bluuebunny/crossref_metadata_2025 huggingface dataset:
Long‐Term effects of multichannel cochlear implant usage
Authors: Waltzman Susan B. , Cohen Noel L. , Shapiro William H.
Published: October 2006

A major concern regarding multichannel (multi‐electrode) cochlear prosthesis usage has been the possibility of long‐term deleterious physiological effects such as the degeneration of spiral ganglion cells, neuronal degeneration, and new bone formation. These effects, if present, would become evident in the deterioration of hearing sensation and performance of the cochlear implant recipient on a battery of audiologic tests.

To date, five patients using the Australian multi‐electrode multichannel cochlear implant have undergone a 1‐year evaluation of the device. The assessment includes a check of electrical threshold and comfort levels for each electrode, sound field pure tone and speech thresholds, the MAC battery, vowel and consonant recognition tests, and speech tracking tasks.

All results were compared to those obtained postoperatively following stimulation and a 3‐month training period. Results to date have shown no deterioration in implant functioning in all patients tested. Periodic extensive monitoring of all implant recipients is advocated in order to evaluate the possibility of long‐term effects.
Nonflammable endotracheal device for co2laser ablation of benign laryngeal and proximal tracheal tumors
Authors: Lawler Robert A. , Chang Juei‐Ling , Dudman Andrew , Rubiano Remigio
Published: October 2006

A Holinger aspirating tube may be utilized as a nonflammable endotracheal device during CO2laser ablation of benign laryngeal and proximal tracheal tumors. Adequate jet ventilation may be performed through this small diameter (3.0 mm), metallic device while providing an unobstructed view of the surgical lesion. This technique was well‐accepted by surgeons during the clinical trials. Because the 3.0 mm outside diameter was significantly smaller than the smallest flexible, uncuffed metal endotracheal tube currently available (6.9 mm), the rigid structure facilitated atraumatic insertion past the surgical lesion. Both the use of this device and the required anesthetic technique are described in three CO2laser ablative procedures. The authors consider that this device increases safety during this potentially hazardous procedure by eliminating the flammable polyvinyl chloride endotracheal tube and cottonoid packings most frequently used during this procedure.
Frey's syndrome: Secondary to condylar fracture
Authors: Goodman Roy S.
Published: October 2006

Frey's syndrome, or gustatory sweating, is most commonly seen as a sequela of superficial parotidectomy. It can also be caused by other forms of trauma, including blunt trauma, but rarely does it occur without trauma.
Pyoderma gangrenosum of the head and neck
Authors: Schwarz Matthew B. , Petroff Mark A. , Anonsen Cynthia K.
Published: October 2006

Pyoderma gangrenosum is an ulcerative skin disorder usually associated with an underlying systemic disease. Head and neck involvement is rare, but possibly more common than once thought. The etiology of this disease is unclear, but may be related to an abnormal immunologic response. There are no pathognomonic histologic or laboratory findings; the diagnosis is made by the clinical appearance of the lesions and disease course. Treatment consists of immunosuppression and local wound care in addition to a search for and treatment of an underlying primary systemic disorder. A case report and review of the literature is presented with discussion of common head and neck manifestations, the differential diagnosis, and treatment alternatives.
The microtrapdoor technique for the management of laryngeal stenosis
Authors: Duncavage James A. , Ossoff Robert H. , Piazza Leonard S. , Toohill Robert J.
Published: October 2006

The use of the carbon dioxide laser as an endoscopic microsurgical instrument has stimulated interest in treating laryngeal and tracheal stenosis. Dedo and Sooy (1984) reported a significant improvement in the management of posterior commissure, subglottic, and high tracheal stenoses with the use of a microtrapdoor flap. A recent laboratory investigation of this method supported the clinical efficacy of this technique. Six patients are evaluated in this report, three with posterior commissure stenosis and three with subglottic or high tracheal lesions. All six patients had a tracheotomy present or performed at the time of their surgical procedures, and each patient had only one procedure. All six had improved airways after the microtrapdoor flaps. Five have been decannulated and one patient with associated hypopharyngeal stenosis still has a tracheostomy because of mild aspiration, although the airway lumen is moderately unproved. It is felt that, as a group, the subglottic and high tracheal lesions respond to this technique better than the posterior commissure stenoses. Details of the technique are presented. This brief clinical report supports the efficacy of the microtrapdoor flap procedure in selected laryngeal and tracheal stenoses.
Major auricular malformations due to accutane® (isotretinoin)
Authors: Jahn Anthony F. , Ganti Krishna
Published: October 2006

Vitamin A and vitamin A derivatives have been described as etiologic factors for a number of congenital malformations. Two infants are presented with major auricular malformations including anotia and severe microtia. The infants were products of a pregnancy complicated by Accutane® ingestion during the first trimester. Both infants had associated central nervous system malformations.

