bluuebunny/crossref_metadata_2025 huggingface dataset:
Mechanisms of Electrically Induced Damage after Cochlear Implantation
Authors: Duckert L. G. , Miller Josef M.
Published: October 2014

This report is the fourth in a series of parametric studies designed to evaluate and define conditions that may produce histological damage by means of electrical stimulation from cochlear prostheses. Earlier studies established damage thresholds for both acute (400 μA rms or 70 μC/cm20) and chronic (100 μA rms or 15 to 20 μC/cm20) stimulation with continuous sinusoidal current of 1,000 Hz. In a subsequent study, a tenfold reduction in the stimulation frequency (to 100 Hz) resulted in a 50% reduction in the acute damage threshold (200 μA rms), which was a smaller reduction than anticipated if damage is dependent only on charge density. This finding and the damage patterns observed in the preceding studies suggested that multiple mechanisms are responsible for the sensory and supporting cell degeneration induced by the electrical stimulus. A similar pattern of structural changes has been observed by other investigators after acoustic stimulation of the cochlea, suggesting that common mechanisms may be involved. With electrical stimulation, electrophoretic effects have been implicated; like acoustic trauma, however, mechanical, biochemical, and metabolic processes may also be involved. This investigation was designed to identify and analyze better the damage mechanisms active in acute stimulation. Sixteen normal guinea pigs were implanted and stimulated using an interrupted 1,000-Hz signal at 500 μA for three hours. Duty cycle was reduced to 50% and signal periodicity ranged from 100 to 1,000 ms. After stimulation, the animals were killed and the cochleas examined with the scanning electron microscope for evidence of pathological changes. Despite reduction of the duty cycle to 50% of the exposure duration used in previous acute stimulation experiments, the degree of damage and the damage pattern were similar to those observed with a continuous stimulus. Alteration in the stimulus intervals appeared to have no effect on the degree and type of damage observed. Our data compare favorably to a parallel model of acoustic trauma in which mechanical injury results in similar damage patterns. Based on our observations we suggest that a primary mechanism of acute tissue damage at higher intensities of electrical stimulation is electromechanical.
Lysozyme Producers in Nasal Mucosa
Authors: Tachibana Masayoshi , Morioka Hiroyuki , MacHino Mitsuo , Tsuruoka Takashi , Tanimura Fumiko , Mizukoshi Osamu
Published: October 2014

The question of whether or not goblet cells in the nasal mucosa are lysozyme producers has yet to be examined. In the present study, lysozyme was localized by the protein A-gold technique in human nasal mucosa with special attention to goblet cells. Both light and electron microscopic immunostaining revealed lysozyme in the secretory granules of the goblet cells, although far less than the amount present in the serous cells of the nasal glands. We concluded that the nasal glands were the main producer and goblet cells the subsidiary producer of lysozyme in nasal mucosa.
A New Adult Microlaryngoscope
Authors: Benjamin Bruce
Published: October 2014

A new “slimline” binocular microlaryngoscope has been designed for use in adults in whom the larynx is difficult or impossible to visualize with standard microlaryngoscopes.
Inverted Papilloma
Authors: Weissler Mark C. , Montgomery William W. , Turner Pamela A. , Montgomery Stuart K. , Joseph Michael P.
Published: October 2014

Two hundred twenty-three cases of inverted papilloma seen at this institution over a 35-year period were reviewed. The number of cases steadily increased over each 5-year period. Common presenting signs and symptoms, association with carcinoma, and results of surgical and radiographic treatment are presented. The pathologic controversy surrounding this disease is discussed, and an argument is made for including all pathologic subtypes and septal, lateral wall, or sinus cases in a common clinical grouping of inverted papilloma. Lateral rhinotomy was found to be associated with fewer recurrences and a better probability of cure than lesser procedures and is recommended as the standard surgical therapy. Radiotherapy was found to be a useful and effective adjunct in cases associated with malignancy or for multiply recurrent and inoperable benign inverted papillomas. Lifelong follow-up is urged.
The Nasal Valve: A Rhinomanometric Evaluation of Maximum Nasal Inspiratory Flow and Pressure Curves
Authors: de Bonilla Julian Santiago-Diez , McCaffrey Thomas V. , Kern Eugene B.
Published: October 2014

The nasal valve is defined as the region of the nasal airway bounded by the caudal end of the upper lateral cartilages and the nasal septum. During inspiration this region of the nasal airway may collapse and produce a marked increase in nasal airway resistance. To define the function of this region, measurements of the nasal airway resistance in 38 subjects were performed. Using anterior mask rhinomanometry, right and left total nasal resistance, right and left upstream nasal resistance, right and left downstream nasal resistance, and right and left transmural collapsing pressure of the nasal valve were measured. Subjects who complained of nasal obstruction and had anatomical evidence of anterior nasal deformity showed a reduced level of transmural closing pressure compared with subjects complaining of no airway obstruction or those with anatomical evidence of posterior nasal deformity. This suggests that premature collapse of the nasal valve due to inadequate cartilaginous support is an important factor in producing nasal airway obstruction in individuals with anterior nasal septal abnormality. In those individuals with nasal airway obstruction and anatomical evidence of posterior nasal deformity, downstream nasal resistance was elevated compared with the asymptomatic group and the group with anatomical evidence of anterior nasal septal deformity. This paper demonstrates that premature collapse of the nasal valve is responsible for the symptom of nasal obstruction in many patients with anterior nasal septal deformity.
Posture and the Nasal Cycle
Authors: Cole Philip , Haight James S. J.
Published: October 2014

