bluuebunny/crossref_metadata_2025 huggingface dataset:
Stability of Hearing over an Eight-Year Period following Wire-Vein Stapedectomy for Otosclerosis
Authors: Sooy Francis A. , Owens Elmer , Neufeld Elizabeth S.
Published: October 2014

This study was undertaken to determine the stability of hearing in patients over an eight-year period following a wire-vein graft stapedectomy procedure for otosclerosis. The method was to compare the four-month and eight-year postoperative hearing test results for a population of 76 patients who had undergone this procedure. No significant decrements in pure-tone thresholds were shown over the eight years for the speech frequencies (500, 1000, 2000 Hz). Decrements of approximately 0.5 dB and 1 dB per year over the eight-year period occurred for 4000 and 8000 Hz, respectively. These decrements did not seem to be associated with aging. A slight decrement of 2.8 percentage points in mean speech discrimination score was shown over the eight-year period, while no change occurred in mean speech reception threshold. There were no serious postoperative complications for this group of patients. These results indicated good stability of hearing over the eight years.
Blood Flow in Otorhinologic Tissue after Histamine and Papaverine
Authors: Clairmont A. A. , Wright R. , Dempsey E. , Sheffield P. A. , Jackson R. T.
Published: October 2014

A method has evolved that allows one to quantitatively measure nutritional blood flow in the labyrinth. Several otic symptoms (e.g., sudden hearing loss) are thought to be due to decreased labyrinthine blood flow. Our aim was to test two common vasodilators, histamine and papaverine, to determine if they were effective in increasing blood flow to otic tissue. The method employs the intracardiac injection of radioactive microspheres (15 μ in diameter). These spheres become embolized in the microcirculation and provide a measure of blood flow in ml/gm/min. Histamine or papaverine were infused intravenously for five min at several doses. Blood flow was measured before and after infusion. Both drugs cause a significant increase in blood flow to temporal bone tissue if used in the appropriate dose range, i.e., about 1 ug/kg/min for histamine and 0.5 mg/kg/min for papaverine. If the dose of either drug is increased to the point that causes a drop of more than 15 mm Hg in systemic blood pressure, there is either no increase or a drop in otic blood flow. This reversal of the drug response is felt to be due to autoregulatory mechanisms in intracranial blood vessels.
Endocrine Problems in Otolaryngology
Authors: Lucente Frank E.
Published: October 2014

Endocrine disorders may complicate, cause or mimic otolaryngologic diseases or interfere with the therapy of these diseases. Although essentially an integrated regulatory system, the endocrine system and its diseases are most readily discussed by considering individual glands. Diabetes is particularly important since the neuropathies, vasculopathies and altered response to infection and to trauma may attend many otolaryngologic problems. Numerous manifestations of thyroid dysfunction are also present, some being primarily anatomical in that they result from enlargement of the gland while others are physiological in that they result from increased or decreased glandular activity. Among the pituitary disorders acromegaly has the greatest otolaryngologic significance, with the altered growth patterns producing numerous symptoms. Adrenal gland syndromes vary widely in their otolaryngologic presentations, and include hyperpigmentation and hypertrichosis. The hypocalcemia of hypoparathyroidism may produce serious neuromuscular abnormalities. An area for future exploration concerns the production of endocrine disorders by nonendocrine tumors.
Pathology of Ménière's Disease
Authors: Gussen Ruth
Published: October 2014

Temporal bone findings are described in a 66-year-old white man with a one and one-half year history of Meniere's syndrome. Unilateral advanced endolymphatic hydrops of the cochlea and saccule, and numerous outpouchings of the utricle and semicircular ampullae were present. There was displacement of the utricle into the perilymphatic space of all the ampullae, as well as retrograde endolymphatic hydrops of most of the crus commune. The endolymphatic duct and intermediate portion of the endolymphatic sac demonstrated a rather straight course to the posterior fossa, with virtually no lateral curving. This same finding, however, was present in the opposite side where there was no evidence of endolymphatic hydrops. The cochlea, on the involved side, demonstrated considerable decrease in spiral ganglion cells and outer and inner hair cells throughout, most severe in the beginning of the basal turn. Degenerative changes were present in all the vestibular sensory receptor areas. Incidental histological otosclerosis of the oval window was found bilaterally. An unusual finding was bilateral focal nodular hyperplasia of the Schwann cells of the facial nerve within the internal auditory canal, with no compression of adjacent nerve trunks. This condition is rare and may simulate true tumors. The etiology here was unassociated with any other neurological disorder and is unexplained.
Lactate Dehydrogenase Activity and Isoenzyme Patterns in Serous Middle Ear Effusions
Authors: Juhn S. K. , Huff John S. , Paparella Michael M.
Published: October 2014

