bluuebunny/crossref_metadata_2025 huggingface dataset:
Extramedullary Plasmacytomata of the Upper Respiratory Tract
Authors: Booth J. B. , Cheesman A. D. , Vincenti N. H.
Published: October 2014

Extramedullary plasmacytomata may arise in any structure containing re-ticulo-endothelial tissue. Such tumors may be either isolated or the initial lesion of a generalized disseminated condition. Ideally, multiple involvement should be diagnosed at the presymptomatic stage; this may be possible by detecting variations in the immunoglobulins. Histologically, electron microscopy is advised to detect the plasma cell in the more undifferentiated case. Nine cases are reported. Two cases showed multiple involvement presenting with extramedullary plasmacytomata. A further case recurred locally many times but is still alive after 22 years. The remaining seven cases showed only isolated extramedullary plasmacytomata; of these, five were benign but in two, the tumor eroded bone locally. Those which subsequently developed multiple myelomata showed changes in the serum proteins, erythrocyte sedimentation rate (ESR) and radiologically, at approximately the same time. Surgical excision and/or radiotherapy was equally successful in those patients with localized disease.
Cryosurgical Control of Cancer: Effects of Freeze Rates, Tumor Temperatures, and Ischemia
Authors: Neel H. Bryan , DeSanto Lawrence W.
Published: October 2014

These studies in mice show that, in order to control malignant tumors consistently by cryosurgery, it is important to utilize low probe-tip temperatures, large probe lip-to-tumor contact surfaces or liquid nitrogen sprays, repetitive probe applications, spontaneous thaw between freezes, freezing to tumor temperatures below −30° C, and rapid rates of freezing. In the experimental tumor-host system, ischemia induced either by local administration of pharmacologic doses of epinephrine or by temporary clamping significantly potentiated heat extraction as reflected in tumor control and the time course of recurrences. The effects of ischemia are seen primarily in the thaw portion of the freeze-thaw cycle, during which time spontaneous thawing is consistently prolonged.
Flexible Fiberoptic Bronchoscopy Its Place in the Search for Lung Cancer
Authors: Marsh Bernard R. , Frost John K. , Erozan Yener S. , Carter Darryl , Proctor Donald F.
Published: October 2014

The use of sputum cytology has demonstrated that conventional bronchoscopic equipment often fails to permit localization of earlier, more peripheral tumors. The flexible fiberbronchoscope now opens up new bronchial horizons but does not replace rigid instruments. Our experience in 300 fiberoptic studies has suggested certain guidelines for determining in which patients the flexible equipment should be used and in which conventional instruments are preferred. By means of a comprehensive endoscopic study, we successfully localized eight “sputum positive,” radiologically occult bronchogenic carcinomas. The fiberbronchoscope is essential in searching the segments for subtle changes of early cancer. These findings are documented by a color television system. A detailed pathological study demonstrates the importance of preoperative marginal biopsies in excluding carcinoma in situ which may extend some distance from even small tumors. In 94 patients with cancer we located 85 (90%) by direct visualization and/or bronchoscopic specimens. Sixty-eight (72%) involved primarily the segmental or more peripheral areas while main bronchus tumors were large and suggested spread from a more distal site of origin. The fiberbronchoscope has greatly extended our capabilities, allowing a better understanding of early lung cancer and greatly improved localization.
Treatment of Esophageal Stricture Complicated by Sudden Death
Authors: Howard John T.
Published: October 2014

An elderly lady with arteriosclerotic cardiovascular disease had had dysphagia intermittently for five years before she came under treatment for a benign esophageal stricture which was associated with an hiatal hernia. When her condition became refractory to bouginage and to the passage of beads over a previously swallowed thread, an attempt was made “to soften” the hard fibrous stricture by injecting triamcinolone mixed with hyaluronidase into it. The obstructing fibrous tissue was not softened immediately after the injection of these drugs. Four days later, with the hope that the steroid had “softened” the fibrous stricture, the patient swallowed a thread preliminary to the passage of dilating beads over it. She retired with the thread in place. During the night she was heard to cough and she was found to be dead five minutes later. At necropsy an hiatal hernia with a benign stricture of the lower esophagus was found. Needle tracts were seen in the stricture and deposits of injected material could be seen in the tissues; one tract went through the esophageal wall and there was minor mediastinitis with abscess formation. However, when the stomach and esophagus were distended with a solution of formalin under pressure, no leak could be found. A small thromboembolus in the lower lobe of the right lung might have caused the patient's death.
Bronchial Foreign Body of Unusual Mode of Entry
Authors: Bryant Frank L.
Published: October 2014

A metallic bronchial foreign body whose mode of entry was through a puncture wound of the left cricothyroid membrane is recorded. Bronchoscopic aspiration was first done primarily to relieve severe dyspnea and six days later extraction of the foreign body was successfully performed.
Candidiasis of the Larynx
Authors: Yonkers A. J.
Published: October 2014