The experiments reported in this communication show that the spontaneous nasal cycle of airflow resistances, which alternates between cavities of seated subjects, persists in healthy young adults standing, supine, and laterally recumbent. In addition, persistence of the cycle was recorded throughout 24–hour periods of unrestricted light activity, rest, and recumbency. Recumbency was found to augment amplitude of the cycle, yet resistance of the combined nasal cavities showed little change to accompany daytime activity or nocturnal sleeping postures. In subjects with normal noses, resistance remained similar to that of upright subjects in the range of 2 to 3 cm of H2O/L/s. By contrast, noses with fixed unilateral obstruction showed high cyclical resistances of the combined nasal cavities. The importance of the cycle in rhinoscopic assessment, nasal airway obstruction, and breathing disorders of sleep is discussed.
Objective Grading of Facial Paralysis
Authors: Burres Steven A.
Published: October 2014

A totally objective method of grading facial palsy, based on the linear measurement of anatomic landmarks, has been tested in 34 randomly selected cases. To account for the pathologic characteristics of facial paralysis, the linear measurement index (LMI) underwent several adjustments from the ground plan devised for normal subjects. The distribution of results both from individual expressions and the entire LMI was examined.
Chondroblastoma of Temporal Bone: Unusual Histologic Features
Authors: Anim J. T. , Baraka M. E.
Published: October 2014

Chondroblastoma of bone only rarely affects the skull and, depending on its location, may have an uncertain prognosis. The histologic spectrum demonstrated by this tumor has been a source of diagnostic confusion, which still persists. A case of chondroblastoma of the temporal bone with unusual histologic features is presented and discussed. Chondroblastoma must be included in the differential diagnosis of bone tumors of the skull containing giant cells. Radical excision is suggested as the treatment of choice in view of unanswered questions regarding its tendency to recur or to progress to frank malignancy.
A Method for the Histopathological Analysis of the Temporal Bone and the Eustachian Tube and its Accessory Structures
Authors: Sando Isamu , Takahara Tetsuo , Doyle William J. , Okuno Hideji , Kitajiri Masanori , Coury William J.
Published: October 2014

A very important contribution to the study of otitis media, one of the diseases most often seen in pediatric patients, is the collection processing, and study of the specimens of the temporal bone and the entire eustachian tube. During the last few years, we have collected, processed, and studied 100 such specimens, and through these experiences our technique has become refined. We now have some important suggestions for otologists interested in the histological study of otitis media as well as in the pathology of the eustachian tube and its relation to middle ear abnormalities. This report details the most successful method for the study of eustachian tube abnormalities and their relationship to middle ear effusion.
Laryngeal Involvement by Mycosis Fungoides
Authors: Ferlito Alfio , Recher Gianfranco
Published: October 2014

Symptomatic involvement of the larynx by mycosis fungoides is rare. We report a case of mycosis fungoides occurring in the larynx of a 74-year-old man. The laryngeal localization was the first visceral manifestation of the disease to be detected clinically.
Acoustic Analyses of Phonation in Patients with Huntington's Disease
Authors: Ramig Lorraine A.
Published: October 2014

While perceptual reports support phonatory disruptions in patients with Huntington's disease, these disruptions have not been quantified objectively. Acoustic analysis offers a method to study phonatory characteristics in these patients noninvasively and to provide objective information related to laryngeal pathophysiology of both clinical and academic interest. Application of acoustic analysis to the sustained vowel phonation of eight patients with Huntington's disease revealed the following abnormalities: low frequency segments (abrupt drops in fundamental frequency of approximately one octave), vocal arrests, and reduced maximal vowel duration. There was evidence of both adductory and abductory phonatory disruption in these patients. These findings are discussed in relation to previous reports of perceptual characteristics of voices of Huntington's disease patients, as well as potential physiologic correlates of choreiform involvement in the phonatory mechanism.
Characterization of T Cell Subsets Using Monoclonal Antibodies in Nasopharyngeal Carcinoma Patients
Authors: Hsu Mow-Ming , Lin Bie-Lien
Published: October 2014

Peripheral blood T cell subsets from 99 patients with nasopharyngeal carcinoma (NPC), 38 age-matched healthy subjects, and 20 patients with head and neck cancer other than NPC were characterized by reactivity with monoclonal antibodies. Patients with NPC showed much lower values of percentage and absolute number of common T cells (OKT3 +) and helper cells (OKT4 +) (p< 0.01) than the control groups. The percentage of suppressor cells (OKT8 +) was found to be higher in NPC patients than in healthy persons (p< 0.001), but the absolute number was still lower in NPC patients. A selective decrease in the ratios of OKT4 + to OKT8 + cells was found in NPC patients (p<0.001). The ratios were correlated inversely to the clinical stage (r = 0.294, p<0.01). After negative selection by complement-mediated cytolysis, the remaining cells were stimulated with phytohemagglutinin. Net counts of isotope incorporation were smaller in all T cell subsets of NPC patients (p< 0.001). These data indicate that the depressed cell-mediated immunity in NPC patients is due to inadequate number and functions of T cell subsets and a relative increased proportion of suppressor T cells.
Stromal Cell Atypia in Sinonasal Polyposis
Authors: Batsakis John G.
Published: October 2014