Biochemical characteristics of middle ear effusions (MEE) should provide a better understanding of the etiopathogenesis of serous otitis media. In order to develop another parameter for the biochemical characterization of the MEE, lactate dehydrogenase (LDH) and LDH isoenzyme patterns in the serous middle ear effusion and serum from 20 patients with serous otitis media were compared. The LDH activity was measured by the usual spectrophotometric method. The isoenzyme patterns were compared on electropherograms using cellulose polyacetate strips. The LDH activity in MEE was significantly higher (P < 0.001) than it was in serum. Fractions of isoenzymes 1 and 2 were each smaller in MEE than in serum. Isoenzymes 4 and 5 have a significantly higher (P < 0.001) fraction in MEE than in serum. Since LDH is an intracellular enzyme and middle ear mucosa is reported to have high content of isoenzymes 4 and 5, the inflammatory changes in the middle ear mucosa which may release intracellular LDH, are suggested as the cause of both higher activity of LDH and the higher fractions of isoenzymes 4 and 5 in MEE than those in the serum.
Tracheobronchiomegaly
Authors: Himalstein Milton R. , Gallagher John C.
Published: October 2014

Tracheobronchiomegaly is a condition of abnormal, probably congenital, enlargement of the trachea, main bronchi, and segmental bronchi. In addition, it is characterized usually by diverticula and sacculations between the cartilaginous rings. As an aid to diagnosis, the authors measured the transverse and anterior-posterior diameters of the trachea and main bronchi at autopsy of 100 men to determine the normal limits. Transverse diameters of the trachea greater than 25 mm, of the right main bronchus greater than 23 mm, and of the left main bronchus greater than 20 mm should raise the suspicion of tracheobronchiomegaly. The diagnosis can be strengthened if bronchographic abnormalities such as sacculations or unusual deformity are found. In using bronchographic measurements, a correction for the slight magnification that results from this technique must be made. Diagnosis also depends on clinical features such as a whooping, chronic cough, poor ability to raise secretions, and repeated episodes of bronchitis and pneumonitis. A routine chest roentgenogram may show a widened tracheal air column. Therapy should include vigorous use of antibiotics and postural drainage.
Clinical Viscometry of Bronchial Secretion
Authors: Bleeker J. D. , Hoeksema P. E.
Published: October 2014

Attention is drawn to the difficulties of estimating the viscoelasticity of organic liquid as bronchial secretion. Neither the capillary viscometer nor the cone-plate viscometer is suitable for this purpose. A new type of viscometer is described which conforms to the requirements of mucus. The instrument operates on the principle of a torsion bar. Use of this instrument showed that the viscoelasticity of bronchial secretion, obtained from the tracheotomies of laryngectomized patients, show great fluctuations in the course of each day. Thus, viscoelasticity measurements made once a day to estimate the effect of a therapeutic procedure, especially if sputum is used, possess no significant value. Only a comparison of day curves will give useful information.
Psychiatric Problems in Otolaryngology
Authors: Lucente Frank E.
Published: October 2014

Otolaryngology and psychiatry both deal with disorders in communication and numerous clinical problems illustrate an overlap between these two disciplines. Primary psychiatric disorders may find somatic expression through otolaryngologic symptoms. In these situations attention must be directed at the underlying psychological disorder. Conversely, primary otolaryngologic disorders may have a broad range of psychological ramifications and complications. Among the areas in which examples are readily found are congenital problems, tonsillectomy and other childhood surgery, adolescent illnesses, cosmetic surgery, head and neck cancer and care of the dying patient.
Suction Flow Drainage in Head and Neck Surgery a New Principle for Postoperative Suction Drainage
Authors: Hallén Olle , Lindström Jörgen
Published: October 2014

Suction drainages are used all over the world in head and neck surgery. Especially in large resections with rather thin skin flaps, it is of great value to try to avoid postoperative hematomas and local infections. A good functioning suction drainage is a valuable factor to eliminate these risks. A careful investigation of most of the drainage types in use, however, shows that a large number of holes in the tube are blocked very soon after wound closure, and the suction capacity is diminished and in many cases insufficient. In order to overcome this disadvantage a new type of drainage with suction and possibilities of a continuous slow flow of Ringer solution has been worked out. This new drainage has been in use for five years and has proved to be superior to the common ones. A correlation between the old and new type of drainage system concerning percentages of blocked holes has also been made.
Neurotological Findings in Diphenylhydantoine Intoxication
Authors: Nozue Michihiko , Mizuno Masahiro , Kaga Kimitaka
Published: October 2014

It is well known that diphenylhydantoine (DPH) can cause such side effects as gingivitis, hypertrichosis, ataxia, nystagmus, diplopia and others. Although there are many reports about DPH intoxication, very few papers mention the neurotological aspects of this condition. Three cases of DPH intoxication which manifested neurotological changes were treated. The common remarkable findings of these cases were equilibrium disturbance, gaze nystagmus and the absence and/or irregularity of optokinetic nystagmus (OKN). As other neurotological findings do not show any peripheral labyrinthine lesion, the equilibrium disturbances noticed in our cases probably did not originate from the labyrinth but from the central nervous system (CNS). The precise origin of gaze nystagmus noted in these cases has not yet been clarified. It seems to be evident, however, that this type of gaze nystagmus is not due to a peripheral labyrinthine lesion. It is well known that the inhibition or the disturbance of OKN may be caused by central lesions, but the origin or localization of the dysfunction in the CNS has not yet been clarified. On the other hand, animal experiments and postmortem examination of patients with DPH intoxication reveal that the main histologic lesions are located in the cerebellum, especially in the Purkinje cells. Although the precise localization of the lesions in our cases is not known the relationship between clinical findings and histological findings of DPH intoxication can be emphasized.
Electrical Stimulation of the Inner Ear
Authors: Walloch Richard , DeWeese David , Brummett Robert , Vernon Jack
Published: October 2014

