bluuebunny/crossref_metadata_2025 huggingface dataset:
Experimental Alteration of Chinchilla Middle Ear Mucosae by Bacterial Neuraminidase
Authors: LaMarco Karen L. , Diven Warren F. , Glew Robert H.
Published: October 2014

Streptococcus pneumoniae secretes a variety of extracellular glycosidases including a neuraminidase which has been found in middle ear effusion from patients with both acute and chronic otitis media. This enzyme cleaves sialic acid from membrane glycoproteins, thereby exposing galactose residues, the penultimate sugar. The ability of partially purified neuraminidase to alter the middle ear mucosa was investigated in the chinchilla. After incubation with neuraminidase, chinchilla middle ears were removed and exposed to galactose residues labeled with tritium. Membrane glycoproteins were solubilized and separated according to molecular weight by sodium dodecylsulfate electrophoresis. Increases in tritium incorporation, when compared to control incubations, indicated that galactose residues had been exposed and sialic acid residues removed from glycoproteins of both high and low molecular weight. Such membrane destruction could contribute significantly to the pathology of otitis media with effusion.
Middle Cranial Fossa Acoustic Neuroma Excision: Results and Complications
Authors: Gantz Bruce J. , Harker Lee A. , Parnes Lorne S. , McCabe Brian F.
Published: October 2014

The middle cranial fossa surgical approach has been used for the removal of acoustic neuromas in 43 patients at the University of Iowa since 1974. Hearing was maintained in 50% of patients with tumors 1.5 cm or less outside the porus acusticus. Postoperative hearing, facial nerve function, and complications were similar to reports using the suboccipital or retrosigmoid approach to preserve hearing for this size tumor. The character of the tumor appears to dictate the postoperative outcome rather than the surgical approach.
Histologic Findings in Two Very Small Intracanalicular Solitary Schwannomas of the Eighth Nerve
Authors: Neely J. Gail , Hough Jack
Published: October 2014

Two very small intracanalicular tumors, resected en bloc with the complete eighth nerve, were serially sectioned in order to study the relationship between the tumors and the nerves of origin. Both cases met the size criteria for hearing conservation surgery; however, the patient with the smaller tumor and the better hearing had no recognizable cochlear nerve fibers passing the tumor. The cochlear nerve in the patient with poorer hearing was completely free of tumor. The tumor with the infiltrated cochlear nerve seemed to originate from the inferior vestibular nerve. The other tumor seemed to arise from the superior vestibular nerve. Proximally, the tumors occupied a more central location in the involved nerves, but they abruptly became eccentric and exophytic as they proceeded laterally. Nerve fibers remaining about the tumors were displaced to the periphery. These nerve fiber aggregates became quite thin and attenuated, frequently separating into smaller aggregates which, ultimately, were incorporated into the tumors. As fibers came closer to the tumors, they tended to change from their longitudinal direction toward a more circumferential orientation about the surface of the tumors. The tumor-nerve fiber interfaces were quite variable throughout the course of the tumor, ranging from large aggregates of nerve fibers distinctly separate from the tumors to aggregates separate but tightly applied to the tumors without a tissue plane between, to aggregates partially incorporated within the periphery of the tumors, to aggregates completely incorporated into the periphery of the tumors. Frequently several types of interfaces were seen in the same section. These findings showed that in one case the cochlear nerve could have been surgically separated from the acoustic tumor; in the other specimen, it could not have been separated. It was impossible to predict between the two. In these two very small tumors, the gross specimen observation correlated reasonably well with the histology, thus suggesting that intraoperative observation may be a predictor in hearing conservation surgery; however, previous studies in slightly larger tumors make this an extremely guarded concept.
Long-Term Results of Concurrent Polychemotherapy and Radiotherapy in Patients with Stomal Recurrence after Total Laryngectomy
Authors: Balm A. J. M. , Versluis R. J. J. , Snow G. B. , Njo K. H. , Karim A. B. M. F. , Tiwari R. M.
Published: October 2014

From 1978 through 1985, eight patients with stomal recurrence after total laryngectomy were treated with a combination of a cytotoxic regimen (vincristin sulfate, bleomycin, and methotrexate [VBM]) and radiotherapy. The essential feature of this combination is the synchronous administration of pulses of VBM and fractionated doses of external radiotherapy in order to achieve potentiation of radiotherapy. On average, four to five pulses of VBM were given. Severe mucositis is the main problem during treatment. Two patients needed nasogastric tube feeding, and treatment was carried out as an inpatient procedure. Five patients are alive with complete local remission at 7 years, 3 years, 2 ½ years, 14 months, and 8 months after treatment. These results appear to be spectacular, even though the number of patients is small. Of the three patients who died, only one had recurrent disease around the tracheostoma. The two other patients were free of disease in the neck when they died 6 and 16 months after treatment of, respectively, lung metastases and a second primary tumor in the lung. Patients with stomal recurrence after total laryngectomy are now routinely treated with synchronous VBM and radiotherapy.
Estrogen Receptor in the Larynx of the Aged Baboon (Papio Cynocephalus)
Authors: Holt G. Richard , Aufdemorte Thomas B. , Sheridan Peter J.
Published: October 2014

