It is evident that early diagnosis and staging of stomal recurrences will yield successful results.

Because the mediastinal dissection operation is now safe, it should be applied more liberally in head and neck oncology situations such as subglottic extension of laryngeal cancer, advanced thyroid cancers, cervical esophageal and tracheal cancers, and all head and neck tumors with low‐nodal disease.
Immunoelectron microscopy of the human inner ear
Authors: Wackym Phillip A. , Micevych Paul E. , Ward Paul H.
Published: October 2006

The immediate fixation required for satisfactory morphologic preservation of the human inner ear has not only limited the ultrastructural study of this region, but has also limited the application of immunohistochemistry. The technique of postembedding protein A‐colloidal gold immunoelectron microscopy was used on human inner ear tissue taken at operation and on celloidin‐embedded temporal bone sections from a traditional temporal bone bank. We describe the utility of postembedding immunoelectron microscopy for studying the localization of a wide variety of antigens including type I collagen, S‐100, and calcitonin gene‐related peptide. The use of this method in material available in temporal bone banks or that has been routinely processed for transmission electron microscopy provides the potential for broad application to collections of otologic material.
Malignant nasopharyngeal tumors in children
Authors: Fearon Blair , Forte Vito , Brama Israel
Published: October 2006

From 1964 to 1984, 25 children with malignant tumors of the nasopharynx were seen, and their progress was followed at The Hospital for Sick Children in Toronto. Two types of malignancies: rhabdomyosarcoma and lympho‐epithelioma were most prevalent with eight cases apiece. The presenting signs and symptoms were related to local and/or regional manifestations of disease. No child presented with signs or symptoms related to distant metastatic disease. The diagnosis and treatment of this series of patients are described briefly.

The advent of combined treatment modalities in the past decade has improved the prognosis for nasopharyngeal tumors, especially for the rhabdomyosarcomas; in general, however, survival rates are still poor, approximating 50%.
Is outpatient suction cautery tonsillectomy safe in a community hospital setting?
Authors: Haberman Rex S. , Shattuck Theodore G. , Dion Nancy M.
Published: October 2006

Tonsillectomy and adenotonsillectomy are frequently performed operations. They are typically done as a day‐of‐surgery admission with discharge on the first postoperative day. Five hundred consecutive tonsillectomies and adenotonsillectomies performed by the authors were retrospectively reviewed to determine if these procedures could safely be performed on an outpatient basis. Primary postoperative hemorrhage was found to be rare using the suction cautery technique. Secondary hemorrhage occurred most commonly on the sixth postoperative day and the overall postoperative bleed rate was 7%. Our conclusion was that suction cautery tonsillectomy and adenotonsillectomy were safe to perform on an outpatient basis.
Interstitial laser phototherapy assisted by magnetic resonance imaging: A new technique for monitoring laser‐tissue interaction
Authors: Castro Dan J. , Ward Paul H. , Lufkin Robert B. , To Stephen Y. D. , Nishimura Earl , Saxton Romaine E. , Layfield Lester J. , Fetterman Harold R. , Castro J. , Tartell Paul B. , Robinson Jeffrey D.
Published: October 2006

The rapid technological advances of magnetic resonance imaging, laser fiberoptics, and compatible probes may allow treatment of deep and sometimes surgically unreach‐able tumors of the head and neck with minimal morbidity through interstitial laser phototherapy. In this study, a new application of magnetic resonance imaging was developed to monitor and quantify laser‐induced tissue damages. Pig skin was exposed to increased levels of argon laser (514.5 ran) at energy densitites between 62.5 and 375 J/cm2 as determined by an accurate and reproducible method of dosimetry. Thermal profiles were recorded using an infrared sensor and Tl‐ and T2‐weighted magnetic resonance images were taken; afterward, biopsies were performed to quantitate the level of tissue damage. Our results demonstrate that above a certain threshold of laser energy, the magnetic resonance imaging findings are temperature dependent. Appropriate development of a scale matching laser energies, temperature profiles, Tl‐ and T2‐weighted magnetic resonance images, and histological quantitation of tissue destruction will allow us to optimize the three‐dimensional control and monitoring of laser‐tissue interactions.
Use of anticytoplasmic autoantibodies in the diagnosis of wegener's granulomatosis with subglottic stenosis
Authors: Gaughan Robert K. , McDonald Thomas J. , DeSanto Lawrence W.
Published: October 2006

