bluuebunny/crossref_metadata_2025 huggingface dataset:
Osteochondroma presenting as a neck mass: A case report
Authors: Scher Natan , Panje William R.
Published: October 2006

Osteochondromas are benign bone tumors which rarely present as neck masses. This report reviews the literature and presents the case of a 10‐year‐old girl with a neck mass and hoarseness due to an osteochondroma of the cervical spine. An extensive diagnostic evaluation and partial surgical excision were necessary. Although rare, osteochondromas should be considered in the differential diagnosis of a firm neck mass. Surgical excision of these lesions is recommended.
Frontal sinus fractures: A review of 72 cases
Authors: Wallis Andrew , Donald Paul J.
Published: October 2006

A retrospective review is presented of 72 patients who sustained frontal sinus fractures (FSF) and were subsequently treated by the department of otolaryngology/head and neck surgery between the years of 1974 and 1986.

Eighty‐four percent of FSF occurred in males and 71% were a result of motor vehicle accidents. Only 24% remained conscious at the time of trauma, and in only one third of the cases was there no other facial fracture. Seventy‐six percent of FSF involved both the anterior and posterior walls—a figure that possibly reflects the referral patterns to a hospital that is a major regional trauma center.

Patients were treated with a variety of procedures including cranialization (42%), osteoplastic flap and fat obliteration (30%), open reduction and internal fixation of the anterior wall (20%), osteoplastic flap and sinus ablation (6%), and intersinus septectomy (1%).

Some difficulty was encountered in documenting sustained follow‐up, which ranged from 2 months to 9 years, and averaged 22 months. Nine percent of patients died in the post‐trauma period. Minor complications were relatively common, but major complications occurred in only 10% of patients. Four patients (6%) suffered meningitis (although the portal of infection was not necessarily through the frontal sinus); one patient (1%) suffered severe pain over the sinus and forehead for at least 12 months after surgery; and a mucocele developed in four patients (6%).
Carcinoma ex‐papilloma: Histologic and virologic studies in whole‐organ sections of the larynx
Authors: Kashima Haskins , Wu Tzyy‐Choou , Mounts Phoebe , Hefener Dennis , Cachay Antonio , Hyams Vincent
Published: October 2006

A patient with adult‐onset recurrent respiratory papillomatosis (RRP), initially diagnosed at age 28 years, was treated with radiation therapy due to the rapid regrowth of lesions. Following 6 years of apparently inhibited growth, papilloma recurred, and squamous carcinoma was diagnosed from a laryngeal biopsy. A spontaneous laryngocutaneous fistula developed, and laryngectomy was performed 14 years after irradiation.

The laryngectomy specimen was snap frozen and representative tissues were stored frozen for viral studies. The larynx was whole‐organ sectioned for histologic examinations; residual papilloma, as well as carcinoma, was observed. Koilocytosis and other virus‐associated histologic changes were also found.

HPV capsid antigen was present in papilloma, carcinoma, and clinically normal epithelium. HPV nucleic acids, conforming to HPV type 6, were present in keratin pearls and dysplastic cells.

According to prior reports, carcinoma developing in preexisting papilloma arises from juvenile‐onset RRP. Irradiated papilloma develop cancer at about 10 years, and the patients rarely survive. Nonirradiated cases develop cancer after 30 years, and some develop papilloma in the hypopharynx and trachea, but most patients survive. Irradiation is not an obligatory precursor for malignant transformation of cancer; however, until now there have been no case reports of favorable outcome after irradiation of papilloma.
The redundant aryepiglottic fold: Report of a new cause of stridor
Authors: Peron Didier L. , Graffino Donatella B. , Zenker David O.
Published: October 2006

This is a report of seven patients with various degrees of stridor and airway obstruction due to redundancy of the aryepiglottic folds. This condition appears to be acquired and is most likely caused by central nervous system, pathology which disrupts the normal neuromuscular function of the larynx.
THE RELATIONSHIP OF CIRCULATING IgA TO CELLULAR IMMUNITY IN HEAD AND NECK CANCER PATIENTS
Authors: Schantz Stimson P. , Liu Frank J. , Taylor Dorothy , Beddingfield Nancy , Weber Randal S.
Published: October 2006

The relationship of circulating IgA titers and multiple parameters of cell‐mediated immunity was examined in 97 patients with head and neck cancer. In 26% of the patients, IgA titers were above one standard deviation of controls, with highest levels noted in patients with advanced disease. In 40 patients for whom multiple immune parameters were tested in vitro, increasing concentrations of IgA were associated with an enhanced immunologic helper state defined by a generalized hypergammaglobulinemia, increased percentage of T4+ lymphocytes, higher T4/T8 ratio, and an increased lymphocyte blastogenesis response to mitogens. IgA concentrations were inversely related to percentages and absolute number of Leu 11+ natural killer cell subsets, and also to disease‐free survival (p < 0.005 by Cox proportional hazards model). The immune correlations identified here are similar to those noted in many autoimmune diseases. Head and neck cancer patients are an immunologically heterogeneous population, among whom elevated IgA blood levels may reflect the autoimmune nature of cancer, an immunologic state defined by its tumor‐promoting capacity.
Surgical management of the mass in the buccal space
Authors: Rodgers Grayson K. , Myers Eugene N.
Published: October 2006

