bluuebunny/crossref_metadata_2025 huggingface dataset:
Fetor from Ulcerated Head and Neck Tumors: Causation and Therapy
Authors: Brusis Tilman , Luckhaupt Horst
Published: October 2014

Almost all extensive tumors of the head or neck generate a fetor very unpleasant for the patient, his family, and the nursing staff. Thirty-one patients suspected of having a microbial superinfection of the tumor masses caused by anaerobes or an aerobe-anaerobe mixed infection were examined, and tumor samples from the oral cavity, throat, and larynx were obtained. Anaerobes could be demonstrated in every case, especially Bacteroides melaninogenicus. In the antibiotic treatment, clindamycin (Cleocin) proved to be superior to metronidazole (Clont). Within 12 to 24 hours after initiation of treatment, at the most 36 hours, the fetor almost always disappeared. The odor was stopped as long as antibiotic therapy continued.
Eustachian Tube Lumen: Comparison between Normal and Inflamed Specimens
Authors: Sadé Jacob , Luntz Michal
Published: October 2014

This study presents measurements of the cross-sectional luminal area of the eustachian tube. Comparisons are made between the lumens of eustachian tubes obtained from temporal bones presenting acute or secretory otitis media and those from noninflamed temporal bones. The material consisted of 71 temporal bones obtained postmortem from individuals up to 2 years of age. Forty-six of these showed no middle ear inflammation, while 25 presented either acute or secretory otitis media. In both groups the lumens of all the eustachian tubes were patent, presenting no obstruction. The mean cross-sectional area of the lumens of inflamed temporal bones was smaller than that of the noninflamed ones. This difference was not found to be statistically significant in the cartilaginous regions and was found to be statistically significant or borderline significant in the bony parts of the eustachian tube.
Acute Airway Obstruction and Achalasia of the Esophagus
Authors: Zikk Daniel , Rapoport Yoram , Papo Joseph , Halperin Doron , Himelfarb Mordechai Z.
Published: October 2014

Patients with achalasia tolerate considerable distension of the esophagus. Respiratory symptoms usually are due to regurgitation and pulmonary aspiration of retained food rather than to a space-occupying mechanism. We describe a case of previously undiagnosed achalasia presenting in an elderly woman with symptoms consistent with tracheal obstruction of acute onset.
Laryngeal Brain Stem Evoked Response
Authors: Anonsen Cynthia K. , Lalakea M. Lauren , Hannley Maureen
Published: October 2014

Sensory stimuli to the larynx evoke a laryngeal adductor reflex mediated by the brain stem via superior and recurrent laryngeal nerves. Aberrant laryngeal reflexes have been proposed to explain a number of poorly understood disorders, including “reflex apnea,” idiopathic laryngospasm, and sudden infant death syndrome. The purpose of the present study was to evaluate far field brain stem recordings following stimulation of the superior laryngeal nerve to determine whether laryngeal brain stem response is a valid measure of laryngeal activity at the brain stem level. The nerve was stimulated electrically in adult cats, and the resultant laryngeal adductor response as well as far field brain stem activity was recorded. For the latter, six reproducible positive and five reproducible negative waves were obtained via posterior pharyngeal (+) and posterior cervical (−) recording electrodes. Response threshold and latencies were measured and evaluated as a function of stimulus parameters. Wave latencies corresponded closely to those reported in prior near and far field evoked response recordings.
Optokinetic Afternystagmus in Humans: Normal Values of Amplitude, Time Constant, and Asymmetry
Authors: Tijssen Marina A. J. , Hain Timothy C. , Straathof Chiara S. M. , Zee David S.
Published: October 2014

It has been suggested that the appearance of directional asymmetry and/or a reduced time constant of optokinetic afternystagmus (OKAN) might be a clinical index of vestibular imbalance. However, we do not know the limits for OKAN parameters in normal humans. Accordingly, we studied OKAN in 30 normal subjects using a “sampling” method, in which a number of values of OKAN are obtained by turning out the lights periodically during optokinetic stimulation. We found that the initial velocity of OKAN has a large intrasubject variability. Accordingly, if precision is desired so as to obtain 95% confidence that the measured mean of the initial velocity of OKAN is within 25% of the true mean in an individual subject, at least eight measurements of the initial OKAN velocity must be taken. When 12 measurements are made, all subjects had a minimum value of 5°/s initial OKAN, and there was little directional asymmetry (mean of −0.47°/s ± 3.13°/s). The intrasubject variability of the time constant of OKAN was similar to the variability of initial OKAN velocity. However, because it is not possible to obtain repeated measures of the time constant in a short period of time, the time constant of OKAN is less likely to be useful in clinical testing.
Comparative Histology of the Tympanic Membrane and its Relationship to Cholesteatoma
Authors: Chole Richard A. , Kodama Kevin
Published: October 2014

The purpose of this study was to determine whether anatomic differences in the tympanic membranes of various species could explain differences in the propensity to form aural cholesteatomas and retraction pockets. Tympanic membranes from humans, dogs, cats, rabbits, guinea pigs, rats, gerbils, and mice were examined histologically. The pars flaccida and pars tensa varied greatly among the species studied. The guinea pig's pars flaccida was very small and had a thin lamina propria. In contrast, the lamina propria of the rabbit and cat pars flaccida were thick. The amount of collagen, elastin, mast cells, and macrophages varied widely. The human and gerbilline tympanic membranes were anatomically dissimilar; for example, the human pars flaccida and pars tensa contained more and denser collagen than did those of the gerbil. The presence of macrophages or mast cells did not correlate with the propensity to develop cholesteatomas. Therefore, anatomic differences among these species do not explain why some develop aural cholesteatomas and others do not.
Air Conduction Thresholds and Secretory Otitis Media: A Conventional and Extra-High Frequency Audiometric Comparison
Authors: Mair Iain W. S. , Fjermedal Oddbjørn , Laukli Einar
Published: October 2014

