bluuebunny/crossref_metadata_2025 huggingface dataset:
Experience with the Wilkie Procedure for Sialorrhea
Authors: Rosen Arie , Ophir Dov , Komisar Arnold , Marshak Gabriel
Published: October 2014

Sialorrhea (drooling) is most commonly seen in children with cerebral palsy or mental retardation. Surgical procedures for the control of sialorrhea include salivary gland excision, parasympathetic nerve section, and salivary duct ligation and/or rerouting. Eighteen children between the ages of 5 and 17 years underwent bilateral submandibular gland excision and rerouting of Stensen's duct (Wilkie procedure). All children had severe drooling associated with cerebral palsy or mental retardation. Follow-up at 7 years showed satisfactory control of sialorrhea in 16 of 18 patients (89%). There was one major complication: Xerostomia. Our results indicate that submandibular gland excision together with parotid duct retropositioning provides effective control of sialorrhea in most cases. Unfavorable head and mandibular posturing seemed to cause persistent sialorrhea in one case.
Exercise in Paleo-Otolaryngology: Head and Neck Examination of Two Egyptian Mummies
Authors: Babin Richard W. , Kahane Joel C. , Freed Rita E.
Published: October 2014

Two Ptolemaic period mummies underwent head and neck examination including high-resolution tomography and endoscopic rhinoscopy and cranioscopy. The anatomy demonstrated characteristic laryngeal calcification and sexual dimorphism. Pathologic findings consisted of severe dental disease and possible chronic ear disease. Postmortem changes revealed the entrance of the embalmers into the cranial cavity, but raised interesting speculation regarding the method of brain removal.
Endoscopic Laser Arytenoidectomy Revisited
Authors: Ossoff Robert H. , Duncavage James A. , Krespi Yosef P. , Shapshay Stanley M. , Sisson George A.
Published: October 2014

Arytenoidectomy is currently the most reliable method of treating patients with bilateral vocal cord paralysis. Although both endoscopic and external approaches have been described, the endoscopic laser technique is more desirable because it requires no incision and allows for the immediate assessment of airway size. Eleven patients with bilateral vocal cord paralysis treated by endoscopic laser arytenoidectomy were presented in 1984. At that time, 10 of the 11 patients had been successfully decannulated. Follow-up on that group of patients revealed that 7 of the 10 successfully treated patients remain decannulated with a good airway, although 2 of these patients required a revision procedure to excise a granuloma. One patient failed at 15 months and has failed two subsequent revision operations, and 2 patients have been lost to follow-up. Since 1984, 17 additional patients with bilateral vocal cord paralysis have been treated by the authors using the same endoscopic laser arytenoidectomy technique; all have been successfully managed, with a minimum follow-up of 3 years. The technique of this operation will be reviewed. This study demonstrates the clinical usefulness of endoscopic laser arytenoidectomy in the treatment of bilateral vocal cord paralysis.
Combined Laryngeal Framework Medialization and Reinnervation for Unilateral Vocal Fold Paralysis
Authors: Tucker Harvey M.
Published: October 2014

The laryngeal framework–Silastic implant technique has become an increasingly attractive alternative to Teflon injection, particularly when there is fixation of the cricoarytenoid joint or the defect to be corrected is larger than usual; but it does not restore ability to change tension in the vocal fold. Unilateral vocal fold reinnervation can overcome this drawback and, when used in conjunction with surgical medialization, may offer return of function very close to normal. Twenty-nine patients with unrecovered unilateral vocal fold paralysis and/or fixation of the cricoarytenoid joint have been managed by use of a Silastic implant combined with unilateral vocal fold reinnervation with no complications. Voice improvement has been assessed on preoperative and postoperative voice recordings. The combined surgical techniques for reinnervation and a modification of Silastic implantation via the laryngeal framework approach are reported.
Arachnoid Granulation Cerebrospinal Fluid Otorrhea
Authors: Gacek Richard R.
Published: October 2014

A case report and review of the temporal bone (TB) collection in the Department of Otolaryngology at SUNY Health Science Center in Syracuse demonstrated the occurrence of arachnoid granulations (AGs) in the posterior fossa surface of the TB and their role in cerebrospinal fluid (CSF) otorrhea. A large AG responsible for CSF otorrhea in a 64-year-old man was excised with soft tissue repair of the dural defect. Sixteen of 188 TBs (8.5%) in the collection contained 24 AGs ranging in size from 0.07 to 80.65 mm3. Nine AGs (37%) were small (< 1 mm3) and did not demonstrate enlargement. Twelve (50%) were of intermediate size (2.50 to 9.32 mm3), and three (13%) were large (49.82 to 80.65 mm3). The intermediate and large AGs were associated with bone erosion and a high incidence of communication with a pneumatized mastoid complex (serous otitis media or meningitis). These findings suggest that AGs of sufficient size to produce bone erosion are the primary responsible lesions in adult-onset spontaneous CSF otorrhea.
New Set of Pediatric Laryngoscopes
Authors: Parsons David S.
Published: October 2014

With new advances in pediatric otolaryngology, the awareness of difficulties with existing laryngoscope instruments has become more apparent. The following paper introduces four new pediatric laryngoscopes for use in premature infants, the neonate and infant, the toddler-size child, and the preadolescent-size child. The reasons for the need of new laryngoscopes are explained, and the modifications to existing scopes that are currently employed are discussed. The need for continuous insufflation of oxygen during difficult as well as routine intubation is underscored with reference to the current anesthesia literature. Ventilating techniques in laryngoscopy for the non-respirator-dependent child are discussed.
Endoscopy of the Cochlea during Cochlear Implantation
Authors: Balkany Thomas
Published: October 2014