With the increasing use of Accutane® for the treatment of cystic acne in young women of child‐bearing age, the dangers of teratogenesis in the head and neck area are greatly increased. This presentation will review two such cases as well as give an overview of the embryogenesis and teratogenesis of the auricle.
Specific lymphokine responses in cervical nodes of patients with laryngeal cancer
Authors: Cortesina G. , Beatrice F. , Morra B. , Barioglio M. G. , Poggio E. , Bussi M. , Difortunato V. , Sacchi M. , Rendine S. , Sartoris A.
Published: October 2006

The role of lymphokines in modulating the immune response in patients suffering from neoplastic disease is still controversial. Recent studies indicate that in patients with head and neck cancer, a decrease in LIF (leukocyte migration inhibiting factor) production is usually present in advanced disease. In this study, the authors investigate:

the LIF production in lymphocytes derived from the peripheral blood and cervical nodes of patients with laryngeal carcinoma by using an autologous pattern (i.e., for each patient, the specific LIF production was challenged by means of an autologous cell extract derived from his own tumor);

the influence of histologically confirmed cervical node metastases on LIF production.

Our results indicate that:

There is a significant decrease in LIF production in patients with histologically proven cervical node metastases as compared to patients with no metastatic foci.

The decrease of LIF production is related to the presence of mononuclear adherent cells. When the latter are removed, there is a significant reversal of specific LIF suppression.

The possible meaning of the data is discussed.
Laryngeal tuberculosis as manifested in the decades 1963‐1983
Authors: Thaller Seth R. , Gross James R. , Pilch Ben Z. , Goodman Max L.
Published: October 2006

Laryngeal tuberculosis is usually a complication of pulmonary tuberculosis and the clinical patterns have changed in recent decades. To evaluate the changing patterns, we reviewed 15 patients seen at the Massachusetts Eye and Ear Infirmary over a 20‐year period and diagnosed as having laryngeal tuberculosis.

The results showed a mean age of 56 years; a male predominance by a 2:1 ratio; minimal pulmonary lesions on radiographic studies in nine patients and one normal radiograph; clinical simulation by the tuberculous lesion of laryngeal cancer; excellent response to antituberculosis therapy; and low infectivity.

Laryngeal lesions and concurrent pulmonary lesions should alert the otolaryngologist to consider systemic disease processes and the most frequent granulomatous lesion of the larynx, tuberculosis.
Persistent traumatic perilymph fistulas
Authors: Glasscock Michael E. , McKennan Kevin X. , Levine Samuel C.
Published: October 2006

Thirty‐four ears have been explored to rule out perilymph fistulas resulting from ear trauma. Eight ears (24%) were identified with a fistula, often persisting months (average 7.5 months) after the precipitating injury. Repair of fistulas, even if done relatively late, markedly reduces vestibular symptoms and may improve low and middle frequency sensorineural hearing. Complications from negative explorations are rare.
Total thyroidectomy in the treatment of thyroid disease
Authors: Chonkich George D. , Petti George H. , Goral William
Published: October 2006

In a review of thyroid surgery during the past 12 years, total thyroidectomy was performed in 20% of the cases. Forty percent were done for malignant disease and 60% for benign disease. Our indications for using this operation in benign thyroid disease include bilateral nodular goiter, Graves' disease, chronic thyroiditis, and cases in which the rapid frozen diagnosis is equivocal for carcinoma.

We feel that the risks of reoperation for recurrent thyroid disease are greater than the risks of a total thyroidectomy as the initial surgical procedure. With the increased use of total thyroidectomy the incidence of permanent hypoparathyroidism can be decreased. We reviewed our preoperative work‐up, indications for total thyroidectomy, surgical technique, diagnostic accuracy of needle biopsy, accuracy of rapid frozen section reports, and postoperative complications.
Obliterative otosclerosis
Authors: Amedee Ronald G. , Lewis Miles L.
Published: October 2006

A total of 2, 985 stapedectomies were done during the 25‐year period 1959 to 1984 in a busy urban otologic practice. One hundred twenty‐three of these cases were found to have obliterative otosclerosis which resulted in a drill‐out stapedectomy. Postoperatively, a minimum of 2 years follow‐up yielded 98 of the original 123 drill‐out cases constituting the study group. Several parameters will be evaluated: 1. Initial hearing gain (measured 3 months after surgery), 2. long‐term hearing results (measured 2 years and beyond), 3. additional sensorineural hearing loss, and 4. probability of bilateral obliterativc disease.
Topography of vestibulocochlear nerve fibers in the posterior cranial fossa
Authors: Natout Ali Y. , Terr Leonid I. , Linthicum Fred H. , House William F.
Published: October 2006

In the posterior cranial fossa, the separation of the vestibular and cochlear subdivisions of the eighth nerve is clear in about 75% of cases. Although in the remaining cases the vestibulocochlear cleavage plane is not visible macroscopically, the large‐fibered vestibular subdivision and the small‐fibered cochlear subdivision are well recognized in histological sections. Within the cochlear subdivision, some fibers of large caliber are mixed with fibers of small caliber in a region we named the “overlapping zone.” We studied, histologically, cross sections of the intracranial portion of six eighth nerves at about 5 mm proximal to the porus acusticus. A computerized video system was used to measure the diameters of the fibers of the vestibular and cochlear subdivisions localized at different distances from the vestibulocochlear cleavage plane. The overlapping zone is located within the cochlear subdivision adjacent to the vestibulocochlear cleavage plane. It has a pear‐like shape, with the larger part occupying the anterosuperior part of the cochlear subdivision. The mean cross‐sectional area of this zone in our six samples is about 0.4 mm2, which is approximately 23% of the area of the cochlear subdivision. The thickness of the zone in the superior‐inferior direction ranges from 0.23 mm to 0.55 mm. The parameters of the described overlapping zone should be taken into consideration in vestibular neurectomy, in which complete sectioning of the vestibular fibers is important.
Tracheal reconstruction: In vitro and in vivo animal pilot study
Authors: Wenig Barry L. , Reuter Victor C. , Steinberg Bettie M. , Strong Elliot W.
Published: October 2006