In the guinea pig the effects of electrical stimulation of the inner ear were measured by recording the evoked potentials at the auditory cortex. The cortical evoked responses to electrical stimuli greatly resembled those resulting from auditory stimuli in the same ears. The similarity was in wave shape, latency, duration, sharpness of thresholds, etc. It was also possible to produce evoked cortical responses when the electrical stimuli were delivered to ears suffering from severe acoustic trauma. These ears were so traumatized by acoustic over-stimulation that they were totally unresponsive to sound. In addition, it was possible to produce electrically evoked cortical responses in ears suffering from drug induced damage. The damage was of sufficient long standing as to produce extensive degeneration in the spiral ganglion. The damage was verified histologically and was severe enough to produce a 90% loss of the spiral ganglion cells. Similar electrical stimulation has been carried out in one human subject with normal hearing. Using sinusoidal electrical currents of approximately 10–100 microamperes, hearing sensations were produced only for stimulus frequencies between 4,000 Hz and 10,000 Hz. The intent had been to place a chronic electrode on the round window membrane of a normal human ear. When the same electrode was used to record the alternating current (a.c.) cochlear potential the resulting data were so insensitive as to suggest that the electrode placement had been less than ideal. Exploration revealed the electrode to have been on the floor of the fossula of the cochlea fenestra. A repeat procedure, with improved visualization, located a new chronic electrode on the round window membrane. Recordings and stimulations are currently in progress with that electrode.
Neural Encoding of Sound Sensation Evoked by Electrical Stimulation of the Acoustic Nerve
Authors: Merzenich Michael M. , Michelson Robin P. , Pettit C. Robert , Schindler Robert A. , Reid Miriam
Published: October 2014

A series of psychoacoustic experiments was conducted in subjects implanted with a permanent intracochlear bipolar electrode. These experiments were designed to reveal the nature of the sensation evoked by direct sinusoidal electrical stimulation of the acoustic nerve. A series of single unit experiments in the inferior colliculus of cats was then conducted, using intracochlear stimulus electrodes identical to those implanted in human subjects in all respects except size, and using identical stimuli. These physiological experiments were designed to reveal how sounds evoked by intracochlear electrical stimulation in humans are generated and encoded in the auditory nervous system. Among the results were the following: 1) The sensation arises from direct electrical stimulation of the acoustic nerve. It is not “electrophonic” hearing arising from electro-mechanical excitation of hair cells. 2) While sounds are heard with electrical stimulation at frequencies from below 25 to above 10,000 Hz, the useful range of discriminative hearing is limited to frequencies below 400–600 Hz. 3) There is no “place” coding of electrical stimuli of different frequency. Tonal sensations generated by electrical stimulation must be encoded by the time order of discharge of auditory neurons. 4) The periods of sinusoidal electrical stimuli are encoded in discharges of inferior colliculus neurons at frequencies up to 400–600 Hz. 5) Both psychoacoustic and physiological evidence indicates that the low tone sensations evoked by electrical stimulation are akin to the sensations of “periodicity pitch” generated in the normal cochlea. 6) Most cochlear hair cells are lost with intracochlear implantation with this electrode. Most ganglion cells survive implantation. Implications of these experiments for further development of an acoustic prosthesis are discussed.
Hearing Loss in Renal Disease: Clinical and Pathological Studies
Authors: Bergstrom LaVonne , Jenkins Pat , Sando Isamu , English Gerald M.
Published: October 2014

Ninety-one of 224 chronic renal patients, most of them hemodialysis and/or transplant patients, had sensorineural loss: 11% noise exposure; 7% genetic; 22% due to multiple factors, including ototoxicity; 41% with hearing loss and ototoxic drug exposure, (but one-fourth had had insufficient drugs to cause hearing loss) and 11% were of unknown etiology. Hearing loss and normal hearing patients exposed to ototoxicity or multiple factors were similar in all parameters but hearing loss. Ten temporal bone cases are described, two from patients with hearing loss of unknown origin. One showed cochlear hydrops, fibrous tissue proliferation in cochlear perilymphatic spaces, Corti's organ degeneration, displaced tectorial membrane and probable metastatic calcification in the stria vascularis. The other case showed hair cell loss. Three patients had had ototoxic drugs; one bad hair cell loss and tectorial membrane abnormalities; one had hair cell loss and metastatic strial calcification; one was normal. One patient had pus in both internal auditory canals. Another bad otosclerotic focus without stapes fixation. Three were normal. We do not yet recognize pathology typical of hearing loss of severe renal disease. Findings seem to fall into two broad categories: those of known entities and those of obscure etiology.
Metastatic Abscess as a Complication of Retrograde Esophageal Dilatation
Authors: Rontal Eugene , Meyerhoff William , Duvall Arndt J.
Published: October 2014

Retrograde dilatation of the esophagus for lye stricture has resulted in two patients with metastatic abscesses. One patient developed a brain abscess and the other a septic arthritis. It is postulated that: 1) the pressure from esophageal dilatation may result in microscopic perforation and/or bacteremia, and 2) that high dose steroid treatment facilitates bacterial seeding by impeding the formation of protective scar tissue. It is therefore felt that a longer time duration should lapse between termination of steroid therapy and the dilatation of an esophageal stricture.
Relationship between Pulmonary Resistance and Changes in Arterial Blood Gas Tension in Dogs with Nasal Obstruction, and Partial Laryngeal Obstruction
Authors: Ogura Joseph H. , Suemitsu Michio , Nelson J. Roger , Kawamoto Satoru
Published: October 2014