We have previously demonstrated that multichannel cochlear implants may be effective in partially obstructed cochleas. In practice, however, it may be difficult to determine whether electrode insertion is feasible prior to attempting it. Initial trials with a flexible fiberoptic otologic endoscope on 10 cadaver temporal bones were previously reported. On the basis of these trials, endoscopy of the inferior segment of the cochlea during cochlear implantation seemed feasible. In the present study, the same endoscope was used on eight subjects undergoing cochlear implantation, six of whom had partially obstructed cochleas. Endoscopy was found to be helpful in visualizing obstructed segments, determining patency after the obstruction was removed, and identifying normal structures of the cochlea. Documentation with videotape and 35-mm photography constitutes the majority of this paper.
Effect of Bleomycin on Hematoporphyrin Derivative Phototherapy of Solid Tumors
Authors: Jones Gregory C. , Cortese Denis A. , Neel H. Bryan
Published: October 2014

Hematoporphyrin derivative phototherapy (HpD-PT) has been successfully used to localize and treat superficial squamous cell cancers. Bleomycin sulfate is a glycopeptide antibiotic that has antineoplastic properties against squamous cell cancers. Because both HpD-PT and bleomycin chemotherapy are accepted forms of treatment for squamous cell cancer and their cytotoxicity is mediated by singlet oxygen and oxygen radicals, we studied the possibility of enhancing the response of solid tumors to HpD-PT by combining this modality with systemic bleomycin chemotherapy in a murine tumor model. Bleomycin did not enhance HpD-PT significantly. Also, we are not confident that HpD-PT alone or in combination with other agents can eradicate solid tumors; it certainly did not in this syngeneic murine tumor model.
Bilateral Semicircular Canal Aplasia with Near-Normal Cochlear Development
Authors: Parnes Lorne S. , Chernoff W. Gregory
Published: October 2014

Congenital malformations of the vestibular labyrinth (pars superior) are rare. We present two patients with computed tomographic findings of bilateral semicircular canal aplasia with normal or near-normal cochleas. Initial bone conduction thresholds were within normal limits, although both patients had significant conductive hearing losses due to congenital middle ear malformations. Bithermal caloric responses were absent in both. To our knowledge these are the first reports of vestibular aplasia concomitant with normal or near-normal cochlear development. These findings conflict with conventional hypotheses that state that inner ear malformations result from arrested development during the normal stages of inner ear embryogenesis.
Effects of Cyclophosphamide on the Pathogenesis of Cytomegalovirus-Induced Labyrinthitis
Authors: Darmstadt Gary L. , Keithley Elizabeth M. , Harris Jeffrey P.
Published: October 2014

Cyclophosphamide was used in this study to define the contribution of the inflammatory response relative to direct cytopathic effects of guinea pig cytomegalovirus (GPCMV) in inducing sensorineural hearing loss in the guinea pig. The eighth nerve compound action potential (CAP) threshold on day 7 after inoculation of GPCMV into the scala tympani was an average of 35 dB greater for control animals than for those that were immunosuppressed with daily intraperitoneal injections of cyclophosphamide (20 mg/kg body weight). The amount of GPCMV antigen in the cochlea, detected immunohistochemically, did not correlate with the CAP threshold. However, the greater the inflammatory response to GPCMV in the cochlea, the higher the CAP threshold and thus the greater the hearing loss. This study demonstrates that the inflammatory response to GPCMV may be more important than direct cytopathic effects of the virus in producing sensorineural hearing loss in GPCMV-induced labyrinthitis.
Changes in the Cochlear Iron Enzymes and Adenosine Triphosphatase in Experimental Iron Deficiency
Authors: Sun Ai-Hua , Li Jin-Ying , Li Zhao-Ji , Xiao Shi-Zhi , Wang Tong-Yi
Published: October 2014

The influences of iron deficiency on the cochlear iron enzymes and adenosine triphosphatase were studied in 68 iron-deficient rats and 68 control rats (normal and with chronic anemia). A disorderly or topographic distribution and reduction or disappearance of the cochlear succinic dehydrogenase and peroxidase reaction products were found in 37.8% of the rats fed on a basic iron—deficient diet for 14 to 100 days. The activity of cochlear sodium-potassium–dependent adenosine triphosphatase in iron-deficient rats was slightly increased, compared to that in normal controls. These results suggest that iron deficiency would produce significant abnormalities of succinic dehydrogenase and peroxidase activity, which in turn would disturb cell respiration and initiate peroxidative damage to the inner ear cells, result in sensorineural hearing loss, or provide a pathologic basis for cochlear deafness.
Arytenoid Subluxation: Diagnosis and Treatment
Authors: Hoffman Henry T. , Brunberg James A. , Sullivan Michael J. , Winter Phillips , Kileny Paul R.
Published: October 2014