Using autoradiographic techniques, tritiated estrogen-receptor complex intranuclear labeling was identified in certain laryngeal tissues of four aged female baboons; no complex labeling was found in the control animal. Three significant findings were felt to be derived from this study. One, surface epithelium of the larynx had essentially no estrogen-receptor activity. Two, all tissues of mesenchymal origin, especially lamina propria, muscle, dense connective tissue, and fat had consistently high levels of nuclear localization of the labeled estrogen. The binding affinity seemed to be the highest at the anterior commissure and the immediate anterior subglottic space. Three, there was a high level of receptor binding in laryngeal cartilage and perichondrium. Since the activated hormone-receptor complex modulates gene expression to alter the amount of mRNA, sex steroids have a direct regulatory effect upon the target cell and, perhaps through an induction process, can exert an indirect effect upon adjacent tissues. It is postulated that since the larynx is a sexually dimorphic organ, the sex steroids and their receptors may play a role in altered phonation during aging and possibly in the development of laryngeal neoplasms and other diseases. Therefore, hormonal manipulation may play a future role in the therapy of laryngeal diseases. This study represents the first demonstration of estrogen receptors by specific anatomic location in the primate larynx with significant localization in the mesenchymal tissues but not in the epithelial tissues.
Vocal Cord Paralysis in Small Children: Principles in Management
Authors: Tucker Harvey M.
Published: October 2014

Vocal cord paralysis in children is an uncommon but often disabling problem. It may be congenital or acquired either in the immediate period surrounding birth or as a postpartum event. Because even unilateral vocal cord paralysis can result in severe respiratory distress in the newborn and in small children, recognition of this problem can be critical. A logical approach to diagnosis and management requires not only that the physician be alert to the problem but also that several procedures be established that can be used together or singly to address the problem, as is most appropriate to the individual case. The usefulness of intubation, tracheotomy, surgical lateralization of the vocal folds, and reinnervation in the management of these problems is discussed, and 30 cases of vocal cord paralysis in children under the age of 5 years are presented.
Vascular Tumors of the Salivary Glands
Authors: Batsakis John G.
Published: October 2014

Tumors of a vascular origin in the major salivary glands are nearly always hemangiomatous, rarely malignant, occur most often in the parotid glands, and are found predominantly in newborns and infants.
Intravenous Anesthesia and Jet Ventilation for Laser Microlaryngeal Surgery
Authors: Gussack Gerald S. , Evans Robert F. , Tacchi Ernest J.
Published: October 2014

Competition between otolaryngologists and anesthesiologists for the limited space of the airway results in compromised control for both concerns. The surgeon desires an unobstructed view, whereas the anesthesiologist must ensure adequate ventilation. The drawbacks of standard methods include inadequate airways, inadequate visualization, and operating room contamination from inspired gases. Since 1984, we have developed a technique utilizing jet ventilation delivered through a metal delivery system providing a relatively safe, ignition-free environment. A total intravenous anesthetic technique is used to avoid any environmental contamination. The newer short acting, high potency narcotic, sufentanil citrate, combined with a short acting muscle relaxant, atracurium besylate or vecuronium bromide, have made this technique an ideal one for our needs. The pulse oximeter provides an invaluable margin of safety. This technique has been employed in 36 microlaryngeal procedures performed on 21 patients with a uniformly smooth perioperative course and only one complication. The technique, possible pitfalls, and applications are discussed.
Current Management of Lesions of the Pediatric Larynx
Authors: Healy Gerald B.
Published: October 2014

A variety of congenital and acquired lesions of the larynx are now managed effectively with the use of the carbon dioxide laser. This instrument seems to be the most effective of all available lasers for this type of therapy. Argon and neodymium:yttrium aluminum garnet lasers do not appear appropriate for such lesions for several reasons. On occasion, patients with congenital and acquired subglottic stenosis, as well as those afflicted with rare tumors of the larynx, require open procedures as part of their treatment regimen. The need for appropriate equipment and competent pediatric anesthesia is paramount when undertaking cases of this type. These patients offer unique challenges to a laryngologist, but correction of their problems is effectively managed by appropriate application of current technology.
Isolation and Characterization of Papillomavirus DNA from Nasal Inverting (Schneiderian) Papillomas
Authors: Respler Don S. , Jahn Anthony , Pater Alan , Pater Mary M.
Published: October 2014

To elucidate the possible role of papillomaviruses as etiological agents in nasal inverting papillomas, DNA hybridization techniques were used. Total DNA from two nasal inverting papillomas was examined for the presence of DNA from human papillomavirus (HPV) types 6 and 11 under stringent conditions of hybridization. Both lesions contained DNA hybridizing with HPV 11. Restriction enzyme digestion and subsequent Southern blotting of the DNA samples revealed that one lesion contained viral DNA identical to HPV 11a. The DNA of the other lesion contained an extra 500 base pair insertion. These results provide definitive evidence for the first time for the association of HPV with nasal inverting papillomas.
Postnatal Development of the Eustachian Tube and its Surrounding Structures Preliminary Study
Authors: Kitajiri Masanori , Sando Isamu , Takahara Tetsuo
Published: October 2014