Candida albicans, the fungus which is responsible for moniliasis, is a common inhabitant of the throat and not ordinarily a pathogen in the adult. In the presence of lowered host resistance by disease, corticosteroid therapy, immunosuppressive drugs or in the presence of altered normal flora by prolonged use of broad spectrum antibiotics, a candida infection may occur. Usually there is little difficulty in assessing the significance of this fungus when it is associated with visible mucus membrane or cutaneous lesions in healthy individuals. However, multiple or persistent isolations of the fungus from body fluids even after the removal of provocative factors such as antibiotics and foreign bodies indicates an invasive disease which requires specific therapy. Mucocutaneous and superficial Candida infections usually respond to topical therapy such as nystatin spray or gargle. When this is ineffective and the patient is still symptomatic, low doses of intravenously administered amphotercin B should be considered as the next step in the management of the infection. In patients with Candida meningitis or endocarditis this regimen is not recommended.
Chronic Granulomatous Disease Involving the Larynx and Bronchus
Authors: Frazer John P.
Published: October 2014

A brief review of chronic granulomatous disease, an immunological and clinical entity, is presented. The clinical and laboratory findings are listed and hereditary aspect discussed briefly. The futility of treatment is mentioned. A case is reported in which laryngeal destruction and bronchial obstruction had been due to this disease.
Composite Nasal Septal Autografts of the Trachea
Authors: Furstoss James A. , Toohill Robert J.
Published: October 2014

A source of readily available material is needed to repair tracheal stenoses when standard techniques cannot be utilized. Composite nasal septal autografts of the trachea were studied in 12 dogs at varying intervals up to 12 months. Results from gross, bronchoscopic, and histologic data have been reported and are encouraging. Two cases utilizing these grafts are presented, using the wedge technique to repair tracheal stenoses.
The Ocular Fixation Index
Authors: Hart Cecil W.
Published: October 2014

The effects of ocular fixation on normal and pathological nystagmus are reviewed, and in particular the effect of opening the eyes during the caloric test is analyzed. The Ocular Fixation Index of Demanez was applied to the records of 100 patients, and the findings tend to confirm the usefulness of this Index as a means of distinguishing peripheral from central lesions.
Central Vestibular Diagnosis Neurologic Examination
Authors: Weiss Alfred D.
Published: October 2014

The aspects of the neurologic examination concerned with lesions in central vestibular structures must take into consideration how these structures function physiologically as components of the much larger sysem controlling static and dynamic equilibrium. Methods for differentiating disturbances in the different components are outlined. There are a number of structures which lie in the brain stem in proximity to the central vestibular mechanisms; disturbances in equilibrium associated with evidence of disturbance in these contiguous structures tend to implicate the central vestibular structures. When the probable localization of lesions has been decided, the history of evolution of symptoms often provides an indication of a probable diagnosis.
The Neurotological Significance of Alterations of Pursuit Eye Movements and the Pendular Eye Tracking Test
Authors: Corvera Jorge , Torres-Courtney Gabriela , Lopez-Rios Guillermo
Published: October 2014

Smooth pursuit eye movements can be studied if the patient follows a target that moves horizontally in a pendular way. The eye movements can be recorded with electro-oculographic technique, and the tracings obtained studied for abnormalities. This constitutes the Pendular Eye Tracking Test (PETT). Three different deformations of PETT tracings have been observed: 1) a basically normal shaped curve with superimposed fast movements; 2) a deformed curve and 3) an absence of the normal sinusoidal tracing. In diseases of the inner ear, the PETT usually shows a normal curve, but sometimes can be slightly modified by the appearance of small, fast movements. In diseases of the central nervous system, the PETT is very often altered, and these alterations are very distinct. Although the three main deformations of the curve can be observed in lesions of any localization in the nervous system, there appears to be certain systematization. The normal curve with superimposed fast movements tends to be associated with cerebellar disease. The deformed curve often appears in connection with a more widespread localization of encephalic lesions, perhaps due to repercussion in the brain stem; and the disappearance of the curve apparently is due to an important lesion in the oculomotor pathways in the tegmentum of the pons and midbrain. The PETT has localizing diagnosic value, especially in the differentiation between diseases of the internal ear and of the central (neurological) connections of the vestibular system.
Anti-Epstein Barr Virus Antibody in Nasopharyngeal Carcinoma
Authors: Hsu Mow-Ming , Chiou Jwo-Farn , McCabe Brian F.
Published: October 2014

A retrospective study of anti-Epstein Barr virus (anti-EBV titers) in the sera of 400 patients with nasopharyngeal carcinoma (NPC) in Taiwan according to the clinical staging system of American Joint Committee is reported. Of NPC patients, 60% were seropositive (> 1:1640), while such values occurred only in 17.7, 10.9 and 20.6% respectively of normal adults, inflammatory diseases of the nose and throat, and head and neck tumor patients other than NPC (control groups). The geometric mean titer was 1:404 in NPC patients, and 1:116, 1:80 and 1:125 respectively in the three control groups. When 321 patients were staged, the seropositive rate increased successively from 12.5% in Stage I to 77.2% in Stage IV. Statistically, Stage I NPC patients had the same titer as the three control groups and a highly significant difference in chi-square tests from those in other stages. Radiotherapy did not influence the anti-EBV titers much; however, there was a definite decrease of titers in patients 7–18 months postradiotherapy. Thirty patients with recurrent disease and 28 patients with distant metastases demonstrated high positive titers and high geometric mean titers falling between those in Stage III and Stage IV. The correlation between EBV and NPC is discussed.
Blue Mantles in Otosclerosis
Authors: Lindsay John R.
Published: October 2014