Cellular atypia in stromal cells of nasal polyps is a peculiar response in fibroblasts or fibrohistiocytes to increased intercellular fluid and/or vascular compromise. Adherence to established histologic criteria will eliminate misjudging these cytologic changes as sarcomas.
Sinus Histiocytosis with Massive Cervical Lymphadenopathy
Authors: Schweitzer Vanessa G. , Bobier Gregg D.
Published: October 2014

Sinus histiocytosis with massive cervical lymphadenopathy (SHML) was originally described in 1969 as a benign clinicopathologic entity characterized by massive bilateral cervical lymphadenopathy, fever, leukocytosis, elevated ESR, and hypergammaglobulinemia, usually occurring within the first two decades of life. We present an illustrated case of an elderly patient with polyclonal hypergammaglobulinemia and a 2-year history of multilobulated cervical and submandibular lymphadenopathy. The etiology and pathogenesis of SHML are not known. Diagnosis requires lymph node biopsy to exclude other causes of cervical lymphadenopathy such as malignant lymphoma, malignant histiocytosis, metastatic carcinoma, and tuberculous lymphadenitis. Histologic examination shows marked dilatation of subcapsular and medullary lymph node sinuses containing large, foamy or vacuolated histiocytes. Although no curative treatment is known, corticosteroids, radiation therapy, vinblastine and oral cyclophosphamide, and surgery have been used to palliate constitutional symptoms and mechanical obstruction from massive lymphadenopathy. Since one third of SHML patients have evidence of disease for 5 years, and a mortality rate of 7% exists with benign histologic disease, all patients with SHML should be carefully screened for evidence of immunodeficiencies that may precipitate a fatal outcome.
Dacryocystorhinostomy
Authors: Tos Mirko , Balle Viggo , Andersen Rud
Published: October 2014

The extranasal method of dacryocystorhinostomy, which totally incorporates the lacrimal sac into the nasal cavity, is described, and the primary and late results of this method are presented in 57 patients with chronic epiphora caused by stenosis of the nasolacrimal duct. Immediately after the operation, the results were satisfactory in all patients. At late follow-up, with a median observation period of 5 years, 80% of the patients were completely free of epiphora and 15 % had periodic epiphora, which was a considerable improvement over the preoperative condition. The described method could become a rhinologic routine procedure in patients with chronic epiphora.
Cholesteatoma: An Epidemiologic Study among Members of Kibbutzim in Northern Israel
Authors: Podoshin L. , Margalit A. , Fradis M. , Tamir A. , Ben-David Y. , Epstein L.
Published: October 2014

In this study 3,056 members (10 years of age and older) of the kibbutzim in the northern part of Israel were examined in order to determine the prevalence of chronic otitis media and cholesteatoma. In addition to demographic factors, the influence of altitude was investigated, but the differences were not found to be significant. The prevalence of chronic otitis media was found to be 0.95% and of cholesteatoma, 0.4%. Of the patients who had chronic otitis media, 41 % suffered from cholesteatoma as well. Chronic otitis media was more prevalent in males than females (0.02>p>0.01) in the Ashkenazic than Sephardic populations (0.05>p>0.02), and in industrial and agricultural workers (0.05>p>0.02), as compared to others. Among cholesteatoma patients a family history was found in 64%. In 71% of patients, illness began in infancy. Fifteen percent of the patients did not know of their disease until they were examined in this study. These results suggest a high rate of cholesteatoma among chronic otitis media patients and emphasize the need for performing more extensive studies to determine the rate of cholesteatoma in the general population. The necessity for preventive ear examinations, earlier diagnosis, and treatment of cholesteatoma is emphasized.
Computed Tomography in the Assessment of Mandibular Invasion by Intraoral Carcinoma
Authors: Close Lanny G. , Burns Dennis K. , Merkel Marie , Schaefer Steven D.
Published: October 2014

A critical factor in the pretreatment evaluation of patients with carcinoma of the oral cavity or oropharynx is the presence or absence of bone invasion. A prospective study was performed to compare the sensitivity and specificity of plain radiographs and computed tomography in detecting mandibular invasion by cancer arising in these sites. Forty-three consecutive patients with previously untreated oral cavity or oropharyngeal carcinoma were evaluated preoperatively by intraoral radiographs (dental occlusal views and panoramic radiographs) and CT, and the results were compared with postoperative pathologic findings. Of the 11 cases in which pathologic examination confirmed bone invasion, conventional x-ray films were positive in seven (63.6%). Computed tomography confirmed bone invasion in all 11 (100%) of these patients. In addition, the CT scan was more specific than conventional x-ray films in detecting bone invasion. Based on the findings in this study, we strongly recommend CT as the only radiographic study necessary to evaluate intraoral carcinoma prior to treatment.
Double Intratemporal Congenital Cholesteatomas Combined with Ossicular Anomalies
Authors: Huang Tsun-Sheng
Published: October 2014