A comparison has been made of air conduction threshold changes up to 1 year after myringotomy, aspiration of middle ear fluid, and insertion of ventilation tubes in ten patients with bilateral and 12 with unilateral secretory otitis media (SOM). Pure tone air conduction thresholds have been analyzed in three frequency groups: Low frequency (LF; 0.25, 0.5, and 1 kHz), high frequency (HF; 2,4, and 8 kHz), and extra-high frequency (EHF; 10, 12, 14, and 16 kHz). In the LF and HF ranges, significant improvement came during the first 24 hours after intubation, while in the EHF range, threshold lowering occurred gradually over the following 2 months. Possible explanations for these findings are discussed.
Regional Blood Flow to the Canine Vocal Fold Rest and during Phonation
Authors: Arnstein David P. , Trapp Terrence K. , Berke Gerald S. , Natividad Manuel
Published: October 2014

Recent reports have suggested that blood flow to the vocal fold decreases during phonation. However, these studies relied on indirect measures of blood flow, such as tissue oxygen tension. Among the differing methods of measuring blood flow, one of the most sensitive is the microsphere surface technique. This technique has been effective in assessing the overall and regional blood flow to a number of different organs, including the cochlea. Employing an in vivo canine model, we injected microspheres into the left atrium. From there, they were distributed and became entrapped in the tissues in proportion to blood flow. We measured the blood flow to the entire vocal fold, as well as the lamina propria and muscularis layers. The results revealed a statistically significant (p<.002) increase in blood flow on phonation. The increase, however, was due to increased flow to the muscularis layer. The flow to the lamina propria remained unchanged during phonation.
Long-Term Results of Sacculotomy in Older Patients
Authors: Wielinga Eize W. J. , Smyth Gordon D. L.
Published: October 2014

In patients with Meniere's disease with incapacitating vertiginous complaints in whom medical treatment has failed, sacculotomies by both the Fick and tack operations are relatively simple surgical procedures, whose short duration of anesthesia and hospitalization of patients minimizes the risks of morbidity in older patients appropriately to their general health, with good results in controlling vertigo. With respect to preservation of hearing, the tack operation is superior to the Fick operation.
Cochlear Implant Revision: Effects of Reimplantation on the Cochlea
Authors: Jackler Robert K. , Leake Patricia A. , McKerrow William S.
Published: October 2014

The removal of an indwelling cochlear implant electrode followed by reinsertion of a new device has been a maneuver of uncertain cosequences to the cochlea and its surviving neural population. The present study was conducted in an attempt to elucidate the factors at determine whether a reimplantation procedure will be successful. Cochlear implantation followed by explanation and subsequent implantation was performed in eight adult cats. Evaluation of cochlear histopathology suggested a significant increase in electrode insertion trauma when there was proliferation of granulation tissue in the round window area and scala tympani. In other cases, atraumatic insertion was achieved without apparent injury to the cochlea. The results of a survey of cochlear implant manufacturers and surgeons indicate that electrode replacement can usually be accomplished without adverse effects. Difficulties have been encountered, however, in moving implants with protuberant electrodes and when reimplantation was attempted on a delayed basis following explanation.
Xanthogranuloma
Authors: Batsakis John G.
Published: October 2014

The skin of the head and neck is an area of predilection for xanthogranuloma, formerly called nevoxanthoendothelioma. Spontaneous resolution is the usual course for this benign, nonneoplastic lesion that is composed of macrophages and Touton giant cells and occurs principally in infants and children. Mucosal lesions occur with or without skin lesions and in the head and neck affect the oral cavity, nasopharynx, and salivary glands.
Mortality after Nasopharyngeal Radium Irradiation for Eustachian Tube Dysfunction
Authors: Verduijn Peter G. , Hayes Richard B. , Habbema J. Dik F. , Looman Caspar , van der Maas Paul J.
Published: October 2014

Cause-specific mortality of 2,510 persons treated before 1965 by nasopharyngeal radium irradiation (average exposure, 1,200 mg/min), followed to 1985, was compared to that of 2,199 nonexposed comparison subjects. No excess was found for the exposed group in overall mortality, cancer mortality, or in mortality of cancer of specific sites. A marginal excess (p = .07) of malignancies of the lymphatic and hematopoietic system was noted in exposed males only. Only one brain cancer (0.2 per 104 person-years) was identified in the exposed group, and two (10.3 per 104 person-years) in the nonexposed group.
Adenoid Cystic Carcinoma of the Parotid Gland: A Review of Surgical Management with Reference to the Facial Nerve
Authors: Weinstein Gregory S. , Conley John J.
Published: October 2014

The purpose of this study was to review a large series of patients with adenoid cystic carcinoma of the parotid gland in order to develop clinical criteria for sacrifice versus selective sparing of the seventh nerve. We studied 43 patients followed over 36 years. Study patients were grouped according to the preoperative status and intraoperative management of the facial nerve. Criteria for choosing various management strategies are discussed.
Speech Pathology in Giant Cell Arteritis
Authors: Nelson Dewey A.
Published: October 2014

