bluuebunny/crossref_metadata_2025 huggingface dataset:
Laryngeal Phonatory Reflex
Authors: Tanabe Masahiro , Kitajima Kazutomo , Gould Wilbur J.
Published: October 2014

The laryngeal phonatory reflex through the internal branch of the superior laryngeal nerve (SLN) was investigated by means of anesthetization of the nerve, after which acoustic signals were subjected to computer analysis to determine how anesthesia affected basic vocal parameters. Results showed that the anesthetization did not affect the abrupt cycle-to-cycle frequency changes and also did not influence the gross control of the fundamental frequency. But slower fluctuation of the fundamental frequency increased following anesthesia. From these results, it is suggested that the anesthetization of the internal branch of the SLN may derange the fine control mechanism of the larynx without affecting overall or gross performance of the phonatory apparatus.
Thorotrast (Thorium Dioxide) Granuloma of the Neck: Surgical Considerations
Authors: Muzaffar Kamil , Nichols Richard D.
Published: October 2014

Thorotrast (thorium dioxide) is a contrast material which was first used for angiography about 40 years ago. Its use was discontinued because of the reported incidences of malignancy following injection. Its long-term effects are related to its long half-life and slow excretion rate. Following extravasation into the soft tissues of the neck, the prolonged radiation effect results in tissue breakdown with formation of granulomas. There can also be cranial nerve palsies, occlusion of the major blood channels, laryngeal edema, pharyngeal and esophageal ulceration, and fistula formation. To avoid these late consequences, it is suggested that Thorotrast granuloma in the neck be excised radically. Partial or limited resections are inadequate.
Structure of the Avian Tectorial Membrane
Authors: Tanaka Katsuhiko , Smith Catherine A.
Published: October 2014

The avian tectorial membrane is a thick massive-appearing structure permeated by cavities, which probably facilitate the diffusion of endolymph. As revealed by scanning and transmission electron microscopy, the cavities are arranged in a characteristic honeycomb-like pattern and each hair bundle is enclosed in an alveolus. The open ends of the alveoli show the impressions of sensory hairs on one side. The rims about the cavities are attached to the microvilli of the supporting cells by means of fibrous material. These morphological aspects are compared with those of reptiles and mammals, and the functional significance of the fibrillar anchors is discussed.
Survey of the Clinical Use of Electrocochleography
Authors: Crowley David E. , Davis Hallowell , Beagley Harry A.
Published: October 2014

A questionnaire on the clinical use of electrocochleography (ECochG) was distributed to clinics throughout the world which use this method. The 26 replies comprised 3696 cases with a median age of 22.5 years. The majority (57.1%) were tested with a trans-tympanic promontory electrode. The risk of any undesirable effect from this electrode placement was negligible (less than 0.1%), but a greater probability (less than 1.0%) of serious complication from general anesthetics was revealed. On the benefit side, ECochG added significant information to the diagnoses of 87.8% of the children and 34.2% of the adults, and in 48.2% of the children and 2.0% of the adults this information was a primary factor in the hearing evaluation and decision on management. The cases for which ECochG was most helpful were predominantly children and neonates with complex neurological or psychiatric problems which interferred with reliable testing by other methods. Comparisons of ECochG with other methods were reported in 63.2% of the cases. The respondents judged 97.4% of these comparisons to reflect favorably on the validity of ECochG.
Benign Granular Cell Tumors of the Larynx: A Review of 36 Cases with Clinicopathologic Data
Authors: Compagno John , Hyams Vincent J. , Ste-Marie Pierre
Published: October 2014

The clinical, microscopic, and gross features of 36 cases of benign granular cell tumor arising in the larynx are reviewed and studied. This infrequent lesion, when in the larynx, is found most commonly on the true vocal cord in adults in their third, fourth, and fifth decades; there is no obvious sex predilection. Slowly increasing hoarseness was the primary complaint in our cases. Clinically, the tumors are considered benign. The most common clinical impression was a vocal cord papilloma. The microscopic pattern of the granular cell tumors is uniform and bland, but there may be a marked pseudoepitheliomatous hyperplasia of the overlying squamous epithelium, often stimulating squamous cell carcinoma. Follow-up information is discussed, as is the origin and histogenesis of this lesion.
Silastic and Gelatin Film Sheeting in Tympanoplasty
Authors: Falbe-Hansen J. , Tos M.
Published: October 2014