A 15-year-old patient had unilateral double congenital cholesteatomas, one isolated to the mastoid and the other located in the petrous pyramid. The presenting symptoms were facial palsy and a conductive hearing loss on the affected side. The case is interesting, not only in that there were two isolated cholesteatomas in the same temporal bone, but also because of the combination of ossicular anomalies. The unusually early detection and surgical intervention in this instance suggest that similar cases of multicentric cholesteatomas may have occurred, but may have been concealed because of the later detection and possible linkage of the cholesteatomas. I would therefore emphasize Sheehy's recommendation that temporal bone radiography never be omitted where idiopathic facial nerve palsy exists.
Audiologic Findings in Young Patients with Hypophosphatemic Bone Disease
Authors: Meister Martha , Johnson Anita , Kim Ghi S. , Popelka Gerald R. , Whyte Michael P.
Published: October 2014

Audiometric tests were conducted on 19 subjects with hypophosphatemic bone disease to investigate whether auditory impairment like that reported in affected adults occurs in young patients. No hearing loss or significant auditory findings were noted among the children or young adult patients. However, sensorineural hearing loss of cochlear origin was identified in the three oldest subjects (40 to 58 years), although a history of noise exposure in two of them could explain the observations. The results indicate that if an association exists between hypophosphatemic bone disease and hearing impairment, the auditory signs will not develop until adulthood in treated patients. Additional studies of large populations of affected adults are needed to identify the incidence and mechanism(s) of the auditory system abnormalities and to assess any effect of medical therapy for the metabolic bone disease.
Anatomy of the round Window Niche
Authors: Proctor Bruce , Bollobas Bela , Niparko John K.
Published: October 2014

The contributing elements to boundaries of the round window niche are superiorly the tegmen fossula fenestra rotunda (roof support), inferiorly the fustis (depth) and area concamerata, anteriorly the sustentaculum (support) and postis anterior (anterior pillar), and posteriorly the postis posterior (posterior pillar) and the subiculum (underlying supporting structure). Variations in their size and orientation can give rise to significant variability in the overall size and shape of the round window niche.
Verrucous Carcinoma of the Temporal Bone
Authors: Edelstein David R. , Biller Hugh F. , Smouha Eric , Kaneko Mamoru , Sacks Steven H. , Parisier Simon C.
Published: October 2014

Verrucous carcinoma, a familiar lesion of the oral cavity and larynx, is distinctly rare in the ear. We report five cases of verrucous carcinoma of the temporal bone, each of which fulfills Ackerman's histologic and biologic criteria. Only three cases of verrucous carcinoma of the ear have been previously reported. Most cases of verrucous cancers of the head and neck demonstrate a lack of nodal involvement, relatively slow growth potential, local invasiveness, and responsiveness to surgical treatment. In our five cases of verrucous carcinoma of the temporal bone, three had a biologic behavior similar to other verrucous tumors, while two cases were unusually aggressive. Three patients were treated surgically and had favorable outcomes, while the remaining two were treated with combination therapy. These cases highlight the difficulty in diagnosis and treatment as well as the lack of understanding of the biologic behavior of this rare otologic entity.
Perilymphatic Fistula: A Histopathologic Study
Authors: Kohut Robert I. , Hinojosa Raul , Budetti Joseph A.
Published: October 2014

Over the last two decades, clinical criteria for perilymphatic fistulae have been defined to the extent that differentiation can be made between such fistulae and other balance-affecting disorders such as Meniere's syndrome. On the assumption that the specimens in the temporal bone bank of the University of Chicago Medical School that had been obtained from patients having vertigo, hearing loss, or both, before those clinical criteria were so defined might have been classified incorrectly, we proposed a retrospective histopathologic study, with prediction of two independent variables: 1) a clinical history and physical findings consistent with the diagnosis of perilymphatic fistula and 2) communication between the vestibule and the middle ear adjacent to or via the fissula ante fenestram. Eleven pairs of temporal bones with the histologic diagnosis of idiopathic labyrinthine hydrops were evaluated before the clinical histories relevant to those specimens were reviewed. In one specimen, a communication between the vestibule and the middle ear space was identified. In none of the other specimens was there a similar communication. As this study continued, significance was given to the histologic details of the communication between the middle ear and posterior canal ampulla. The temporal bones without these communications did not have clinical histories consistent with the diagnosis of perilymphatic fistula.
Clinical Use of an Insert Earphone
Authors: Clemis Jack D. , Ballad William J. , Killion Mead C.
Published: October 2014

There are several applications of and advantages to using an insert earphone. An insert earphone has three parts: a transducer to convert electrical energy to sound, a conduit to deliver the sound into the ear canal, and a coupler connecting the device to the canal. The data from this study indicate that there is a distinct advantage in using insert earphones over TDH-49 phones (standard headphones) in the attenuation of low frequency ambient noise. The use of insert earphones will permit one to test hearing in areas of higher ambient noise than was previously possible. Insert earphones are used to shorten the hearing aid selection process. A technique is described in which only one real ear measurement is required for an accurate hearing aid fitting. Most, but not all, of the masking dilemmas that are encountered with standard headphones are circumvented or eliminated by using insert earphones. In brain stem auditory evoked reponse testing, the insert earphone reduces the stimulus artifact without influencing the acoustic signal. Finally, the insert earphone solves the collapsing ear canal problem.
Recurrent Mixed Tumor
Authors: Batsakis John G.
Published: October 2014

Recurrence of benign neoplasms can usually be attributed to incomplete excision. Such is the case with benign mixed tumors of salivary glands. Certain histopathologic features of mixed tumors, however, appear to facilitate recurrences. These are: 1) a predominantly myxoid composition, and 2) transcapsular extension by the tumor. Multicentric origin is possible, but it must be regarded as a much lower order of probability.
Carbon Dioxide Laser Resection of Superficial Oral Carcinoma: Indications, Technique, and Results
Authors: Guerry Thomas L. , Silverman Sol , Dedo Herbert H.
Published: October 2014