The discovery of a mass in the buccal space provides a diagnostic and therapeutic challenge. A common approach for the removal of the mass in the buccal space has been through the oral cavity. However, there is an ever‐present danger of injury to the facial nerve and Stensen's duct with this approach. Experience with tumors in this area prompted a review of the anatomy of the buccal space and resulted in an improvement in the surgical technique. Our external approach through an extended parotid‐submandibular incision provides excellent exposure which minimizes the risk of complications during excision of these tumors and provides an excellent cosmetic result.
Vertigo caused by basilar artery compression of the eighth nerve
Authors: Benecke James E. , Hitselberger William E.
Published: October 2006

Vascular compression syndromes in the posterior cranial fossa have become well described clinical entities, especially for the fifth and seventh cranial nerves. Jannetta has proposed vascular compression of the eighth nerve as the etiology of hearing loss, tinnitus, and vertigo in some patients.

The case that follows illustrates a clear‐cut example of vestibular symptoms arising from vascular compression of the eighth nerve. The patient involved had disabling peripheral vertigo refractory to medical management. Magnetic resonance imaging documented a tortuous basilar artery compressing the eighth nerve on the involved side. This was confirmed at surgery, and a selective section of the vestibular nerve provided complete relief of disabling symptoms and preservation of hearing.

The authors describe the details of this case and the enigma of eighth nerve symptoms due to vascular compression.
Margins of safety with transantral orbital decompression
Authors: Kent Kriston J. , Merwin Gerald E. , Rarey Kyle E.
Published: October 2006

This study involves evaluation of the surgical limits of transantral orbital apex decompression (as described by Ogura) by performing the operation on 17 cadaveric half‐heads. Measurements were then made of the proximity of bone removal to several vital structures including the optic nerve, carotid artery siphon, cavernous sinus, and frontal lobe dura. Entrance into the sphenoid sinus was found to be routine. Adequate decompression requires maximum removal of bone at the orbital apex and incision of the periorbita without damage to the adjacent vital structures. This requires: 1. knowledge of ethmoid and sphenoid sinus anatomy and recognition of anatomic variations, 2. removal of bone under direct visualization, and 3. incisions of the periorbita be made most posteriorly first to prevent prolapse of orbital fat anteriorly which obscures vision of the critical orbital apex periorbita.
Airway reconstruction following laryngotracheal thermal trauma
Authors: Miller Robert P. , Gray Steven D. , Cotton Robin T. , Myer Charles M.
Published: October 2006

Care of burn patients is a complex problem for the trauma team involving management of fluid and electrolyte imbalances, infections, and ultimately reconstruction. Patients with burns of the head, neck, and upper thorax present a series of unique problems because of a high incidence of associated upper and lower airway thermal trauma necessitating intubation and ventilatory support.

A series of cases requiring laryngotracheal reconstruction following severe burns to the head and neck region is reported. Methods of treatment are discussed as well as modifications of standard burn therapy to decrease the incidence of severe scarring.
Surgical treatment of vertigo with retrolabyrinthine vestibular neurectomy
Authors: Monsell Edwin M. , Wiet Richard J. , Young Nancy M. , Kazan Robert P.
Published: October 2006

Results for control of vertigo and preservation of hearing in patients who have had a retrolabyrinthine vestibular neurectomy (RVN) by our group were analyzed retrospectively. This procedure consists of selective section of the vestibular nerve in the posterior cranial fossa. Vertigo was completely controlled in all but two of 31 patients, one of whom required revision surgery to control attacks. Analysis of these two cases suggests that the cause of persistent vertigo is incomplete neurectomy. With our current surgical technique in patients with Meniere's disease, hearing results were not statistically different from our results with surgery of the endolymphatic sac. Control of vertigo was much more successful with the RVN than endolymphatic sac surgery.
Delayed endolymphatic hydrops: A review of 15 cases
Authors: Hicks George W. , William Wright J.
Published: October 2006

Delayed endolymphatic hydrops is a disease entity that can be differentiated from Meniere's disease. This condition was first reported simultaneously by Nadol, et al. and Wolfson and Leiberman, with further clarification by Schuknecht. The disease is characterized by a profound sensorineural hearing loss in one ear, with the onset of episodic vertigo from that ear after a prolonged period of time (ipsilateral delayed endolymphatic hydrops) or the development of fluctuating hearing loss and/or episodic vertigo in the opposite ear after a prolonged period of time (contralateral delayed endolymphatic hydrops). This paper is a review of 15 cases of delayed endolymphatic hydrops, eight ipsilateral and seven contralateral. The results of this study indicate that surgical treatment for the ipsilateral form of the disease gave the best results. For the contralateral variant, it appears that medical measures should be the therapy of choice resorting, in the event of their failure, to conservative surgical intervention on what may be the only hearing ear to preserve hearing and control vertigo.
Mycobacterial cervical lymphadenitis: A persistent diagnostic problem
Authors: Alleva Michael , Guida Robert A. , Romo Thomas , Kimmelman Charles P.
Published: October 2006