In order to further address the problem of tracheal stenosis, an animal model was created to simulate both local and regional tracheal injury. An epithelial equivalent created from a fibroblast‐collagen matrix was used to attempt to either inhibit or lessen the degree of tracheal stenosis that was evident in animal models. Preliminary data appears to show that the epithelial equivalent is effective in limiting and perhaps even abolishing the development of tracheal stenosis.
Sternocleidomastoid myocutaneous flap
Authors: Charles Glenwood A. , Hamaker Ronald C. , Singer Mark I.
Published: October 2006

The sternocleidomastoid myocutancous flap has several applications for reconstruction of defects about the head and neck. It is used for augmentation of facial defects, carotid artery protection, and repair of oral cavity defects. Additional reconstructive efforts suggest the sternocleidomastoid myocutancous flap can be used for facial reanimation and as an osteomyocutaneous flap incorporating the clavicle for mandibular reconstruction. Reports of unreliable viability and resection of the sternocleidomastoid muscle during neck dissection decreases the applicability of the flap. Twenty‐seven sternocleidomastoid flaps were used in 26 patients for head and neck reconstruction. In contrast to the reported 40% to 50% incidence of superficial slough or total flap necrosis, three (11%) flaps developed superficial (cutaneous) slough while two patients developed inclusion cysts. The technique includes elevation of the sternocleidomastoid muscle with the overlying platysma and skin originally described by Owens. The procedure is modified by removing the epithelium on the tunneled portion of the flap. This allows the flap to be used as a one‐stage method of reconstruction without sacrificing the additional blood supply from the platysma and overlying dermis.
Use of human amniotic membrane in otolaryngologic practice
Authors: Zohar Yuyal , Talmi Yoav P. , Finkelstein Yehuda , Shvili Yitschak , Sadov Rima , Laurian Nelu , Tikvah Petah
Published: October 2006

Human amnion is a readily available allograft with low antigenicity, high antimicrobial potential, and the ability to foster cpithelialization. We have used human amniotic membrane in our department for replacing nasal mucosa in Rendu‐Osler‐Weber disease, as tympanic membrane grafts, and for covering head and neck sites after flap necrosis. Our experience shows moderate success for management of severe epistaxis and excellent results in covering surfaces after flap necrosis.

Use of amnion in eardrum perforations was unsuccessful and was discontinued. Properties of human amniotic membrane are listed and its application in the otolaryngologic practice is reviewed.
Otologic manifestations of benign intracranial hypertension syndrome: Diagnosis and management
Authors: Sismanis Aristidbs
Published: October 2006

Benign intracranial hypertension (BIH) is a syndrome characterized by increased intracranial pressure (IIP) without focal signs of neurological dysfunction. The diagnosis is essentially made by exclusion of various causes of IIP. The classic presenting symptoms of BIH are headache and/or visual disturbances. Otologic manifestations of this syndrome have not been described in detail.
A vented laryngeal stent with phonatory and pressure relief capability
Authors: Eliachar Isaac , Roberts Jay K. , Hayes James D. , Tucker Harvey M.
Published: October 2006

This prototype vented laryngeal stent incorporates a dome‐shaped, one‐way valve that allows articulation of transmitted vibrations to produce speech, while preventing aspiration and not interfering with deglutition. The stent is placed endoscopically and is used in conjunction with a T‐tube or a tracheostomy tube.

The stent has been placed in seven patients for chronic aspiration, after partial laryngectomy, and with laryngotracheal reconstruction for stenosis. Aspiration pneumonia has not been seen in any patient after placement of the appropriate stent, with follow‐up of 2 to 6 months. One patient's swallowing improved and none deteriorated. All patients were able to phonate with the stent in place. No significant long‐term sequelae are apparent in three patients whose stents were removed after resolution of their primary diseases.
The efficacy of myeingotomy and ventilation tube insertion in middle‐ear effusions in patients with nasopharyngeal carcinoma
Authors: Wei W. I. , Engzell U. C. G. , Lam K. H. , Lau S. K.
Published: October 2006

Myringotomy and insertion of a grommet are effective in the management of middle‐ear effusion resulting from nasopharyngeal carcinoma. The procedure was carried out in 46 ears in 30 patients, resulting in significant improvement of hearing. The complication rate of the operative procedure is not negligible in this group of patients, and it is higher if the patients had received radiotherapy at the time of operation.
Post‐Tonsillectomy bleeding: An evaluation of risk factors
Authors: Tami Thomas A. , Parker Gregg S. , Taylor Robert E.
Published: October 2006

While tonsillectomy is usually a safe operation, it is always accompanied by the risk of immediate postoperative bleeding. Despite continued efforts to eliminate this problem, it remains a persistent risk. In reviewing 775 consecutive cases of tonsillectomy, immediate postoperative bleeding occurred in 21 (2.7%). Diagnostic, demographic, hematologic, hemodynamic and surgical management factors were evaluated. The role of local anesthesia for tonsillectomy was also examined. Postoperative bleeders were more likely to have abnormal preoperative clotting studies, greater elevations of their mean postoperative blood pressures, and unusual surgical indications. Local anesthetic cases were, shorter, had less intraoperative bleeding and were not associated with greater postoperative bleeding. We conclude that local anesthesia is safe and efficient and that identifiable factors are associated with primary post‐tonsillectomy bleeding. An awareness of these factors can help identify potential postoperative bleeders.
Percutaneous embolization for control of nasal blood circulation
Authors: Parnes Lorne S. , Heeneman Hans , Vinuela Fernando
Published: October 2006