This paper contains a review of the signs and symptoms of giant cell arteritis, especially speech and respiratory manifestations of the disease, which are demonstrated by a new case history. An elderly woman presented with speech that was falsetto, breathy, and marked by downward pitch breaks and phonation breaks. In addition, she had visual loss, headache, edema along the scalp and pharyngeal arteries, polymyalgia rheumatica, elevation of Westergren erythrocyte sedimentation rates, and positive arterial biopsy results. Her speech disorder recurred during an exacerbation. A vascular mechanism is proposed to explain her unusual speech, acute recurrence, and rapid recovery. This explanation (reversible ischemia of the laryngeal musculature) has been proposed by other authors in previous studies.
Ferret Model for Acquired Subglottic Stenosis
Authors: Alexander Keith J. , Schuller David E.
Published: October 2014

Researchers continue to look for an improved animal model for the study of acquired subglottic stenosis. This report describes a ferret model that reliably produces 40% to 60% stenosis with a method analogous to the pathophysiology of prolonged endotracheal intubation. Unlike some previously developed animal models, this model has a low morbidity and a perioperative mortality of less than 5%. Ferrets are small, hardy animals that are inexpensive and easy to house, handle, and anesthetize. They are readily available from breeders in a uniform size, age, and sex. Their airway is disproportionately large for their body size, making them particularly well suited for the study of acquired subglottic stenosis and subsequent surgical therapy.
Audiologic Threshold Monitoring of Patients Receiving Ototoxic Drugs
Authors: Meyerhoff William L. , Yellin Wende , Maale Gerhard E. , Roland Peter S.
Published: October 2014

An effort was made to determine the efficacy of auditory threshold monitoring of patients receiving ototoxic drugs. Forty-four patients treated with either tobramycin or vancomycin for osteomyelitis were tested at the beginning of treatment, following treatment, and twice weekly during treatment when possible. All patients had renal function carefully monitored. Peak and trough drug levels were kept out of the toxic range throughout the study. In no patient did indisputable ototoxicity occur, and therefore, no conclusion about the most efficacious schedule for auditory monitoring of patients receiving ototoxic drugs was made, and what constitutes a significant intratherapeutic threshold shift is still in question. Until further data are collected, monitoring of renal function and peak and trough drug levels, as well as patient counseling, is recommended. Pretherapy and posttherapy auditory monitoring and intratherapeutic monitoring of high-risk patients and those who develop aural symptoms may prove beneficial.
Anomaly of the Hypoglossal Nerve: Embryologic, Anatomic, and Surgical Considerations
Authors: Weinstein Gregory S. , May Mark
Published: October 2014

An anomaly of the hypoglossal nerve was discovered during a procedure to anastomose the 12th and 7th cranial nerves. This anomaly is described, and an embryologic mechanism is proposed to explain the occurrence of this particular anomaly. The surgical anatomy of the hypoglossal nerve is reviewed, and reasonable approaches to the surgical identification of the hypoglossal nerve are discussed.
Lermoyez's Syndrome: Histopathologic Report of a Case
Authors: Xenellis John E. , Linthicum Fred H. , Galey Frank R.
Published: October 2014

This paper reports findings in a pair of temporal bones from a patient with clinical evidence of Lermoyez's syndrome, a rare variant of Meniere's disease. Endolymphatic hydrops is limited to the basal turn of the cochlea and saccule in Lermoyez's syndrome, but more generalized in Meniere's disease.
Pathologic Findings in the Labyrinthine Segment of the Facial Nerve in a Case of Facial Paralysis
Authors: Jackson C. Gary , Hyams Vincent J. , Johnson Glenn D. , Poe Dennis S.
Published: October 2014

The histopathologic findings for a patient with acute facial paralysis caused by herpes zoster oticus who obtained no return of active facial function after 1 year are presented. All imaging studies were nondiagnostic. Biopsy of the labyrinthine segment was performed. Histopathologic analysis showed a sharp line of demarcation between sclerotic nerve proximal to and necrotic nerve distal to the meatal foramen area of the fallopian canal. This finding is consistent with observations that the lesion producing Bell's palsy and herpes zoster oticus usually is situated at the meatal foramen.
Posterior Semicircular Canal Occlusion for Intractable Benign Paroxysmal Positional Vertigo
Authors: Parnes Lorne S. , McClure Joseph A.
Published: October 2014

Benign paroxysmal positional vertigo (BPPV) is most often a self-limited disorder arising from the posterior semicircular canal of the undermost ear in the Hallpike position. Some individuals with this disorder have severe and protracted symptoms requiring more than expectant therapy. We describe two patients with intractable BPPV and profound sensorineural hearing loss in the affected ear treated by transmastoid posterior semicircular canal occlusion. Postoperatively, both were relieved of their BPPV and demonstrated preserved lateral semicircular canal function as measured by electronystagmography. We feel this new procedure provides a simpler and possibly safer alternative to singular neurectomy and should be given future consideration in the treatment of intractable BPPV in a normal-hearing ear.
Glottographic Analysis of Phonation in the Excised Canine Larynx
Authors: Slavit David H. , Lipton Richard J. , McCaffrey Thomas V.
Published: October 2014