The most common manifestation of mycobacterial infection encountered in otolaryngologic practice is cervical lymphadenitis. Mycobacterial cervical lymphadenitis, or scrofula, remains a diagnostic and therapeutic challenge because it mimics other pathologic processes, and because of the inconsistent reliability of physical and laboratory findings. Twenty‐five cases of scrofula were treated at our institution from 1973 to 1986. Positive chest x‐ray was exhibited by five (20%) patients. Histologic examination of the excisional biopsy was the most reliable test with 100% positive specimens. This study emphasizes the marked variability in clinical presentation of scrofula and the importance of surgical excisional biopsy for histologic diagnosis.
Ototoxicity of high‐dose cisplatin by bolus administration in patients with advanced cancers and normal hearing
Authors: Kopelman Jeff , Budnick Amy S. , Sessions Roy B. , Kramer Marc B. , Wong George Y.
Published: October 2006

Our institution undertook a phase I trial to define the toxicity of high‐dose (150 to 225 mg) bolus administration (every 3 to 4 weeks) of cisplatin in patients with advanced cancers. All patients reported had baseline normal hearing. Hearing levels were measured prior to each course of chemotherapy. Audiological monitoring included conventional assessment of pure tone sensitivity at 500 to 8,000 Hz and assessment of ultra high frequencies (9,000 to 20,000 Hz). After one to two doses, 100% of patients failed to respond at 9,000 Hz and above. In the 2,000 to 8,000 Hz range, repeated administration of the drug effected successively lower frequencies with progressive loss, until a maximum threshold shift or plateau was reached at each frequency between 3,000 and 8,000 Hz. The plateau for cisplatin ototoxicity appears to fall within the moderate hearing loss range (40 to 60 dB HL) in the high frequencies. All patients complained of tinnitus and difficulty understanding speech in the presence of background noise. The pattern of pure tone audiometric alteration is consistent in all patients, all dosages, and each method of administration. The ultra high frequency alteration is prompt and dramatic.
Olfactory esthesioneuroma: A report of 40 cases
Authors: Schwaab G. , Pacheco L. , Marandas P. , Le Guillou C. , Richard J. M. , Micheau C. , Wibault P. , Domenge C.
Published: October 2006

Olfactory esthesioneuroma is a rare malignant tumor arising in the olfactory epithelium. Forty cases observed at the Institut Gustave‐Roussy from 1956 to 1987 are reported. This tumor usually grows slowly and is usually local, but it is important to be aware of the possibility of lymph node involvement (17%) and, particularly, of rapid development of distant metastases (25%), usually within 6 months. CT scan, and more recently, NMR have proved to be of value in choosing the surgical approach. In view of the usual point of departure, a combined neurosurgical and transfacial approach seems to be a satisfactory approach for obtaining oncological control of the lesion. The role of chemotherapy is discussed. The main prognostic factors seem to be the size of the lesion, the intracranial extension, and the lymph node involvement.
The sublabial transseptal transsphenoidal approach to sellar and parasellar lesions
Authors: Eisele David W. , Flint Paul W. , Janas Janice D. , Cummings Charles W. , Weymuller Ernest A. , Kelly William A.
Published: October 2006

Multiple surgical approaches to the sella turcica have been described. The sublabial transseptal transsphenoidal approach provides a safe, cosmetically acceptable route to the sella with excellent exposure. Since 1976, we have employed this technique for the surgical treatment of pituitary neoplasms and parasellar tumors. The University of Washington experience with the sublabial transseptal transsphenoidal approach to the sella in a series of 253 patients is reported with respect to the otolaryngological aspects of the surgical technique, results, and complications of the procedure. In addition, a literature review of major studies that used this procedure is included, and the reported results and complications are compared to those of the present study.
Clinical effects of alpha‐interferon dose variation on laryngeal papillomas
Authors: Mullooly Virginia M. , Abramson Allan L. , Steinberg Bettie M. , Horowitz Marilyn S.
Published: October 2006

Achieving optimal clinical control of recurrent respiratory papillomatosis with prolonged treatment with human leukocyte (alpha) interferon appears to be dose‐related and often requires individualized dosage elevation. Six of eight patients in this study needed a maximum dose of 18 × 106 IU/week for part of the therapy period to achieve better disease control. The strong correlation found between dosage and response suggests that it is the interferon causing the effect on disease expression, not just the unpredictable nature of the disease.

An effect on papilloma growth was observed in all patients during IFN therapy. Three patients were able to be tapered off IFN with only minimal recurrence seen in one patient. No toxic side effects were observed.
Rhinocerebral mucormycosis: Results of aggressive surgical debridement and amphotericin B
Authors: Ochi James W. , Harris Jeffrey P. , Feldman Jeffrey I. , Press Gary A.
Published: October 2006

Rhinocerebral mucormycosis is a fulminant, devastating fungal disease. The use of amphotericin B, combined with aggressive surgical debridement, has increased survival rates from approximately 20% to 70%.

Eleven patients with this rare disease have been treated over the past 6 years. Therapy with amphotericin B was begun in all patients as soon as the diagnosis of mucormycosis was suspected. Seven patients underwent aggressive surgical debridement; all seven had disease involving the sphenoethmoidal complex, requiring external ethmoidectomy with or without sphenoidotomy. Six patients had maxillary sinus disease, requiring Caldwell‐Luc antrostomy or maxillectomy. Three patients required orbital exenteration. Surgery was performed within 24 hours of diagnosis on all but two of our patients.