Blue mantles refer to cord-like processes of pathological bone staining bluish gray with H & E and identical with bone in sclerotic areas of otosclerosis. Their incidence, location and relationship to otosclerosis in 114 temporal bones showing various types of otosclerosis were reviewed. A larger number of bones without otosclerosis were examined as controls. Blue mantles were almost constant in diffusely distributed types of otosclerosis. Cases with one or more foci of otosclerosis, clinical and nonclinical showed blue mantles in order areas of the capsule in the majority. Blue mantles were found bilaterally in a few cases of unilateral otosclerosis, also in a sibling of a case with proven clinical otosclerosis. They were found also in three cases of a similar number without otosclerosis. Blue mantles appear to be another manifestation of the same genetic disorder as otosclerosis.
Xeroradiographic Zonography of the Larynx and Hypopharynx
Authors: Woesner Merlin E. , Braun Ernest J. , Sanders Isaac
Published: October 2014

A new technique for the roentgenographic study of the larynx and hypopharynx in the frontal projection is described. Xeroradiographic zonography is a convenient technique requiring minimal patient cooperation and enjoying good patient acceptability. It requires no topical anesthesia or instillation of positive contrast material; yet, it produces significant diagnostic radiological information to supplement clinical examination of the larynx and hypopharynx. The technique has largely replaced other methods of roentgenographic evaluation of the larynx and hypopharynx in our own institution, and has resulted in new interest on the part of clinicians dealing with neoplasms of the laryngopharyngeal area in adjunctive roentgenographic study.
Secretory Immunoglobulin a (SIgA) in Middle Ear Effusions; A Further Report
Authors: Mogi Goro , Honjo Shoichi , Maeda Shoichi , Yoshida Toyoharu , Watanabe Noritake
Published: October 2014

Immunochemical and immunofluorescent studies of secretory immunoglobulin A (SIgA) in otitis media with effusion were carried out to investigate the local immunologic defense system and secretory activity in the middle ear. SIgA was isolated from pooled middle ear effusions by an immunoadsorbents technique and its antigenicity and subunit structure compared with SIgA derived from other external secretions, such as saliva, nasal discharge, and colostrum. The antigenicity and subunit structure of the isolated SIgA from middle ear effusions were identical or very similar to those of SIgA obtained from other external secretions. Radioimmunodiffusion analysis revealed that SIgA was present in 43 of 47 (91.5%) cases of serous middle ear effusion, whereas the sera from only 3 of 47 (6.4%) of these patients was found to have SIgA. Immunoelectrophoresis, using anti-SIgA antiserum, and radioimmunoelectrophoresis detected free SC (secretory component) in 1 of 47 (2%) serous and 6 of 30 (20%) mucoid effusions. Apices of epithelial cells and glandular acinar cells of the middle ear mucosa obtained from patients with otitis media with effusion were stained specifically with anti-SC antibodies. Findings of the study would suggest: 1) that the middle ear maintains the local immunologic defense system, as do respiratory tracts and salivary glands, and 2) that while serous middle ear effusions are a mixture of normal middle ear secretions bathing the membrane surface and transudates from serum, mucoid effusions are the result of enhanced epithelial secretory activity and transudates.
Ethacrynic Acid Ototoxicity Potentiation by Kanamycin
Authors: Prazma Jiri , Browder J. P. , Fischer N. D.
Published: October 2014

The ototoxicity of ethacrynic acid and kanamycin in combination has been investigated during acute and chronic conditions of exposure. The effect of the combination of 10 mg/kg of ethacrynic acid and 100 mg/kg of kanamycin during both exposure conditions is manifested by a significantly greater drop in measured potentials than is present in the combination with lower doses of kanamycin (50 mg/kg). This effect is manifested mainly by changes in EP. The action of ethacrynic acid and kanamycin, therefore, appears to affect primarily the metabolism of the stria vascularis. According to our electrophysiological findings during acute conditions, not only simultaneous drug exposure can increase the ototoxic effect, but sequential exposure also seems to create a treatment hazard if ethacrynic acid is given following prior exposure to an ototoxic antibiotic. Therefore, a careful evaluation of the drug history in every patient should be carried out before using ethacrynic acid for treatment.
Conductive SISI Test
Authors: Byers Vincent W.
Published: October 2014

The conductive SISI (short increment sensitivity index) test is an indirect procedure to estimate bone-conduction thresholds for middle ear pathology patients. A series of SISI tests are run, beginning at 20 dB S.L. and increasing in 10 dB S.L. steps, until a 100% SISI score is obtained. The following equation predicts the bone-conduction threshold:

[Formula: see text]

The results of 25 conductive SISI tests on a conductive hearing loss group indicate that the equation approximates the measured B.C. threshold. There was no statistical difference between the predicated B.C. thresholds (12.4 dB) and measured B.C. thresholds (10.4 dB) for the group.
Bilateral Pneumothorax Five Days after Tracheotomy Decannulation
Authors: Lehmann William B.
Published: October 2014

Bilateral pneumothorax occurred suddenly five days after uneventful tracheotomy decannulation. This near-fatal complication responded promptly to thoracentesis.
Pathological Changes in the Middle Ear Joints
Authors: Belal Aziz , Stewart Terence J.
Published: October 2014