Arterial blood gas tension and pulmonary resistance were measured in dogs with surgically created (A) nasal, and (B) laryngeal obstructions. Preobstruction mean values were obtained in all parameters for normal control data. Postobstruction measurements were made, serially, over a period ranging from three days to three months. Changing the dogs from nose to mouth breathers resulted in significant adverse changes in laryngeal resistance, especially marked in the expiratory phase, decreased Po2 and retention of Pco2 as well as some change in pulmonary resistance. Laryngeal obstruction resulted in significant pre and postobstruction differences in pressure-flow relations in the larynx, k1 and k2 values and arterial hypoxemia. Results suggest some anatomic and physiologic changes occurring in the lower airway as a result of marked nasal and partial laryngeal obstruction.
Carcinoma in Pleomorphic Adenomas of Salivary Glands
Authors: Boles Roger , Johns Michael E. , Batsakis John G.
Published: October 2014

Because of the variability of the histological appearance of a given mixed tumor of the salivary gland and because of “recurrences” following less than total removal, biologically benign (not capable of metastasis) mixed tumors have been considered malignant. The true malignant mixed tumor, or more commonly carcinoma, arising from preexisting mixed tumors are unusual and ill-defined in the literature. These tumors make up no more than 5% of the mixed tumor category and occur primarily in the parotid gland. In this report, we present a clinico-pathological appraisal of the malignant mixed tumor based on five cases from the University of Michigan Medical Center and relate our experience to that in the literature. The importance of recognizing the malignant mixed tumor, or “carcinoma ex-mixed tumor,” lies in the accelerated recurrence rate and surprisingly high metastatic rate manifested by this lesion. Minimal treatment is radical total excision. Wide, early excision of the primary “benign” stage of these mixed tumors should reduce the problem of ultimate “malignification.”
Mucoceles of the Frontal Sinus: Causes and Treatment
Authors: Bordley John E. , Bosley William R.
Published: October 2014

The records of 56 patients presenting with mucoceles and/or pyoceles have been reviewed. The most frequent complaints recorded were frontal headaches, eye problems, postnasal discharge, frontal sinus tenderness, and fluctuant swellings of the forehead. Roent-genographic studies demonstrated a high incidence of orbital roof erosion and anterior frontal sinus table erosion. Posterior frontal sinus table erosion and osteomyelitis were also demonstrated. In about half of the cases there was x-ray evidence of clouding of the frontal sinus. In one third of the patients a soft tissue mass could be demonstrated in the frontal sinus. Osteomas were reported in the frontal sinus in four cases. Surgery employed included the Macbeth osteoplastic procedure, the Goodale osteoplastic operation, the Lynch-Howarth operation, the radical frontal sinuseetomy with sinus collapse, and a local incision of a small mucocele. Analysis of the results indicates that the collapse operation had the greatest success, with only one recorded failure. Surgical revision of nine failures successfully eradicated the disease. The most frequent predisposing factors to mucocele formation were previous frontal sinus infection, previous surgery involving the frontal sinus including neurosurgical procedures that violated the sinus, external trauma to the sinus, long standing nasal allergy, and osteomas in the nasofrontal area of the sinus. The average interval between the primary insult to the frontal sinus and surgical confirmation of the frontal sinus mucocele was seven and one-half years. Such a lapse of time makes the establishment of the cause of mucocele formation in the frontal sinus difficult and short term evaluation of the surgery for their eradication uncertain. It would appear that the ultimate relief of the condition will lie in the hands of the surgeon.
Endoscopy of the Air Passages with Special Reference to Scleroma
Authors: Acuña Ricardo Tapia
Published: October 2014

Peroral endoscopy has contributed to other medical specialties such as anesthesia and thoracic surgery. Scleroma is a chronic infection of the respiratory tract prevalent in the tropics of the American continent. Two hundred and thirty-two patients suffering from scleroma were seen at the Department of Otolaryngology of the General Hospital of Mexico City. The first symptoms may appear within the first decade of life, being seen a little more frequently in females than in males. The etiologic agent is considered to be the Klebsiella rhinoscleromatis. Onset is in the nose, resembling a common cold. The larynx is involved in 15% of the patients and the bronchi in 2%. Clinically, all phases of scleroma may suffer spontaneous changes. Atrophy of the mucosa may be confused with other diseases such as ozena or leprosy. Treatment includes the administration of antibiotics having specific action against the germ and tracheostomy in dyspneic patients. Direct laryngoscopy and bronchoscopy are indicated in many of the patients. Laryngostomy or even lobectomy has been performed in our series. Cure is possible in older patients who have been treated for many years.
Diagnosis of Tracheal Tumors
Authors: Karlan Marc S. , Livingston Peter A. , Baker Daniel C.
Published: October 2014