Both arytenoid subluxation and recurrent laryngeal nerve paralysis (RLNP) may result from injury to the larynx, and they may be difficult to distinguish clinically. A patient with arytenoid subluxation who was initially believed to have RLNP was treated with medialization laryngoplasty 1 year after the injury. Preoperative magnetic resonance imaging and computed tomography effectively demonstrated the cricoarytenoid subluxation, which was confirmed by intraoperative electromyography (EMG) showing normal electrical activity in the thyroarytenoid muscle. Photographs from preoperative fiberoptic laryngoscopy are presented to identify the appearance of arytenoid subluxation. Computed tomographic findings and photographs from laryngoscopy of two patients with RLNP documented by intraoperative EMG evaluation are presented to help distinguish the clinical appearance of this disorder from arytenoid subluxation. An integrated approach to the diagnosis and treatment of arytenoid subluxation is presented.
Electrical Pacing for Dynamic Treatment of Unilateral Vocal Cord Paralysis
Authors: Kojima Hisayoshi , Honjo Iwao , Omori Koichi , Isshiki Nobuhiko , Nonomura Mitsuharu , Shimizu Yasuhiko
Published: October 2014

In order to explore the possibility of clinical application of laryngeal pacing as a treatment for unilateral vocal cord paralysis, we examined the reactivity of atrophic muscle to electrical stimulation in dogs whose recurrent laryngeal nerves were damaged by crushing, dissection followed by resuturing, or a 3-cm neurectomy. The threshold level to induce enough vocal cord adduction reached the maximum at 2 weeks after nerve injury, decreased with time, and never surpassed 7 V in each case. On the basis of results of these preliminary probings, laryngeal pacing was conducted on a dog 15 months after resection of the laryngeal nerve. Adduction of the paralyzed vocal cord for synchrony with the intact cord was achieved by 7 V of electrical stimulation of the thyroarytenoid muscle that was triggered by signals from the cricothyroid muscle.
Effect of Head Extension on Equilibrium in Normal Subjects
Authors: Jackson Richard T. , Epstein Charles M.
Published: October 2014

A dynamic posturography system was used to test the effect of 55° head extension on postural sway in 20 normal subjects. There was a highly significant increase in sway with head extension under two conditions; in both, the support surface moves proportionally to body sway angle (sway-referenced feedback). The largest increase in sway occurred when the eyes were closed and the support surface was sway-referenced. This latter condition removes vision, reduces the effectiveness of ankle proprioception, and forces the subject to depend mostly on vestibular information for equilibrium. We suggest that head extension increases sway because the utricular otoliths are put into a disadvantageous position. This may be another example of the role of utricular input in the control of balance.
Effect of Aldosterone Antagonist on the DC Potential in the Endolymphatic SAC
Authors: Mori Nozomu , Uozumi Naruhiko , Yura Kazuyo , Sakai Shun-Ichi
Published: October 2014

The effect of aldosterone and canrenoate, known as an aldosterone antagonist, on the DC potential in the endolymphatic sac (ESP) was examined in the guinea pig. Intravenous administration of aldosterone (1 mg/kg) induced no change in the ESP for 60 minutes after the injection. However, canrenoate, an aldosterone antagonist, produced a dose-dependent decrease in the ESP. Pretreatment with aldosterone attenuated the decrease in the ESP by canrenoate. The results suggest the possibility that aldosterone may play a role in the endolymph absorption of the endolymphatic sac.
Treatment of Intractable Aspiration Using a Laryngeal Stent or Obturator
Authors: Weisberger Edward C.
Published: October 2014

Twenty-five patients were treated with a laryngeal stent for potentially reversible chronic aspiration of life-threatening magnitude. The causes of the intractable aspiration were diverse and included chronic neurologic disease, extensive head and neck surgery, and severe gastroesophageal reflux. The advantages of this technique are noted in comparison to those of more invasive procedures. Disadvantages of the laryngeal stent and complications encountered are also covered. The long-term results show that all but one patient had a significant improvement in their chronic aspiration with the stent in place. However, only eight patients achieved adequate oral deglutition without aspiration following stent removal.
Skull Base Malignancy following Long-Term Sinus Mucocele and Osteomyelitis
Authors: Sercarz Joel A. , Wang Marilene B. , Calcaterra Thomas C.
Published: October 2014

A case of skull base malignancy following long-term sinus mucocele is presented. While the similarity in clinical signs between sinus mucocele and malignancy has recently been emphasized in the literature, no previous case of skull base malignancy following frontoethmoid mucocele has been reported. The literature is reviewed and the association between inflammatory conditions and sinus malignancy is outlined.
Granulomatous Sialadenitis
Authors: Batsakis John G.
Published: October 2014

Granulomatous inflammation in salivary tissues is most often a response to liberated ductal contents, particularly mucin, in various degrees of obstructive sialadenopathy. Far less often is a granulomatous sialadenitis the result of specific infective granulomas or systemic granuloma-forming diseases, In these instances, the salivary parenchymal involvement is usually secondary to disease localization in regional lymph nodes.
Cholesterol Cysts of the Temporal Bone: Diagnosis and Treatment
Authors: Goldofsky Elliot , Holliday Roy A. , Hoffman Ronald A. , Cohen Noel L.
Published: October 2014

Cholesterol cyst (or granuloma) of the temporal bone, a recognized clinical entity distinct from cholesteatoma, is more common than previously thought. Apparently it is caused by obstruction of previously pneumatized temporal bone air cells. Surgical cure is achieved by drainage and reestablishment of normal pneumatization. This paper reviews 14 cholesterol cysts of the temporal bone, emphasizing the importance of preoperative imaging and surgical approach. Use of magnetic resonance imaging differentiates cholesterol cysts from cholesteatoma or other neoplasms. Computed tomography delineates the location of the lesion and defines temporal bone anatomy essential to surgical approach. The two studies together allow the surgeon to properly plan drainage, as in the case of a cholesterol cyst, versus excision or exteriorization, as in the case of cholesteatoma. The infralabyrinthine approach to a petrous apex cholesterol cyst is the procedure of choice when hearing preservation is desired.
Italian Experience of Voice Restoration after Laryngectomy with Tracheoesophageal Puncture
Authors: Recher Gianfranco , Cristoferi Valentina , Pesavento Gastone , Ferlito Alfio
Published: October 2014