A retrospective medical record review was done of 51 consecutive patients with 56 biopsy-proven squamous cell carcinomas of the oral cavity and oropharynx treated for cure by one of the authors (H.H.D.) using the carbon dioxide laser via microdirect pharyngoscopy. All 51 patients were followed for at least 3 years unless they died, and 27 were followed for 5 years. The tumors treated were superficial, accessible lesions without bone involvement or clinically apparent metastases. Eighteen patients had had irradiation or surgery at the same site, so were having salvage CO2 laser surgery. Indications and technique are discussed. Local recurrence and disease control rates were comparable to those of conventional local surgical excision at 3 and 5 years. Complication rate was low. Carbon dioxide laser resection with microscopic control is, we propose, an excellent modality for transoral excision of carefully selected lesions, and it offers increased precision, better visualization, minimal bleeding, and decreased postoperative morbidity compared to other surgical techniques.
Imbrication Reconstruction following Partial Laryngectomy
Authors: Liu Chen , Ward Paul H. , Pleet Lawrence
Published: October 2014

Experience over a 16-year period with 38 patients who underwent partial laryngectomy with imbrication reconstruction is reviewed. We have found this technique to be an expeditious and highly successful means of eradicating T1 or T2 glottic cancer. The use of the patient's own full-thickness, adjacent normal tissue with imbrication of cartilage produces an adequate airway, an almost normal-appearing larynx, and a remarkable posttreatment voice quality, better results than from most cordectomies or vertical hemilaryngectomies. It is valuable as a salvage procedure after full-course radiation. Imbrication laryngoplasty is an alternative and a preferred modality for treatment of young people with early glottic carcinoma for whom the possible carcinogenic properties of radiation must be considered. The survival results are comparable with the more extensive vertical laryngectomies.
Posterior Glottis
Authors: Hirano Minoru , Kiyokawa Kensuke , Kurita Shigejiro , Sato Kiminori
Published: October 2014

Two sets of investigations were conducted with excised human larynges. 1) The glottis was closely observed and photographed from above and below in three conditions: neutral, adduction, and abduction. 2) The structure surrounding the posterior glottis was histologically investigated in the same three conditions. The results are as follows. 1) The structure surrounding the posterior glottis consists of three portions: the posterior wall of the glottis, the lateral wall of the posterior glottis, and the cartilaginous portion of the vocal fold. 2) During vocal fold adduction, the posterior part of the larynx closes completely not at the glottis but at the supraglottis, resulting in formation of a conic space in the posterior glottis that can be viewed only from below. 3) The posterior glottis accounts for approximately 35% to 45% of the entire glottic length and 50% to 65% of the entire glottic area. 4) The mucosa of the posterior glottis has ciliated epithelium. The lamina propria consists of two layers. 5) The posterior glottis can be regarded as a respiratory glottis.
The Quiet Revolution
Authors: van Nostrand A. W. Peter
Published: October 2014

In the past decade many of the techniques of cell biology developed in the research laboratory have been applied to tissue diagnosis. Increasing use of electron microscopy has allowed ready differentiation of many neoplasms with an identical appearance under the light microscope. The identification of highly specific antigenic substances in individual cells using monoclonal antibodies in the immunoperoxidase technique has allowed a degree of diagnostic accuracy not previously available in tissue diagnosis. Recent efforts have been directed at more accurately predicting biological behavior on the basis of cellular characteristics. Techniques being introduced include morphometry (computer-assisted image analysis), cytophotometry (measurement of cellular DNA content), flow cytometry (analysis of cells in suspension for DNA content and other physical and chemical properties), scanning electron microscopy, and cytogenetics (the study of cellular chromosomes).
Vocal Cord Paralysis in Children 1 Year of Age and Younger
Authors: Gentile Richard D. , Miller Robert H. , Woodson Gayle E.
Published: October 2014

Twenty-two patients 1 year of age or younger were diagnosed as having unilateral or bilateral vocal cord paralyses between 1962 and 1985. There was a marked male predominance, and 12 of the paralyses were bilateral. Congenital neurological malformations were the cause in six patients, birth trauma in five, surgery in four, syphilis in one, and six cases were idiopathic. Tracheotomy was necessary in 11 of the patients with bilateral paralyses. Ten of the 16 patients for whom follow-up was available had resolution of the paralysis from 1 week to 5 years of age. The importance of making an accurate diagnosis is stressed, as is using the fiberoptic laryngoscope.
Risk Factors for Neonatal Acquired Subglottic Stenosis
Authors: Dankle Steven K. , Schuller David E. , McClead Richard E.
Published: October 2014