Percutaneous embolization to control the nasal blood circulation was used in 19 patients with vascular nasal disorders. Embolization was the initial treatment for intractable posterior epistaxis in 11 patients, 9 (82%) of whom were controlled without further treatment. Used as an adjunct to surgery on vascular nasal tumors, embolization reduced intraoperative blood loss in four patients to an average of 800 cc. In four patients with Osler‐Weber‐Rendu disease, treatment with embolization did not significantly alter the course of their disease. Overall, however, this relatively new technique enhances successful management of difficult epistaxis cases.
Methods and complications of rhinophyma excision
Authors: Amedee Ronald G. , Routman Marc H.
Published: October 2006

For years cosmetic surgeons have sought methods of treatment of large rhinophyma. These include creation of flaps with excision of excess skin, dermabrasion, free‐hand shave, and others. The CO2 laser has been used by itself, or in combination with other methods to vaporize the rhinophyma. Advantages of the laser include hemostasis, better view of the tissues, thin layer‐by‐layer removal of the hyperplastic sebaceous glands, and careful shaping of the resection edges. Disadvantages include risk of facial burns and overabundant removal of tissue with cartilage exposure. We present a case of rhinophyma excision using the CO2 laser and the complication of excessive vaporization of the sebaceous tissue. Included is a discussion of other complications of laser excision of rhinophyma, possible methods of reconstruction, and a literature review.
Diagnosis, staging, and treatment of juvenile nasopharyngeal angiofibroma (JNA)
Authors: Antonelli Antonino Roberto , Cappiello Johnny , Lorenzo Diego Di , Donajo Carlos Alberto , Nicolai Piero , Orlandini Alberto
Published: October 2006

Nineteen patients with juvenile nasopharyngeal angiofibroma (JNA) were surgically treated with different techniques from January 1968 through December 1985. Two patients had undergone a previous operation at another hospital; all patients were males (mean age 15.4), and the most common symptom was nasal obstruction (84.2%). Lateral extension into the pterygomaxillary fossa occurred in 14 patients (73.6%), and 2 also had intracranial invasion (10.5%).

In five cases, the tumor's cytosol was analyzed for hormonal receptors. Negative values for estrogen and progesterone receptors were obtained, although the content of dehydrotestosterone receptors was highly positive. These results tend to support the hypothesis of JNA's androgen‐dependence.

The authors emphasize the need of a preoperative staging classification based on clinicoradiological data in selecting the most adequate surgical approach. Tumors with lateral extension into the pterygomaxillary fossa can be easily removed through a midface degloving; large involvement of the infratemporal fossa requires, also, a transzygomatic dissection. In JNAs with intracranial extension a combined intracranial‐extracranial approach is advisable.
Temporalis muscle‐gale a flap in craniofacial reconstruction
Authors: Aeden Richard L. , Mathog Robert H. , Thomas L. Murray
Published: October 2006

With the advent of increasing technological and surgical sophistication in craniofacial surgery, reconstructive efforts are challenged to provide a reliable means of compartmentalization. When dural integrity is compromised in the face of nasopharyngeal or paranasal communication, the risk of ascending infection and potential life‐threatening meningitis mandate cranial and facial compartments, separated by sufficient and healthy soft tissues. This paper describes a method of providing pedicled soft tissue coverage and support for the contents of the anterior cranial fossa using a temporalis muscle‐galea rotation flap. The vascularized myofascial tissues, capable of carrying skin and bone grafts, are well suited to cover and protect large areas of the skull base. Several cases are described to show the advantages and disadvantages of the technique.
Salivary gland tumors of the palate: The ucla experience
Authors: Tran Luu , Sadeghi Ahmad , Hanson David , Ellerbroek Nancy , Calcaterra Thomas C. , Parker Robert G.
Published: October 2006

A retrospective review of 38 patients with salivary gland tumors of the palate treated between 1961 and 1984 is presented. The majority of tumors were identified at an early stage. Most (23 of 38 cases) originated over the hard palate. The most common histological type was adenoid cystic carcinoma (22 cases). Twenty‐five patients were treated with surgery alone, of whom, three had wide local excision. Thirteen patients received postoperative radiation therapy in addition to surgery. The local control was comparable for surgery alone and combined therapy (88% and 85%, respectively) although the combined therapy group was biased by more advanced disease, inadequate margins, and/or poorly differentiated histologies. Mucoepidermoid lesions had an excellent prognosis with local control of 100%. In contrast, there was a 23% recurrence rate for adenoid cystic carcinoma. Regional neck node metastasis was noted in 2% of the patients.