In 78 patients, representing 10% of the most severe cases of chronic otitis media and in whom the mucosa from the promontory had been removed or severely damaged, the promontory was covered in one-stage mastoidectomy-tympanoplasty with a large piece of thin silastic or of Gelfilm.® The results in the silastic group, comprising 50 patients, and in the Gelfilm® group, comprising 28 patients, were compared on the basis of various criteria. The results proved better in the Gelfilm® group. In particular, the percentage of recurrent perforations was considerably lower than in the silastic group. In one-stage operations, which we prefer, it is therefore recommended to use Gelfilm® rather than silastic.
Eustachian Tube Ventilatory Function in Relation to Cleft Palate
Authors: Bluestone Charles D. , Beery Quinter C. , Cantekin Erdem I. , Paradise Jack L.
Published: October 2014

The ventilatory function of the Eustachian tube was assessed in a group of infants and children with cleft palate, some of whom had received palatal repair. Those whose palates had been repaired were better able, in general, to equilibrate applied positive middle ear pressures than were those with open clefts. In many of the patients whose palates had been repaired, the results of Eustachian tube function studies were similar to those in normal subjects. Differences in Eustachian tube ventilatory function are assumed to be related to differences in tubal compliance. Excessive compliance probably results in, or exaggerates, functional Eustachian tube obstruction. Improvement in tubal function following palate repair is probably related to factors resulting in greater tubal stiffness.
Effect of Microaerosol Inhalation on the Pattern of Breathing
Authors: Sasaki Clarence T. , Newman Andrew , Akitaya Tadashi , Kirchner John A.
Published: October 2014

The nose and supraglottic larynx appear to play significant roles in the modification of the breathing pattern in response to a nonirritating solution delivered as a microaerosol. Slower breathing, reflexly produced by such a method, might benefit partial airway obstruction by reducing turbulence and, therefore, the work of breathing without altering tidal volume.
Osteogenesis Imperfecta Congenita and Tarda: A Temporal Bone Report
Authors: Zajtchuk Joan T. , Lindsay John R.
Published: October 2014

The temporal bone report of an operated case of osteogenesis imperfecta tarda is presented. Histological examination confirmed the presence of bilateral fixation of the footplate by otosclerosis as the cause of the conductive hearing loss. Fragility of bony septae in the mastoid and of the stapedial crura were observed. Sensorineural impairment in later years with a reduction in neural elements in the cochlea appear related to the extent and activity of the otosclerotic foci. Additional temporal bone reports of three cases of osteogenesis imperfecta congenita show lack of deposition of the skein-like bone in the endochondral layer, sparse bony septae in marrow spaces and deficiency of the periosteal layer. The stapedial crura were thin and in two cases both were deformed and fractured.
Giant Cell Tumor of the Sphenoid Bone
Authors: Gupta I. M. , Gupta O. P. , Samant H. C. , Bhatia P. L. , Agarwal A. K. , Pant G. C.
Published: October 2014

The clinical features of the giant cell tumor of the sphenoid bone have been discussed and a case report has been added to the fourteen cases reported in the literature. Such cases may first report to an ophthalmologist, an otolaryngologist, a neurologist, or an internist. They should consider this condition in a patient who complains of headache, ocular symptoms such as diplopia, and diminution of vision progressing to complete blindness. The presence of multiple cranial nerve palsies involving II, III, IV, V, and VI nerves in various combinations and the sellar erosion in the lateral x-ray of the skull are quite suggestive of this tumor which should be confirmed by biopsy. The telecobalt therapy appears to give the best results.
Disconjugate Eye Movements during Electronystagmographic Testing in Patients with Known Central Nervous System Lesions
Authors: Kimm Joseph , MacLean James B.
Published: October 2014

A tacit assumption underlying current ENG testing is that the eyes move conjugately. However, considering the intricate neuroanatomical pathways within the ocular motor system in addition to the elaborate vestibulo-ocular connections, we think it reasonable that disconjugate eye movements may result with certain CNS lesions. Recently we have employed independent eye movement measuring techniques in order to assess the movement of each eye separately during our ENG valuations. The preliminary work has revealed that disconjugate eye movements occurred even with extra-axial lesions which spared the medial longitudinal fasciculus. These data may be valuable for the neurotologist with regard to differential diagnosis and prescription of a treatment plan for the patient. The eye movement patterns of patients with confirmed CNS lesions and other interesting findings are presented.
The Latero-Medial Inferior Pontine Syndrome
Authors: Applebaum Edward L. , Ferguson R. J. Lawrence
Published: October 2014

A case is presented with a pontine vascular lesion involving the V, VI, VII, and VIII cranial nerves. The diagnostic evaluation included audiometry and electronystagmography as well as arteriography, pneumoencephalography, and brain scan. Total deafness developed in the involved ear and was present for seven weeks before complete recovery occurred. Electronystagmographic findings consistent with a brain stem lesion also resolved following recovery of the patient. Audiometry and electronystagmography are described and documented for the first time in a report of a patient with a latero-medial inferior pontine syndrome. A discussion of some of the unique features of the brain stem vasculature and its relationship to clinical syndromes involving the brain stem is given.
Value of Special Auditory Tests in the Latero-Medial Inferior Pontine Syndrome
Authors: Noffsinger Douglas , Kurdziel Sabina , Applebaum Edward L.
Published: October 2014