This report concerns 102 cases of tracheoesophageal puncture performed as a means of secondary voice restoration after total laryngectomy, in 70 patients proving unable to learn esophageal speech and as a treatment of choice in a further 32 cases. Complications arose in 21 cases but were generally minor and could be overcome. Results were favorable in 45 of 70 and 29 of 32 cases, respectively. The method was considered effective, particularly when supported by the patient's determination to learn a verbal communication method.
Rat as a Potential Model for Hearing Loss in Biotinidase Deficiency
Authors: Rybak Leonard P. , Whitworth Craig , Weberg Aruna D. , Scott Vernedra , Bhardwaj Bhavna
Published: October 2014

Biotinidase deficiency is an inborn error of metabolism that is transmitted as an autosomal recessive disorder. Symptoms include hearing loss, ataxia, blindness, mental retardation, and seizures. The metabolic defect is an inability to recycle the vitamin biotin, which is an important cofactor in key enzymes. We therefore sought to develop an animal model for this disorder by inducing biotin deficiency. Rat pups were divided into control and experimental groups. Control rats were fed a normal diet whereas experimental animals were given a diet deficient in biotin. Animals from both groups underwent brain stem auditory evoked potential testing at various ages. Wave I thresholds at various ages were similar in both groups, Latencies for wave I, however, and interpeak latencies (I-IV) were prolonged in the biotin-deficient groups compared to controls. Scanning electron microscopy of the organ of Corti in biotin-deficient animals showed no significant hair cell loss, The biotin-deficient developing rat appears to acquire functional changes in the auditory brain stem. These effects may be caused by defective myelination, since biotin is important in fatty acid metabolism.
Facial Nerve and Medially Invasive Petrous Bone Cholesteatomas
Authors: Bartels Loren J.
Published: October 2014

Eight patients with extensive petrous bone cholesteatomas that invaded the labyrinth and fallopian canal are presented. The eight cases are added to a tabulation of prior literature reports to elucidate concepts of routes of extension of medially invasive temporal bone cholesteatoma. Medially invasive petrous bone cholesteatoma develops insidiously, often without symptoms other than facial palsy and/or unilateral deafness. Typically, a history of chronic ear disease can be obtained. While hearing is unlikely to be preserved in this group of patients, facial nerve function can usually be preserved, and a facial nerve graft was not necessary in our series. Acute facial nerve palsy or facial nerve paresis progressing to palsy in patients with a history of chronic ear disease should be studied radiographically for petrous bone cholesteatoma, even if there is no physical evidence of cholesteatoma.
Abscesses of the Neck in Infants and Young Children a Review of 112 Cases
Authors: Hawkins Donald B. , Austin John R.
Published: October 2014

A review of 112 patients 5 years of age and younger with cervical abscesses is reported. Staphylococcus aureus and group A β-hemolytic Streptococcus were cultured most often: In 39% and 17% of patients, respectively. Sixteen patients (14%) had unusual abscesses such as infected congenital cysts, cat-scratch disease, or mycobacterial abscesses. One patient had a necrotizing infection with group A streptococci and anaerobic streptococci. Intravenous antibiotic therapy was used in 104 patients, with 94% of these patients receiving a penicillin derivative, usually an antistaphylococcal penicillin. Ninety-six percent of the patients had incision and drainage of their abscesses; 8 patients required more than one incision and drainage. Two patients required airway intervention, 1 by intubation and 1 by tracheotomy. Most pediatric cervical abscesses respond well to appropriate intravenous antibiotic therapy and incision and drainage.
Endoscopic Laser Therapy for Obstructing Tracheobronchial Lesions
Authors: Beamis John F. , Vergos Konstantinos , Rebeiz Elie E. , Shapshay Stanley M.
Published: October 2014

The Lahey Clinic experience using laser bronchoscopy for relief of obstructive tracheobronchial lesions during a 7-year period from 1982 to 1989 involves 269 patients treated with 400 procedures. The carbon dioxide (CO2) laser was used for tracheal stenosis and granulation tissue. The neodymium:yttrium-aluminum-gamet (Nd:YAG) laser was used for all obstructing endobronchial neoplasms. Indications for therapy included severe dyspnea, hemoptysis, and postobstructive pneumonitis. All patients had relatively central lesions. A rigid bronchoscope was used to treat 88% of patients, and 12% of patients were treated with a flexible bronchoscope. One death occurred during the intraoperative period. Eleven deaths occurred within 1 week of therapy and were related to the presence of extensive malignant lesions or to coronary artery disease. Our experience indicates that bronchoscopic application of the CO2 or Nd: YAG laser affords effective palliation for patients with obstructive tracheobronchial lesions. The Nd:YAG laser is recommended for patients with bulky vascular endobronchial neoplasms, and the CO2 laser is best reserved for patients with benign tracheal stenosis and granulation tissue.
Sinus Aspergillosis and Allergic Fungal Sinusitis
Authors: Hartwick R. Warren , Batsakis John G.
Published: October 2014