An excised canine larynx model of phonation was developed to assess the effect of vocal fold length and tension on glottographic waveforms. The canine larynx in an experimentally produced phonatory model vibrated in a two-mass system comparable to human voice production. The recorded glottographic waveforms for the excised canine larynx were similar to signals recorded in humans in the chest register. Vocal fold length, longitudinal vocal fold tension, glottic width, and airflow rate were varied while simultaneous measurements were made of the subglottic pressure, electroglottographic signal, photoglottographic signal, and acoustic signal. The model used is illustrated and discussed, with emphasis on the method of simulating the actions of all of the intrinsic laryngeal muscles, including the thyroarytenoid muscles. The open quotient and speed quotient, calculated from the glottographic signals, were dependent on vocal fold length and tension and glottic width. These results suggest that glottographic analysis, particularly speed quotient and open quotient, provide valuable information on vocal fold vibration during phonation, and may be important in assessing laryngoplasty procedures.
Velar-Pharyngeal Status in Cleft Palate Patients with Expected Adenoidal Involution
Authors: Morris Hughlett L. , Brown Carl K. , Wroblewski Sandra K. Miller , Van Demark Duane R.
Published: October 2014

This study was designed to provide information about whether cleft palate patients with hypertrophied adenoids maintain velarpharyngeal contact during the time of expected adenoidal atrophy. Thirty-nine subjects were selected from a large longitudinal study on the basis of availability of lateral still x-ray films taken in series from 5 to 16 years of age. Ratings of velar-pharyngeal contact and ratings of adenoid size were obtained from the films. The obtained data indicated the expected decrease in adenoid size but also, for the group, maintenance of velar-pharyngeal contact. However, three of the 39 subjects were judged to show loss of such contact during the period of study, and an additional four had surgery for velopharyngeal incompetence after the completion of the study. All seven appeared to show significant deterioration of velopharyngeal status in middle or late adolescence. Implications of these findings are discussed.
Otolaryngologic Management of Posttransplant Lymphoproliferative Disease in Children
Authors: Sculerati Nancy , Arriaga Moises
Published: October 2014

Twelve of 14 children (86 %) given a pathologic diagnosis of posttransplantation lymphoproliferative disease (PTLD) at the Children's Hospital of Pittsburgh presented with head and neck symptoms, and are included in this retrospective analysis. Upper airway obstruction was the most common symptom, evident in nine children (75%). Ten children (83%) had febrile illnesses with dysphagia, odynophagia, and evidence of hypertrophy of components of Waldeyer's ring. Associated findings included cervical adenopathy, sinusitis, and otitis media. The two remaining children had an intratracheal and paratracheal mass, respectively. Excision of obstructing lymphoid tissue with proper handling of the specimen is advocated for diagnosis and relief of airway obstruction. Systemic therapy is necessary for treatment of PTLD and includes reduction of immunosuppression. Erythromycin causes elevation in cyclosporine levels and should be avoided in patients taking this drug.
Metastases to Major Salivary Glands
Authors: Batsakis John G. , Bautina Erna
Published: October 2014

Secondary neoplastic involvement of the major salivary glands, most often the parotid, can be from regional (supraclavicular) and distant (infraclavicular) primary neoplasms. Cutaneous squamous cell carcinomas and melanomas are the most frequent offenders, and their numbers dominate all statistics dealing with metastases to the salivary glands and their lymph nodes. Carcinomas of the lungs, breast, and kidneys are the most frequent infraclavicular neoplasms that metastasize to the major salivary glands, and they most often manifest a hematogenous dissemination. Supraclavicular primary disease metastasizes to the salivary glands and their lymph nodes via a more diverse manner: Direct extension, lymphatic spread, or, less often, blood vascular transport.
Carcinoid Tumors of the Middle Ear
Authors: Krouse John H. , Nadol Joseph B. , Goodman Max L.
Published: October 2014

Carcinoid tumors of the middle ear are rare lesions that represent a class within the spectrum of adenomatous neoplasms. We present four cases that were diagnosed and treated at our institution since 1973, and review the pool of 12 cases in regard to their presentation, symptomatology, physical examination, audiometric and radiographic evaluations, operative procedure and findings, histopathology, and postoperative course. Successful treatment of these low-grade malignancies requires complete excision of the tumor mass, along with the ossicles if they are involved with disease, in order to prevent local recurrence. Although locally invasive, these tumors have a low propensity for distant metastasis. The diagnosis of carcinoid tumor should be considered in all cases of adenomatous neoplasms of the middle ear and mastoid.
Primary Lymphoplasmacytic Lymphoma of the Larynx: A Rare Localization of Malt-Type Lymphoma
Authors: Diebold Jacques , Ghandour Christiane , Audouin Josée , Betti Pierre , Viry Bernard , D'Ornano Gerard
Published: October 2014

Laryngoscopy carried out in a 46-year-old man revealed a left paralaryngeal tumor. The mass was entirely removed by left pharyngolaryngotomy. Microscopic study showed a diffuse malignant lymphoma of low-grade malignancy, exhibiting all the criteria of the MALT-type lymphoma: The proliferation of centrocyte-like and lymphoplasmacytic cells, lymphoepithelial lesions, and the presence of germinal centers. Primary lymphoma of the larynx is a rare condition. Most of the reported low-grade lymphomas and the pseudolymphomas probably belong to the category of MALT-type lymphoma. Remission can be obtained by surgery, radiotherapy, and polychemotherapy.
Changes in the Capillaries of the Stria Vascularis after Hemorrhagic Shock
Authors: Watanabe Kensuke , Yokoyama Kazunori , Harada Hiromi
Published: October 2014