A histological study was made of the middle ear joints in association with several middle ear disorders, including congenital anomalies, acute and chronic otitis media, congenital syphilis, otosclerosis, Paget's disease, and primary and secondary neoplasms. Although the numbers of cases are small, the data suggest that the degenerative changes in the joints are more severe and in higher incidence than expected as a function of aging. Whereas advanced changes may be present, including fusion of the articular surfaces, it seems improbable that the joint changes contribute to the conductive hearing losses existing in these ears.
Sodium and Potassium Concentrations in the Endolymph and Perilymph of the Cat
Authors: Makimoto Kazuo , Silverstein Herbert
Published: October 2014

Inner ear fluid from the scala vestibuli, scala tympani, scala media, utricle, and cerebrospinal fluid were collected from 47 normal cats, and analyzed for sodium and potassium concentrations with a flame photometer. Each compartment was found to have its own different values for sodium and potassium concentration. Perilymph in the scala vestibuli possesses a lower sodium concentration than perilymph in the scala tympani; in potassium concentration the perilymph in the scala vestibuli shows a higher value than that of the scala tympani. Compared with cochlear endolymph, utricular endolymph contains a higher concentration of sodium and a lower concentration of potassium. These concentration differences, which are related to the characteristics of membrane transport in each compartment of inner ear fluid, are considered to be adequate to sustain normal biological conditions of the inner ear.
Ultrastructure of Olfactory Epithelia in Mice after Smoke Exposure
Authors: Matulionis Daniel H.
Published: October 2014

Olfactory epithelium from three groups of C57B1/6J and SWR/J mice exposed once or twice daily to 10% cigarette smoke for six or nine days was examined at the ultrastructural level. Olfactory epithelium of SWR/J experimental mice was not affected by cigarette smoke. However, prominent alterations were noted in this epithelium of C57B1/6J smoke treated mice. These alterations included a reduction in size and (possibly) number of olfactory vesicles which sometimes failed to protrude above the epithelial surface and greatly reduced numbers of olfactory vesicle sensory cilia. In the supporting cell population an abnormal electron-lucent cell type was noted among the usually darker types. Both cell types were frequently found protruding abnormally above the epithelial surface. Microvilli of supporting cells were markedly reduced in number. The present study revealed that the olfactory epithelia in all mice of the same strain are not affected equally by acute smoke exposures. In affected animals the degree of morphological alteration suggests that normal olfaction might have been impaired. Strain differences in reaction to smoke insult indicate that susceptibility is genetically determined.
The Similarities of Optokinetic After-Nystagmus to the Vestibular Nystagmus
Authors: Takemori Setsuko
Published: October 2014

Optokinetic after-nystagmus (OKAN) was investigated quantitatively in the rhesus monkey to clarify the physiological characteristics. OKAN was always induced after optokinetic nystagmus (OKN) in darkness, was dependent on the preceding OKN and increased up to 135°/sec. OKAN was not influenced by changing the period of OKN. OKAN was very strongly suppressed in light, but the responses were still dependent on the preceding OKN. The responses of OKAN were not changed by the level of illumination during OKN. OKAN showed the response decline in the repetitive testings on one day and in daily tests in all parameters of OKAN. Also, OKAN had a secondary phase. Thus there were many similarities between OKAN and the vestibular nystagmus induced by caloric or rotatory stimulation.
Sequence of Degeneration of Corti's Organ and its First-Order Neurons
Authors: Johnsson Lars-Göran
Published: October 2014

In our temporal bone material, sensory and neural degeneration do not occur independently. Usually there is a good correlation between the extent and severity of hair cell loss and the nerve degeneration in the osseous spiral lamina. Sensorineural degeneration in ototoxicity and after sound exposure is mostly sensory in nature in the initial phase of the process. Presence of supporting elements effectively delays secondary nerve degeneration. Degeneration of Corti's organ can often be complete, but the corresponding nerve degeneration is usually only severe to subtotal, never complete. Sensorineural degeneration which is predominantly neural (without parallel hair cell loss) is rare and occurred in less than 5% of our material. Severe subtotal nerve degeneration with hair cells still remaining was found only in one single temporal bone. Furthermore, Spoendlin's experiments in the cat suggest that in man also a portion of the first-order cochlear neuron could have an unusual degeneration behavior and may not degenerate in the case of compression or transection. The fact that sensory and neural degeneration rarely occur in reasonably “pure” forms may explain why it is often difficult to distinguish between them by means of audiological tests alone.
Electrocochleography
Authors: Simmons F. Blair
Published: October 2014

Promontory recording of click-evoked auditory nerve potentials is the most accurate objective test of cochlear function available today. As a truly diagnostic clinical test, however, its use is limited to a small group of problem cases, usually children with multiple diagnostic problems, inasmuch as most hearing losses can be measured in other ways. High frequencies are more accurately measured than those below about 2 kHz.
Electronystagmography: Significant Alterations in Tumors of the Cerebellopontine Recess
Authors: Benitez Jaime T. , Bouchard Kenneth R.
Published: October 2014