Endotracheal intubation has proven to be a relatively safe and effective means of securing the airway in neonates. Some concern remains, however, regarding airway management in critically ill infants who require assisted ventilation for extended periods. Among the various risk factors associated with the complication of acquired subglottic stenosis in neonates, the one most frequently cited has been “prolonged” intubation, although opinion varies regarding the definition of this term. Various recommendations exist that attempt to establish the limits of “safe” periods of intubation for infants. Some feel that tracheotomy is indicated when airway support is required beyond those limits. In an attempt to define important risk factors involved in the development of neonatal subglottic stenosis, a retrospective analysis of infants admitted to the Neonatal Intensive Care Unit of Columbus Children's Hospital who required intubation during a 3-year period from 1977 to 1980 was undertaken. Of 343 infants who survived hospitalization, five patients were identified as having acquired subglottic stenosis. The average duration of intubation for these five patients was 56.2 days. The incidence of subglottic stenosis for infants whose duration of intubation ranged from 3 to 50 days was 0.4% (1/245). Infants with birth weights less than 1,500 g appeared more susceptible to the development of intubation-related laryngeal injury. The conclusion of this study is that endotracheal intubation is an appropriate means of long-term airway management in neonates hospitalized in a pediatric intensive care unit, providing other known risk factors are minimized.
Intranasal Microsurgery of All Paranasal Sinuses, the Septum, and the Lacrimal Sac with Hypotensive Anesthesia
Authors: Heermann Joachim , Neues Dieter
Published: October 2014

Since 1958 all intranasal surgery at Krupp Hospital (including 2,986 operations in 1984) have been performed with the Zeiss operating microscope. Anesthesia with hypotension is important to improve the results. To facilitate focusing, a balanced movable position of the microscope directed by head motions of the surgeon and a semi-Fowler's position for the patient have proven best. Large fenestrations above and below the lower turbinates permit maxillary sinus surgery under direct binocular vision with the aid of mirrors or endoscopes. For the last 12 years the Caldwell-Luc approach was used in less than 2% of operations. All ethmoidal, lacrimal sac, and epistaxis surgery is performed intranasally. In 1984 frontal sinus surgery was performed in 59 cases with an intranasal and in 11 cases with an osteoplastic procedure. For a larger defect of the ethmoidal roof in severe injuries, conically trimmed rib cartilage is wedged into the defect from above. Having performed more than 4,000 ethmoidal operations we have never experienced an iatrogenic CSF leakage, or persisting postoperative visual or ocular disturbance. In order to achieve the necessary skill, training on 50 cadavers is required.
Experimental Retraction Pocket Cholesteatoma
Authors: Wolfman David E. , Chole Richard A.
Published: October 2014

An animal model for retraction pocket (primary acquired) cholesteatoma is presented. Bilateral eustachian tube obstruction by electrocauterization of the nasopharyngeal portion was performed in 16 Mongolian gerbils. Animals were killed at 2, 4, 8, and 16 weeks. At 2 weeks all animals had bilateral serous effusions and retracted tympanic membranes. At 4 weeks, four of eight ears had middle ear fluid, retractions, and cholesteatomas. After 8 weeks, five of eight ears had middle ear effusions, and four of these had cholesteatomas; one ear had total atelectasis with a cholesteatoma filling the bulla. By 16 weeks, six of eight ears had developed cholesteatomas. Some animals did not develop effusion or retraction because of failure or recanalization of eustachian tube obstruction. This study provides experimental evidence that aural cholesteatomas may arise by retraction of the tympanic membrane.
Osteoperiosteal Flap in the Treatment of Ozena
Authors: Rasmy Emad
Published: October 2014

An osteoperiosteal flap taken from the anterior wall of the maxilla and pedicled on its periosteum was developed to narrow the nasal cavity of 15 patients with ozena. Good results were obtained in over 80% of cases. Crusting, fetor, and epistaxis disappeared. The nasal mucosa appeared healthy. The bulge in the lateral nasal wall persisted. The method is not liable to graft rejection or shrinkage. The advantages of this new technique are discussed.
Tumor Recurrence within Myocutaneous Flaps
Authors: Ellison David E. , Hoover Larry A. , Ward Paul H.
Published: October 2014

Myocutaneous flaps have become increasingly popular in reconstructive head and neck surgery. As surgeons have gained familiarity with them, many of the advantages, limitations, and complications of these flaps have become apparent. A rare but serious complication of myocutaneous flaps is recurrent tumor within the pedicle. Three cases of squamous cell carcinoma involving three different myocutaneous flaps are presented and the literature is reviewed. Possible mechanisms of tumor metastasis to myocutaneous flap pedicles are discussed. Surgeons must be aware of the possibility of tumor involvement of reconstructive flaps to facilitate early diagnosis and aggressive treatment.
Management of Plexiform Neurofibroma of the Larynx
Authors: Sidman James , Poole Michael , Wood Robert E. , Postma Duncan S.
Published: October 2014

We report the ninth case of plexiform neurofibroma of the larynx, which occurred in a 2-year-old with multiple café au lait spots and obstructive sleep apnea. In discussing this clinical problem, we have attempted to make the following points. 1) A patient's having more than six café au lait spots of greater than 1.5-cm diameter is diagnostic of von Recklinghausen's disease. 2) It is much more difficult to completely excise plexiform neurofibroma than nonplexiform neurofibroma. 3) The association of juvenile xanthogranuloma with von Recklinghausen's disease may be a risk factor for the later development of leukemia.
Laser Therapy of Dysphonia Plica Ventricularis
Authors: Feinstein Isabel , Hilger Peter , Szachowicz Edward , Stimson Barbara
Published: October 2014