As a result of severe hemorrhagic shock in guinea pigs, the blood flow in the capillaries of the stria vascularis was blocked, but that of the spiral ligament was unaffected. It is therefore postulated that the thick layer of basal cells and fibrocytes around the stria vascularis and the capillaries leaving the stria vascularis plays an important role in the formation of blood sludging.
Tracheobronchopathia Osteochondroplastica
Authors: Nienhuis David M. , Prakash Udaya B. S. , Edell Eric S.
Published: October 2014

Tracheobronchopathia osteochondroplastica is an unusual disease of obscure causation characterized by cartilaginous or bony outgrowths into the lumen of the tracheobronchial tree. Our retrospective review of 15 patients, 8 of whom were women, revealed a mean age of 63.5 years. The most common symptoms were cough (66%), hemoptysis (60%), dyspnea on exertion (53%), and wheeze (30%). Thirteen percent of the patients were asymptomatic. Chest radiography was not helpful in the diagnosis. Tracheal tomography revealed typical beaded intraluminal calcification in 4 of the 12 patients tested. Mirror laryngoscopy initially revealed the abnormalities in 30% of the patients, and bronchoscopy confirmed the diagnosis and determined the extent of the disease in all patients. Even though upper airway involvement has been thought to be uncommon, 40 % of our patients demonstrated abnormalities of the larynx and upper trachea. Histologic confirmation of heterotopic bone formation was obtained in 60% of the patients. Pulmonary function tests showed mild obstructive lung disease. There were no deaths directly attributable to the disease. Treatments attempted included cryotherapy, laser excision, external beam irradiation, and bronchoscopic removal of the obstructing lesions.
Staging Proposal for External Auditory Meatus Carcinoma Based on Preoperative Clinical Examination and Computed Tomography Findings
Authors: Arriaga Moises , Curtin Hugh , Hirsch Barry E. , Takahashi Haruo , Kamerer Donald B.
Published: October 2014

An accepted staging system for squamous cell carcinoma of the external auditory meatus is currently lacking and would permit accurate comparison of treatment strategies and results for patients with this unusual neoplasm. In order to develop such a staging system we reviewed the prognostic variables and the accuracy of radiographic diagnoses in 39 patients undergoing temporal bone resection for squamous carcinoma of the external auditory meatus. Predictors of poor survival were extensive tumor involvement, facial nerve paralysis, middle ear involvement, and cervical or periparotid lymphadenopathy. In a comparison of 12 specific anatomic sites, computed tomography was found to be an accurate indicator of histopathologically proven tumor invasion. On the basis of this clinical-radiographic-histopathologic analysis, we propose a TNM staging system for external auditory meatus carcinoma utilizing preoperative computed tomography and physical examination. This system fulfills the requirements of the American Joint Committee on Cancer that a staging system should provide a sound basis for therapeutic planning for cancer patients by describing the survival and resultant treatment of different patient groups in comparable form.
Inner Ear Decompression Sickness Combined with a Fistula of the round Window
Authors: Adkisson Gregory H. , Meredith Andrew P. d'E.
Published: October 2014

Inner ear barotrauma with rupture of the round or oval window secondary to diving and decompression sickness (DCS) of the inner ear can be a difficult diagnosis to differentiate. The dive profile or associated elements of DCS will often confirm the diagnosis. Occasionally, diagnosis is made during recompression or during operation. The differential diagnosis is important, since immediate recompression is indicated for inner ear DCS, while it is contraindicated in cases of inner ear barotrauma. We have found no cases reported in the world literature in which both diseases have been diagnosed and proven simultaneously. We present a case of a diver who developed DCS with inner ear manifestations complicated by a round window fistula. Treatment and clinical outcome are discussed along with a brief review of the suspected cause.
Inhibition of Osteoclast Recruitment at a Local Site by 1-Hydroxyethylidene-1,1-Bisphosphonate (HEBP)
Authors: Adachi Kristi , Chole Richard A.
Published: October 2014

We hypothesized that bisphosphonates, a class of antiosteolytic drugs that affect bone cells, may block localized bone modeling in the middle ear. Prior studies have shown that transmitted pressure in the middle ear leads to osteoclastic bone resorption. Catheters were surgically implanted into the middle ear cavity (bulla) of 31 Mongolian gerbils. The animals were then divided into two groups, one subset receiving a bisphosphonate, and the other receiving no drug. Positive air pressure was applied to one middle ear, and the other side served as a control. At the end of the experimental period, tissue specimens were obtained, and histomorphometric evaluation of the ventral bullae was performed. Significant differences in osteoclast surface, osteoclast number, and mean individual osteoclast profile area led us to conclude that administration of the bisphosphonate used at the dose studied inhibits localized recruitment and activation of osteoclasts.
Teflon versus Thyroplasty versus Nerve Transfer: A Comparison
Authors: Crumley Roger L.
Published: October 2014