Despite prompt diagnosis, aggressive surgical debridement, therapy with amphotericin B, and correction of metabolic acidosis, our mortality rate was 82%. Rhinocerebral mucormycosis remains a rapidly progressive, frequently fatal disease.
The transoropalatal approach to the atlantoaxial‐Clival region: Considerations for the head and neck surgeon
Authors: Harris Jeffrey P. , Godin Michael S. , Krekorian Terry D. , Alksne John F.
Published: October 2006

The transoropalatal approach to the atlantoaxial‐clival area provides excellent exposure for neurosurgical decompression and fusion procedures. The technique has been effectively applied in the treatment of bony and soft tissue abnormalities of the anterior spinal region. Although this approach is safe and reliable, it is not part of the otolaryngologist's usual surgical armamentarium.

In the present study, we describe the case histories of five patients who underwent resection of the odontoid process for cervicomedullary compression. Neurological compromise was manifested by progressive upper and/or lower extremity paresis in all patients. In each patient, a transoropalatal approach was used. The surgical technique is discussed, and the prevention of possible sequelae, including velopharyngeal incompetence and palatal or pharyngeal wound dehiscence, is addressed.
Management of bilateral acoustic tumors
Authors: Glasscock Michael E. , Woods Charles I. , Jackson C. Gary , Welling Bradley
Published: October 2006

Bilateral acoustic tumors (Neurofibromatosis 2) have now been shown to arise in patients with gene abnormalities separate from those with von Recklinghausen's disease (Neurofibromatosis 1), The management of patients with this disease has long posed a particularly challenging problem for the neurotologist. This retrospective study reviews our series of 38 patients and updates a previous report. Thirty‐four patients underwent surgical excision of tumors on one or both sides. Hearing conservation was attempted in 20 with hearing preservation possible in eight. Recent advances in understanding the hereditary etiology of this disease, changing methods for diagnosis, preferred surgical techniques, and guidelines for appropriate patient management are discussed.
Speech restoration and complications of primary versus secondary tracheoesophageal puncture following total laryngectomy
Authors: Maniglia Anthony J. , Lundy Donna S. , Casiano Roy C. , Swim Scott C.
Published: October 2006

The tracheoesophageal (TE) fistula with a speech prosthesis has become the method of choice for vocal rehabilitation in many postlaryngectomy patients. Several modifications of the procedure have been described including primary TE puncture at the time of laryngectomy. Fear of increased risk of complications has kept the primary procedure from widespread usage. Our series of 95 TE fistula procedures from 1980 to 1988 revealed 33 to be primary and 62 secondary. Eighty‐five percent (85%) (28 of 33) patients in the primary group achieved long‐term satisfactory speech (1 year or more of follow‐up). Complications occurred in 36% of this group of patients. The success rate for the secondary group was 69% (43 of 62), while the complication rate was 21%. There were no instances of death, sepsis, or media‐stinitis associated with either primary or secondary TE fistula patients. It appears that the primary TE fistula can be performed as safely and effectively as the secondary procedure.
Transcutaneous teflon® injection for paralytic dysphonia
Authors: Mccaffrey Thomas B. , Lipton Richard
Published: October 2006

Transcutaneous Teflon augmentation of the vocal cord was performed 21 times in 19 patients with unilateral vocal cord paralysis. The larynx was visualized using flexible fiberoptic video‐endoscopy and, after local anesthesia to the skin over the cricothyroid membrane, an 18‐gauge 2‐inch needle was introduced through the cricothyroid membrane. Under fiberoptic visualization, the needle was inserted into the paralyzed vocal cord through its undersurface. Teflon was injected with a syringe to produce medialization of the vocal cord. The position of the vocal cord and voice quality were monitored throughout the procedure. No complications were encountered. All patients experienced a reduction in breathiness of voice that was rated as a significant improvement by the patient and surgeon. Two patients required reinjection of Teflon for optimal improvement.
Computer‐aided three‐dimensional reconstruction and measurement of the round window niche
Authors: Takahashi Haruo , Sando Isamu , Takagi Akira
Published: October 2006

The goal of this study was to clarify the three‐dimensional shape of the round window niche and to measure this structure three‐dimensionally using the computer‐aided reconstruction method we developed.

The equipment used in this study included a personal computer (NEC 98‐XA), a high‐resolution 14‐inch color CRT, a digitizer (Hitachi HDG‐1111), and a printer. We studied five normal temporal bones obtained from five individuals with negative otologic histories, who hod been 5 months and 14, 15, 18, and 59 years old at death.

In each case the round window niche was located posteroinferior to the round window. The round window niches had wide openings to the middle ear cavity that became narrower near the aperture; thus, the round window niche seemed to be shaped like a pouch.