Aspergillosis of the sinonasal tract has four basic clinicopathologic presentations depending on the mucosal or extramucosal involvement by the fungus. Two are saprophytic (aspergilloma and allergic Aspergillus sinusitis) and two are infectious (chronic indolent and invasive fulminant sinusitis). Tissue-invasive and angioinvasive aspergillosis can be a rapidly lethal disease, particularly in the immune-compromised host. The allergic form of paranasal sinus aspergillosis is presumed to be initiated by hyperreactivity to fungal antigens. Not all allergic fungal sinusitis is associated with Aspergillus species, and culture confirmation is necessary to distinguish the fungal agent. Surgical removal of the offending fungus is the mainstay of therapy in all forms of sinonasal aspergillosis and other fungal sinusitis. Antifungal agents and steroids complement surgical removal, depending on the form of the sinusitis
Insertion of the Tensor Veli Palatini Muscle into the Eustachian Tube Cartilage in Cleft Palate Cases
Authors: Matsune Shoji , Sando Isamu , Takahashi Haruo
Published: October 2014

Differences in insertion of the tensor veli palatini muscle (TVPM) into the lateral lamina of the eustachian tube (ET) cartilage between cleft palate (CP) cases and controls were investigated histologically. Thirty temporal bones with entire ETs were studied: 10 from individuals with CP and 20 controls. The ratio of the length of the ET cartilage with insertion of the TVPM to its total length from the nasopharyngeal end to near the tubal isthmus was calculated in all 30 cases. In all 20 controls, but in only 6 of 10 CP cases, the TVPM inserted into the lateral lamina of the ET cartilage at its tip portion (χ2 test, p < .025). The ratio was significantly smaller in CP cases (0.178 ± 0.172) than in controls (0.419 ± 0.120) ( t = 4.305, p < .001). We believe that abnormal insertion of the TVPM into the ET cartilage is one of the causes of the functional obstruction of the ET that contributes to the frequent bouts of otitis media experienced by those with cleft palate.
Normal and Abnormal Growth at the Nasoseptovomeral Region
Authors: Sarnat Bernard G.
Published: October 2014

The purpose of this report is to review and summarize a selected series of previously reported experiments at the nasoseptovomeral region dealing with both normal growth and the effects of certain operative procedures in young and adult rabbits. The methods of study included gross and serial cephalometric radiography with radiopaque implants, histology, and autoradiography. Findings indicated that the frontonasal suture region was an active secondary site of growth unaffected by extirpation. Examples of differential sutural growth were presented. The proximal and distal regions of both the nasal bone and septum were their most active sites of growth. Extirpations of the central section of the cartilaginous nasal septum resulted in severe upper facial deformity in young but not in adult rabbits. Trauma to the nasal bone region in the young rabbit did not result in severe facial deformity as did trauma to the cartilaginous nasal septum. Another purpose of this report is to present some of the different approaches used to study the nasoseptovomeral region.
Sublingual Gland
Authors: Batsakis John G.
Published: October 2014

The smallest of the major salivary glands, the sublingual gland is unusually the origin of a salivary neoplasm. When it is, however, the odds are greatly in favor of the neoplasm's being malignant. The gland is also uniquely associated with two nonneoplastic disorders: The cervical ranula and herniation through the mylohyoid muscle
Recurrent Parotitis and Sialectasis in Childhood: Clinical, Radiologic, Immunologic, Bacteriologic, and Histologic Study
Authors: Ericson Sune , Zetterlund Birgitta , Öhman Jan
Published: October 2014

Twenty children with juvenile recurrent parotitis, between 3 months and 16 years of age at onset, were followed up over a period of 7 to 22 years. Radiologic, histopathologic, cytologic, immunologic, and bacteriologic studies were performed to investigate the cause of sialectasis, commonly found in juvenile recurrent parotitis, and the pathogenesis of the disease. It was considered that a combination of a congenital malformation of portions of the salivary ducts and infections ascending from the mouth following dehydration of the children are contributory to the pathogenesis of the disease. The results of the investigations into the cause of the disease appear to exclude an auto-immunologic response or an allergic condition, an immature immune response, mumps, a sensitivity to upper respiratory tract infection, and familial factors.
Toxic Shock Syndrome Associated with Pharyngitis and Submandibular Space Abscess
Authors: Sales J. Hugh , Kennedy Kevin S. , Galantich Peter T. , Gomez Patrick J.
Published: October 2014

Toxic shock syndrome continues to be encountered more frequently with the head and neck areas as sources of the toxin. In head and neck surgery practice it is most commonly noted following nasal packing. An unusual case associated with staphylococcal pharyngitis and spontaneous submandibular space abscess is reported and the literature concerning the subject is reviewed. Treatment is eradication of the infective focus, aggressive support of vital functions, and parenteral antistaphylococcal antibiotics.
Tinnitus Suppression by Cochlear Implants
Authors: McKerrow William S. , Schreiner Christoph E. , Merzenich Michael M. , Snyder Russell L. , Toner Joseph G.
Published: October 2014

The beneficial effects of cochlear implants on tinnitus have been noted in several studies, but few detailed appraisals of the phenomenon have been made. Six patients fitted with the UCSF/Storz cochlear implant device were studied. The effects of use of the implant device on tinnitus were monitored, and suppression of tinnitus was tracked throughout periods of stimulation and poststimulation. Tinnitus was effectively suppressed in five of six patients with the device on and with noise input, and reduction of perceived tinnitus loudness occurred in four of six with the device on but without acoustic input to the speech processor. Unilateral stimulation frequently resulted in bilateral tinnitus suppression. These studies reveal that profound tinnitus suppression is obtained by patients using their cochlear implants. Further work is required to quantify the optimal mode of stimulation, but these findings suggest that tinnitus sufferers may ultimately benefit from development of electrical stimulation tinnitus suppression devices.
Abolition of Optokinetic Afternystagmus by Aminoglycoside Ototoxicity
Authors: Hain Timothy C. , Zee David S.
Published: October 2014