This experience indicates that radical resection of palate salivary gland malignancy with adequate margins results in excellent local control. Adjuvant radiation therapy is recommended in cases where there is a question of adequate margins and in advanced lesions of high grade tumors.
Laryngeal image biofeedback
Authors: Bastian Robert W. , Nagorsky Matthew J.
Published: October 2006

The proper treatment of many voice disorder patients includes modification of voice production. Laryngeal image biofeedback (LIB), a new technique to help selected patients modify vocal fold posture and thereby vocal production is described. The effectiveness of this technique as a learning tool is assessed in 20 subjects.
Telescopic video‐otoscopy using a compact home video color camera
Authors: Yanagisawa Eiji , Carlson Roy D.
Published: October 2006

Our method of telescopic video‐otoscopy using a telescope (Hopkins) and a compact home video camera is presented.

Telescopic video‐otoscopy is a most effective method of demonstrating and documenting the anatomy and pathology of the tympanic membrane, ear canal, and mastoid cavity.

It is of considerable value for teaching, patient counseling, and making a permanent record. It obtains instantaneously a video print‐out either in black‐and‐white or in color of video images of telescopic otoscopy.

A simple and economical method of telescopic pneumatic otoscopy (pneumatic teleotoscopy) is also described.

Telescopic video otoscopy combined with the use of a video printer is a useful addition to the clinical practice of otology.
Vertigo in the pediatric and adolescent age group
Authors: Hill Britton B. , Block Linda D.
Published: October 2006

Since episodic vertigo in the pediatric and adolescent age group is unusual and therefore not well known to most otolaryngologists, we present six cases to show some of the various presentations and different underlying causes. These cases covered a wide diagnostic spectrum: meningioma, medulloblastoma, childhood migraine with vestibular symptoms, childhood Meniere's syndrome (one case due to perilymph fistula), and benign paroxysmal vertigo of childhood. The two patients with tumor and the patient with perilymph fistula were treated surgically; the other patients are being managed conservatively since these childhood conditions usually tend to diminish with time.
A review of 925 cases of tympanoplasty using formaldehyde‐formed‐fascia grafts
Authors: Hicks George W. , William Wright J.
Published: October 2006

In this review of 925 cases of total and anterior perforations of the tympanic membrane reconstructed through the use of formaldehyde‐formed‐fascia (3‐F) grafts, the postoperative nonperforation rate is 97.6%; blunting and/or lateralization of the graft was avoided in 93.5% of cases. Closure of the postoperative air‐bone gap within 20 dB was achieved in 70% of cases. This update of a previously reported paper reinforces our opinion that the 3‐F graft is an effective tool for the closure of tympanic membrane perforation with or without ossicular chain reconstruction.
Hyperlipidemia in association with childhood sensorineural hearing loss
Authors: Strome Marshall , Topf Paul , Vernick David M.
Published: October 2006

In adults there has been an association noted between hyperlipidemia and sensorineural hearing loss. Etiologic considerations include hyperviscosity of the serum, vascular occlusion and an increased susceptibility to noise. Until now this correlation, to our knowledge, has not been made in the pediatric population. Several children with bilateral fluctuating sensorineural hearing losses have been identified with hyperlipidemia. The fluctuations in hearing varied with lipid levels. With dietary controls, the cholesterol levels returned to what would be near the norm for the pediatric population and hearing returned to near baseline. Unexplained fluctuating sensorineural hearing losses in children warrant the consideration of hyperlipidemia. Discovering a potentially reversible etiology for hearing loss is significant but more importantly, may lead to the early detection of hyperlipidemia in the young patient.
Juvenile nasopharyngeal angiofibroma: An update of the ucla experience, 1960–1985
Authors: Economou Tasia S. , Abemayor Elliot , Ward Paul H.
Published: October 2006

The UCLA experience with juvenile angiofibroma (JNA) over a 25‐year period is reviewed. There were 83 patients, the majority being adolescent males. Surgery was the primary method of treatment for disease not extending intracranially; 63 of 68 patients (92.5%) became asymptomatic with this modality. In patients treated with a single course of primary radiation, 10 of 14 (78.5%) became asymptomatic. Trends in diagnosis and treatment were evaluated. Contrast computerized tomography reliably assesses tumor extent. Preoperative arteriography is essential for the evaluation and embolization of feeding vessels; this in turn significantly reduces operative blood loss and the need for transfusions. Radiotherapy should be reserved for disease extending intracranially and should be in doses of 3,600 cGy or larger.
Adjustable dissection and surgical table as an aid to teaching
Authors: Work Walter P.
Published: October 2006

An adjustable dissection and surgical table for teaching residents, fellows, staff, and other medical and allied health personnel about anatomy and simulated techniques of surgery in the laboratory setting is described. The table can be attached to a standard House‐Urban temporal bone dissection bench. The temporal bone laboratory can thus serve a dual purpose in teaching ear and soft tissue anatomy and surgical techniques of the head and neck. In this setting such a dual purpose laboratory can often include basic and clinical research activities as a third function.
Clinical diagnosis of immune inner‐ear disease
Authors: Hughes Gordon B. , Nalepa Nancy J. , Kinney Sam E. , Barna Barbara P. , Calabrese Leonard H.
Published: October 2006

The purpose of this study was to develop a high‐risk clinical profile of patients with autoimmune (immune‐mediated) inner‐ear disease. The records of 52 patients diagnosed over the past 5 years were reviewed. Age, sex, bilateral versus unilateral involvement, otologic symptoms, concomitant systemic immune disease, and presenting clinical diagnoses were recorded.