Results from a special battery of auditory tests are used to document, for the first time, recovery from a total unilateral hearing loss occurring as part of a latero-medial inferior pontine syndrome. Although sensitivity for pure tones and speech was regained within two months of onset, definite retrocochlear signs persisted for nine months. The tests which best demonstrated the lingering retrocochlear abnormality were binaural masking level difference procedures for 500 Hz pure tones and speech and examination of the amplitude of the acoustic reflex over a ten second time period. The relative sensitivity of other speech and pure tone tasks in detecting the retrocochlear problem is detailed.
Brain Stem Tumor and Otoneurologic Manifestations: Report of a Case with Autopsy
Authors: Makishima Kazumi , Ogata Jun
Published: October 2014

The otoneurologic findings in a 30-year-old male patient who died of a brain stem tumor have been correlated with the histopathology of the temporal bones and brain. The patient was examined on two occasions. A sensorineural hearing loss, which was moderate in the right ear and mild in the left ear, was found. Abnormal vestibular function, indicative of central pathology, was also demonstrated. The right side of the medulla oblongata and pons was largely replaced by the tumor. The cochlear and vestibular nuclei and their connecting fibers were involved with the tumor. Histopathological changes were more prominent in the right cochlea and VIII nerve than in the left and were minimal in the vestibular portion of the labyrinths. The otoneurological findings suggested a central nervous system (CNS) lesion, and the morphologic observations confirmed the central origin of the symptoms and signs. Manifestations of lesions of the central auditory and vestibular pathways are discussed.
Experimental Aural Cholesteatoma Causing Bone Resorption
Authors: Abramson Maxwell , Asarch Richard G. , Litton Ward B.
Published: October 2014

A series of experiments were carried out on 55 guinea pigs in four groups to study the conditions fostering bone resorbing epidermal cysts. The first group had free grafts of canal wall skin applied to the cochlea with and without talc application. The second group had canal skin flaps applied to the cochlea with and without subsequent talc application. The third group had talc applied either to the tympanic membrane or on the cochlea. The fourth group had a canal skin flap inserted into a mucosal pocket in the bulla. The animals were killed three to four months after surgery and the temporal bones were prepared for histology. Epidermal cysts were found at the cochlea in 8 of 55 animals. Cochlear fistulas were found in 6 of 55 animals. The fistulas were associated with epidermal cysts in three cases, otitis media in two cases, and talc granuloma in one case. These experiments show that migrating skin attached to a source of epithelium is capable of inducing bone resorption. Chronic foreign body granulomas and chronic sepsis are also capable of resorbing bone. These three conditions all produce a layer of undifferentiated connective tissue containing chronic inflammatory cells lying against the resorbing bone.
Genetic Sensorineural Deafness in Adults
Authors: Paparella Michael M. , Hanson David G. , Rao K. N. , Ulvestad Rolf
Published: October 2014

Progressive genetic sensorineural hearing loss is a common problem in adults which is frequently incorrectly diagnosed or escapes diagnosis as to etiology altogether. If the hearing problem becomes manifest in the twilight of the patient's life it is often identified with the nondescriptive term “presbycusis.” In all patients with sensorineural hearing loss, extrinsic (environmental) causes should be ruled out after which intrinsic or genetic etiology should strongly be considered, recognizing that extrinsic factors can be superimposed. A group of young adults was studied and diagnosed as having genetic progressive hearing loss. Polytomography ruled out the theoretical possibility of cochlear otosclerosis. The diagnosis of this disorder rests most heavily on the history and audiometric configuration which is characteristically flat or basin shaped with fairly good discrimination. Of further diagnostic significance was the fact that some patients, early in the course of their difficulty, presented with a predominantly low- or high-frequency loss which, over time, assumed a flat audiometric shape. The most important pathological finding from human temporal bone studies was atrophy of the stria vascularis.
Eustachian Tube Lymphatics
Authors: Pulec Jack L. , Kamio Tomokazu , Graham Malcolm D.
Published: October 2014

Serous otitis media is the most common cause of hearing impairment. The role of lymphatic obstruction in the pathogenesis of serous otitis media is significant. A method for removal of the human Eustachian tube specimen and two techniques for identification of Eustachian tube lymphatic capillaries are described. One involves the antemortem intratympanic installation of Berlin blue. The other utilizes electron microscopy. Lymphatic capillaries cannot be reliably differentiated from blood capillaries with the light microscope. With electron microscopy, lymphatic capillaries can be differentiated from blood capillaries by differences in the basement membrane. The lymphatic capillary has gaps in the basement membrane with large nuclei in the wall. A blood capillary has a continuous basement membrane and sometimes red blood cells can be identified in the lumen. Using these methods, Eustachian tube lymphatic capillaries in the human are described for the first time in this report.
Conservative Management of Ménière's Disease: Furstenberg Regimen Revisited
Authors: Boles Roger , Rice Dale H. , Hybels Roger , Work Walter P.
Published: October 2014