We studied optokinetic afternystagmus in eight subjects with loss of or impairment of vestibular function due to ototoxic antibiotics. We found that the initial amplitude, the time constant, and the slow-phase cumulative eye position of optokinetic afternystagmus were significantly reduced in the patients. Slow-phase cumulative eye position most reliably distinguished our patients' responses from those of a normal group.
Primary Tumors of the Facial (Extracranial) Nerve
Authors: Sneige Nour , Batsakis John G.
Published: October 2014

Nearly 25% of all primary neurogenous tumors arise from peripheral nerves in the head and neck. The extracranial parts of the facial nerve, however, rank low as potential sites. Their tumors nonetheless pose diagnostic and management problems. In the intraparotid location the neurogenous tumors most often present as mass lesions, accompanied, in one third of patients, by various degrees of facial weakness. With the exception of a peculiar predilection of childhood plexiform neurofibromas to afflict the facial nerve, the majority of the tumors are neurilemomas. Recurrences are unusual after surgical removal of either neurilemomas or neurofibromas. The rare facial nerve sarcoma is a high-grade malignancy
Regulation of Phonatory Efficiency by Vocal Fold Tension and Glottic Width in the Excised Canine Larynx
Authors: Slavit David H. , McCaffrey Thomas V.
Published: October 2014

An excised canine larynx was used to assess the effects of glottic width and vocal fold tension on acoustic power, aerodynamic power, and vocal efficiency. Multiple regression analysis of the data obtained from 10 larynges revealed that with increased vocal fold tension there is a logarithmic decline in radiated acoustic power, while aerodynamic power remains constant (p < .05). Vocal efficiency has a similar logarithmic decrease with increased tension (p < .05). With narrowing of the glottis, the acoustic power increases more than the aerodynamic power delivered to the larynx, and the efficiency increases. The inverse relationships glottic width has with acoustic power and vocal efficiency are best described by a reciprocal model (p < .01). There is a negative linear relationship between glottic width and aerodynamic power. These results suggest that within the larynx the energy conversion is regulated by glottic aperture and longitudinal vocal fold tension. The optimal width for efficiency appears to be the narrowest width that produces phonation within the modal register, whereas increased tension decreases the efficiency of the glottis.
Electrode Insertion Trauma in Cochlear Implantation
Authors: O'Leary Michael J. , House William F. , Fayad Jose , Linthicum Fred H.
Published: October 2014

Residual hearing conservation may be important in cochlear implantation of children and of adults with disabling tinnitus responsive to extracochlear stimulation. Damage to the neural elements of the cochlea during electrode insertion may have a negative impact on residual hearing conservation. Histologic analysis of eight temporal bones with cochlear implants reveals trauma at essentially two locations: The round window insertion site and along the basal turn of the cochlea. In four of the bones, insertion at the round window resulted in damage to the osseous spiral lamina and the electrode was inserted through the scala media into the scala vestibuli. Evidence of secondary reactive osseous formation was also noted in these bones. This paper relates the surgical anatomy of the round window to histologic findings and microanatomical dissections. Recommendations for implantation surgery include creation of a cochleostomy by removal of the floor of the round window niche and a superior-to-inferior angle of electrode insertion.
Histopathologic Correlation of Spiral Ganglion Cell Count and New Bone Formation in the Cochlea following Meningogenic Labyrinthitis and Deafness
Authors: Nadol Joseph B. , Hsu Wenchong
Published: October 2014

Bacterial meningitis is a common cause of profound deafness and, hence, a common cause of deafness in published series of patients treated with a cochlear prosthesis. Labyrinthitis ossificans is a common finding in meningogenic labyrinthitis and has been considered a relative contraindication to cochlear implantation. In the present study, the numbers of remaining spiral ganglion cells in cases of meningogenic labyrinthitis were correlated with the severity of new bone formation within the inner ear. Six temporal bones in which profound sensorineural hearing loss occurred in life secondary to meningogenic labyrinthitis were studied by serial section light microscopy. Some degree of labyrinthitis ossificans was found in four of six. There was a moderately strong negative correlation between the number of years of total deafness and the percentage of normal of the remaining spiral ganglion cell count. There was a strong negative correlation between the degree of bony occlusion by labyrinthitis ossificans and the normality of the spiral ganglion cell count. The percentage of bony occlusion of the membranous labyrinth increased with the years of total deafness. The significance of these findings for cochlear implantation of individuals with meningogenic labyrinthitis is discussed.
Magnetic Resonance Imaging of Pediatric Head and Neck Cystic Hygromas
Authors: Yuh William T. C. , Robinson Robert A. , Buehner Linda S. , Dolan Kenneth D. , Kao Simon C. S. , Phillips Jeffrey J.
Published: October 2014