A significant nystagmographic alteration in the examination of ten patients with tumors of the cerebellopontine recess was impaired ocular pursuit movements when the eyes were moving towards the side of the lesion as detected by eye tracking and optokinetic tests. Unilateral diminution of optokinetic response was found towards the side of the tumor (moving target towards the unaffected side). The presence of saccades during optokinetic response provided additional information, even when the responses appeared symmetrical. Investigation of spontaneous lateral gaze and positional nystagmus contributed in less extent to the diagnosis of the lesions. A caloric test indicated mainly the side of the lesion, but gave little information as to the size of the tumor.
Traumatic Oval Window Fistula with Cerebrospinal Fluid “Gusher”
Authors: Mulvaney Thomas J. , Montandon Pierre B.
Published: October 2014

An eight-year-old boy fell and struck the right mastoid region, with immediate onset of vertigo, nystagmus, and right deafness. No fracture was found, and emergency tympanotomy disclosed an intact ossicular chain, rupture of the annular ligament, and cerebrospinal fluid gushing from the oval window. Treatment is described, possible explanations are discussed, and pertinent literature reviewed.
Transection of the Posterior Ampullary Nerve for the Relief of Benign Paroxysmal Positional Vertigo
Authors: Gacek Richard R.
Published: October 2014

Five patients with incapacitating benign paroxysmal positional vertigo (BPPV) for one year or longer were managed surgically by transection of the posterior ampullary nerve. An approach to this nerve was devised based upon a careful study of the posterior ampullary nerve in temporal bone dissections and specimens of the inner ear. Using the round window membrane as the principal landmark, the singular canal was exposed in the round window niche via a tympanotomy approach under local anesthesia. Transection of the posterior ampullary nerve promptly and completely relieved the signs and symptoms of BPPV in all five patients. A severe sensorineural hearing loss was produced in one case as a result of traumatic labyrinthitis. Transection of the posterior ampullary nerve in the round window niche is recommended to: 1) relieve severe BPPV of one or more years duration, and 2) add to the completeness of transcanal labyrinthectomy by denervating the inaccessible posterior canal crista.
Interaction of Neomycin with Phosphoinositide Metabolism in Guinea Pig Inner Ear and Brain Tissues
Authors: Schacht Jochen
Published: October 2014

Phospholipids of guinea pig inner ear tissues were labeled in vivo by perfusing the perilymphatic spaces with 32P-labeled inorganic phosphate. The most highly labeled lipids obtained after a 45 min incubation time were phosphatidylinositol phosphate and phosphatidylinositol diphosphate. 32P-incorporation into the latter in the Organ of Corti was significantly decreased in guinea pigs previously treated with neomycin (100 mg/kg body weight) for 21 days. In in vitro experiments with subcellular fractions of guinea pig cerebral cortex, neomycin (10−4 M) altered the labeling of the polyphosphoinositides from γ−32P-ATP and inhibited their hydrolysis. It is suggested that neomycin toxicity is mediated by an inhibition of polyphosphoinositide turnover.
Measurement of Vibration of the Basilar Membrane in the Squirrel Monkey
Authors: Rhode William S.
Published: October 2014

The Mössbauer technique, which can be used to measure very small velocities, on the order of 0.2 mm/sec, has been used to measure the response of the basilar membrane to tones and clicks in squirrel monkeys. The results verify that there is a mechanical frequency analysis performed in the cochlea and that the traveling wave theory holds true. The resonance curves indicate that the tuning of the basilar membrane is greater than was thought. The basilar membrane in the 7–8 kHz region of the cochlea vibrates nonlinearly at frequencies near the “resonant frequency.” The click response shows that the “tail” of the decaying oscillatory response does not decrease in proportion to click amplitude while the early displacements of the basilar membrane have a nearly linear relationship with click amplitude. These results are in good agreement with the results of the measurements using tones as stimuli. Experiments examining postmortem behavior of the basilar membrane indicate a rapid decrease in the sensitivity of vibration along with a decrease of up to one octave in the “resonant” frequency within a six hour period after the animal's death. The shift in resonant frequency is accompanied by a corresponding shift in the phase characteristic. The low frequency slope of the resonance curve becomes 6 dB/octave exactly as Békésy found while the high frequency slope decreases slightly. Comparison of the mechanical resonance curves with the neural data for single auditory nerve fibers in the squirrel monkey indicates that the exquisite tuning exhibited in the nerve cannot be explained solely on the basis of the mechanical behavior of the basilar membrane.
Cholesteatoma: Pathological Considerations in Surgical Planning
Authors: Morgenstein Karl M.
Published: October 2014

The management of cholesteatoma has been a controversial subject for many years. Advances in technology, magnification and surgical skills have enabled the otologist to deal more effectively with cholesteatoma over the years. However, attention must be paid to the pathological nature of cholesteatoma when planning surgical attack upon it. Rather than simply being skin that has gotten lost and becomes unable to cleanse itself of its epithelial debris, cholesteatoma is an invasive, erosive and destructive process. It feeds upon the bone by invading it with osteoclastic cells and others which are apparently capable of regenerating cholesteatoma matrix. Unless these residua are removed along with the matrix, one cannot be certain of total ablation of disease. Microscopic inspection at the operating table cannot be trusted to make this determination. Therefore, the case is presented for dealing with cholesteatoma in a two-stage operation. One-stage operations which reconstruct the ear at the same time as the removal of cholesteatoma matrix predispose to the recurrence of cholesteatoma in several ways. The neophyte otologist should not feel that extraordinary operations are the standard and should be prepared to utilize the basic mastoid operations as a preliminary to timed reconstruction of the middle ear. Observation of the ear over an interval is the best way to determine that cholesteatoma has been removed in its entirety.
Osteoplastic Epitympanotomy
Authors: Wullstein Sabina R.
Published: October 2014