The postnatal development of the eustachian tube and its surrounding structures (tubal cartilage, tubal gland, tensor veli palatini muscle, and levator veli palatini muscle) was investigated in serial vertical histologic sections from 12 normal temporal bones of individuals whose ages ranged from 39 weeks' gestation to 19 years of age. After projecting tissue sections onto paper and tracing the structures, several measurements were made in order to analyze this development. Findings revealed that 1) the eustachian tube and its accessory structures developed postnatally up to the age of 19 years. 2) The lumen area in a 19-year-old specimen was 4.7 times that of the 1-day-old infant. The development of the tube was greatest in the pharyngeal part. Postnatal development of the eustachian tube appears to be related to growth of the face. 3) The cartilage area in the 19-year-old specimen was 3.6 times that of the 1-day-old infant. 4) The mucosal acinar cells were predominant in infants but no greater than the number of serous acinar cells by the age of 19 years. 5) The areas of the tensor and levator veli palatini muscles in a 19-year-old specimen were 5.1 and 11.1 times, respectively, those of the 1-day-old infant. This preliminary study reports the postnatal development of the eustachian tube and its accessory structures, a subject never thoroughly investigated to date. However, because of the limited number of cases available, further investigation of a greater number of cases should be performed so that the relationship between tubal development and alterations in function that occur with age can be understood clearly.
Progressive Hearing Loss from Strial Dysplasia
Authors: Hashimoto Sho , Schuknecht Harold F.
Published: October 2014

An otherwise healthy male patient had a bilateral, slowly progressive hearing loss first noticed in early childhood and possibly present at birth. Audiometric studies at the age of 32 showed a moderately severe, bilateral, mixed type hearing loss. He died of unrelated causes at the age of 34. Studies of the temporal bones showed bilateral hypoplasia and atrophy of the striae vascularis as the cause of hearing loss. The history and findings are consistent with a genetically determined hypoplasia and atrophy of this structure.
Carcinoma Ex Papillary Cystadenoma Lymphomatosum
Authors: Batsakis John G.
Published: October 2014

Epithelial malignancy in a Warthin's tumor exists in three forms. The most common is a coexistent, separate neoplasm. Metastasis to the lymphoid component of Warthin's tumor follows, and the least common is a primary carcinoma arising from the ductal component of the tumor.
Comparison of Surgical Techniques in the Treatment of Laryngeal Polypoid Degeneration
Authors: Lumpkin Samuel M. M. , Bishop Sandra G. , Bennett Suzanne
Published: October 2014

Surgical excision has been the accepted treatment of laryngeal polypoid degeneration, or chronic polypoid corditis. We report on 29 women with polypoid degeneration who received one of three surgical treatments: Vocal fold stripping, carbon dioxide laser obliteration, or the Hirano technique. The duration of postoperative dysphonia was longest with the laser removal and shortest with the Hirano technique. A combination of vocal hygiene management and the Hirano technique of removal provided the most efficacious treatment.
Voice Rehabilitation Practices among Head and Neck Surgeons
Authors: Lopez Marvin J. , McElroy T. Hewitt , Kraybill William , Guerra Oscar
Published: October 2014

Voice rehabilitation practices among head and neck surgeons were surveyed to determine the proportional contribution of various methods of speech support and the impact of recent developments in this field. Of the 400 head and neck surgeons contacted, 212 (53%) responded and 196 provided data. Noninvasive methods of speech support continue to predominate in this country. Esophageal speech is used by all surgeons in some of their patients. The introduction of tracheoesophageal puncture techniques for prosthetic placement has added a new dimension to speech rehabilitation and is used almost 30% of the time by those who use it (88% of surgeons surveyed). The proportional use of the most common methods of speech support is almost identical between head and neck surgeons of a general surgical background and otolaryngologists. The incidence of total failures to achieve voice rehabilitation is less than 10 %.
Primary Ciliary Dyskinesia: Quantitative Investigation of the Ciliary Ultrastructure with Statistical Analysis
Authors: van der Baan S. , Bezemer P. D. , Veerman A. J. P. , Feenstra L.
Published: October 2014

In this study the ultrastructure of cilia in patients with primary ciliary dyskinesia was compared to that in patients with other respiratory infections and with that in healthy individuals. After statistical anaJysis of the findings, the prevalence and the specificity of morphological changes in primary ciliary dyskinesia were established. Guidelines were developed by which the existence of primary ciliary dyskinesia can be ascertained in biopsies of nasal mucosa via transmission electron microscopy.
Monitoring of the Glycerol Test with Sinusoidal Harmonic Acceleration in Meniere's Disease Patients
Authors: Ballad William J. , Clemis Jack D.
Published: October 2014

Changes in auditory pure tone threshold and speech discrimination and the phase and gain in the sinusoidal harmonic acceleration test were measured in subjects with endolymphatic hydrops (Meniere's disease) following the administration of glycerol. Although all subjects showed a marked improvement in auditory function, a comparable change in vestibular function, as measured by the sinusoidal harmonic acceleration test, was not observed.
Mesenchyme Remaining in Temporal Bones from Patients with Congenital Anomalies
Authors: Takahara Tetsuo , Sando Isamu
Published: October 2014