We retrospectively reviewed the magnetic resonance imaging (MRI) findings of eight pathologically proved cystic hygromas in seven pediatric patients. All lesions showed multiple cysts, best depicted on T2-weighted images (T2WI). Six of the eight lesions had well-defined borders. Fluid-fluid levels were visualized in seven of eight lesions, with very high signal intensity of the upper fluid on T2WI. On T1-weighted images, all lesions showed a mean signal intensity greater than that of muscle (1.6 times) and cerebrospinal fluid (CSF; 4.04 times) and less than that of fat (0.5 times). On T2WI, the mean signal intensity was greater than that of CSF (1.8 times), muscle (9.45 times), and fat (2.54 times). Chemical analysis of the cystic fluid from one lesion showed high lipid content and hemorrhage, consistent with the preoperative and in vitro MRI findings on the fluid from the same patient. Lesion anatomic distribution showed frequent posterior triangle involvement; however, the epicenter of 75% of the lesions was outside the posterior triangle. Only one lesion had involvement limited to the posterior triangle. There was equal distribution of right and left sides and no midline lesion. Seven lesions displaced the sternocleidomastoid muscle laterally, whereas one displaced it posteriorly, with no evidence of muscle infiltration. Only those patients with submucosal involvement (two of seven) had respiratory symptoms. Gadolinium provided no additional information with regard to diagnosis or extent of involvement. Our experience indicates that MRI is useful in the diagnosis and treatment planning of cystic hygromas.
Primary Culture of Chinchilla Middle Ear Epithelium
Authors: Nakamura Akihiko , Lim David J. , DeMaria Thomas F. , van Blitterswijk Clemens A.
Published: October 2014

Chinchilla middle ear epithelium was successfully cultured in medium containing Dulbecco's modified Eagle's medium, Ham's F12 mixture, and fetal bovine serum. After 3 to 5 days, the explants produced outgrowths of primarily flat polygonal and ciliated cells that persisted for up to 10 days in culture. These cells in the outgrowth often formed a “dome” indicating the presence of functional polarization and fluid transportation capability. The ciliated cells were more frequently found near the explant, and were fewer in number in the area distant from the explant. This finding suggests that the ciliated cells in the outgrowth are migrated ciliated cells deriving from the explant. That secretory cells were not identified in the outgrowth indicated that the present culture technique did not support secretory activity. Using the present culture technique, we were able to maintain the explants and primary cultured cells for up to 14 days in a majority of cases; hence, these techniques appear to be applicable to a number of in vitro studies.
Carcinoma in Situ and Microinvasive Squamous Cell Carcinoma of the Vocal Cords
Authors: Rothfield Robert E. , Myers Eugene N. , Johnson Jonas T.
Published: October 2014

A retrospective study was undertaken to assess the outcome of 20 patients who underwent microlaryngoscopy and stripping of their vocal cord(s) with and without laser ablation of adjacent tissue for carcinoma in situ and/or microinvasive squamous cell carcinoma of the glottic larynx. Eighteen of 20 (90%) patients are currently free of disease following this course of treatment. The two treatment failures were in patients who had been lost to follow-up. A structured approach is presented to the clinical management of carcinoma in situ and microinvasive squamous cell carcinoma. We propose that the technique of tissue removal, microcup forceps stripping with or without laser ablation, is not the critical determinant of successful outcome, but rather that compulsive follow-up is most important to ultimate treatment success.
Cochlear Implants: Histopathologic Findings Related to Performance in 16 Human Temporal Bones
Authors: Fayad Jose , Linthicum Fred H. , Galey Frank R. , Otto Steven R. , House William F.
Published: October 2014

This paper presents results of a histologic study of 16 temporal bones with cochlear implants from 13 subjects. Damage caused by electrode insertion in the basal turn of the cochlea was evaluated. Dendrite and spiral ganglion cell populations were compared to clinical performance scores to determine structures necessary for stimulation and the minimum number needed for electrical stimulation. Results show that damage from insertion of long electrodes was located mainly at the most anterior part of the basal turn; that despite total degeneration of dendrites in the area near the electrode, some spiral ganglion cells remained; and that spiral ganglion cells or possibly axons are the stimulated structures and that fewer of them than previously thought are necessary to achieve a hearing sensation from electrical stimulation.
Bilateral Acoustic Neurofibromatosis (Neurofibromatosis 2): A Disorder Distinct from Von Recklinghausen's Neurofibromatosis (Neurofibromatosis 1)
Authors: Flexon Phillip B. , Nadol Joseph B. , Montgomery William W. , Schuknecht Harold F. , Martuza Robert L.
Published: October 2014

A case report of bilateral acoustic neurofibromatosis (NF-2) is presented with temporal bone histopathology. The distinct clinical and genetic features of NF-2 are reviewed in the context of recent data that show it to be a disorder distinct from classic von Recklinghausen's disease (NF-1).
Implication of Surfactant Apoprotein in Otitis Media with Effusion
Authors: Yamanaka Noboru , Kobayashi Kazutoyo , Kuroki Yoshio , Kataura Akikatsu , Akino Toyoaki
Published: October 2014

A two-site simultaneous immunoassay using monoclonal antibodies against human surfactant apoprotein (SAP) was used to measure SAP in middle ear effusions (MEEs). In 130 MEE samples from children with otitis media with effusion, SAP was detected in 54 samples (SAP-positive cases, 41.5%). In the remainder, the SAP concentration was below the sensitivity of the immunoassay (SAP-negative cases, 58.5%). A significant difference in periods of observation was found between the SAP-positive cases (17.3 ± 16.8 months) and the SAP-negative cases (26.2 ± 22.5 months) (p < .01). The percentage of positive cases was highest in the serous MEE group (81.2%) and decreased in the purulent MEE group (57%), the mucoid MEE group (30%), and the hyperviscous MEE group (13.6%), in that order. In the purulent MEE group and the mucoid MEE group, the period of observation was significantly shorter in the SAP-positive cases (18.3 ± 20.4 months and 20.2 ± 19.4 months) than in the SAP-negative cases (35.9 ± 24.5 months and 25.4 ± 18.7 months) (p < .05). These results suggest that SAP is present in the middle ear cleft and may be a good prognostic predictor of otitis media with effusion in children.
Laryngeal Manifestations of Gout
Authors: Guttenplan Michael D. , Townsend Mary J. , Hendrix Robert A. , Balsara Gulnar
Published: October 2014