Surgical rehabilitation of the paralyzed larynx is currently performed by Teflon injection, thyroplasty, and reinnervation techniques. Proponents of the two newer techniques maintain that they are preferred to Teflon injection because superior phonatory quality is achievable. This paper was written in an attempt to dissect the issues regarding this question. Teflon remains the quickest and least expensive procedure, but further experience with stroboscopic and other voice analyses reveals that the other procedures demonstrate some superiority in phonatory quality over Teflon. In this author's hands, the nerve transfer offers the best opportunity to achieve a normal phonatory voice. In addition, it is the only one of the three procedures that leaves the vocal cord entirely undisturbed — Important in the event one of the other two procedures becomes necessary.
Auditory Brain Stem Implant: Effect of Tumor Size and Preoperative Hearing Level on Function
Authors: Otto Steven R. , House William F. , Brackmann Derald E. , Hitselberger William E. , Nelson Ralph A.
Published: October 2014

The auditory brain stem implant is an investigational device designed to provide hearing sensations to patients without functioning auditory nerves. We analyzed results from 17 implants in 15 patients to determine if tumor size or preoperative hearing level might be related to proper device function. We found no significant correlation between preoperative hearing level or tumor size and device function. We also found no significant correlation between preoperative hearing level and tumor size in these 15 patients.
Percutaneous Pedestal in Cochlear Implantation
Authors: Parkin James L.
Published: October 2014

Direct electrical connection between an external sound-processing device and intracochlear electrodes is accomplished via a percutaneous pedestal. Patient pedestal complaints and experience have been recorded. Pedestal problems have been classified into six classes, with class 0 indicating no problems and the severity of problem increasing in classes 1 through 4. Class 5 indicates pedestal trauma. No class 5 problems were encountered. At 48 months of experience, 53% of patients were class 0 and 26% were class 1. The pedestal experience is detailed in the paper. The percutaneous pedestal has been found to be a well-tolerated, efficient system for information transfer in cochlear implant patients.
Histopathologic Grading of Salivary Gland Neoplasms: I. Mucoepidermoid Carcinomas
Authors: Batsakis John G. , Luna Mario A.
Published: October 2014

Histopathologic grading of salivary gland neoplasms has been done with various degrees of success and hence various degrees of acceptance among pathologists and otolaryngologists–head and neck surgeons. Given their histopathologic diversity, three carcinomas — Mucoepidermoid, adenoid cystic, and acinic cell — would seem to be suitable candidates for grading. In this, the first of a three-part series, the authors present a three-level grading scheme for mucoepidermoid carcinomas. It combines histocytologic and growth features of the carcinomas that independently or together, in other grading proposals, have shown prognostic value.
Removal of Blunt Foreign Bodies from the Esophagus
Authors: Hawkins Donald B.
Published: October 2014

Historically, removal of blunt foreign bodies from the esophagus by esophagoscopy under general anesthesia has been considered to be relatively safe and effective. In recent years, alternative techniques of blind removal with balloon catheters or bougies have been advocated. This paper reports 246 esophagoscopies performed over a 19-year period to remove blunt esophageal foreign bodies. Eighty-one percent of the foreign bodies were coins and 74% were in children under 3 years of age. There were no deaths, no perforations, and no instances of mediastinitis. The only complications encountered were those due to esophageal erosion and/or respiratory problems secondary to longstanding foreign bodies. In the author's opinion, esophagoscopy is the best method for removal of all esophageal foreign bodies. There simply does not seem to be a need for alternative methods involving blind removal.
Endoscopic Management of Early Supraglottic Cancer
Authors: Zeitels Steven M. , Vaughan Charles W. , Domanowski Gerard F.
Published: October 2014

An initial endoscopic surgical approach to early supraglottic cancer provides the surgeon with the ability to accurately stage these lesions, avoiding possible undertreatment while allowing for a valuable treatment option for those supraglottic cancers with histologically incontrovertibly superficial disease. Early invasion of the preepiglottic and paraglottic spaces can be determined accurately without altering or delaying any treatment option (open surgical excision, radiotherapy, or chemotherapy). The tendency of supraglottic cancers to transgress the natural foramina of the epiglottis is well established, and the concern about this depth of invasion is reflected by the 1977 revised staging criteria, which required assessment of the preepiglottic space (PES). Along with the microscope and the carbon dioxide laser, the adjustable supraglottiscope facilitates the determination of PES invasion and facilitates en bloc excision of superficial supraglottic cancers. The resulting morbidity typically is no different from that with routine direct endoscopy and biopsy.
Idiopathic Sudden Sensorineural Hearing Loss and Postnatal Viral Labyrinthitis: A Statistical Comparison of Temporal Bone Findings
Authors: Khetarpal Umang , Nadol Joseph B. , Glynn Robert J.
Published: October 2014

Although the cause of idiopathic sudden sensorineural hearing loss remains uncertain, a viral origin has been suggested in many cases on the basis of anamnestic microbiologic and pathologic data. Twenty-two temporal bone specimens from 18 patients who during life suffered a sudden partial or complete sensorineural hearing loss were studied. On the basis of clinical data, these cases were assigned to one of three diagnostic categories, and the temporal bones were studied by light microscopy and serial section analysis. The implications of the histopathologic findings for the pathogenesis of idiopathic sudden sensorineural hearing loss are discussed.
Conversion between Systems of Hearing Handicap Measurement: An Empirically Determined Computational Procedure
Authors: Coren Stanley , Hakstian A. Ralph
Published: October 2014