The maximal diameter of the round window niche was 2.98±0.23 mm. The shortest distance between the aperture of the round window niche and the margin of the round window was 0.66±0.16 mm. The volume of the round window niche, on average, was 4.65±0.67 mm3. The volume of the round window niche was found to be correlated with the area of the round window.
Lateral skull base surgery for cancer
Authors: Krespi Yosef P.
Published: October 2006

The management of malignant tumors of the lateral skull base remains a challenging problem. Sixty‐two patients underwent lateral skull base resection for cancer. Preoperative evaluation included complete neurotologic examination, CT scan, MRI, and carotid angiography. During surgery, the nasopharynx, the posterior maxilla, the infratemporal fossa structures, the mandibular ramus, and the parotid gland were resected en bloc. Reconstruction of the surgical defect was performed using pectoralis and/or rhombotrapezius myocutaneous flaps. Although the overall cure rate was not greatly improved, patients with lateral skull base malignancies now enjoy extended periods of palliation and a better quality of life.
Type II collagen distribution in the ear of the developing chick embryo
Authors: Ishibe Tsukasa , Choe In Seong , Yoo Tai June
Published: October 2006

The localization of type II collagen was immunohistochemically studied in the developing chick ear using monoclonal antibodies. Type II collagen appeared under the basal lamina of the otocyst from developmental stages 14 to 16. In the otic capsule, endolymphatic duct, and semicircular canal membrane, type II collagen appeared in stage 23 or 24. From stages 28 to 29, type II collagen appeared in the primitive columella, endolymphatic sac, and fibrocartilaginous plate. Type II collagen was first observed in the crista ampullaris, basilar membrane, macula sacculi, and utriculi in stages 30 and 31. Type II collagen was not detected in the endolymphatic sac beyond developmental stage 37 and the amount of type II collagen in the otic capsule and columella decreased after stage 40. The wide distribution of type II collagen in the inner ear throughout the development of the chick embryo suggests that this collagen may act as a basic structural component of the ear.
The endoscopic teflon® keel for posterior and total glottic stenosis
Authors: Langman Alan W. , Lee Kelvin C. , Dedo Herbert H.
Published: October 2006

Most cases of posterior commissure stenosis today result from endotracheal intubation. The problem has been very difficult to repair. Posterior commissure stenosis has been treated by repeated dilations, which do not work, and reconstructive measures by means of laryngofissure to excise the scar followed by the placement of round stents alone or round stents in combination with mucosal or skin grafts. This treatment also fails frequently. Some, but not all, cases have been cured with laser surgery via microdirect laryngoscopy. An endoscopically placed Teflon® keel has been useful in the treatment of posterior glottic and total glottic stenosis when laser surgery is not feasible. Nine patients with posterior glottic stenosis, two of whom initially had total glottic stenosis, have undergone placement of the posterior commissure Teflon keel. Six patients had resolution of the stenosis and were decannulated. One required an arytenoidectomy for a fixed cricoarytenoid joint before successful decannulation. Two patients had marked improvement of their laryngeal airway with this approach, but have not yet been decannulated because of fixed cricoarytenoid joints.
Cochlear implantation after transmastoid labyrinthectomy
Authors: Kveton John F. , Abbott Cynthia , Drumheller Geralyn , Cohen Nancy , Poe Dennis S. , April Max
Published: October 2006

Hearing rehabilitation with an intracochlear prosthesis is well documented in patients who have an intact otic capsule prior to implantation. However, the suitability for implantation of patients who have undergone extensive procedures involving the otic capsule such as labyrinthectomy has not been directly addressed. This report documents a case of a patient deafened by a transmastoid labyrinthectomy who subsequently received a cochlear implant. Postimplantation performance of this patient was compared with the performance of three other postlingual implant recipients. The results suggest that labyrinthectomy is not a contraindication to auditory rehabilitation by a cochlear implant. The implications of implantation in a surgically manipulated otic capsule are discussed.
Giant fibrous dysplasia of the mandible: Surgical management
Authors: Kreutziger Keith L.
Published: October 2006

Giant fibrous dysplasia of the mandible (GFDM) represents a far advanced lesion which may be monostotic, polyostotic, a component of craniofacial fibrous dysplasia, a component of Albright's syndrome, or associated with other endocrinopathies. The current philosophy is to consider fibrous dysplasia of the mandible (FDM) as one of a group of lesions classified as fibro‐osseous lesions of the jaws. The natural course and manifestations in the mandible result in GFDM if they are unabated by curative therapy or if stabilization or regression does not occur. A rational therapeutic approach depends upon the extent of the disease at the time of diagnosis. The earlier in the disease process that the diagnosis is made, the more likely that a curative surgical procedure may be undertaken. Complete resection of the diseased mandible should be performed when feasible. A lesser surgical procedure has no curative potential and is performed only as a palliative, cosmetic delaying procedure.
Results of tympanoplasty for congenital aural atresia and stenosis, with special reference to fascia and homograft as the graft material of the tympanic membrane
Authors: Minatogawa Toru , Nishimura Yoshihiko , Inamori Torn , Kumoi Takeo
Published: October 2006

The surgical management of congenital aural atresia is a challenging, complex procedure, and the risks are great. The otologic surgeon is responsible for keeping a patent external auditory canal and for achieving satisfactory hearing.