This new access to solve the problem of tympanoplasty attacks the diseased area of the middle ear opening it directly and completely. It offers the absolutely unhindered approach to the most dangerous area of pathology, mainly the “anterior point of danger.” The retrotympanic spaces, if not affected, as in the majority of cases, may remain closed. But with the same approach, surgery may be enlarged all over the mastoid without touching the posterior wall of the external meatus. The procedure ends with complete reconstruction of the middle ear and the outer canal. Results in hearing are good. The method is in general use at the Department since 1970.
Hypersomnia Caused by Upper Airway Obstructions; A New Syndrome in Otolaryngology
Authors: Simmons F. Blair , Hill Michael W.
Published: October 2014

A new cause for excessive sleepiness during the day is gradually emerging from 24-hour polygraph sleep studies: intermittent upper airway obstruction which is usually hypopharyngeal but can also be nasal in origin. Three such cases are described. One was cured by a permanent tracheotomy and another by a submucous resection.
Endolymphatic Sac Response to Cryosurgery of the Lateral Ampulla
Authors: Schindler Robert A. , Lundquist Per-G. , Morrison Murray D.
Published: October 2014

Cryosurgical destruction of the sensory epithelium of the lateral ampulla provides an opportunity to study the response of the endolymphatic sac to aseptic labyrinthine trauma. The lateral ampullae of ten young guinea pigs were cryosurgically injured one to four days prior to sacrifice, and the ampullar morphology was correlated with that of the endolymphatic sac. The maximum extent of the ampullar lesion was noted two days after surgery, and the endolymphatic sac demonstrated histological signs of an increased activity with evidence of fluid reabsorption and phagocytosis of endolymphatic debris. Four days after cryosurgery, the epithelial surface of the ampulla had healed, the endolymph had cleared, and the activity of the endolymphatic sac had diminished. These experiments confirm the important role of the endolymphatic sac in response to labyrinthine trauma.
Melanocytes of the Vestibular Labyrinth and Their Relationship to the Microvasculature
Authors: LaFerriere Keith A. , Arenberg I. Kaufman , Hawkins Joseph E. , Johnsson Lars-Göran
Published: October 2014

The melanocytes of the vestibular labyrinth as seen in colored guinea pigs show a characteristic pattern of distribution in the wall of the utricle and in the ampullae, but they are not present in the wall of the saccule. They are found mainly in well-vascularized regions of apparent secretory or metabolic importance, including the “dark cell” areas. Their dendrite-like processes are often in intimate contact with the capillaries, although no pinocytotic vesicles or other indications of transfer of substances between the melanocytes and the capillary endothelium are seen under the electron microscope. In the human ear, the apparent density of the melanocytes varies with skin color. They are numerous in the cochlea, especially in the bony wall of the modiolus and on the osseous spiral lamina, and they occur also in Reissner's membrane and in the stria vascularis. In the vestibular system they are found in the wall of the saccule as well as in the utricle, the crus commune, and the ampullae, but not in the semicircular canals. They tend to be diffusely scattered, rather than to form the well-defined, intensely pigmented areas that are characteristic of the guinea pig. Close contacts with capillaries are seen mainly in the tympanic portion of the spiral ligament. The significance of melanin and the melanocytes in the labyrinth is unknown, but both the anatomical relation of certain melanocytes to capillaries, and the biochemical relation of melanin to the catecholamines support the hypothesis that they may have a vasomotor function. Other evidence, including the not infrequent association of sensorineural deafness with hereditary disorders of pigmentation also suggests that the melanocytes may play a role of some biological consequence in the inner ear.
Early Averaged Electroencephalic Responses to Clicks in Neonates
Authors: McRandle Carol C. , Smith Mary A. , Goldstein Robert
Published: October 2014

The early (approximately 8–50 msec latency) averaged electroencephalic responses (AER) to 55 dB HL clicks were elicited from ten normal newborns 36 to 72 hours after birth. Early components were observed in all ten babies with 512 clicks presented at 4.5/sec and 9.0/sec. Mean peak latencies in msec were: Po — 11, Na — 17, Pa — 28, Nb — 35, and Pb — 51. The neonates' early component waveforms closely resemble those of adults. The latency and waveform stability of the early components in neonates and adults support the belief in the primary auditory (lemniscal) system as the mediator of these responses. Furthermore, the repeatability of the early components of the AER makes them more reliable response indices than the late components (approximately 50–400 msec) for audiometry with neonates.
Pyriform Sinus: Functional Visualization
Authors: Brewer David W. , Gould Leo V.
Published: October 2014