Our hypothesis that more mesenchyme remains for a longer time in the middle ear clefts of infants with congenital anomalies in the ear and/or other parts of the body than in the ears of infants without such anomalies has been tested. One hundred four human temporal bones obtained from 81 individuals with congenital anomalies in the ear and/or other parts of the body, with ages ranging from 24 weeks' gestation to 35 years, were processed histologically, stained with H & E, and examined under the light microscope. The slides were projected under a microprojector, and the mesenchyme remaining in each of 19 portions of the middle ear cleft was measured by compensating polar planimetry and expressed as a percentage of the total potential middle ear space in that histologic section. By comparing the findings in the present study with those of a previous study in which mesenchyme remaining in ears from normal age-matched controls was measured, we found that more mesenchyme remained for a longer time in the middle ear cavities of infants with congenital anomalies than in those of control infants (p<.01). In addition, the amount of mesenchyme remaining was in direct proportion to the degree to which development of the middle ear was anomalous.
Non-Hodgkin's Lymphoma of the Larynx in Children
Authors: Cohen Seymour R. , Thompson Jerome W. , Siegel Stuart E.
Published: October 2014

Non-Hodgkin's lymphomas (lymphosarcomas) of the larynx are rare occurrences in children. This paper reports a child 9 years 3 months of age with isolated non-Hodgkin's lymphoma of the larynx, and gives a 15-year follow-up report of a previously published case of a child 4 years 7 months of age. Both children presented with the chief complaint of progressive airway obstruction, and both cases were misdiagnosed, as chronic allergic epiglottitis in the first patient, and nonresponsive croup in the second patient. Once we established a histologic diagnosis and excluded disseminated disease, we instituted treatment with local irradiation and systemic multiagent chemotherapy. Complete remission was achieved, and the two patients have been free of disease since their treatments were started 2 years and 9 years ago, respectively.
Esophageal Reflux and Dysmotility as the Basis for Persistent Cervical Symptoms
Authors: Ossakow Steven J. , Elta Grace , Colturi Thomas , Bogdasarian Ronald , Nostrant Timothy T.
Published: October 2014

To examine a possible esophageal basis for cervical symptoms, we studied 63 patients with persistent cervical complaints, 36 patients with gastroesophageal reflux but no cervical symptoms, and ten normal subjects. Patients were evaluated for a history of pyrosis and regurgitation and underwent otolaryngologic examination, barium esophagram, upper endoscopy, esophageal biopsy, standard esophageal manometrics, acid reflux testing, and Bernstein examination, as well as tests of esophageal dysmotility and acid clearance time before and after bethanechol (50 μg/kg, two doses). Standard diagnostic examinations usually were normal in patients with cervical symptoms. Pyrosis, regurgitation, and a positive Bernstein examination were uncommon in patients with cervical symptoms. This occurred despite frequent acid reflux (68%) and poor acid clearance (79%). Esophageal dysmotility also was common (63%). Patients with reflux but no cervical symptoms and normal subjects had a normal acid clearance time, and dysmotility was unusual (8%). We conclude that patients with cervical symptoms have diminished esophageal sensitivity despite frequent and long acid exposure. The pathophysiologic significance of this observation is discussed.
Supraglottitis and Hemophilus Parainfluenzae: Pathogenic Potential of the Organism
Authors: Dudley James P.
Published: October 2014

Hemophilus parainfluenzae may be a normal inhabitant of the pharynx, but it can have pathogenic potential elsewhere in the body. It has been identified as a cause of bacteremia and meningitis. The case discussed here represents the first report of H parainfluenzae-induced supraglottis in a child. In reviewing its pathogenic potential in the upper respiratory tract, it appears that its major effect could be the ability to transfer ampicillin resistance to ampicillin-susceptible Hemophilus influenzae.
Wound Healing of Canine Vocal Folds after Phonosurgery
Authors: Okamura Hiroshi , Yumoto Eiji , Okamoto Kazunori
Published: October 2014

To develop phonosurgical techniques, the authors investigated the healing mechanisms of wounds on the vocal folds of canine larynges, and devised a method to cover the raw surfaces of such wounds. To restore the normal physiologic properties of the vocal folds, the normal mucosa should be removed as little as possible in phonosurgery. When the mucosa of the vocal folds is extensively removed by surgical intervention and the raw surface cannot be covered with the local pedicle flap, it should be covered with a free mucosal flap. We found an activated human fibrinogen concentrate, which is a biologic tissue adhesive, to be suitable for adhering a free mucosal flap to the raw surface by a laryngomicrosurgical approach.
Histologic and Histochemical Study of Effects of Anabolic Steroids on the Female Larynx
Authors: Talaat M. , Angelo A. , Talaat A. M. , Elwany S. , Kelada I. , Thabet H.
Published: October 2014

The larynges of 30 unmated, mature female albino mice were examined histologically and histochemically after injecting them with 19-nandrolone phenylpropionate. Permanent irreversible changes, in the form of parakeratosis and squamous metaplasia of the epithelium, and hypertrophy of the muscle fibers, were observed together with persistence of increased alkaline phosphatase enzyme intensity in the endothelium of capillaries and increased activity of nonspecific esterase in the muscles. Similar changes may be responsible for the alteration in the human female's voice after prolonged treatment with anabolic steroids.
New Endoscope for (Laser) Endoscopic Diverticulotomy
Authors: Holinger Lauren D. , Benjamin Bruce
Published: October 2014