Tumors of the trachea are rare. Unfortunately, the inclusion of tracheal tumors in the differential diagnosis of adult onset wheezing is even more rare. Twenty-one cases seen at the Columbia-Presbyterian Medical Center are reviewed. The average delay in diagnosis from the patient's first doctor visit was ten months. Major symptoms, related to airway obstruction, include wheezing, cough, shortness of breath and hemoptysis. Pain, dysphonia and weight loss were associated exclusively with malignancies. Routine x-rays and physical examinations do not elucidate the pathology. Eleven of twenty chest x-rays were reported negative. Special x-ray studies described were positive in every case ordered despite negative chest survey. Endoscopy is necessary for the definitive diagnosis. A program to limit the physician delay is proposed. Individual case reports are used to illustrate these points. They include a case of sclerosing hemangioma type of fibrous histiocytoma and one of neurilemmoma, both reported for the first time in the English literature.
Minibikes, a New Factor in Laryngotracheal Trauma
Authors: Alonso William A. , Caruso Vincent G. , Roncace Emilio A.
Published: October 2014

The growing popularity of minibikes among adolescents is evident by the number of advertisements and participants. Potentially fatal injuries to the neck were observed among several minibike enthusiasts. Typically, a minibike rider with his neck in extension unexpectedly collides with a hidden wire or cable. With only abrasions or contusions on his neck, the subject arrives at the emergency room in extreme airway distress. Attempts to manipulate his neck for mouth-to-mouth resuscitation or intubation produce greater air hunger. Only a low tracheotomy performed rapidly can save his life. The basic pathology in all cases encountered has been a laryngotracheal separation. Other associated injuries have been a fractured larynx, damaged recurrent laryngeal nerves, esophageal rupture and pneumothorax.
Spontaneous Positioning and Postural Nystagmus: A Synopsis
Authors: Stroud Malcolm H.
Published: October 2014

Spontaneous nystagmus when obvious and well marked is a useful indicator of disturbed oculomotor control. Not all cases are due to vestibular disturbance. Some causes are enumerated including congenital, cerebellar and vestibular lesions. Recording artifacts must be excluded. Positioning nystagmus can be physiological. When onset of the nystagmus is delayed or the duration persists considerably beyond completion of the positioning, then the term positional nystagmus is used. Various types and some possible causative mechanisms are briefly mentioned.
Vestibular Decruitment
Authors: Torok Nicholas
Published: October 2014

Vestibular decruitment is a qualitative phenomenon of the caloric nystagmus. It is a pathognomonic finding which indicates or strongly suggests central nervous system pathology.
Vascular Channels in the Auditory Ossicles in Man
Authors: Anson Barry J. , Winch Thomas R.
Published: October 2014

A second, extended study was made on the pattern of internal vascular anatomy of the stapes, incus, and malleus, employing serially sectioned specimens and reconstructions prepared from the sections. The descriptions and figures account, in detail, for the structural features in a specimen of a newborn infant and a 19-year-old male. Statements based mainly thereupon are supported by a study of a large number of additional otological series, from fetal stages in which the process of bone formation was just initiated to those of advanced years. It is established that the numerous blood vessels of intraosseous supply traverse channels of widespread distribution in the malleus and incus, or of restricted regional presence in the stapes — Differences wholly dependent upon the developmental changes which bring the ossicle to maturity. Vessels gain access to, and leave, these internal channels by openings that are unlike the nutrient foramina in a typical long bone of the human skeleton: they are distributed along the external surface of each ossicle, rather uniformly in the case of the malleus and incus, less so in that of the stapes; they are not limited to the extremities. Through the peripheral apertures, the contained blood vessels communicate with those of submucosal location. Some of the latter then pass through the numerous mucosal septa, becoming continuous with other arteries and veins of ossicular supply situated as follows: medially, on the wall of the cochlear and canalicular parts of the middle ear; laterally, on the surface of the tympanic membrane; midway, with vessels which course with the stapedius tendon as branches or tributaries of vessels in the facial canal. The vacant spaces of the autograft or homograft are ready for fresh occupancy by the blood vessels of the operated tympanic cavity. The extent to which the channels are reclaimed in transplants that are interposed in the ossicular chain of the human ear remains to be determined. In the larger sense, the local changes made around the ossicles are but part of a more inclusive process of reconstitution of a vascular complex that encompasses the entire middle ear.
Synaptic Contacts within the Intraganglionic Spiral Bundle and other Recent Ultrastructural Findings in Relation to Concepts of Efferent Cochlear Innervation
Authors: Maw A. Richard
Published: October 2014

Synaptic contacts which show many characteristic features of chemically transmitting axodendritic synapses have been demonstrated in guinea pigs, in the unmyelinated component of the so-called olivocochlear bundle (OCB) within the intraganglionic spiral bundle. Morphologically the synaptic contacts appear to form part of a cholinergic innervation. Previous reports by the author have described termination of the myelin sheath of OCB fibers and demonstrated branching of unmyelinated axons in this region. Denervation studies at an ultrastructural level following excision of the superior cervical ganglion support light microscopy fluorescent histochemical evidence for an adrenergic innervation, which distributes in part within the intraganglionic spiral bundle and the osseous spiral lamina. Although it has not been possible to demonstrate anatomical continuity between these separate findings, the pathways in which they may be involved are discussed.
Ectopic Salivary Gland and Sinus in the Lower Neck
Authors: Stingle Walter H. , Priebe Cedric J.
Published: October 2014