The presenting diagnoses were Cogan's syndrome, Meniere's syndrome, Dandy's syndrome without hearing loss, or progressive sensorineural hearing loss without dizziness. Because Cogan's and Dandy's syndromes were relatively uncommon, the typical high‐risk clinical profile was a middle‐aged patient (often female) with bilateral, asymmetric, progressive sensorineural hearing loss, with or without dizziness, and occasional systemic immune disease such as rheumatoid arthritis.

When a more common clinical diagnosis cannot be reached in suspicious patients, immune laboratory tests should be obtained and a trial of immunotherapy offered. Positive test results and beneficial response to therapy support a presumptive diagnosis of immune inner‐ear disease.
The management of congenital cholesteatoma: Surgical results of 42 cases
Authors: Rizer Franklin M. , Luxford William M.
Published: October 2006

Radical surgery for congenital cholesteatoma leaves the patient, usually a child, with an ear that requires care for life. At the Otologic Medical Group, the intact canal wall technique has been used for many patients with cholesteatoma. To determine results of this management in the treatment of congenital cholesteatoma, we reviewed records of all patients treated between 1974 and 1985.

Forty‐two ears were studied in 41 patients. A closed middle‐ear space was achieved in all cases, and an intact canal wall was maintained in 41 (98%). Follow‐up averaged 4.3 years.

Of the 41 cases with serviceable hearing before surgery, 28 (68%) had postoperative hearing within 10 dB of the best preoperative bone conduction threshold. Thirty‐eight of the 41 achieved a final hearing result within 20 dB of the best bone conduction threshold.
Multichannel cochlear implantation: Utah‐design
Authors: Parkin James L. , Stewart Bruce Edwin
Published: October 2006

The Utah‐design multichannel cochlear Implant consists of six intracochlear monopolar electrodes, one promontory electrode, and an indifferent electrode. Connection of the intracochlear system to the external sound processor is via a percutaneous pedestal system. Four of the intracochlear electrodes receive simultaneous stimulation. Twenty patients implanted at the University of Utah with more than 1 year of sound processor use were evaluated for the study. All patients wear their sound processors on a daily basis. Seven of the 20 are able to use the telephone without special devices. Nineteen patients were tested with open set CID sentences with an average 42.2% response. A comparison was made between live voice and taped voice open‐set spondee word list performance, showing slightly better overall performance with live voice.
Transoral excision of lateral parapharyngeal space tumors presenting intraorally
Authors: Goodwin W. Jarrard , Chandler J. Ryan
Published: October 2006

Six patients with parapharyngeal space tumors presenting intraorally over the past 16 years were managed by transoral excision. All had benign tumors of salivary gland origin (1 monomorphic and 5 pleomorphic adenomas) and 3 of 6 patients were asymptomatic. There were no surgical complications and blood loss was minor in all cases. One patient, who had refused treatment for more than 40 years, presented with dyspnea and dysphagia, and required a tracheotomy for safe induction of anesthesia. Only one patient was hospitalized for more than 3 days and only one tumor recurred — as a malignant pleomorphic adenoma 3 years later.
An animal model for tinnitus
Authors: Jastreboff Pawel J. , Sasaki Clarence T. , Brennan James F.
Published: October 2006

Subjective tinnitus remains obscure, widespread, and without apparent cure. In the absence of a suitable animal model, past investigations took place in humans, resulting in studies that were understandably restricted by the nature of human investigation. Within this context, the development of a valid animal model would be considered a major breakthrough in this field of investigation. Our results showed changes in the spontaneous activity of single neurons in the inferior colliculus, consistent with abnormally increased neuronal activity within the auditory pathways after manipulations known to produce tinnitus in man. A procedure based on a Pavlovian conditioned suppression paradigm was recently developed that allows us to measure tinnitus behaviorally in conscious animals. Accordingly, an animal model of tinnitus is proposed that permits tests of hypotheses relating to tinnitus generation, allowing the accommodation of interventional strategies for the treatment of this widespread auditory disorder.
Ranulas — Mucoceles of the oral cavity: Experience in 26 children
Authors: Crysdale W. S. , Mendelsohn J. D. , Conley S.
Published: October 2006

Ranulas or mucoceles of the floor of the mouth are uncommon but do occur in approximately 5% of patients undergoing submandibular duct relocation for the management of uncontrollable sialorrhea. Review of our experience with 26 patients over 12 years ending in 1986 substantiated a concept previously advocated by other authors that ranulas are usually extravasation pseudocysts developing after disruption of sublingual gland elements, and that excision of the ipsilateral sublingual gland is the management approach of choice.
Interferon alfa‐n1 (wellferon)® in juvenile onset recurrent respiratory papillomatosis: Results of a randomized study in twelve collaborative institutions
Authors: Kashima H. , Leventhal B. , Mounts P. , Clark K. , Cohen S. , Dedo H. , Donovan D. , Goepfert H. , Fearon B. , Gardiner L. , Mccabe B. F. , Lusk R. , Muntz H. , Richardson M. , Whisnant J. , Weck P. , Wold D. , Singleton G. , Yonkers A.
Published: October 2006