This study reviews twenty years' experience at the University of Michigan with 500 consecutive patients suffering from symptoms of Ménière's disease. An especially strong tradition of medical therapy for Ménière's disease has prevailed at the University of Michigan because of the influence of Albert C. Furstenberg, who developed and promoted the Furstenberg regimen of a low-sodium diet and diuretics. It has been our distinct clinical impression over the years that the Furstenberg regimen has been quite satisfactory in relieving the most disturbing symptoms of Ménière's disease in the vast majority of cases and often in patients who have failed other treatment programs. This study quantifies, as much as possible, our extensive experience with this disease and confirms for us the efficacy of this treatment. Relatively few operative procedures have had to be performed for conservative treatment failures in our hands. The success of this conservative management program has been largely dependent upon the strict adherence by the patient to a professionally prescribed, low-sodium diet. Occasional patients with chronic symptoms which are refractory to medical management continue to be a problem, particularly since it is in this group of patients that bilateral involvement tends to ultimately occur.
Electronystagmography: A Review of 17 Years Experience
Authors: Rubin Wallace
Published: October 2014

The clinical concepts of electronystagmography (ENG) and vestibular testing are simple. They are not mysterious, complicated, nor time consuming. Every patient afflicted with dizziness deserves such a recording as part of the vestibular workup. No one would consider the evaluation of a patient with a hearing loss complete without an audiogram, and in 1975 no patient with a complaint of dysequilibrium has been properly or sufficiently evaluated without an ENG recording of balance function.
Sensorineural Hearing Loss due to Cochlear Otospongiosis: Theoretical Considerations of Etiology
Authors: Linthicum Fred H. , Filipo Roberto , Brody Sidney
Published: October 2014

Several theories have been advanced to explain the sensorineural hearing loss that occurs in patients with otospongiosis: toxic substances produced by the otospongiotic focus; vascular shunts between the inner ear vessels and the otospongiotic focus; and atrophy of the organ of Corti and stria vascularis due to unknown causes. Presented here is yet another theory: impingement upon the cochlear walls by the otospongiotic focus, causing a narrowing of the lumen of the cochlea and distortion of the basilar membrane.
Communications
Authors: Crowley David E.
Published: October 2014

A conference was held to consider conceptual issues, methodological problems and preliminary findings related to auditory research with aging animals. Current concepts from various areas of experimental gerontology were discussed in relation to research on the aging auditory system and to the problem of human presbycusis.
Delayed Clearance of Tantalum by Radiologically Occult Cancer
Authors: Stitik Frederick P. , Proctor Donald F.
Published: October 2014

The best current treatment of bronchogenic carcinoma is prompt surgical excision of early lesions before mediastinal and extrathoracic spread occurs. Bronchoscopy, in a patient with a positive cytology and a negative chest radiograph, is a long, time-consuming procedure. Tantalum bronchography done prior to the bronchoscopy will significantly reduce the time necessary for bronchoscopy. Tantalum is cleared solely by mucociliary action. Early bronchogenic carcinoma, when sufficiently large enough, will destroy the ciliated epithelium, thus impairing mucociliary clearance and altering mucus secretion. Tantalum bronchography has localized these early x-ray negative lesions, both by minimal mucosal irregularity and by delayed clearance. In the past three years we have localized the radiologically occult malignancy in four out of five patients.
Clinical Experience with Pleuroscopy Utilizing the Bronchofiberscope
Authors: Kerby Gerald R. , Pierce George , Ruth William E.
Published: October 2014

The gas sterilized bronchofiberscope has been utilized as a pleuroscope for visual exploration of the pleural space and forceps biopsy of abnormal lesions in 16 patients with undiagnosed pleural disease. The instrument was inserted through a small (1–2 cm) incision. Aspiration of pleural fluid and instillation or aspiration of air to produce a controlled pneumothorax are easily accomplished through the instrument's suction channel. In eight patients with undiagnosed pleural effusion, biopsy of visualized nodules established the diagnosis of carcinoma. Three patients with bronchogenic carcinoma and pleural effusion had no pleural metastases at pleuroscopy which was confirmed in two patients who had thoracotomy and lung resection. Parenchymal subpleural nodules of metastatic carcinoma were confirmed by pleuroscopic biopsy in one patient. Biopsy via the pleuroscope was unsuccessful in two patients, one with pleural fibrosis, probably related to asbestosis, and one with mesothelioma. Both required open surgical biopsy of the pleura. There has been minimal patient discomfort and no serious complications.
Treatment of Papillomatosis of the Larynx with Transfer Factor
Authors: Quick Cedhic A. , Behrens Hans W. , Brinton-Darnell Margo , Good Robert A.
Published: October 2014