A case report of ectopic salivary gland tissue in the lower neck is presented. This rare lesion should be included in the differential diagnosis of draining sinuses in the neck. It arises most probably by heteroplasia within remnants of the second branchial cleft. The clinical picture is one of drainage of clear secretion from a sinus in the lower anterolateral neck usually without a history of pain or infection. It shares several clinical features with the more commonly occurring branchial fistula, but it may be distinguished by its appearance on an x-ray contrast study. A correct preoperative diagnosis makes removal more simple and direct.
Immunoglobulin E (IgE) in Middle Ear Effusions
Authors: Mogi Goro , Honjo Shoichi , Maeda Shoichi , Yoshida Toyoharu , Watanabe Noritake
Published: October 2014

This study was undertaken to further clarify the relation of atopic allergy to otitis media with effusion. Ninety-six specimens of middle ear effusions and corresponding sera were collected from 92 patients, and each sample was quantitatively measured by a radioactive single radial diffusion (RSRD) technique for immunoglobulin E (IgE) concentration. Specimens consisted of 70 serous effusions (38 acute and 32 chronic) and 26 mucoid effusions (10 acute and 16 chronic). The mean concentration of IgE in the serous effusions was 143.1 ± 28.7 ng/ml, and in the corresponding sera 227.5 ± 40.7 ng/ml. The mean concentration of IgE in the mucoid effusions was 221.7 ± 48.9 ng/ml and in the corresponding sera 398.0 ± 81.5 ng/ml. The difference between these values was not statistically significant. In both mucoid and serous types the mean IgE concentration was lower in the effusions than in the sera from the same patients, but this difference was not statistically significant. The mean value of the IgE concentration in mucoid effusions was higher than in the serous effusions, but this difference was not significant. Three of 70 serous effusions (4.3%) and 4 of 26 mucoid effusions (15.4%) had an IgE concentration exceeding 500 ng/ml. In only 2 of the 96 cases (2.1%) did the IgE concentration in effusion exceed both the 500 ng/ml level and the IgE concentration in the corresponding serum. Results of this study suggest that IgE in middle ear effusions, rather than being a local product, may be derived from the serum, and also that the fluid is not an atopic allergic effusion.
Fluoride Therapy for Osteoporotic Lesions
Authors: Parkins Frederick M.
Published: October 2014

The clinical research and the metabolic and therapeutic concerns related to the administration of fluoride for osteoporotic lesions are reviewed. Two or three daily administrations of 22.4 mg of sodium fluoride (NaF) have been shown to stimulate osteoblastic activity. When accompanied by supplemental calcium (Ca) new normal bone is deposited leading to an increase in total bone mass. The Ca should be given daily in 600 to 1,000 mg quantity at times separate from the fluoride ingestion to avoid formation of insoluble calcium fluoride. Vitamin D may also be prescribed to aid Ca absorption. The precise mechanism of action is not yet known. Promising clinical results have been obtained with a variety of osteoporotic conditions including “otosclerosis.”
Use of a Pulsed-Flow Lavage Unit for Bronchial Washing
Authors: Sanderson David R. , Wise James K. , Woolner Lewis B. , Moses Harold L. , Fontana Robert S.
Published: October 2014

A pulsating lavage irrigation system was employed during diagnostic bronchoscopy in patients with suspected bronchogenic carcinoma to facilitate collection of specimens for cytologic examination. No untoward effects were observed, and good quality samples of exfoliated cells were recovered. This method also might have application in the management of patients with suppurative lung disease or retained secretions and in situations in which a large volume of lavage solution is desired.
Aspiration Pneumonitis: A Review and Experiment on Tracheobronchial Lavage
Authors: Sudderth Michael E.
Published: October 2014

The gastric acid aspiration syndrome was first described by Mendelson in 1945. The usual clinical features of cyanosis, tachycardia, hypotension and dyspnea are produced when liquid vomitus of less than 2.5 pH is inhaled into the tracheobronchial tree. Treatment usually includes airway control, positive pressure oxygen administration, fluid replacement, steroids and antibiotics. The role of bronchoscopy and tracheobronchial lavage in treatment has never been clearly defined. Sixty dogs were studied using bronchoscopy and normal saline lavage following hydrochloric acid aspiration. Using the parameters of survival, blood gas values, lung weight and pathology, no benefit was demonstrated. Bronchoscopy and lavage are not recommended unless solid particle aspiration occurs.
Prophylaxis of Predisposed Otitis Externa
Authors: Hutchison Jimmie L. , Wright D. N.
Published: October 2014

Evaluation, in the guinea pig ear, of fourteen water repellent or therapeutic compounds has resulted in the recommended use of 360 Medical Fluid® as a prophylactic agent for those persons with a high risk of otitis externa. This compound was found to adhere well, be easy to apply and was nonirritating. Use of this material prevented adverse bacterial growth in ear canals exposed to water for up to seven days. The significance of maintaining the normal Gram positive bacterial flora in the external ear canal and the role of cerumen in maintaining a healthy meatal surface is discussed. A system for monitoring the health of the ear canal through measurement of the Gram positive/Gram negative bacterial ratio is suggested.
Tympanometric Pattern Classification in Relation to Middle Ear Effusions
Authors: Beery Quinter C. , Bluestone Charles D. , Andrus W. Scott , Cantekin Erdem I.
Published: October 2014