Dysphonia plica ventricularis involves the faulty participation of the ventricular folds in the act of phonation. The speech disorder was one of the first to be described with the use of indirect laryngoscopy. This dysphonia can occur as a compensation for anatomic or physiologic alterations within the larynx (vicarious type) or as isolated ventricular fold hypertrophy unaccompanied by other obvious laryngeal disorders (usurpative type). Conservative phoniatric therapy has been the primary modality of treatment for dysphonias resulting from ventricular fold hypertrophy, with surgical intervention being reserved for those patients not responding to speech therapy. We describe the successful use of the carbon dioxide laser in the excision of the hypertrophied false vocal cords in a patient who failed conservative management with speech therapy.
Congenital Bronchoesophageal Fistula in the Adult
Authors: Smith B. Davison , Mikaelian Diran O. , Cohn Herbert E.
Published: October 2014

Congenital bronchoesophageal fistulas usually present in infants and may occur with or without esophageal atresia. Twenty cases of congenital bronchoesophageal fistula in adults have been reported in the English literature. Another case of this rare developmental anomaly is presented here. The radiographic, endoscopic, surgical, and pathologic findings are discussed with a review of the literature.
Synchronous Airway Lesions in Infancy
Authors: Gonzalez Carlos , Reilly James S. , Bluestone Charles D.
Published: October 2014

Stridor in the young infant is evaluated by careful laryngoscopy. When a lesion of the larynx is diagnosed, the necessity and risk of bronchoscopy are challenged. To assess the need for careful examination of both the upper and lower respiratory tract, a 2-year retrospective study was performed at the Children's Hospital of Pittsburgh. Of 103 infants who underwent diagnostic laryngoscopy and bronchoscopy for airway obstruction, stridor, or both, 18 (17.5%) had two or more synchronous airway lesions detected. Laryngoscopy alone, without further workup of the entire respiratory tract (ie, bronchoscopy, radiographic studies) may fail to detect concurrent disorders in infants with airway obstruction.
Flexible Laryngoscopy in Neonates, Infants, and Young Children
Authors: Hawkins Donald B. , Clark Richard W.
Published: October 2014

Flexible laryngoscopy was performed 453 times on 264 patients 4 years of age or younger. Sixty-five percent were under 6 months of age. Stridor was the indication for laryngoscopy in 60% of the patients. Problems secondary to intubation and poor voice each were indications in 12%. The most common finding was laryngomalacia, followed by laryngeal edema, normal larynges, and vocal cord paralysis or paresis. Subglottic stenosis was diagnosed in 17 patients. Flexible laryngoscopy is a relatively noninvasive, safe, and effective technique for examining the larynx of infants and young children.
Subglottic Stenosis: Retrospective Analysis and Proposal for Standard Reporting System
Authors: Grundfast Kenneth M. , Morris Michael S. , Bernsley Curtis
Published: October 2014

A retrospective analysis was undertaken reviewing management of 67 patients treated for subglottic stenosis (SGS) at the Children's Hospital National Medical Center (CHNMC) between 1980 and 1985. Forty-seven (90%) of the patients were followed for at least 18 months from the time diagnosis was made. Twenty-three (66%) of the patients followed for at least 18 months were successfully decannulated or had an adequate airway without tracheotomy. To compare efficacy of management of SGS at the CHNMC with management outcomes previously reported, a review of medical literature was undertaken and data from the most significant reports on management of SGS were collated and tabulated. Since analysis of published reports did not yield a consensus regarding optimal methods for management, and statistics in many published reports were absent or unclear, authors of the previously published reports were contacted personally by means of a letter and survey questionnaire. Results of the survey show that many authors have not performed a statistical review of their case data to determine relative efficacy of different surgical procedures. Thus, retrospective review of cases managed at the CHNMC as well as information obtained from leading experts in management of SGS indicate that there is no single optimal procedure or technique for management of all cases of SGS. Further, the way in which surgical procedures for management of SGS are being reported makes difficult the process of meaningfully comparing results reported by different surgeons. a reporting system is proposed that uses specific terms and objective parameters.
Auditory Brain Stem Evoked Response Characteristics in the Full-Term Newborn Infant
Authors: Morgan Donald E. , Zimmerman Marilyn C. , Dubno Judy R.
Published: October 2014

The auditory brain stem response to click stimuli was investigated in a group of 50 full-term healthy newborns, as well as in a group of 20 older children and adults. The stimulus parameters of click level and click repetition rate were varied systematically to quantify the characteristics of the auditory brain stem response in the full-term newborn infant. The results reveal increased latencies for waves I, III, and V for all conditions among the newborns, relative to the older age group. The results suggest that the neurological system is the primary source of differences between newborns and older subjects, but do not rule out the possibility that external ear, middle ear, or cochlear mechanisms may also contribute to the differences observed.
Respiratory Distress Due to Diffuse Cervical Hyperostosis
Authors: Sidi Jack , Har-El Gady , Hadar Tuvia , Matz Shoshana , Shvero Jacob , Abraham Aristide
Published: October 2014

Cervical spondylosis and ankylosing hyperostosis of the cervical vertebrae are common findings. Although these hypertrophic changes can be completely asymptomatic, it is known that dysphagia may occur occasionally in the presence of massive cervical hyperostosis. Laryngotracheal symptoms due to cervical hyperostosis are less frequent and may be managed initially as tumors of the esophagus, trachea, or thyroid gland. The management of two severe cases of dyspnea due to cervical ankylosing hyperostosis are discussed.
Interposed Cartilage as a Precaution against Extrusions of Ceramic Ossicular Replacement Implants
Authors: Zöllner Christoph
Published: October 2014