Subglottic stenosis is one of the lesser known manifestations of Wegener's granulomatosis and poses great difficulty in confirming the diagnosis. We present the use of the anticytoplasmic autoantibodies (ACPA) blood test, which has been shown to be highly specific for Wegener's granulomatosis, for corroboration of Wegener's granulomatosis in a patient with subglottic stenosis for whom tissue biopsies were nondiagnostic. The ACPA test and the presentation, diagnosis, and management of subglottic stenosis due to Wegener's granulomatosis are discussed. Otolaryngologists must be aware of the varied manifestations of Wegener's granulomatosis and the availability of the ACPA blood test as an aid in confirming the diagnosis.
Waveform morphology and amplitude variability in facial‐nerve electroneurography
Authors: Kelleher Michael J. , Gutnick Howard N. , Prass Richard L.
Published: October 2006

This study assesses the effect of using bipolar recording electrodes in the nasolabial crease versus using monopolar recording electrodes in the crease and on the nasal alae.Seven normal patients had three trials of facial‐nerve electroneurography on three separate test days. Peak‐to‐peak amplitudes of combined motor action potentials were measured; amplitude variability was not affected by the measurement site. A biphasic waveform shape was most consistently obtained by using the nasal alae as the recording point rather than the nasolabial crease. We hypothesize that alar electrodes primarily detect combined motor action potential activity from relatively synchronous, fast‐conducting facial‐nerve fibers, while the combined motor action potential detected by electrodes in the nasolabial crease reflect a relatively complex summation of both fast and slow fibers.
The risk of cholesteatoma in congenital aural stenosis
Authors: Cole Randolph R. , Jahrsdoerfer Robert A.
Published: October 2006

Congenital aural stenosis, as compared to congenital aural atresia, carries a much greater risk of cholesteatoma. In a review of over 600 patients with major congenital ear malformations, 50 patients (54 ears) were found to have congenital aural stenosis. Ninety‐one percent of the ears in patients 12 years and older with a stenosis of 2 mm or less presented with cholesteatoma.

Based on this review, the following opinions are given: 1. A bony ear canal opening of 2 mm or less puts the patient at risk of cholesteatoma formation; 2. the cholesteatoma is slow‐growing; and 3. undiagnosed cholesteatoma will cause extensive damage to the ear by early adulthood. We recommend surgery for patients with stenosis of the external ear canal measuring 2 mm or less. The appropriate time for surgery is late childhood or early adolescence, before irreversible damage has occurred.
Same‐Day‐stay adenotonsillectomy
Authors: Helmus Christian , Grin Mina , Westfall Rolleen
Published: October 2006

The records of 1088 consecutive adenotonsillectomy patients at Butterworth Hospital's Same Day Stay Department were reviewed. Of 1088 patients, 1082 were discharged the same day. Only one of the 1082 discharged patients had a significant bleeding complication during the first postoperative night, and no patient had vomiting or dehydration problems. With the special combined efforts of the otolaryn‐gologist, the anesthesiologist, the nurses, and the hospital administration, same‐day‐stay adenotonsillectomy is a justifiable and cost‐effective procedure.
Intratemporal facial nerve anastomosis: A temporal bone study
Authors: Eby Thomas L. , Pollak Anita , Fisch Ugo
Published: October 2006

The temporal bone findings in a patient who suffered a transverse temporal bone fracture and subsequently underwent intratemporal facial nerve anastomosis are presented. The patient returned a year after surgery with otor‐rhea and partial return of facial function that was documented clinically, and by electromyograph 12 days before death. The temporal bone shows breakdown of the posterior external canal wall and infection of the surgical cavity. At the facial nerve anastomosis, there is a fibrosis and lack of myelination in the few regenerating nerve fibers. These results demonstrate a seldom‐mentioned complication of the translabyrinthine approach, and suggest changes in the technique of facial nerve anastomosis to improve the results.
Treatment of frey's syndrome with topical 2% diphemanil methylsulfate (prantal®): A double‐blind evaluation of 15 patients
Authors: Laccourreye O. , Brasnu D. , Laccourreye H. , Bonan B.
Published: October 2006

All patients were alternatively treated with topically applied placebo and topically applied 2% diphemanil methylsulfate (an anticholinergic agent). A 10‐day period was allowed between applications for return of symptoms. Two‐percent diphemanil methylsulfate provided partial relief in 33.3% of patients and total relief in 40% of patients. Involvement of the hairy temporal line region with gustatory sweating was the main reason for failure. Duration of relief varied from 2 to 4 days. The only side effect was dryness of the mouth noted in two patients.
Decompression of the brain stem and superior cervical spine for congenital / Acquired craniovertebral invagination: An interdisciplinary approach
Authors: Wood David E. , Good Terry L. , Hahn Joseph , Bumphrey Francis , Bell Gordon , Wood Benjamin G.
Published: October 2006