Audiograms collected from 821 individuals were used to determine the interrelationships among five systems of determining hearing handicap based upon pure-tone thresholds. These were the American Academy of Ophthalmology and Otolaryngology, the British Association of Otolaryngologists and the British Society of Audiology, the American Medical Association, the industrial, and the full-range averages. A high degree of correlation (average r = .981) was found among the various indices. Using the regressions between all possible pairs of indices, we constructed a table that allows conversion between the various systems involving only very simple computation.
Immunohistochemical Study of Cytokeratin Expression in Normal and Pathologic Middle Ear Mucosa of the Rat
Authors: Vennix Paul P. C. A. , Kuijpers Wim , Peters Theo A. , Tonnaer Edith L. G. M. , Ramaekers Frans C. S.
Published: October 2014

The expression of cytokeratins in the epithelium of the middle ear and external auditory meatus of the rat was studied on cryosections of ethylenediaminetetraacetic acid–decalcified specimens by use of a panel of monoclonal antibodies. The normal middle ear epithelium revealed a complex cytokeratin profile, including regional differences. The induction of sterile middle ear effusions resulted in increased cytokeratin expression. Infective effusions were accompanied by both quantitative and qualitative changes in the cytokeratin expression patterns. The difference observed between the cytokeratin profiles of external meatal skin and those of middle ear epithelium may form a useful tool for research into cholesteatoma development.
Supraglottic Contributions to Pitch Raising
Authors: Yanagisawa Eiji , Mambrino Lawrence , Estill Jo , Talkin David
Published: October 2014

Several questions pertaining to pitch raising recur frequently. Does the larynx rise with the production of higher frequencies? What happens to the pharyngeal walls between the soft palate and the larynx when the fundamental frequency is raised? How does the soft palate participate in pitch raising? To answer these questions, the present study was undertaken with the recently described simultaneous velolaryngeal endoscopy technique. Nine professional singers were asked to find the limits of their vocal range in any of six voice qualities: Speech, falsetto, cry/sob, twang, belting, and opera. Simultaneous activities of the larynx, the pharyngeal walls, and the soft palate were submitted to videoendoscopy with synchronous voice recording and studied with spectroanalysis of discrete segments of the total phonation range. Our dual endoscopic study showed that 1) the larynx rose in all subjects with the production of higher frequencies, 2) with the highest fundamental frequency, the lateral pharyngeal walls significantly contracted toward the midline in an “upside-down V shape,” creating a very narrow pharyngeal tube, and 3) the soft palate lifted and the velopharyngeal port narrowed considerably with higher frequencies.
Magnetic Resonance Imaging and Computed Tomography in Pediatric Head and Neck Masses
Authors: Sato Yutaka , Berbaum Kevin S. , Yuh William T. C. , Loes Daniel J. , Ryals Tony J. , Kao Simon C. S. , Dolan Kenneth D.
Published: October 2014

Fifty-three magnetic resonance imaging (MRI) and 25 computed tomography (CT) studies of 53 head and neck masses in pediatric patients were reviewed retrospectively. All lesions had pathologic proof except for 2 metastatic and 2 recurrent lesions, which only had prior pathologic confirmation at their primary sites. These included 12 malignant tumors, 23 benign tumors, 6 inflammatory masses, and 12 congenital lesions. The MRI performance ranged predominantly from good to excellent in detection of the lesion and the extent of involvement and in contrast to the surrounding tissue; when CT comparison was available, MRI proved to be equal to or better than it in detection of these factors and in preoperative diagnosis. Our results suggest that MRI should be the method of choice for the initial evaluation of the pediatric head and neck region, especially in those patients requiring multiple examinations. However, CT and MRI should be used conjunctively in complicated cases, especially those possibly involving lesions with calcifications or bony involvement.
Undifferentiated Carcinomas of Salivary Glands
Authors: Batsakis John G. , Luna Mario A.
Published: October 2014

Undifferentiated carcinomas of salivary glands are those epithelial malignancies whose light-optic histopathologic features are not sufficient to place them in other defined classes of carcinoma. They are ultrastructurally heterogeneous and can manifest neuroendocrine differentiation. With or without the latter, the carcinomas are biologically high-grade and rank with salivary duct and high-grade mucoepidermoid carcinomas in terms of morbidity and mortality.
Management of Subglottic Stenosis in the Adult
Authors: McCaffrey Thomas V.
Published: October 2014

Twenty-one adult patients were surgically treated for severe subglottic stenosis refractory to endoscopic treatment. Patients were treated by anterior or anterior and posterior cricoid division with costal cartilage grafting. Seventy-six percent of the patients were successfully decannulated. Success of treatment was not dependent on cause of the stenosis or age or sex of the patient. There was a significantly better outcome (p< .05) in patients with isolated subglottic stenosis versus those with combined glottic and subglottic stenosis.
Surgical Treatment of Laryngeal Web with Mucosa Graft
Authors: Isshiki Nobuhiko , Nose Kensuke , Taira Tatsuzo , Kojima Hisayoshi
Published: October 2014

Surgical treatment of laryngeal webbing varies with the extent and site of the web. An extensive one seems to be best treated by laryngofissure and skin or mucosa transplantation. Recent experiences with four cases of thick glottal webbing indicated that a mucosa graft was better for the voice result than a skin graft. For success in the airway and voice results, the salient points in surgery include 1) precise midline thyrotomy, 2) shaping of the vocal cord under fiberoptic control, and 3) mucosa grafting with the combined use of a pliable stent or fibrin glue for fixation.
Surgical Applications of Ultrathin Flexible Bronchoscopes in Infants
Authors: Wood Robert E. , Azizkhan Richard G. , Sidman James , Lacey Stuart R. , Drake Amelia
Published: October 2014