The present report studied hearing changes that occurred after tympanoplasty and the long‐term results of tympanoplasty in 12 cases of congenital aural atresia or stenosis. Patients were followed for more than 2 years after surgery. In four ears, an allograft of the tympanic membrane with an attached malleus was used, with a good graft take and hearing results. An autograft of temporal fascia was used in eight ears. Hearing acuity decreased in six of the eight ears and was maintained in two ears. Three primary surgery patients required revision surgery for postoperative restenosis of the external auditory canal. Some comments have been made with regard to this problem. Emphasis is also placed on the selection of patients for surgery using a thorough audiologic and roentgenologic evaluation.
The morphology of the nasal septum in identical twins
Authors: Grymer Luisa F. , Melsen Birte
Published: October 2006

A comparison was made of the nasal septums of 41 pairs of identical twins to assess the impact of genetic and environmental factors on the formation of deformities of the nasal septum. Deformities of the anterior nasal septum (cartilaginous septum) were present in 22% of all the individuals studied, and in the posterior nasal septum (bony septum), some deformity was present in 74% of the persons studied. The distribution of deformities within pairs suggests that anterior deformities might be of external origin (e.g., traumatic), and posterior deformities may be considered to be part of a normal developmental process of the maxillary complex, where both genetic and epigenetic factors may play a role.
Artificial agonist/antagonist coupling in paralyzed muscles: Electronic balance of reinnervated straps from facial activity in the rabbit
Authors: Broniatowski Michael , Grundfest‐Broniatowski Sharon , Davies Charles R. , Jacobs Gordon B. , Nosé Yukihiko , Tucker Harvey M.
Published: October 2006

Normal striated muscular contraction such as occurs in the face is the result of finely balanced activities monitored by the central nervous system. Previous approaches to rehabilitation have been limited to restoring only motor function, ignoring the proprioceptive input that normally originates at the level of each muscle. In this pilot study, proprioceptive information originating in facial muscles (considered as agonists) is artificially channeled to nerve pedicles, reinnervating straps in the rabbit to produce antagonist action. Further development of this concept can lead to finer control of reinnervated muscles of the face or elsewhere.
Preoperative therapeutic considerations in chronic suppurative otitis media
Authors: Papastavros Theodore , Giamarellou Helen , Varlejidea Stratos
Published: October 2006

The present randomized, prospective study of 119 cases of chronic suppurative otitis media compares the effectiveness of inexpensive, atoxic, nonallergenic disinfectants applied locally, to that of a number of occasionally toxic antimicrobial chemotherapeutic agents, administered systemically. Systemic treatment resulted in a cure rate of 53.5% (SEp=5.9%) while ototopical treatment resulted in a 39.5% cure rate (SEp=7%). Eradication of pathogens or colonization by a nonpathogen occurred in 50.7% (SEp=5.9%) with systemic treatment, and in 39.5% (SEp=7%) with ototopical treatment. Bacteriological modification was 2.5 times more frequent with systemic treatment than with ototopical treatment. No recurrences were noted with ototopical treatment, while 13% to 36% recurrence rates were noted in various subgroups of cases treated systemically. Cure rates achieved with particular drug regimens (administration based on sensitivity tests in vitro) were: Azactam 25% (5%‐57% confidence limits), sulfamethoxazole plus trimethoprim 58.6% (38%‐76%), ciprofloxacin 87.5% (47%‐99%), ciprofloxacin plus metronidazole 90% (55%‐99%). Cure rates with other drugs were inconclusive because of the limited number of observations.
Allergic aspergillosis: A newly recognized form of sinusitis in the pediatric population
Authors: Manning Scott C. , Brown Orval E. , Vuitch Frank , Weinberg Arthur G.
Published: October 2006

In 1983, Katzenstein, et al. first described a form of noninvasive sinusitis in adults, which was histologically identical to allergic bronchopulmonary aspergillosis, with mucin‐containing eosinophils, Charcot‐Leyden crystals, and fungal elements resembling Aspergillus species. The authors have treated six pediatric patients ages 8 to 16 who had findings typical of allergic Aspergillus sinusitis. All patients presented with nasal polyposis and progressive facial deformity. All patients had computed tomography findings of diffuse expansile sinus disease and four patients had evidence of bony erosion, raising the suspicion of malignancy. At surgery, all were found to have multiple sinuses densely packed with greenish‐black inspissated mucin. Therapy consisted of wide surgical drainage with careful follow‐up and nasal steroids.
Advantages of pectoralis musculocutaneous flap pharyngeal reconstruction
Authors: Stein David W. , Schuller David. E.
Published: October 2006

Pharyngeal reconstruction commonly involves grafts or flaps. Recent reports have emphasized the advantages of skin graft reconstruction. The purpose of this paper is to assess the results of pharyngeal reconstruction with the pectoralis musculocutaneous flap following composite resection and neck dissection. Thirty‐five patients who had predominantly advanced disease (88% stage IV) were treated in the Department of Otolaryngology at The Ohio State University. Oral diet was tolerated by 73.5% of the patients at the time of discharge. Of these, 80% were on a soft diet. Ultimately, 91% of the patients were able to tolerate an oral diet. The median hospital stay was 13 days. The estimated blood loss, blood replacement, complications, days to decannulation, and surgical time were analyzed. These results suggest that flap reconstruction leads to short hospitalization and provides an excellent opportunity for an oral diet.
Glottal closure in the hemiparalyzed canine larynx
Authors: Regenbogen Elliot
Published: October 2006