Transfer factor was used in two patients with laryngeal papillomatosis in an attempt to influence the thymus dependent small lymphocytes to become immunologically effective in their attempt to control the lesions. Following transfer factor, therapy laboratory tests showed altered reactivity of the lymphocyte stimulation tests for delayed hypersensitivity, and the results of the in vitro lymphocyte cytotoxic assay suggested that transfer factor improved the ability of lymphocytes to kill the tumor cells. Clinically, a change in the skin responses to the tests of delayed hypersensitivity was observed, and a change in the endoscopic appearance of the lesions occurred. Histologically, the specimens showed a marked influx of immune cells when transfer factor was being administered. Finally there was a significant clinical improvement in the disease state.
Carcinoma and Juvenile Papillomatosis
Authors: Zehnder Paul R. , Lyons George D.
Published: October 2014

A 41-year-old male presented with a fungating squamous cell carcinoma growing through the skin around his tracheostomy site. His history revealed a long-term laryngeal growth treated only by tracheostomy in 1955. He had been followed intermittently since age 25 and in 1968 a biopsy diagnosis of juvenile papillomatosis was made. This case is outlined until his death and the literature is reviewed concerning malignant changes in papillomatosis with and without radiation treatment. Malignant degeneration is reported in 3–14% of squamous papillomas. Critical histologic evaluation of such lesions is required to establish the diagnosis. When the criteria of maligancy are strictly adhered to, malignant change is considered exceedingly rare.
Extraluminal Foreign Bodies (Coins) in the Food and Air Passages
Authors: Yee King F. , Schild Joyce A. , Holinger Paul H.
Published: October 2014

Four children with foreign bodies found outside the lumen of the upper food and air passages are presented. The diagnostic difficulty of such extraluminal foreign bodies and the importance of accurate localization by endoscopy and radiologic examination prior to external surgical removal are discussed.
The Problem of the Open Safety Pin
Authors: Marsh Bernard R.
Published: October 2014

The open safety pin lodged in the stomach or esophagus presents a challenge to surgical judgment and technical skill. Most foreign bodies causing trouble lodge in the esophagus. Once in the stomach, uneventful passage can be expected in 80 to 90% of cases. Active intervention is reserved for those where intestinal performation is likely or where there is failure to progress. We have used the fiberesophagoscope to remove three open safety pins from the stomachs of two patients whose symptoms and threat of perforation required intervention. The microbiopsy forceps was used successfully to retrieve the open pins, but a newly developed grasping forceps for use with the fiberesophagoscope now provides a more secure hold on such foreign bodies. Rigid instruments retain their value for selected cases, but the flexible equipment now provides an important advance in the management of the open safety pin in the stomach.
Unexpected Radiographic Findings Related to Foreign Bodies
Authors: Morioka Wilfred T. , Smith Thomas W. , Maisel Robert H. , Cantrell Robert W.
Published: October 2014

In two asymptomatic patients, routine preoperative radiographs revealed three pennies in the esophagus in one patient and a spring from a toy in another patient. In contrast, two symptomatic patients, one with a flip-top cap from a beer can in the esophagus and the other with a piece of photographic film in the larynx, had negative findings on their radiographs. Salient points of the cases are that diagnois can be delayed by inadequate history, misinterpretation of signs and symptoms, and unexpected radiographic findings. Special attention should be focused on the flip-top cap ingestion case. Sixty-five percent of 677 people polled have placed flip-top caps into full cans. Fifty-two people almost swallowed a flip-top cap. Otolaryngologists should be alerted about the radiolucency of this metallic foreign body, and the general population should be discouraged from this dangerous practice.
Foreign Body Removal: A New Role for the Fiberoptic Bronchoscope
Authors: Zavala Donald C. , Rhodes Mitchell L.
Published: October 2014

Artificial and animal lung models initially were used to investigate the removal of foreign bodies from the tracheobronchial tree with the flexible fiberoptic bronchoscope. Different extraction instruments (claw, basket, forceps, and balloon catheter) were passed separately through the channel of the bronchofiberscope, and tested for usefulness prior to human application. The Fogarty balloon catheter served as a valuable aid in dislodging impacted objects so that the operator could then grasp them with the claw, basket or forceps. The wire claw recovered many of the metallic and organic objects, the wire basket was successful in retrieving only the bulky objects and the forceps (ACMI) was effective in capturing all of the metallic foreign bodies. These techniques, developed in our laboratory, are now being used to augment rigid bronchoscopy in the removal of foreign bodies from adults and older children. At the present time fiberoptic foreign body removal is not recommended for pediatric cases because of the small diameter of the trachea and glottis in infants and young children.
Hypogeusia, Dysgeusia, Hyposmia, and Dysosmia following Influenza-Like Infection
Authors: Henkin R. I. , Larson A. L. , Powell R. D.
Published: October 2014