In the United States, traditional treatment of the hypopharyngeal (Zenker's) diverticulum has been single stage transcutaneous diverticulectomy. Complications following this procedure include mediastinitis, vocal cord paralysis, esophageal stenosis, fistula, and recurrent or persistent diverticulum. Endoscopic diverticulotomy, widely used throughout Europe, is relatively straightforward and efficacious. Transoral management of these diverticulae has allowed symptomatic relief with a low incidence of complications. A new endoscope has been developed to facilitate use of the carbon dioxide laser for endoscopic diverticulotomy. The instrument combines the characteristics of the Dohlman endoscope (bilateral distal slots) with a wider proximal end for microscopic endoscopy, a smoke evacuator channel, a fiberoptic light carrier, and a handle adaptable for suspension microendoscopy.
Nontraumatic Subluxation of the Atlantoaxial Joint: Grisel's Syndrome
Authors: Wilson Brian C. , Jarvis Bennie L. , Haydon Richard C.
Published: October 2014

Grisel's syndrome is defined as subluxation of the atlantoaxial joint not associated with trauma or bone disease. Primarily an affliction of children, the disorder may occur in association with any condition that results in hyperemia and pathologic relaxation of the transverse ligament of the atlantoaxial joint, including several common otolaryngic entities. Grisel's syndrome has been noted infrequently in the otolaryngologic literature; this paper reports a case from West Virginia University Hospital of a 6-year-old boy with radiographic evidence of retropharyngeal cellulitis following meningitis progressing to atlantoaxial subluxation. Discussed are the pathophysiologic aspects of Grisel's syndrome with an anatomic explanation recently described to account for the syndrome.
Cochlear Hair Cell Loss in Ears with Cholesteatomas Scanning Electron Microscopy Study
Authors: Chole Richard A. , Chiu Maggie
Published: October 2014

Cochleas from 16 Mongolian gerbils with spontaneous aural cholesteatomas, and four of similar age without cholesteatomas, were examined by scanning electron microscopy to quantify cochlear hair cell loss. Loss of hair cell stereocilia was found in all ears with cholesteatomas and was increased when compared with uninvolved ears from animals of similar age. The hair cell loss assorted with gerbilline cholesteatomas appeared to be most marked in the middle turn of the cochlea and increased in severity with increasing size of the cholesteatomas. Outer hair cells were affected more than inner hair cells. Inner and outer hair cell loss was not significantly different infected cholesteatomas versus sterile cholesteatomas. The greater damage to hair cels at the middle turn compared to the basal turn suggests that these losses may be the result of some agent acting through the cochlear wall rather than through the round window.
Stapedial Electromyograms Recorded by Electrocochleography
Authors: Yagi Nobuya , Nakatani Hiroaki
Published: October 2014

The stapedial reflex (SR) can be obtained by the impedance method only when the middle ear is intact. In order to examine the function of the stapedius muscle in diseased ears, the recording of the stapedial electromyogram by an electrocochleographic (ECoG) method was considered. The SR was recorded simultaneously by the impedance method in ten normal subjects for comparison. The outputs of ECoC were averaged by a signal processor up to 200 times under a longer sweep time, and a large biphasic wave with a latency of about 11 ms was obtained on the ECoC records. The amplitude increase of the biphasic wave caused by raising the intensity of the acoustic stimulation paralleled that of the SR. This means that the biphasic wave obtained by ECoC with a latency of about 11 ms originated from the stapedius muscle.
Perilymph Fistula: The Stanford Experience
Authors: Shelton Clough , Simmons F. Blair
Published: October 2014

Seventy-eight tympanotomies were performed to determine the presence of perilymph fistulas (PLFs); of these, 51 % were found. The oval and round windows of all patients were grafted, whether PLFs were present or not. Of those patients with PLFs, 64 % had resolution of their major symptom; when no PLF was found, 44% had a similar outcome. We concluded that 1) PLFs often behave as if they are epiphenomena in relation to hearing and balance, 2) PLFs can be intermittent, 3) PLF surgery is disappointing for restoration of hearing in sudden hearing loss when compared to the rate of spontaneous recovery, 4) stabilizing a fluctuating or progressive loss is a more realistic goal, and 5) establishing preoperative criteria for exploration is still a problem.
Patent Eustachian Tube in the Underaerated Middle Ear: A Paradox
Authors: Buckingham Richard A.
Published: October 2014

Secretory otitis media, middle ear atelectasis, and retraction type cholesteatomas are the most frequently occurring chronic middle ear diseases; and eustachian tube obstruction and the generation of negative or less than atmospheric middle ear pressure is said to be an essential factor in the pathogenesis of these diseases. It has been found that habitual sniffing causes high degrees of negative middle ear pressure in diseased ears; this finding demonstrates eustachian tube patency rather than obstruction. Ears intubated for chronic secretory otitis media, middle ear atelectasis, and cholesteatoma were examined to identify patent eustachian tubes. More than one third of the patients aspirated a solution into the middle ear with one or more sniffs by aspirating air from their middle ears, demonstrating eustachian tube patency rather than obstruction.
Subperiosteal Mastoid Abscesses in Chronic Suppurative Otitis Media
Authors: Ibekwe A. Olu , Okoye Benjamin C. C.
Published: October 2014