Ultrathin flexible bronchoscopes with controlled distal angulation allow the conventional diagnostic examination of the lower airways of even the smallest infants. These instruments may be passed through small endotracheal or tracheostomy tubes while ventilation is maintained. It is thus possible, under direct visualization, to control the manipulation of surgical instruments where they could not otherwise be seen, or to study airway dynamics and anatomy intraoperatively without extubating the patient.
Stapes Surgery in Osteogenesis Imperfecta: Analysis of Postoperative Hearing Loss
Authors: Garretsen J. T. M. , Cremers W. R. J.
Published: October 2014

The disappointing results in 12 of 58 stapedectomies, including 4 revision operations, performed on osteogenesis imperfecta patients were analyzed and compared with reports in the literature. It is concluded that the results described as disappointing were not always the product of the stapes operation. A progressive sensorineural hearing loss arising independently of the operation as a result of progression in the disease process of osteogenesis imperfecta appears to have a severe influence on the final hearing threshold.
Ultrastructural Evidence of a Merocrine Secretion in the Human Endolymphatic SAC
Authors: Rask-Andersen Helge , Linthicum Fred H. , Danckwardt-Lillieström Niklas , House William F.
Published: October 2014

The results of a light and transmission electron microscopic analysis of an endolymphatic sac (ES) from a patient suffering from episodic vertigo, tinnitus, and hearing loss are presented. A biopsy of the intraosseous portion of the ES was obtained during a translabyrinthine approach to section the vestibular nerve in the internal acoustic meatus. The material consisted mainly of tubular epithelial structures filled with heavily stained material. Pathologically dilated and degranulated rough endoplasmic reticuli and disaggregation of polyribosomes with accumulation of solitary ribosomes in the cytosol and endoplasmic reticulum suggested a disturbed epithelial cell protein synthesis. Ultrastructural evidence of an increased merocrine secretion of glycoprotein conjugates into the ES was noted. This made it possible to analyze the presumed intracellular secretory pathways. An increased number of intraepithelial lymphocytes and monocytes was observed. Since the inner ear had been subjected to surgical intervention before the vestibular nerve section, no conclusions can be drawn as to whether the patient's symptoms were related to the disturbed protein metabolism and hypersecretion of glycoprotein conjugates into the ES. The findings support earlier experimental results that indicate that the ES has not only a resorptive function but also a secretory one.
Patterns of Physical and Sexual Abuse of Communicatively Handicapped Children
Authors: Sullivan Patricia M. , Brookhouser Patrick E. , Knutson John F. , Scanlan John M. , Schulte Laura E.
Published: October 2014

Evidence suggests that handicapped children are at increased risk for abuse and neglect. Communicatively impaired youngsters are particularly vulnerable because of their limited ability to report the maltreatment. Of 482 abused handicapped children evaluated at Boys Town National Research Hospital, 212 had hearing impairment, 87 speech language disorders, 39 learning disorders, 43 behavioral-emotional disturbances, 74 mental retardation, 5 visual impairment, 3 cleft lip or palate, and 19 other disorders. The perpetrator was either a relative or a “trusted other” in 97.2% of sexual abuse cases. Handicapped males were much more likely to be victims of sexual abuse than nonhandicapped males in the general population. Children being educated in residential schools were more likely to be sexually abused than mainstreamed youngsters. These children may be at risk for abuse from a wide variety of potential perpetrators, including teachers, dormitory counselors, van drivers, clergy, classroom aides, older students, peer siblings, scout leaders, abused peers, baby-sitters, and custodians.
Expression of Intermediate Filament Proteins in the Adult Human Cochlea
Authors: Bauwens Louis J. J. M. , Veldman Jan E. , Ramaekers Frans C. S. , Bouman Henk , Huizing Egbert H.
Published: October 2014

The immunohistochemical localization of intermediate filament proteins was studied in frozen sections of chemically fixed, nondecalcified adult human cochleas. Cytokeratins were found in all epithelial cells lining the cochlear duct (including most supporting cells of the organ of Corti) but were absent in the hair cells. Neurofilament proteins were present in the nerve endings at the hair cells, in the neural bundles, and in the ganglion cells. Vimentin staining occurred in most of the supporting structures and was roughly complementary to the regions showing cytokeratin staining and neurofilament staining. However, the region of the spiral prominence and outer sulcus, as well as the pillar cells and Deiters' cells in the organ of Corti, showed coexpression of vimentin and cytokeratins. No definite immunostaining was observed with antibodies to desmin and glial fibrillary acidic protein.
Adenoidectomy in Otitis Media
Authors: Sadé Jacob , Luntz Michal
Published: October 2014

For many years adenoids were thought to affect adversely middle ear (ME) aeration by obstructing the eustachian tube opening, leading to ME infections and effusions. Consequently, the adenoids have often been removed in children suffering from ME diseases; indeed, adenoidectomy is still performed around the globe on millions of children annually. Opinions vary, however, on the usefulness of the operation in various ME diseases. The purpose of this study is to review the available studies concerning the relationship of adenoids to the ME as well as the effect and benefit of adenoidectomy on ME effusions and ME infections.