Although compensation of voice with unilateral recurrent laryngeal nerve paralysis is commonly held to be the result of the unaffected vocal fold crossing past midline, or overcrossing, this mechanism of compensation has rarely been documented accurately. Beagle dogs were used to create a model of another proposed mechanism of compensation, known as midline drift. Six animals underwent sectioning of the left recurrent laryngeal nerve. One week later, three of the dogs underwent removal of the left posterior and lateral cricoarytenoid muscles. The effects of these procedures were studied by subjective assessment, direct laryngoscopy, and sound spectrographic analysis. Results indicate that glottal closure was improved after the second surgical procedure. The clinical implications of the results are discussed and compared with other manners of compensation hypothesized in the literature.
Reconstruction of circumferential defect of the hypopharynx: Experimental studies and clinical application of a new method
Authors: Chang Shyue‐Yih
Published: October 2006

Reconstruction of circumferential defect of the hypopharynx is a challenging problem in head and neck surgery. Reconstruction with a totally tubed pectoralis major myocutaneous flap (PMMCF) has been advocated in recent years, but this procedure has the disadvantage of excessive bulkiness. In order to solve this problem, the author experimented with a partially tubed platysma myocutaneous flap and an inner surface of apron skin flap of the anterior neck in the reconstruction of the circumferential defect of the hypopharynx in ten dogs. Subsequently, the same surgical technique using PMMCF instead of the platysma myocutaneous flap was used for reconstruction following total laryngopharyngectomy in eight patients. The new partially tubed flap was successful in solving the problem of excessive bulkiness of the totally tubed PMMCF.
Wound healing: Relationship of wound closing tension to tensile strength in rats
Authors: Morin Garrison , Burgess Lawrence P.A. , Rand Michael , Graeber Geoffrey M. , Voussoughi Jafar
Published: October 2006

A study was conducted to better define the relationship between closing tension and the resulting tensile strength of scars in incisional wounds. Five groups consisting of ten hairless rats were studied. Transverse wounds were created and closed on the back of each rat, with closing tension varied by excising amounts of skin in widths of 0 (control), 15, 30, 45, and 60 mm. The tensile strengths were determined at 28 days. Higher mean tensile strengths were demonstrated in the two groups requiring the highest closing tensions (45 mm and 60 mm of skin excision) with P=0.0028 and P=0.00016, respectively. A logarithmic relationship between closing tension and tensile strength was demonstrated using linear regression analysis with t=6.18, p<.0001, and R2=.44.
Delayed diagnosis and treatment of acoustic neuroma
Authors: Traquina Diana N. , Guttenberg Irving , Sasaki Clarence T.
Published: October 2006

The records of 25 patients who underwent excision of acoustic neuroma between 1980 and 1987 were reviewed. All patients originated from southern New England. Facial nerve function was preserved in 92% of all patients, and 42% of patients with tumors less than 2.0 cm retained residual hearing postoperatively. These rates compare favorably with those found in larger series.1‐3

Our series demonstrated that 60% of patients complained of hearing loss for longer than 2 years prior to tumor diagnosis. The mean duration of hearing loss prior to diagnosis was 4.2 years. Although sophisticated diagnostic methods were generally available, early detection of tumors did not occur, despite the early onset of auditory symptoms. The emergence of sophisticated computer‐assisted diagnostic tests and the development of technologically advanced operative methods have reduced operative morbidity, but interestingly, have had little influence on early tumor diagnosis. Late detection of acoustic neuroma in an otherwise medically sophisticated community suggests the need for improved awareness among patients and their primary care providers. Failure of early detection may occur more commonly than generally appreciated, despite the availability of technologically advanced methods of diagnosis.
Cutaneous malignant melanoma of the head and neck
Authors: Fisher Samuel R.
Published: October 2006

A computer‐aided analysis of 5,109 patients with malignant melanoma was performed. Patient population characteristics according to body site (head and neck, extremity, and trunk) were determined for the following parameters: sex, histologic type of melanoma, Clark's level, Breslow thickness, age, clinical status of regional nodes, presence or absence of ulceration, and recurrence. Head and neck melanomas accounted for 17% of the total population (N=877). A detailed analysis of general population characteristics according to subsites within the head and neck region (ear, face, neck, nose, and scalp) was performed. Survival characteristics were determined for head and neck patients according to lymph node surgery, histologic type of tumor, and tumor thickness. The effect on survival of lymph node dissection (elective for stage I disease and therapeutic for stage II disease) was analyzed by univariate and multivariate methods. Elective lymph node dissection (ELND) was performed on 77 patients and 39 patients underwent therapeutic nodal dissection (TLND). Overall, survival was significantly improved following ELND as compared to TLND; however, multivariate analysis indicated the improved survival was related to variations of age within the population rather than the beneficial effect of lymph node surgery. Elective lymph node dissection did significantly reduce the incidence of recurrence for head and neck patients (p=0.002). Since recurrence was demonstrated to be directly related to survival, the trend toward improved survival following ELND after 5 years was felt to be important. There was no difference in survival according to the histologic type of melanoma.
Sleep‐related laryngeal obstruction presenting as snoring or sleep apnea
Authors: Kavey Neil B. , Whyte Jamie , Blitzer Andrew , Gidro‐Frank Stephen
Published: October 2006