In Europe and America, acute mastoiditis usually appears as a complication of acute otitis media, and some patients develop subperiosteal mastoid abscesses. In Nigeria, however, most subperiosteal mastoid abscesses develop from chronic otitis media with cholesteatoma. Of the 16 patients with subperiosteal mastoid abscesses discussed, 11 (69 %) had cholesteatoma and only five (31 %) had granulation tissue in the mastoid cavity. The ideal treatment for these cases is modified radical mastoidectomy. Radiographic investigation of the mastoid can be useful in the diagnosis of cholesteatoma in the presence of a subperiosteal mastoid abscess.
Alpha-Interferon (Wellferon) as an Adjunct to Standard Surgical Therapy in the Management of Recurrent Respiratory Papillomatosis
Authors: Benjamin Bruce N. , Harrison Henley , Gatenby Paul A. , Cameron Kaye , Kitchen Robert , Basten Antony
Published: October 2014

Ten patients received lymphoblastoid alpha-interferon (Wellferon) in a crossover study so that Wellferon and standard microsurgical laryngeal laser therapy could be compared to laser therapy alone. Wellferon was administered initially at an intravenous high dose of 15 megaunits/m2 for 5 days followed by a daily dose of 2 megaunits/m2 subcutaneously for 6 months. Dosage was adjusted according to predefined toxicity. One patient was withdrawn from the study. Of the others, all but one received over 75 % of the planned total dose. At follow-up of the nine assessable patients, complete remission was achieved in two of them, partial remission in four, and no response in the remainder. The two complete remissions were sustained for 2 years, but the four partial remissions were not sustained. Thus, a role for alpha-interferon in the kind of regimen used here remains to be established.
Functional Disorder of Eustachian Tube in Experimental Otitis Media with Effusion following Inoculation of Bacterial Endotoxin
Authors: Nakai Yoshiaki , Esaki Yusuke , Ohashi Yoshihiro , Ikeoka Hiroshi , Kato Shoko , Koshimo Hiroyuki , Kato Motoaki
Published: October 2014

A 10-μg/mL solution of lipopolysaccharide derived from Klebsiella pneumoniae was inoculated into the middle ears of guinea pigs. The animals were killed painlessly on the first, third, or seventh day after inoculation, and the mucosal samples from the bony portion of the eustachian tube were examined for ciliary activity and epithelial morphology. On the first and third days, when middle ear effusions were present, deterioration of ciliary activity and morphologic changes in the mucociliary system were observed. On the seventh day, when middle ear effusions were absent, the ciliary activity had recovered to normal. Our data show that endotoxin extracted from K pneumoniae can produce otitis media with effusion and that dysfunction of cilia caused by endotoxin is a factor responsible for the manifestation of otitis media.
Congenital Stenosis of the Lower Esophagus Associated with Leiomyoma and Leiomyosarcoma of the Gastrointestinal Tract
Authors: Cohen Seymour R. , Thompson Jerome W. , Sherman Neil J.
Published: October 2014

The purpose of this paper is to report our analysis of four generations of a family with congenital strictures of the lower esophagus associated with leiomyoma of the gastrointestinal tract. Two members of the family died of sarcomatous degeneration of the leiomyoma and one is still alive 2 years after resection of the malignancy. Three family members had surgical repair of the congenital stricture. Surgical repair was unnecessary in one, for whom repeated dilatations alleviated the symptoms. Since there were no direct female descendants in this family, it is unknown whether this hereditary disease is carried by a sex-linked dominant gene. There are no reports in the literature of a familial tendency to congenital strictures of the esophagus, nor are there any reports of strictures in association with gastrointestinal leiomyoma and the later development of sarcomatous degeneration. The literature is reviewed, syndromes of leiomyoma of the esophagus and gastrointestinal tract are detailed, the particulars of the family tree and the patients are described, and the study is summarized.
Computed Tomography in Determining Laryngeal Involvement of Hypopharyngeal Carcinoma
Authors: Hirano Minoru , Cho Jae Shik , Kurita Shigejiro , Tanaka Hisashi
Published: October 2014

In 22 patients with hypopharyngeal carcinoma, the extent of laryngeal involvement was estimated preoperatively by means of computed tomography and visual inspection including mirror examination and fiberscopic and strobofiberscopic video recordings. All patients underwent laryngopharyngectomy, and the surgical specimens were subjected to a whole organ section study. The results of the preoperative evaluations were related to the histopathologic findings. Computed tomography was reliable for the estimation of paraglottic space involvements. It was also useful in detecting carcinomatous invasion into the preepiglottic space and aryepiglottic fold, but there were some false positives for these structures. It was not always reliable in assessing invasion of the laryngeal cartilages. It provided a very accurate estimation of involvement for the thyroarytenoid muscle and a considerably accurate assessment for the lateral cricoarytenoid and interarytenoid muscles and the recurrent laryngeal nerve. It was useful in detecting involvement of the posterior cricoarytenoid muscle, but there were a fair number of false positives. For the cricothyroid muscle, the estimation based on CT was not very reliable. Some erroneous judgments on CT were corrected in a comprehensive evaluation that included visual inspection.
Universal Ventilation Laser Tracheoscope
Authors: Shapshay Stanley M. , Beamis John F. , McDonald Ellen
Published: October 2014