Hypogeusia, with or without dysgeusia, and hyposmia, with or without dysosmia, followed an influenzal-like infection in 87 of 143 consecutive patients who presented at the Taste and Smell Clinic at the NIH with taste and smell abnormalities. Findings in this disease included pale nasal mucous membranes with marked patency of the nasal airway, a positive Rudolph sign, elevated detection and recognition thresholds for several tastants and odorants, disruption of the pore region of the taste bud observed on electron microscopy and infiltration of the upper lamina propria of the nasal mucous membrane with chronic inflammatory cells observed on light microscopy. These findings, taken together, are relatively specific for the diagnosis of this surprisingly common disorder.
Cleft Larynx: A Report of Seven Cases
Authors: Cohen Seymour R.
Published: October 2014

The purpose of this paper is to familiarize the otolaryngologist with a difficult and frequently missed anomaly. It is hoped that this will increase the number of successfully managed patients with this affliction. Of the seven herein reported cases, four were posterior clefts limited to the cricoid lamina. Three were more extensive laryngotracheoesophageal clefts. Seven cases are thus added to the approximately 30 cases reported in the world literature. The limited cricoid lamina defect can only be diagnosed by endoscopic examination, and is treated medically. Feedings must be given by gastrostomy only. A tracheotomy is indicated only when oral secretions are aspirated into the tracheobronchial tree. The more extensive laryngotracheoesophageal cleft requires surgical repair through a lateral pharyngotomy approach. When the cleft is extensive and extends into the chest, surgery must include a thoracic approach. The occurrence of cleft larynx in association with tracheoesophageal fistulae, with or without atresia, may be more frequent than generally realized. A search should be made for this anomaly in patients who aspirate after atresia repair has been accomplished, before attributing this symptom to severe stricture formation, or recurrence of the fistula. The problem of aspiration in posterior cleft larynx is due to the lateral and posterior displacement of the arytenoids. This malposition is due to the absence or deficiency of the interarytenoidius muscle so that the posticus muscle is unopposed. The term “posterior cleft larynx” should be used only where the defect is limited to the cricoid lamina, while laryngotracheoesophageal cleft should be applied to the more extensive defect.
Second Primary Cancer after Irradiation of Laryngeal Cancer
Authors: Lawson William , Som Max
Published: October 2014

Thirty (5.6%) of 535 patients followed 5–25 years after treatment of cordal carcinoma (T1A,B) developed a second primary laryngeal carcinoma. When analyzed by treatment modality, 3.9% of operated cases and 9% of irradiated cases formed new laryngeal or laryngopharyngeal malignancies. An explanation by radiation-induced carcinogenesis for this statistically significant difference between the two groups is discussed. It is also suggested that supervoltage radiation directed to the laryngeal mucosa may produce the diminished latent period observed between the appearance of the second primary carcinoma.
Experimental Granuloma of the Larynx
Authors: Kirchner Fernando R.
Published: October 2014

This paper describes a series of experiments that were performed in dogs, attempting to reproduce in the laboratory a chronic granulomatous reaction of the larynx. The purpose of this work was to learn about the possible pathogenesis of these lesions and to find the reasons behind their chronicity and recurrence. The practical aspects of this research were to formulate and, hopefully, to develop reasonable diagnostic and therapeutical approaches that could be used in the treatment of patients. The positive and negative results of these experiments indicate that the granulomatous response is probably influenced not only by external factors, but also by intrinsic factors. Clinically these findings led to the concept of not circumscribing judgment to the peripheral changes only, but to the assessment of all facts surrounding each individual case.
Radiation Failures in Cancer of the Larynx
Authors: Skolnik Emanuel M. , Martin Lawrence , Yee King F. , Wheatley Michael A.
Published: October 2014

Overwhelming statistics have been published regarding the success of radiation therapy in the management of laryngeal carcinoma. The fate of those patients whose cancers are not controlled by radiotherapy is often left to speculation. An analysis is made of 61 patients with early and advanced laryngeal cancer treated initially with radiation therapy and subsequently operated upon because of recurrent or persistent tumor. Frequently, diagnosis of recurrence is difficult or delayed. Preservation of voice can only be accomplished when recurrence of T1 and T2 lesions is detected early and strict criteria are followed. Conservation surgery is not feasible for early lesions which progress after radiation failure. Advanced T3 and T4 lesions which become radiation failures also require laryngectomy for salvage. In cancer of the larynx, there is a definite, identifiable group of patients in whom surgery would be advisable as the initial therapy.
Rehabilitation of the Shoulder after Radical Neck Dissection
Authors: Saunders W. H. , Johnson E. W.
Published: October 2014