Sixty‐six patients with clinically severe juvenile‐onset recurrent respiratory papillomatosis (RRP) were entered into a 12‐month randomized crossover study to evaluate interferon alpha‐n1 Wellferon® (WFN) as an adjuvant to CO2 laser surgical excision. Eligibility required disease onset to be before age 16, and an endoscopic excision requirement of at least three operations in the 6 months immediately prior to entry. Patients were randomized to Observation versus WFN at a dose of 5 MU/m2 daily for 28 days and three times weekly for 5 months. The patient groups were comparable in extent of disease at entry. Total extent of disease was determined by a composite score derived from the number of diseased anatomic sites and extent of surface area and lumen encroachment present at each site. Standard endoscopic excisions were performed every 2 months and clinical courses compared on a basis of composite scores determined at each endoscopy. Statistically significant improvement occurred in the patient group which received WFN. We conclude that interferon alpha n‐1 is an effective adjuvant to surgery in RRP management.
Anesthesia management of microlaryngeal laser surgery in children: Apneic technique anesthesia
Authors: Cohen Seymour R. , Herbert Wayne I. , Thompson Jerome W.
Published: October 2006

The purpose of this paper is to describe apneic technique general anesthesia which has been used in children for suspension microlaryngoscopy in the nontracheotomized patient.

Apneic anesthesia uses a paralyzing drug in combination with controlled ventilation using halothane or isoflurane, nitrous oxide and oxygen, delivered through an endotracheal tube. Patients are monitored throughout the procedure with end‐tidal CO2 levels and a cutaneous oximeter. Surgery is performed without the impediment of an endotracheal tube.

This method, used in 240 patients ranging in age from 3 months to 18 years, eliminates the danger of a laser fire, gives an unobstructed view of the larynx, is safe, and is free of complications. All outpatients were discharged from the hospital within a few hours after the surgical procedure.
Spontaneous tonsillar hemorrhage
Authors: Griffies W. Scott , Wotowic Paul , Wildes Thomas O.
Published: October 2006

Spontaneous tonsillar hemorrhage (STH) of noniatrogenic causes occurs most frequently from infection. Infection can lead to erosion into a major vessel, such as the carotid artery or a smaller peripheral tonsil vessel. Whereas fatal erosion into a major vessel from a deep neck abscess was relatively common in the past, it is rare since the advent of antibiotics. Spontaneous tonsillar hemorrhage, when it does occur, appears to occur most commonly in a peripheral tonsil vessel from bacterial tonsillitis.

Medical records of 860 patients with conditions considered to be susceptible to STH were reviewed. Ten cases of STH were identified. All were from peripheral tonsil vessel hemorrhage; none was secondary to major vessel erosion. Bacterial tonsillitis was the most common cause of STH and occurred in 8 of 10 cases. This condition accounted for an incidence of STH in tonsillitis of 1.1%. A history of chronic tonsillitis appeared to predispose a patient to STH. Other causes of STH were infectious mononucleosis and neoplasm.

Seven of the ten peripheral STHs presented with bleeding from an obvious venous source. The other three patients had significant hemorrhages which led to arteriography. Arteriograms are indicated in patients with clinical features suggesting possible major vessel erosion or in those patients where significant bleeding is not from an obvious peripheral source. A peripheral STH can be successfully managed with local intervention and tonsillectomy.
The prevention of carotid artery rupture with isobutyl‐2‐cyanoacrylate
Authors: Costantino Peter D. , Atiyah Raja A. , Mico Alan S. , Sisson George A
Published: October 2006

Carotid artery exposure and rupture is one of the most feared complications of head and neck surgery. The ideal method for preventing rupture of an exposed artery should be easy to perform, safe, effective and should spare local and regional flaps for later use in reconstruction. Isobutyl‐2‐cyanoacrylate (Bucrylate®) is a commercially available compound that appears to meet these criteria.

Test animals were divided into two groups. The carotid arteries of 12 dogs (group A) were exteriorized bilaterally and coated with Bucrylate® unilaterally. Group B (four dogs) underwent the same procedure except that the vessels were bilaterally coated. Wounds were dressed twice daily with moist‐to‐dry gauze. No antibiotics were given.

Nine of the 12 unprotected arteries in group A ruptured within 2 weeks, and one unprotected artery ruptured on postoperative day (POD) 29. Two dogs healed over both, vessels. In group B, three dogs ruptured their arteries within 2 weeks. One dog healed over both vessels. Gross and histologic examination of the arteries showed a striking difference between coated and uncoated vessels.

We believe that Bucrylate® and cyanoacrylate adhesives hold promise in the clinical protection of exposed carotid arteries.
Paralyzed eyelids reanimated with a closed‐eyelid spring
Authors: May Mark
Published: October 2006

Implantation of gold weights and open wire springe to close the eyelid have provided good corneal protection in selected patients with eyelid paralysis. These techniques, however, do not overcome lower eyelid drooping. The closed‐eyelid spring technique was developed to address this problem, and, to date, the author has implanted 27 closed‐eyelid springs. This technique has reestablished a voluntary blink, provided corneal protection, and effectively held the lower lid in a relatively normal position in 25 of 27 patients. This report describes patient selection, surgical technique, and results of implanting closed‐eyelid springs to reanimate paralyzed eyelids.
Autosomal dominant osteopetrosis: An otoneurological investigation of the two radiological types
Authors: Bollerslev Jens , Grøntved Aksel , Anderson Poul Erik
Published: October 2006