A pilot study of the pyriform sinuses simultaneously visualized by video-fluoroscopy and fiberoptic video techniques utilizing two microphones and a synchronizing signal was carried out on seven patients. Patients were requested to breathe quietly, sniff, cough, clear their throats, whisper, yawn, phonate a low pitched “ah” and a high pitched “e”, as well as phonate on inspiration. On comparative study of the video tapes, variable findings were noted during the several phonatory efforts with the high pitched “e”. These presently remain unexplained. Sniffing by patients with paretic, paramedian, or intermediate paralysis of the vocal cords allowed us to see a progressive lack of descent and closure of the involved sinus. In addition, the anteromedial margins were less vigorously sucked inward and downward and even made to flutter on the involved side. Such a combined method of visualization appears to hold promise for additional delineation of the range of normal as well as further identification of abnormal function of the laryngopharynx.
Place of Fiberoptic Endoscopy in Bronchoesophagology
Authors: Olsen Arthur M.
Published: October 2014

Flexible and rigid instruments are both useful in the endoscopic examination of the tracheobronchial tree and esophagus. Although either instrument may be employed in many cases, there are specific indications for the use of flexible fiberoptic endoscopes in both bronchology and esophagology; and likewise, the rigid instruments are mandatory in the management of some endoscopic problems. Ideally, the bronchologist and the esophagologist should be proficient in the use of both the rigid and the fiberoptic endoscope. If this is not possible, those who are competent only with flexible fiberoptic endoscopes must work closely with the fully trained bronchoesophagologists. Peroral endoscopy is already shared by otolaryngologists, thoracic surgeons, gastroenterologists, and specialists in thoracic medicine. Although multiple disciplines probably will continue to be involved in bronchoscopy and esophagoscopy, these specialties must not be so broad that no one will be completely competent in bronchoesophagology.
Flexible Fiberoptic Bronchoscopy in the Critically Ill Patient
Authors: Lindholm Carl-Eric
Published: October 2014

Flexible fiberoptic bronchoscopy (FFB) was used in a high risk group of patients treated in the Intensive Care Unit (ICU) of Presbyterian University Hospital in Pittsburgh. Regional atelectasis on the basis of retained secretions regressed in 78% of trials following FFB and many valuable diagnoses of airway pathology were obtained. The bronchofiberscope inserted transnasally without previous intubation did not significantly interfere with intratracheal pressure changes and alveolar ventilation during spontaneous breathing. However, the instrument caused high positive end expiratory pressures (PEEP) when inserted through tracheal tubes of 7.5 mm internal diameter (I.D.) or less in patients on volume controlled ventilation. This effect could be pronounced enough to cause mediastinal emphysema and probably tension pneumothorax. Suction applied through the channel of the bronchofiberscope caused decreased oxygenation both in patients who maintained spontaneous ventilation and in those maintained on volume controlled ventilation during FFB. Adequate airway, 100% oxygen ventilation during the procedure, and good patient cooperation or relaxation was important for diminishing the risk of potential complications.
Effect of Laryngofissure on the Developing Canine Larynx
Authors: Calcaterra Thomas C. , McClure Robert , Ward Paul H.
Published: October 2014

Tracheostomy during infancy often results in serious complications and even death. The current policy in many medical centers is to recommend extended hospitalization of an infant whenever tracheostomy is necessary. Almost all obstructing diseases of the infant larynx are treated by tracheostomy because of the concern that surgical intervention of the larynx may result in impaired laryngeal growth inadequate for airway or phonation. Since no applicable clinical or experimental reports could be found in the literature, a study was designed to determine the effect of laryngofissure on laryngeal development and function. Six five-week-old dogs underwent an anterior laryngofissure, three of which had placement of a Teflon® keel. The keels were removed six weeks later. Four five-week-old dogs served as controls. At maturity eight months later the ten animals were sacrificed just after direct laryngoscopy. Full vocal cord mobility was found, and the glottic aperture, including the anterior commissure, appeared to be normal. The larynges were excised and found to have the same dimensions and weight as did the controls. Microscopic studies revealed little scarring at the anterior commissure, and the thyroid lamina were bridged by fibrous and cartilaginous tissue with minimal displacement of the lamina. The results of this study suggest that the infant larynx may be divided by a midline vertical thyrotomy without impairment of laryngeal development or function.
Recording Auditory-Nerve Potentials as an Office Procedure
Authors: Montandon Pierre B. , Megill Norman D. , Peake William T. , Kahn Amy R. , Kiang Nelson Y.S.
Published: October 2014

Recording auditory-nerve potentials from human subjects is already a routine procedure in the laboratory. In order to bring such recording capabilities into the office of practicing otologists, a number of difficulties had to be overcome. First, a small signal averager was built and incorporated into a stimulus generating and response recording system. The entire system was made portable and self-sufficient. The effects of electrical interference and background acoustic noise were shown to be tolerable. After studies of how responses vary with electrode location, electrodes were designed to be placed on the ear canal so that no invasive procedures were necessary. Methods were found to simplify the procedure so that recordings can be made in a matter of minutes by one person working alone.
Sensorineural Impairment in Unilateral Otosclerosis
Authors: Linthicum Fred H. , Lalani A. S.
Published: October 2014

Audiometric findings were evaluated in a group of patients with clinical unilateral otosclerosis. A comparison was made between bone conduction threshold in the better hearing ear and the ear with the mixed hearing loss. Over 50% of the patients had a significant elevation in the bone conduction thresholds in the ear with clinical otosclerosis as compared to the uninvolved ear. A pair of temporal bones from a patient with unilateral otosclerosis and unilateral mixed hearing loss is presented.
Nonacoustic Stimulation of the Middle Ear Muscle Reflex
Authors: Fee Willard E. , Dirks Donald D. , Morgan Donald E.
Published: October 2014