A universal ventilation laser fiberoptic tracheoscope has been developed for use in endoscopic treatment of patients with obstructing benign and malignant lesions of the subglottis-cervicotrachea and laryngectomy tracheal stoma. This instrument features a ventilation connector for either side port or Venturi jet ventilation and a proximal connector with a sheath for delivery of a 0° telescope, laser fiber, and suction catheter. Difficulties encountered with exposure and ventilation during laser treatment of the subglottis-cervicotrachea and laryngectomy stoma are overcome with this new instrument.
Invasion of Cranial Nerves and Brain Stem by Herpes Simplex Virus Inoculated into the Mouse Tongue
Authors: Thomander Lars , Aldskogius Hakan , Vahlne Anders , Kristensson Krister , Thomas Eva
Published: October 2014

Herpes simplex virus type 1 (HSV) of a highly or slightly neuropathogenetic strain was inoculated into the tongues of mice. After appropriate survival times, the animals were killed and portions of the facial and trigeminal nerves as well as the brain stem were examined with virus isolation and immunocytochemistry for the presence of HSV. Both virus strains were demonstrated in the geniculate and trigeminal ganglia and in the CNS portion of the facial and trigeminal nerves, as well as in various brain stem areas including the trigeminal tract and nucleus, the facial and hypoglossal nuclei, and nuclei in the reticular formation. The results indicate that HSV is transported to the CNS by efferent and afferent axons of the tongue and subsequently via transneuronal passage to various brain stem nuclei. These findings provide an anatomic basis for a putative relationship between HSV and cranial nerve dysfunction.
Otologic Disease in Patients with Acquired Immunodeficiency Syndrome
Authors: Kohan Darius , Rothstein Stephen G. , Cohen Noel L.
Published: October 2014

A 5-year retrospective study evaluating otologic disease in patients with acquired immunodeficiency syndrome (AIDS) was conducted at the New York University Medical Center-Bellevue Hospital Center. Twenty-six patients with documented otologic disease who met the Centers for Disease Control criteria for AIDS were identified and their charts were analyzed according to presenting complaints, physical examination, diagnostic modalities, pathologic condition, management, and outcome. A marked diversity of otologic diseases of varying severity was noted. The majority of patients complained of hearing loss and otalgia during their hospitalization for treatment of AIDS-related opportunistic infections. The most frequent diagnoses were otitis externa, acute otitis media, and otitis media with effusion. Sensorineural hearing loss frequently appeared to be related to ototoxic medications and neurologic infections.
Osteoclasts in Chronic Otitis Media, Cholesteatoma, and Otosclerosis
Authors: Chole Richard A.
Published: October 2014

Bone resorption and remodeling are characteristic of chronic otitis media with and without cholesteatoma and otosclerosis. The consequences of this remodeling process may be hearing loss, repeated infection, vestibular disturbance, or intracranial complications. Evidence of osteoclastic bone resorption was found in surgical specimens of 11 of 24 cases of cholesteatoma, two of three cases of chronic otitis media, and three of ten cases of otosclerotic stapes; all three spongiotic lesions had osteoclasts. With careful serial sectioning these cells are almost always multinucleate and have the typical appearance of osteoclasts with ruffled borders. Some specimens had evidence of bone erosion in the absence of osteoclasts; this finding represents an inactive phase of the remodeling process. Since the osteoclast plays an important role in the resorption and remodeling of bone in these middle ear diseases, the source, physiology, and local control of these cells are of prime importance in investigating the pathophysiology of these diseases. At the present time, the local control of activation and recruitment of osteoclasts, as well as their chemotactic responses, is poorly understood.
Reconstructive Techniques for Tympanosclerosis
Authors: Austin David F.
Published: October 2014

Tympanosclerosis is found in more than 30% of patients with chronic ear disease. Clinically significant tympanosclerosis is defined as that affecting the surgical procedure by requiring removal to effect a hearing improvement. This type is seen in less than half of all patients with tympanosclerosis. The incidence and patterns of involvement are documented for 352 of the author's surgical patients subdivided into two groups: One operated on in the early 1960s and another observed more than 15 years later. The surgical techniques employed for hearing restoration are described, as are the hearing results obtained. The findings would indicate that tympanosclerosis is amenable to surgical correction, with a success rate approximately that of nontympanosclerotic ears. The special techniques needed to avoid complications when the disease invades the oval window are emphasized.
Malignant Rhabdoid Tumor
Authors: Batsakis John G. , Manning John T.
Published: October 2014

Immunocytochemistry and electron microscopy have allowed more precise identification and classification of neoplasms formerly considered as representatives of other groups. The malignant rhabdoid tumor is one example. Principally neoplasms of the kidney, rhabdoid tumors present uncommonly in the head and neck, where because of the age of the patients and the neoplasms' resemblance to rhabdomyosarcoma, misdiagnosis is possible and likely. Wherever it arises, the lesion is usually fatal
Laryngeal Framework Surgery in the Management of Spasmodic Dysphonia
Authors: Tucker Harvey M.
Published: October 2014

Spasmodic dysphonia continues to be a management problem for otolaryngologists. Selective lysis of the recurrent laryngeal nerve has been useful in the management of this disease. Reported long-term results, however, reveal that spasm recurs in approximately 40% to 50% of initially successful patients in spite of persistence of the unilateral vocal fold paralysis. Although some of these failures can be recaptured with subsequent laser surgery, the overall “cure” rate does not exceed 70%, even in the best hands. The contributions of Isshiki, LeJeune, and Tucker have demonstrated that tension in the vocal folds can be adjusted by laryngeal framework surgery. Experience with 16 patients suffering from adductor spasmodic dysphonia suggests that laryngeal framework surgery is useful in the management of this disorder.
Voice Restoration following Laryngectomy: The Role of Primary versus Secondary Tracheoesophageal Puncture
Authors: Wenig Barry L. , Levy Joan , Mullooly Virginia , Abramson Allan L.
Published: October 2014