Since 1980 we have used middle ear implants of aluminum oxide ceramic in some reconstructions of the ossicular chain. We had opportunities to examine 108 ears (91 patients); the longest period of postoperative observation was 4 years. Follow-up examinations showed that the rates of extrusion and liability to extrusion can be reduced by interposing a small disk of autologous cartilage and perichondrium. Moreover, interposing cartilage tends to improve audiometric results. On the basis of our study, we strongly recommend the interposition of a disk of autologous cartilage and perichondrium between the middle ear implant and eardrum when an Al2O3 implant is used.
Prostaglandin E2 of the Upper Aerodigestive Tract
Authors: Johnson Jonas T. , Rabin Bruce S. , Wagner Robin L.
Published: October 2014

Mucosal specimens obtained from the upper aerodigestive tract of 101 patients were assayed for prostaglandin E2 (PGE2). Prostaglandin was detected in all specimens evaluated. Children and nonsmoking adults demonstrated lower concentrations of PGE2 than smoking adults. Tumor specimens from patients with squamous cell carcinoma of the upper aerodigestive tract demonstrated significantly increased levels of PGE2 (P<.05). Normal mucosa obtained from patients with squamous carcinoma elsewhere in their upper aerodigestive tract was found to contain significantly more PGE2 than that from adults without tumors (P<.05). The amount of PGE2 released from a tissue biopsy was not related to the amount of mononuclear cell infiltrate. No age-related trends in PGE2 levels were noted. Prostaglandin levels were higher in patients with advanced tumors in comparison to smaller tumors. The possible impact of elevated levels of PGE2 upon the immune system, the subsequent development of second primary carcinomas, and the relationship between PGE2 and the use of tobacco products is discussed.
Spontaneous Thrombosis of the Internal Jugular Vein
Authors: Kennedy Kevin S. , Tami Thomas A. , Strom C. G. , Friedman Jeffrey C. , Hyder Jace W.
Published: October 2014

The internal jugular vein is an uncommon site of deep venous thrombosis. Infection, prolonged central venous catheterization, and trauma are the usual causes of this condition. We present an unusual case of spontaneous thrombosis of the internal jugular vein. The evaluation of this case included a search for possible anatomic, hematologic, and oncologic conditions which could predispose to hypercoagulability and thrombosis. Anticoagulation therapy resulted in complete resolution of thrombosis and subsequent recanalization of the internal jugular vein.
Effect of Automatic Signal-Processing Amplification on Speech Recognition in Noise for Persons with Sensorineural Hearing Loss
Authors: Dempsey James J.
Published: October 2014

Hearing aids with automatic signal-processing circuitry (ASP) have recently become available commercially. This investigation tested the claims of manufacturers that the ASP hearing aid improves speech recognition in noise. Word recognition scores were obtained from ten hearing-impaired adults using two different hearing aids (ASP and conventional) and four background noise conditions (quiet, + 5, 0, and −5 dB signal-to-noise ratios). The results indicated that the more difficult the listening condition, the greater the advantage provided by the ASP instrument. The ASP hearing aid may prove to be beneficial to many hearing-impaired individuals who have difficulty communicating in noisy situations.
Human Endolymphatic Sac: Morphologic Evidence of Immunologic Function
Authors: Wackym Phillip A. , Friberg Ulla , Linthicum Fred H. , Bagger-Sjöbäck Dan , Bui Hang T. , Hofman Florence , Rask-Andersen Helge
Published: October 2014

The ultrastructure of ten normal human endolymphatic sacs (ES), fixed immediately after death and obtained at autopsy, was observed by transmission electron microscopy. The roles of the epithelium, subepithelial space, vasculature, and ES leukocytes were morphologically studied to evaluate possible immunologic functions of the human ES. In addition, five intraosseous ES biopsies from patients undergoing translabyrinthine acoustic neuroma resection were studied using the immunoperoxidase technique to identify specific leukocyte subpopulations. Evidence of phagocytic activity included the presence of phagocytic epithelial cells, monocytes, macrophages, and polymorphonuclear leukocytes. Immune surveillance was suggested by intraepithelial and subepithelial T-lymphocytes, numerous fenestrated blood vessels, and the presence of a homogeneously staining substance within the lumina of ES epithelial tubules. No B-lymphocytes were found. The findings support the existence of a local immune system of the normal human inner ear.
Cross-Reactive Antibodies in Type B and Nontypeable Hemophilus Influenzae-Induced Experimental Otitis Media
Authors: Yamaguchi Tatsuji , DeMaria Thomas F. , Lim David J.
Published: October 2014

Cross-reactive antibodies directed against type b (TBHI) or serologically nontypeable (NTHI) strains of Hemophilus influenzae were investigated in experimental otitis media. Cross-reactive antibody to TBHI was demonstrated in sera and middle ears from chinchillas infected with an NTHI, and cross-reactive antibody to NTHI developed in sera and middle ears of chinchillas challenged with TBHI. The absorption test data presented indicate that the sera and middle ear effusions from chinchillas challenged with either TBHI or NTHI had not only specific antibody activity to the challenged strain but also antibody activities against the probable common cell antigens of H influenzae. These data indicate that it may be possible to develop a polyvalent vaccine effective against the various and divergent strains of H influenzae, including the serologically nontypeable isolates.