The purpose of these experiments was to determine the incidence of the middle ear reflex in response to several nonacoustic (tactile and air jet) stimuli among subjects with normal hearing who had an acoustic reflex and selected patients with severe hearing loss. The results demonstrate that the incidence of response to tactile stimulation increases as the facial area stimulated approaches the auricle. The response to an air jet stimulus directed toward the eye is high; however, the clinical utility of the air jet may be limited because it often results in a startle reaction and head movement, and the response appears to fatigue easily. In normal listeners the response to auricular air jet stimulation probably results from both acoustic and tactile stimulation. The presence of a reflex to tactile stimulation, together with normal tympanometry constitutes strong evidence of a normal middle ear; but the absence of a reflex to acoustic or tactile stimuli still leads to an ambiguous determination of potential stapedial muscle function.
Upper Digestive Tract Burns Caused by Denalan® Denture Cleanser Powder
Authors: Abramson Allan L. , Eason Robert L. , Pryor William H. , Messer Eugene J.
Published: October 2014

Denture cleansers are ubiquitous compounds frequently found in the household. Severe oral cavity burns were clinically observed in a two-year-old female who accidentally ingested a denture cleanser powder, Denalan.® Experimental studies were carried out to investigate the caustic, chemical and histopathological properties of this compound. Denalan® was found to be a powerful alkali agent which caused severe upper digestive tract burns.
Radionuclide Angiography in Juvenile Angiofibroma of the Nasopharynx
Authors: Castor W. R. , Lentle B. C. , Glazebrook G. A.
Published: October 2014

Radionuclide angiography was performed by intravenous injection of 99mTc-pertechnetate and recorded by serial gamma camera scintiphotographs. Its usefulness as a prebiopsy or preoperative procedure is demonstrated by two case reports of angiofibroma of the nasopharynx and it was also found to be useful for radiation therapy follow-up assessment. Radionuclide angiography offers a convenient and safe method to assess the vascularity of a mass and by this technique the surgeon may be alerted to the possibility of severe postbiopsy hemorrhage and also the occasional dramatic complications of radiological carotid angiography can be avoided.
Mucosal Histochemistry in Secretory Otitis
Authors: Palva Tauno , Palva Antti
Published: October 2014

Mucosal biopsies were taken from 20 ears with secretory otitis media (glue ear) and histochemical stainings were made for comparison with data obtained from biochemical analysis of the fluids. Acid phosphatase, lactate dehydrogenase (LD), and malate dehydrogenase (MD), the activity of which in the ear fluids was 20 to 30 times higher than in serum, were found to appear as strong precipitates in the middle ear epithelium, particularly in the top layer. Alkaline phosphatase activity was only exceptionally seen in the epithelium but appeared in the capillaries and histiocytes. Nonspecific esterase appeared irregularly in the epithelium and regularly in histiocytes. The latter two had lower activities in ear fluids than in serum. Epithelial secretory cells and subepithelial glands and cysts showed strong alcian blue (AB)-positive staining. Positive material appeared also in the cytoplasm of the epithelial cells and in the intercellular substance. Distinct PAS-positive staining appeared in the columnar epithelium and particularly in the free mucus on top of the epithelium but was less pronounced in the glandular structures and absent from the cysts.
Collagenase Activity in Epidermoid Carcinoma of the Oral Cavity and Larynx
Authors: Abramson Maxwell , Schilling Robinson W. , Huang Cheng-chun , Salome Ronald G.
Published: October 2014

Tumor invasion requires the breakdown of the main structural protein, collagen. A series of fourteen epidermoid carcinomas of the larynx and oral cavity produced a collagen dissolving enzyme in vitro as demonstrated by the breakdown of 14C-labeled collagen. Oral cavity tumors showed greater activity than laryngeal carcinomas while both sites were more active than uninvolved mucosa from the same patients. Tumor associated collagenase activity, in common with previously described collagenases, can only be demonstrated in vitro and requires protein synthesis. Maximum tumor collagenase occurred at 24 hours in vitro and then declined as compared with the maximum collagenase at 72 hours in vitro produced by oral cavity mucosa. The 14 patients in our series were ranked in order of the collagenase activity of their tumors. At 18 months after the diagnosis, four of the six patients with the most active tumors were dead of cancer and one patient was alive with persistent cancer. High collagenase activity may be a factor in the clinical aggressiveness of epidermoid carcinomas of the head and neck.
Effect of Intracochlear Aminooxyacetic Acid on Cochlear Potentials and Endolymph Composition
Authors: Bobbin Richard P. , Gondra Maria I.
Published: October 2014

Aminooxyacetic acid (AOAA; 1 mM) when perfused through the scala tympani of guinea pigs produced a biphasic reduction in the endocochlear potential, together with a shift in the input-output functions of the cochlear microphonics and the compound action potential of the cochlear nerve. Since the ionic (Na+, K+) content of the scala media was not altered, it appears that such changes did not underlie the reduction recorded in the endocochlear potential. The negative direct current potential recorded in the organ of Corti did not appear to be affected by the drug. Attempts to antagonize the effects of AOAA with pyridoxine failed.