Gout is a disorder of purine metabolism characterized by hyperuricemia with rare involvement of the head and neck. We present a 72-year-old woman with a known history of gout who presented with hoarseness and a lesion suspicious for carcinoma of the larynx. Endoscopic biopsy revealed a tophus of the true vocal cord with characteristic birefringent crystalline deposits and giant cell granuloma. There have been limited reports of gouty involvement of the larynx, more commonly involving cricoarytenoid arthritis. Tophi of the laryngeal soft tissues are exceedingly rare. In this paper we will discuss the pathophysiology and management of this interesting clinical entity.
Abnormalities of Lateral Cartilaginous Lamina and Lumen of Eustachian Tube in Cases of Cleft Palate
Authors: Matsune Shoji , Sando Isamu , Takahashi Haruo
Published: October 2014

Development of the lateral lamina (LL) of the eustachian tube (ET) cartilage was investigated in cleft palate (CP) cases and controls by measuring the areas of the LL and medial lamina (ML) of the ET cartilage in histologic cross section, and comparing the ratio of the area of LL to that of ML (LL/ML) in CP cases and controls. The degree to which the ET lumen appeared straight or C-shaped in cross section was also measured. Thirty temporal bones with the entire ET — 10 CP cases and 20 controls — were studied. The ratio of the areas of the ET cartilage was significantly smaller ( t = 2.903, p < .01) and the curvature of the ET lumen was significantly less ( t = 2.080, p < .05; χ2 = 3.936, p < .05) in CP cases than in controls. In addition, in all 30 CP cases and controls, the ratio of the areas of cartilage was significantly less in specimens with straight ET lumens than in those with C-shaped lumens ( t = 2.713, p < .02). The results appear to show that the ET cartilages and lumens are anomalous in CP cases. These anomalies are considered to be important factors in active ventilatory dysfunction of the ET.
Glycoconjugates in the Chinchilla Tubotympanum
Authors: Lim David J. , Coticchia James M. , Heiselman Fred A. , Ueno Kazuyoshi , Bakaletz Lauren O.
Published: October 2014

Various biotinylated lectins were used to characterize and semiquantitate glycoconjugate residues in the tubotympanum. Epithelial goblet cells were stained predominantly by WGA, LFA, SNA, RCA-I, Con-A, LCA, SBA, PHA-E, and UEA; this finding suggests they contain α-neuraminic acid, β-galactose, α-mannose, N-acetyl α-galactosamine, and α-fucose. Glandular mucous cells were stained predominantly by WGA, LFA, SNA, and RCA-I; this finding suggests that they contain α-neuraminic acid and β-galactose. The glandular serous cells were stained predominantly by Con-A, WGA, and LFA; this finding suggests that they produced α-mannose and α-neuraminic acid that represented serum-type glycoprotein. The positive staining of epithelial goblet cells and glandular mucous cells with PNA after neuraminidase digestion suggests that they produced mucin-type glycoproteins. The staining of the mucous blanket by WGA, LFA, SNA, RCA-I, LCA, PNA, SBA, PHA-E, and UEA suggests the presence of α-neuraminic acid, β-galactose, N-acetyl α-galactosamine, and α-fucose. The epithelial cell (nonsecretory) surface was stained largely by WGA, LFA, SNA, RCA-I, Con-A, and LCA; this finding suggests the presence of α-neuramimic acid, β-galactose, and α-mannose.
Blood Flow in Expanded Tissue Treated with an Anticontractile Agent
Authors: Canady John W. , Kelly Kevin M. , Squier Christopher A. , Bardach Janusz
Published: October 2014

The present study investigates blood flow at several stages of expansion with and without enhancement by anticontractile agents (papaverine). Twelve 1-kg guinea pigs were divided into two groups. In group 1 were six animals undergoing tissue expansion without anticontractile agents, and in group 2 were six animals treated with a saturated solution of papaverine prior to expansion. Laser-Doppler velocimetry was used to monitor the changes in blood perfusion that occurred with each expansion. Animals pretreated with papaverine (group 2) maintained higher blood flow following inflation of the expander than untreated animals (group 1). This study provides physiologic evidence of the benefits of pharmacologic enhancement of the expansion process. Agents of this type may have a future role in the prevention of ischemic complications.
In Situ Hybridization and Laryngeal Papillomas
Authors: Rimell Frank , Maisel Robert , Dayton Vannesa
Published: October 2014

The technique of in situ hybridization with biotin-labeled probes was applied to 20 patients with laryngeal papillomatosis (9 with adult-onset disease and 11 with juvenile-onset). Ten patients were noted for epithelial transformation of their laryngeal disease. All patients, regardless of their clinical outcome, tested positive for human papillomavirus group 6/11. The biotin method of in situ hybridization proved to be a sensitive method in this study, identifying the infecting viral group in 23 of 24 samples. This study also tested for group 16/18 and is the first to test for the presence of group 31/33/35 in the larynx. These viruses or members of related groups have been reported in malignancies of the head and neck as well as the uterine cervix. They have yet, however, to be identified in benign laryngeal papillomas or laryngeal papillomas that have undergone epithelial transformation.