A transoropharyngeal/transpalatal approach to the clivus and anterior cervical spine in association with a midline labiomandibular glossotomy has proved successful in the treatment of craniovertebral instability. Nine cases at this institution between 1978 and 1986 were retrospectively reviewed. A head‐and‐neck surgeon, along with a neuro‐surgeon and/or orthopedic surgeon collaborated on these procedures. The indications, methods, operative techniques, results and postoperative complications are presented.
Experimental model of immune‐mediated hearing loss using cross‐species immunization
Authors: Orozco Charles R. , Niparko John K. , Richardson Bruce C. , Dolan David F. , Ptok Martin U. , Altschuler Richard A.
Published: October 2006

The presence of immune‐mediated hearing loss was investigated in an animal model. Eight guinea pigs and four mice underwent immunizations with a preparation of chick or guinea pig cochlear tissue and Freund's adjuvant. Hearing thresholds were monitored by auditory brainstem response (ABR) testing over a 5‐week period after immunization. The serum and temporal bones of test and control animals were then examined using an enzyme‐linked im‐munosorbent assay (ELISA), immunocytochemical, and his‐tological techniques.

Hearing loss of 20 dB or greater occurred in eight animals. ELISA demonstrated antibodies to cochlear antigens in the sera of all test animals. Immunocytochemistry revealed immunostaining of hair cell stereocilia in the organ of Corti and saccule. Endolymphatic hydrops, and organ of Corti degeneration was observed in the temporal bones of three animals.

This study provides evidence to suggest that cross‐species immunization with cochlear antigens might produce a humoral response that can be associeted with inner ear pathologic change and sensorineural hearing lose.
Symptoms of vocal attrition in women army instructors and new recruits: Results from a survey
Authors: Sapir Shimon , Atias Joseph , Shahar Amnon
Published: October 2006

Symptoms of vocal attrition were surveyed with a questionnaire in 130 Israeli women army instructors, a high‐risk group for vocal attrition, and in 386 Israeli women recruits, presumably a low‐risk group. Results showed!, a high prevalence of symptoms in both groups, but a significantly higher prevalence among the instructors; 2. significant correlation between number of symptoms and rapid, excessive, and loud speech habits in both groups; and 3. significant correlation between number of symptoms and difficulties in performing instructional duties. These findings suggest that 1. vocal attrition is related to both external demands on the voice and idiosyncratic speech habits; and 2. vocal attrition has a significant impact on performance and work‐efficiency.
Computed tomography staging of the paranasal sinuses in chronic hyperplastic rhinosinusitis
Authors: Friedman William H. , Katsantonis George P. , Sivore Michael , Kay Scott
Published: October 2006

In this study, the computed tomography scans of 100 patients with chronic hyperplastic rhinosinusitis were reviewed to establish a clinical staging system. Fourteen percent of the patients were classified as Stage I (single‐focus disease); 36% as Stage II (multifocal disease responsive to conservative therapy); 32% as Stage III (diffuse disease partially responsive to medication); and 16% as Stage IV (diffuse disease associated with bony changes and poorly responsive to conservative treatment). The incidence of recurrent or persistent disease ranged from 13% for Stage II to 30% for Stage IV. Stage I and HI patients had 13% and 18% recurrence rates, respectively. Computed tomography staging is shown to be useful in outlining operative strategies and is a reliable prognosticates of the disease process.
Vocal cord paralysis in children deborah
Authors: Rosin Farb , Handler Steven D. , Potsic William P. , Wetmore Ralph F. , Tom Lawrence W. C.
Published: October 2006

Bilateral vocal cord paralysis is a common cause of stridor in infants and children. There are significant differences in this entity between children and adults with regard to etiology, diagnosis, management, and outcome. A review of 10 years' experience at Children's Hospital of Philadelphia identified 51 children seen with the diagnosis of vocal cord paralysis. These cases were evaluated with respect to etiology of paralysis, whether unilateral or bilateral, delay in diagnosis, need for tracheotomy, abnormality of voice, surgical treatment, and outcome. Guidelines for management for a child with vocal cord paralysis are presented with emphasis on flexible endoscopic evaluation and conservative management.
Myogenic influences on the electrical auditory brainstem response (EABR) in humans
Authors: Fifer Robert C. , Novak Michael A.
Published: October 2006

Two cases demonstrating the effects of myogenic artifact on the electrical auditory brainstem response (EABR) when using a promontory stimulation site are presented. Intensity‐response functions were obtained in the unparalyzed condition, then repeated after infusion of a neuromuscular paralyzing agent. In both cases, the myogenic response was observed at lower stimulus intensities than the EABR components. As intensity increased, the myogenic responses grew at extremely rapid rates and made any subsequent identification of auditory responses virtually impossible. To alleviate the adverse influence of myogenic components, general anesthesia and a paralyzing agent must be incorporated into the test protocol when acquiring the EABR using a promontory site of stimulation.
Magnetic stimulation of the facial nerve
Authors: Metson Ralph , Rebeiz Elie , West Carol , Thornton Aaron
Published: October 2006