Tympanometric evaluation using an otoadmittance meter and X-Y plotter was performed on 129 ears of 70 children with history of recurrent acute otitis media, or evidence otoscopically of persistent middle ear effusion, or both. Myringotomy, performed immediately following the tympanometric procedure, confirmed the presence or absence of effusion. Following myringotomy, tympanometric patterns, as shown by susceptance and conductance tracings at 220 and 660 Hz, were identified and middle ear pressures and otoadmittance peak values were determined. These findings were compared and criteria were developed which best determined the presence or absence of effusion. The results revealed the following: 1) High negative middle ear pressure is not necessarily a reliable indicator of middle ear effusion. 2) Tympanometry can be used reliably as an indicator of effusion. A combination of pattern classification and susceptance criteria enabled correct prediction of effusion in 93% of these children. One pattern at B660 was found to be pathognomonic of effusion. 3) In general, otoadmittance at 660 Hz appears to be a better indicator of effusion than 220 Hz.
Application of Inverse Filtering for Detecting Laryngeal Pathology
Authors: Koike Yasuo , Markel John
Published: October 2014

Inverse filtering analysis was performed on acoustic speech samples of the vowel sound “ah” produced by ten selected patients and ten normal adults. The inverse filter output signal is the residue obtained by automatically extracting the effects of the supraglottal structure from the acoustic speech signal. For normal speakers, the residue consists of a series of rather sharp periodic spikes having low amplitude noise between periods. For pathological voices, the residue consists of lower amplitude, less sharp spikes having higher amplitude noise between periods. Comparisons between the acoustic speech waveforms and the residue signals illustrate the superiority of the residue signal for detecting irregularity, and thus suggest the feasibility of applying inverse filtering as an aid to laryngeal diagnostics.
Cervical Metastasis from an Unknown Primary
Authors: Fried Marvin P. , Diehl William H. , Brownson Richmond Jay , Sessions Donald G. , Ogura Joseph H.
Published: October 2014

Forty-nine patients with cervical metastases from unknown primaries were treated during an 11-year period. Thirty-one (63%) of these patients were treated for cure rather than palliation. The three-year survival rate of these patients treated for cure was 39%. Although the treatment of these patients varied, a systematic mode of therapy has evolved: patients with histopathologic diagnosis of epidermoid carcinoma, or undifferentiated malignant tumor, metastatic to the neck from an unknown primary, are treated with full course radiation therapy (6000–7000 rads at 1000 rads per week). This is delivered to the nasopharynx, pyriform fossae, base of tongue, and the neck, and is followed by radical neck dissection in those patients in whom the neck nodes remain palpable. Six of the last 11 consecutive patients treated in this manner are long-term survivors. This paper describes the evaluation of patients with cervical metastases from unknown primaries as well as their therapy.
Auditory-Nerve Potentials from Ear Canals of Patients with Otologic Problems
Authors: Montandon Pierre B. , Shepard Neil T. , Marr Elizabeth M. , Peake William T. , Kiang Nelson Y. S.
Published: October 2014

The feasibility of making rountine measurements of human auditory-nerve potentials in an office environment is demonstrated. Using a portable device for stimulus generating and response recording, auditory-nerve potentials are recorded from subjects with normal and abnormal hearing by means of an electrode placed on the skin of the ear canal. The results can be compared with those of others obtained under laboratory conditions. Preliminary results indicate that in many instances, the nature of the hearing deficit is related to the latency and size of the click-evoked auditory-nerve potentials. The precise relationships between nerve responses and specific disease conditions are still difficult to formulate.
Primary Oat-Cell Carcinoma of Head and Neck
Authors: Gelot Raghuvir , Rhee Tae Ryang , Lapidot Abraham
Published: October 2014

A case of primary oat-cell carcinoma of the larynx in a 68-year-old white female is described, bringing to a total of three the reported cases in the world literature. The tumor is highly malignant and notorious for the speed with which it metastasizes. Treatment should be aggressive from the beginning. We believe that even for a localized tumor of this kind, a minimal procedure should be widefield laryngectomy with elective radical neck dissection even if clinically, nodes are not palpable. Since the tumor is highly radiosensitive, radiotherapy should be used postoperatively.
Effect of Fistulae on Endolymphatic Hydrops
Authors: Kimura Robert S. , Schuknecht Harold F.
Published: October 2014

An experiment was performed on 31 guinea pigs to study the effect of fistulae of the horizontal canal, superior canal, common crus, and utricle on the course of experimentally induced endolymphatic hydrops. The effect of fistulae on corresponding parts of normal ears was also studied in an additional 17 animals. The results indicated a remarkable consistency in healing of the fistulae in both groups of animals. Fistulae had no significant effect on the course of endolymphatic hydrops, irrespective of whether the fistulae were made immediately before or several months after obliteration of the endolymphatic duct or whether a polyethylene strut was introduced into the membranous labyrinth. Once again, the functional significance of the endolymphatic sac was clearly apparent, for ablation of the sac consistently produced severe hydrops and atrophic changes in sensory and neural structures. Assuming that the mechanisms of labyrinth repair in the guinea pig are comparable to the higher mammalian ear, it is apparent that procedures designed to surgically fistulize the membranous labyrinth are of questionable value and are probably not rational therapeutic approaches to the management of Ménière's disease.
Visual Suppression of Vestibular Nystagmus after Cerebellar Lesions
Authors: Takemori Setsuko
Published: October 2014