A protocol was established at our institution to compare a series of primary and secondary tracheoesophageal punctures using the Singer-Blom voice prosthesis. Over a 24-month period, 20 primary and 18 secondary punctures were performed. Voice production, fluency of voice, and functional use were graded. Our data support the use of both primary and secondary voice restoration following laryngectomy.
Botulinum Toxin Injection for the Treatment of Oromandibular Dystonia
Authors: Blitzer Andrew , Greene Paul E. , Brin Mitchell F. , Fahn Stanley
Published: October 2014

Dystonia is a neurologic disorder characterized by abnormal, involuntary movements causing twisting and turning postures; it is postulated to be a disorder of central motor processing. The dystonias, when classified by region of the body involved, have been characterized as focal, segmental, and generalized. Focal dystonia can affect jaw mechanics, leading to forceful contraction of the jaw muscles and resulting in inappropriate deviation of the jaw. Localized injections of botulinum toxin have been used successfully in the management of other focal or segmental dystonias. We have treated 20 oromandibular dystonia patients with botulinum toxin. Six patients had only jaw and tongue involvement; 11 had blepharospasm and jaw involvement; and three had jaw involvement as part of a more generalized dystonia. Five patients had been diagnosed originally and treated as having temporomandibular joint syndrome. All but one of the patients had improvement of their symptoms with the toxin injections. The patients averaged 47% improvement with the injections.
Current and Future Horizons in Laryngeal and Voice Research
Authors: Ward Paul H. , Gerratt Bruce R. , Hanson David G. , Berke Gerald S.
Published: October 2014

Voice dysfunction is associated with neuromuscular impairment of laryngeal control and is often difficult to diagnose by indirect examination of the larynx. The newer techniques, currently used in the UCLA—Veterans Administration Medical Center Laboratories, provide some methods that aid in the diagnosis of voice impairment by providing documented objective data. Illustrative case reports of disorders of neuromuscular dysfunction of the larynx are presented and future research needs and direction are discussed.
Sinus Histiocytosis with Massive Lymphadenopathy
Authors: Sneige Nour , Batsakis John G.
Published: October 2014

Sinus histiocytosis with massive lymphadenopathy is a lymphoreticular disorder of obscure pathogenesis with extranodal lesions and a variable clinical course. Clinical manifestations are most often in the head and neck, with 97% of patients showing cervical lymphadenopathy and a significant but lesser number having lesional infiltrates in the upper aerodigestive tracts, particularly the nasal cavity and salivary glands.
Clinical Applications of Evoked Acoustic Emissions: Results in Normally Hearing and Hearing-Impaired Subjects
Authors: Bonfils Pierre , Uziel Alain
Published: October 2014

Click-evoked otoacoustic emissions were recorded in a group of normally hearing subjects (n = 52 ears) and a group of patients demonstrating several common types of sensorineural hearing loss (n = 85 ears) in order to study the clinical applicability of acoustic emissions. In the normally hearing population, all ears demonstrated acoustic emissions that could be elicited at intensities below the normal subjective threshold for the sequence of clicks (mean, −5.2 dB hearing level [HL]). Sixty-seven percent of the normal ears showed long (>20 ms) click-evoked emissions, and spectral analysis showed a broadband spectral component with several narrowband frequency peaks. In patients with sensorineural hearing loss, the incidence of acoustic emissions decreased and the detection threshold increased linearly with increasing threshold. No emissions were elicited from ears exhibiting subjective click thresholds >35 dB HL. Hearing-impaired ears showed a significantly higher proportion of short duration emissions and a significant reduction in the mean number of narrowband frequency peaks in comparison to the controls. Therefore, acoustic emissions can be used as a reliable technique for objective study of normal micromechanical activity within the cochlea and for detection of subtle changes in cochlear disease. However, they have not been demonstrated to be useful in differentiating cochlear disease.
Temporal Bone Computed Tomography in the Preoperative Evaluation for Cochlear Implantation
Authors: Mueller Donald P. , Dolan Kenneth D. , Gantz Bruce J.
Published: October 2014

High resolution computed tomography of the temporal bone is performed routinely in the preoperative evaluation for cochlear implantation. A retrospective review was performed to determine the effect of these studies. The clinical significance was determined through consultation with the referring otolaryngologist and review of the operative reports. Twelve examinations were reviewed. Abnormalities were identified in 12 of the 24 ears examined (eight of 12 patients studied). In two patients the CT examination strongly influenced the selection of the ear to be implanted. In four additional cases information felt to be useful in preoperative planning was provided. Useful information related to potential complications with the mechanical insertion of the electrode apparatus. We conclude that temporal bone abnormalities are common in the population undergoing cochlear implantation and that high resolution temporal bone CT is essential in preoperative evaluation. The CT scan should be interpreted with adequate knowledge of the operative procedure to evaluate any possible barriers to the mechanical insertion of the internal components of the system.