Otoneurological examination was performed on 14 patients with autosomal dominant osteopetrosis. Eight patients had radiological type I osteopetrosis, characterized by a pronounced osteosclerosis of the skull and an enlarged thickness of the cranial vault. Six patients had type II, in which osteosclerosis is most pronounced at the base of the skull. All investigated patients except one had otoneurological manifestations, but only two of the 14 had otoneurological complaints. Symptoms were related to radiological types. Involvement of the trigeminal nerve was seen only in type I, whereas involvement of the facial nerve was found primarily in type II. Conductive hearing loss was particularly common in type I, and may reflect a high frequency of otosclerosis. Tomography of the petrous bones showed a significant narrowing of the internal acoustic meatus in type I (p<0.01) when compared to normal controls, but no significant narrowing in type II.
Metastatic thymoma to the head and neck
Authors: Barat Michael , Rybak Leonard P. , Dietrich John
Published: October 2006

Malignant thymoma is a mediastinal tumor which spreads primarily by local invasion. Spread to regional lymph nodes and distant organs is variable. The most common sites of metastasis in the head and neck region are the supraclavicular nodes and the brain. Cervical lymph node metastasis as the presenting symptom of malignant thymoma has not yet been reported in the otolaryngologic literature. We present three cases of metastatic thymoma to the neck from a series of 28 thymomas, ten of which were malignant. The clinical presentation, histopathological features, therapy, and prognosis of malignant thymomas are discussed.
Treatment of locally advanced, high‐grade, malignant tumors of major salivary glands
Authors: Reddy Sarada P. , Marks James E.
Published: October 2006

A retrospective review of 45 patients with Stage in and IV malignant tumors of the major salivary glands was undertaken to determine tumor control and patient survival after treatment with surgery and conventional ionizing‐radiation therapy. Eight of the 23 patients received early postoperative radiotherapy after initial surgical resection, with a local control rate of 75%. Twelve of 23 patients had surgery as definitive treatment and the tumor recurred locally in all; seven of these 12 patients were subsequently salvaged by further surgery plus postoperative radiotherapy or by radiotherapy alone, with 58% ultimate local control. The remaining three patients had unresectable tumors at diagnosis and received radiation alone, with a local tumor control rate of 33%. Patients were also analyzed according to the extent of surgical resection prior to radiation therapy and according to radiation dose. Eighty‐eight percent of completely resected, 50% of partially resected, and 44% of unresected tumors were locally controlled for an overall local control rate of 61%. The 5‐year survival rate was significantly higher for patients with local tumor control than for patients who failed locally (31% vs. 0%).
Vestibular function in experimental endolymphatic hydrops
Authors: Andrews James C. , Honrubia Vicente
Published: October 2006

Endolymphatic sac ablation in the guinea pig can result in a dilated membranous labyrinth and low‐frequency hearing loss similar to patients with Meniere's disease. However, this animal model fails to develop analogous symptoms of a Meniere's crisis such as sudden hearing loss and marked vestibular imbalance. Possibly, factors in addition to endolymphatic hydrops must be present to result in a crisis episode. By placing animals in an inverted posture, their intralabyrinthine pressure was elevated, causing additional stress on the inner ears. Standard electronystagmographic techniques were used to monitor vestibular imbalance, which appeared as spontaneous nystagmus in the dark. Nineteen of 23 animals with unilateral endolymphatic hydrops showed spontaneous nystagmus in an inverted posture. Physiologic mechanisms explaining these results are described.
Auditory brainstem response in obstructive sleep apnea
Authors: Wetmore Stephen J. , Henderson Catherine , Doshier Nita W. , Milligan Lynda Beth
Published: October 2006

Auditory brainstem, response (ABR) has been used by several investigators to study the role of the brain stem in the pathophysiology of obstructive sleep apnea (OSA). These studies have produced conflicting results.

We studied 27 preoperative OSA patients and 17 controls using click stimuli presented at a slow (11.7/second) rate and at a fast (57.7/second) rate. ABR was repeated postoperatively in 18 patients.

There were no statistically significant differences in the ABRs of preoperative OSA patients when compared with the control group. However, the preoperative recordings showed statistically significant prolonged latencies for wave III (p < 0.01) and interpeak latency (IPL) I‐III (p < 0.01) when compared to postoperative recordings. Rapid‐rate testing was not helpful.

Although normal sleep does not cause ABR abnormalities, the pathological sleepiness seen in OSA patients may cause brainstem dysfunction manifested by prolonged ABR latencies. These abnormalities may resolve with treatment of OSA.
Glottographic measures of vocal fold vibration: An examination of laryngeal paralysis
Authors: Hanson David G. , Gerratt Bruce R. , Berke Gerald S. , Karin Rom R.
Published: October 2006

Photoglottography and electroglottography were applied to groups of patients with recurrent laryngeal nerve paralysis, superior laryngeal nerve paralysis, and combined recurrent and superior laryngeal nerve paralyses of idiopathic causes. Individual patients with resection of the vagal nerve above the origin of the superior laryngeal nerve were also studied. Open Quotient and Speed Quotient were calculated from the photoglottography signals. Speed Quotient values significantly differentiated recurrent laryngeal nerve paralysis from idiopathic paralysis and superior laryngeal nerve paralysis, as well as from normal function. Data from patients with vagal resection clearly differentiated them from patients with recurrent laryngeal nerve paralysis. The measure of Open Quotient distinguished pathological phonation from normal, but was not as useful for separation of differing lesions. Electroglottography appeared to be less useful than photoglottography. The pathophysiology underlying the observed glottographic signals is discussed.