After classical radical neck dissection with removal of the sternocleidomastoid muscle and division of the spinal accessory nerve, there are certain disabling or disagreeable musculoskeletal defects. This paper describes the muscular deficiencies and gives a set of exercises which can be counted on to minimize the problems.
Carcinoma of the Nasopharynx in Children
Authors: Snow James B.
Published: October 2014

Seven children with carcinoma of the nasopharynx have been treated and followed for five years. In this group of patients there were no cranial nerve palsies or radiographic evidence of destruction of the base of the skull. Four of the seven patients are living and well. The development of lymphoepithelioma in two siblings is of great interest from an environmental and genetic point of view. The older sibling developed the clinical manifestations of the tumor at 12 years of age and four years later the younger sibling developed them at 14 years of age. The possible etiologic relationship of carcinoma of the nasopharynx to the Epstein-Barr virus is discussed. The good survival rate in these patients under 21 years of age suggests that the prognosis in carcinoma of the nasopharynx is better in the younger age group than in adults. The management of these patients illustrates that carcinoma of the nasopharynx should be managed as a regional rather than a systemic disease. Systemic drug therapy is sometimes advocated because of confusion over the name lymphoepithelioma on the assumption that these tumors are more related to lymphomas and lymphosarcomas than carcinomas. It is clear that lymphoepitheliomas should be managed as carcinomas.
Rates of Ion Movement from Plasma to Endolymph in the Dogfish
Authors: Maren Thomas H. , Swenson Erik R. , Addink Albert D. F.
Published: October 2014

The rates of movement of Na+, Rb+, Cl− and HCO3− from plasma to endolymph were studied in the elasmobranch fish, Squalus acanthias, by use of the appropriate isotopes. Rb+ was used as a marker for K+. The half-times to equilibrium for Na+, Rb+ and Cl− were about 100 hours; for HCO3− it was 6 hours. The equilibrium ratios, endolymph/plasma, are Na+ 0.87, K+ 26, Cl− 1.37, HCO3− 1.47. Carbonic anhydrase inhibition decreased the rate of HCO3− accumulation, suggesting that the process is actually the formation of endolymphatic HCO3− from plasma or tissue CO2. Increase in plasma pCO2 elevates endolymph HCO3− concentration. The secretory tissue contains carbonic anhydrase and Na-K-ATPase. These and other data suggest that a dominant feature of endolymph chemistry may be HCO3− formation linked in some fashion with K+ transport, through rates catalyzed by these two enzymes.
Brain Stem and other Responses in Electric Response Audiometry
Authors: Davis Hallowell
Published: October 2014

For electric response audiometry of young children who require sedation, an indicator is desired that is more reliable than the slow vertex potential. There are four leading candidates: 1) The electrocochleogram (ECochG) is very reliable with a transtympanic electrode on the promontory, but this is a surgical procedure and requires a general anesthetic. 2) The early midbrain responses give similar information with external electrodes, but they are complex and low in voltage. 3) The muscle reflexes (sonomotor responses) are a crude indicator with high and variable thresholds and are not suited to precise audiometry. 4) The “middle” responses, perhaps cortical in origin, are good candidates, but they have not yet been adequately validated in the clinic. For the midbrain responses, and particularly for the ECochG, close synchronization of nerve impulses is essential. This requires a compromise with selectivity of frequency. High-tone audiometry by electrocochleography and midbrain responses is satisfactory, but limitations are increasingly severe below 2 kHz, where each sound wave is a separate acoustic stimulus. Low-frequency tones stimulate the basal turn of the cochlea at relatively low sensation levels. This makes assessment of the apical portion of the cochlea very difficult, even with the midbrain “frequency-following response” (FFR).
Technique for Glottic Reconstruction following Vertical Partial Laryngectomy: A Preliminary Report
Authors: Hirano Minoru
Published: October 2014

In order to obtain a good phonatory function after glottic reconstruction following vertical partial laryngectomy, the following basic conditions should be satisfied: (1) adequate glottic closure should occur during phonation; (2) the top of the bulge constructed on the affected side should be located at the level of the vocal cord in order to facilitate vocal cord vibration and to prevent false cord vibration; and (3) the surface of the bulge should be smooth. A technique for glottic reconstruction which appears to meet these conditions is described. The sternohyoid muscle is dissected at the level 5 cm below the vocal cord, and the upper portion is used as a single pedicled flap. The muscle flap is bent approximately 90° at the level of the upper border of the cricoid cartilage and inserted into the intralaryngeal wound so as to make a large bulge. The muscle flap is covered by hypopharyngeal mucosa or a free graft of oral mucosa.
Sinus Barotrauma in Divers
Authors: Fagan Paul , McKenzie Bart , Edmonds Carl
Published: October 2014