Intracranial activation of the facial nerve is now possible with the noninvasive techniques of magnetic stimulation. Brief magnetic pulses generated by a coil overlying the parietal scalp elicit compound muscle action potentials of similar shape and amplitude and greater latency than those produced by electroneurography. Mapping studies demonstrate the compound muscle action potentials to be of constant latency and varying amplitude with changing coil location. Maximum compound muscle action potential amplitudes are obtained with the coil center located in a rectangular area superior and posterior to the ear canal. A comparison of large and small diameter coils showed them to be equally effective for painless facial nerve stimulation; however, the smaller coil allowed for a more localized field of activation. Magnetic stimulation has the potential to provide cross‐the‐lesion testing of facial nerve function.
Magnetic resonance imaging of facial nerve neuromas
Authors: Parnes Lorne S. , Lee Donald H. , Peerless Sydney J.
Published: October 2006

Facial nerve neuromas are uncommon tumors often confused with other tumors of the temporal bone and cerebellopontine angle. Radiologically, it may be impossible to differentiate an intracanalicu‐lar facial nerve neuroma from an acoustic neuroma. We present three case reports of facial nerve neuromas arising within the internal auditory canal to show the important magnetic resonance imaging features of these tumors. One tumor extended into the cerebellopontine angle, middle cranial fossa, and middle ear. Another filled the internal auditory canal and extended through the cerebellopontine angle to the brain stem. The third occurred in a patient who had neurofibromatosis as well as numerous other intracranial tumors. We feel that gadolinium‐enhanced magnetic resonance imaging provides the most useful information in the preoperative assessment of this disorder.
Paranasal sinus bony anatomic variations and mucosal abnormalities: CT analysis for endoscopic sinus surgery
Authors: Bolger William E. , Parsons David S. , Butzin Clifford A.
Published: October 2006

Coronal plane computerized tomographic (CT) scanning has dramatically improved the imaging of paranasal sinus anatomy as compared to sinus radiographs. Increasingly, subtle bony anatomic variations and mucosal abnormalities of this region are being detected. Data regarding the “background” prevalence of these findings are needed to determine their clinical relevance.

A detailed analysis of coronal plane CT scans of the paranasal sinuses obtained in 202 consecutively imaged patients was conducted. Special attention was directed toward identifying bony anatomic variations and mucosal abnormalities. Anatomic variations studied included pneumatization of the middle turbinate, paradoxical curvature of the middle turbi‐nate, Haller's cells, and pneumatization of the unci‐nate process. Such bony anatomic variations were detected in 131 (64.9%) of 202 patients and were found with a similar frequency in patients scanned for sinus complaints and in those scanned for nonsinus reasons.

Mucosal abnormalities were detected in 168 (83.2%) of 202 patients. For those patients scanned during the evaluation of sinus‐like complaints, mucosal abnormalities were noted in 153 (92.2%) of 166 cases, and were predominantly detected in the anterior ethmoid region. For patients scanned during nonsinus evaluations, mucosal abnormalities were detected in 15 (41.7%) of 36 cases, without predilection for the anterior ethmoid region.

Discussion regarding the prevalence and clinical significance of paranasal sinus bony anatomic variations and mucosal abnormalities is included as a guide to assist the otolaryngologist and/or radiologist in the evaluation of coronal sinus CT scans.
Hilger facial nerve stimulator: A 25‐year update
Authors: Lewis Brent I. , Kahn Jonathan M. , Adour Kedar K. , Lewis Alison J.
Published: October 2006

Percutaneous nerve excitability testing using the Hilger facial nerve stimulator was introduced about 25 years ago. The test is reliable, easy to use, and inexpensive; it continues to be the most frequently used method for predicting prognosis of facial nerve disorders. Between 1966 and 1974, we recorded 10,243 nerve excitability tests on 865 patients with a mean of 3.29 tests for each peripheral branch and 3.43 for the trunk. Using a multiple regression model, we determined the effect on nerve stimulation values of age, sex, race, diabetes, hypertension, partial or complete clinical paralysis, diagnosis of herpes zoster, year of testing, and eventual facial paralysis recovery profile. We discuss statistical reliability, provide a table of interpretive results, and offer “tips and traps” invaluable to the practitioner. A prospective study of 25 patients with residual facial paralysis was evaluated by two separate otolaryngologists to determine intertester reliability.