The difference between snoring (with or without sleep apnea) and laryngeal stridor resulting from laryngeal dysfunction may not be readily apparent. Two cases of Shy‐Drager syndrome and one undiagnosed case in which laryngeal dysfunction was exacerbated by sleep are reported. Such dysfunction might create life‐threatening situations for which emergency tracheostomy should be considered. The importance of differentiating stridor from snoring is discussed.
Auditory perceptual problems in non‐organic hearing disorder
Authors: Hasbrouck Jon M.
Published: October 2006

A series of 22 patients who presented with non‐organic hearing disorder were examined for auditory perceptual problems. A test battery that examined eight areas of auditory perception revealed significant auditory perceptual problems in each of the 22 patients. The results indicate a view that differs from the traditional view of non‐organic hearing disorder as either conscious feigning of a hearing disorder or an unconscious symptom of an unidentified emotional disorder. The information presented here indicates that specific auditory processing disorders could adversely affect patients' hearing and that auditory perceptual disorders could be diagnosed and treated.
Brain herniation into the middle ear: Two idiopathic cases treated by a combined intracranial‐mastoid approach
Authors: Iurato Salvatore , Ettorre Giovanni Carlo , Selvini Cristian
Published: October 2006

One hundred thirty‐nine cases of brain herniation into the middle ear and mastoid have been reported in the world literature during the last 40 years. In 29 cases the herniation was idiopathic. In idiopathic cases, intermittent CSF otorhinorrhea, a history of intermittent “serous otitis media,” and a conductive hearing loss were the main clinical findings. Polytomography or CT‐scan revealed a tegmen antri or tympani defect in some patients. There are three surgical approaches for treatment of brain herniation into the middle ear: neurosurgical, otological, and combined.

Two new idiopathic cases were successfully treated by the combined approach.
A method for ossicular reconstruction with tragal cartilage autografts
Authors: Mundada Pandharinath S. , Jaiswal Subhalaxmi J.
Published: October 2006

Reconstruction of the ossicular mechanism using a tragal cartilage autograft frequently presents problems, including displacement of the cartilage graft, maintenance of firm and accurate contact between the graft and ossicular remnants, and loss of stiffness of the graft.

To avoid these problems, we have used the cartilage graft and overlying perichondrium of appropriate size, with a tunnel made between the outer perichondrium and the cartilage to accomo‐date remnants of the incus or handle of the malleus. The graft has a small perichondrial flap on the other end for firm anchorage to the arch of the stapes or the footplate. This allows the cartilage graft to be firmly anchored with the adjacent ossicular remnants. The presence of perichondrium with the graft helps to maintain nutrition, stiffness, and the configuration of the cartilage. With minor modifications, we have used this technique in 115 patients to reconstruct different types of ossicular defects, with commendable hearing results.

Of the 115 operated ears, an air‐bone gap closure within 10 dB was found in 14.8%, within 15 dB in 34.8%, and within 20 dB in 24.4% of ears. In another 20.8% of cases, the air‐bone gap closure remained in the range of 25 dB or less. The longest follow‐up was 13 years 7 months.

The presented technique is easy and effective and solves most of the problems of cartilage ossiculoplasty.
Autologous and homologous fibrinogen sealants: Adhesive strength
Authors: Laitakari Kyösti , Luotonen Jukka
Published: October 2006

The adhesive strength of autologous fibrinogen sealants prepared from the individual patient's blood with the help of ammonium sulphate or polyethylene glycol was compared to that of a homologous commercial fibrinogen sealant. The concentration of the fibrinogen harvested by each method was measured. The bonding power measurements were carried out by gluing pieces of human dura, rat skin, or cotton cloth together. The commercial fibrinogen sealant yielded the highest concentration of fibrinogen and also proved to be the strongest of the glues tested. The PEG glue was better than the AS glue. Humidity did not have a significant influence on adhesive strength, nor did deep‐freezing worsen the properties of the fibrinogen sealants. In addition to the commercial products, the self‐made fibrinogen glues, especially the PEG glue, were also strong enough for oto‐laryngologicnl use.
Trachea stoma vent voice prosthesis
Authors: Shapiro Myron J. , Ramanathan Vadakkencherry R.
Published: October 2006

Having been in use for the past couple of years, the “duckbill” valved Silastic® tube developed by Blom and Singer is well established as a device for vocal rehabilitation of the laryngectomee. The newer “voice button” prosthesis developed by Panje incorporates a similar valve in Silastic®. Neither of these devices can be used with tracheal stomal stenosis or with a deep tracheal stoma behind prominent sternomastoid muscles.

The ritual of taping the Blom‐Singer prosthesis and the frequent failure of the tape to hold are other distinct disadvantages. Limitations are imposed on patient selection with the Panje prosthesis because of the rigid dimensions and the possibility of aspiration of the device, as well as the necessity for manual dexterity on the part of the patient.

A new device has been fashioned utilizing the “duckbill” Silastic® tube as a valve attached to a new type of trachea stoma button. This appears to have universal application, is not difficult to change, requires no taping, and is self‐maintaining. There is no possibility of aspiration. The device is simple and appears to overcome many of the disadvantages of the other two.

The tracheal esophageal puncture must be made in a cephalad direction so that the tracheal air diverted through the prosthesis will be directed toward the pharynx and not toward the esophagus. Prostheses directed caudad will not function and those patients should be repunctured.