Visual suppression of calorically induced vestibular nystagmus was observed following discrete lesions of various structures in the cerebellum. Unilateral lesions of the flocculus resulted in a complete loss or a significant reduction in visual suppression when the quick phase of the nystagmus was directed to the ipsilateral side of the lesions, and bilateral flocculus lesions caused a bilateral loss of suppression. Nodulus lesions resulted in a loss of suppression, and this loss tended to recover in time. Lesions of the dentate nucleus resulted in a very short term loss of suppression. Extirpation or lesions of the uvula, vermis, para-flocculus, cerebellar cortex, or the fastigial or interpositus nuclei had no observed effect on the visual suppression of vestibular nystagmus. The results of this study suggest that the flocculus and nodulus function as intermediators through which the visual system can modify or alter vestibular reflexes. Also, this phenomenon, that is, loss of visual suppression after the flocculus and nodulus lesion, is very useful to diagnose the localized lesion in the cerebellum.
Idiopathic Facial Paralysis, Pregnancy, and the Menstrual Cycle
Authors: Hilsinger Raymond L. , Adour Kedar Karim , Doty H. E.
Published: October 2014

The records of 42 women with Bell's palsy during pregnancy, and of 91 nonpregnant women, whose dates of onset of Bell's palsy and of the preceding menstrual cycle were precisely known, were studied for factors that might show relation between pregnancy or the menstrual cycle and Bell's palsy. Of the 42 cases in pregnancy, 31 occurred in the third trimester, five in the first two weeks postpartum, and six in the first two trimesters combined. Our calculated frequency of Bell's palsy in pregnant women is 45.1/100,000 births; for nonpregnant women of the same age group the calculated incidence is 17.4/100,000 per year. No causative relation was found between toxemia, hypertension or primigravidity, and Bell's palsy. Over 60% of the cases in nonpregnant women occurred in the first 14 days of the menstrual cycle with peaks on the first and seventh days and near ovulation. No clear evidence for an etiologic relationship was seen with edema or hormonal changes in either pregnancy or the menstrual cycle. A number of factors in pregnancy and the menstrual cycle suggested an etiologic role for herpes simplex virus reactivation in Bell's palsy. There was no evidence that prednisone treatment is contraindicated during pregnancy.
Innervation of the Cochlea of the Guinea Pig by Use of the Golgi Stain
Authors: Smith Catherine A.
Published: October 2014

Nerve fibers with distinctive branching patterns have been demonstrated in guinea pigs by use of the Golgi stain. The cochlear nerve fibers in the basal turn tend to supply a limited segment of the basilar membrane and have most endings on a single row of hair cells. The efferent olivocochlear nerve fibers ramify in a manner which varies from base to apex. Some efferents which terminate on outer hair cells also give branches which course in the inner spiral bundle. Other nerve fibers were studied in the spiral lamina which did not penetrate into the organ of Corti.
Early Lung Cancer Detection and Localization
Authors: Sanderson David R. , Fontana Robert S.
Published: October 2014

The Mayo Lung Project was established to develop and evaluate a screening program for early lung cancer in high-risk subjects. Men who are more than 45 years of age and who smoke one package of cigarettes or more daily are screened by the use of thoracic roentgenograms, three-day pooled sputum cytology, and lung health questionnaires at four-month intervals. These data are compared with data from similar subjects screened only on entry into the project. During the past three years, 34 patients who had no roentgenographic evidence of lung cancer were identified and examined because of carcinoma cells in sputum. Of these 34 patients, 27 have had bronchoscopic localization of their tumors and definitive treatment, and 3 had upper respiratory tract neoplasms and also have been treated. Of the remaining four, one patient died suddenly after myocardial infarction and three patients have not had localization or treatment because of other severe complicating medical problems. Localization of roentgenographically occult lung cancer is reliable by the use of bronchofiberoscopy and meticulous, thorough sampling from the tracheobronchial tree. A search must be made for upper airway cancers in the same high-risk population, and the possibility of second primary bronchogenic tumors also must be considered. Although follow-up is short, 22 of the 27 treated lung cancer patients were found with stage I disease. The outlook for 19 of these 27 is encouraging an average of 16 months after surgical resection.
Special New Low Resistance to Flow Tube and Endotracheal Tube Adapter for Use during Fiberoptic Bronchoscopy
Authors: Carden Edward , Raj Phulchand P.
Published: October 2014

This paper describes endotracheal tubes and adapters which are designed specially for fiberoptic bronchoscopy; the tubes are designed in such a way that they are wide at the upper part but are narrow and thin walled in the part of the tube which goes through and below the cords. By designing tubes in this manner, the resistance to flow of gas through the tube when the fiberoptic bronchoscope is in place is very much reduced and the safety of the whole precedure is enhanced. A special adapter for use under these circumstances is also described which utilizes a commercially available swivel tracheostomy adapter with a special silicone diaphragm fitted onto the top to enable the fiberoptic bronchoscope to be placed through the diaphragm and keep a sealed system. A plug is available for the hole in the diaphragm when the fiberoptic bronchoscope is not being used. Clinical and laboratory data show that these pieces of equipment perform the function for which they were designed.