Sinus barotrauma is a common occupational disease of divers, with the incidence of descent barotrauma approximately double that of ascent. Pain chronologically associated with the change of pressure is the most dominant symptom and is seen in 92% of the cases presented for treatment. The majority complain of a frontal distribution of pain, with ethmoidal and maxillary being much less significant. Epistaxis is the second commonest symptom, and may be the sole symptom in some ascent cases. A history of recent or past sinus barotrauma or upper respiratory tract pathology is very common. Clinical examination supports the evidence of upper respiratory tract pathology in many cases. The radiological signs of abnormality were present in over three quarters of the cases examined. Of these the maxillary sinus was affected in most cases, the frontal in approximately one quarter and the ethmoidal in less than a fifth. The pathology was more commonly that of mucosal thickening, but in 12% of cases there was a fluid level. It is noted that although symptoms were predominantly frontal, x-ray changes were most often present in the maxillary sinuses.
Nasal-Cardiopulmonary Reflexes: A Role of the Larynx
Authors: Jackson Richard T.
Published: October 2014

A brief review of the literature from otorhinolaryngology and the basic sciences shows the existence and role of nasal-cardiopulmonary reflexes in animals and man There is ample evidence that odors, fluids and mechanical stimulation of the nasal mucosa will induce changes in the lungs and cardiovascular system. The proposition that nasal obstruction also produces cardiopulmonary changes is briefly reviewed. The suggestion is made that one of the functions of the nose is to act as an expiratory brake. The removal of this brake could result in changes in laryngeal resistance that lead to poor ventilation.
Local Anesthesia for Suspension Microlaryngoscopy
Authors: Calcaterra Thomas C. , House James
Published: October 2014

Despite the strong trend toward use of general anesthesia for laryngoscopy, local anesthesia retains inherent advantages from the standpoint of patient safety and maintenance of physiologic function of the larynx during endoscopy. Topical anesthesia produces incomplete sensory blockade and is unsatisfactory for suspension laryngoscopy. A method of infiltration anesthesia is described whereby profound anesthesia of the base of the tongue, valleculae, and larynx can be achieved to allow suspension laryngoscopy.
Vidian Nerve and the Eustachian Tube
Authors: Nathanson Steven E. , Jackson R. T.
Published: October 2014

The vidian nerve was stimulated electrically in the dog and this resulted in a reduced patency of the Eustachian tube. The effect was atropine resistant. This physiological evidence in the dog corresponds to anatomical evidence in man of a parasympathetic, vasodilator nerve bundle passing through the vidian to the sphenopalatine ganglion and then via the pharyngeal nerve to the Eustachian tube mucosa. Additional parasympathetic routes to the tube may exist.
Hereditary Abductor Vocal Cord Paralysis
Authors: Gacek Richard R.
Published: October 2014

Familial bilateral abductor cord paralysis was described in the father and two sons of a family in which the remaining siblings (one boy and three girls) were normal. The onset of stridor ranged from six months to nine years after birth in these patients who were all treated with a tracheostomy. Normal development and intelligence was experienced by all three patients. Since previous reports of hereditary abductor cord paralysis described mental retardation in all patients who were maintained without tracheostomy, anoxia from unrelieved laryngeal obstruction may be a significant complication following nonsurgical management of patients who appear to tolerate bilateral abductor vocal cord paralysis.
Malignant Degeneration of Nonirradiated Juvenile Laryngeal Papillomatosis
Authors: Shapiro Robert S. , Marlowe Frank I. , Butcher James
Published: October 2014

Malignant degeneration in nonirradiated juvenile laryngeal papillomatosis is exceedingly rare. Review of the world literature reveals one case in the English literature and two in the German literature. A 23-year-old patient, representing the youngest reported case in the English literature, is presented.
Quantitative Measurement of Smooth Pursuit Eye Movements
Authors: Baloh Robert W. , Kumley Warren E. , Sills Andrew W. , Honrubia Vicente , Konrad Horst R.
Published: October 2014

Smooth pursuit eye movements were quantitatively assessed in 25 normal subjects and 22 patients. A laboratory digital computer was used to compute 200 eye velocity samples per second and to statistically compare these eye velocity measurements for five different object velocities. Of six statistics evaluated, mode eye velocity showed the least variability in normal subjects and was most frequently abnormal in patients. Compared to normal subjects, patients with brain stem degeneration and cerebellar-pontine angle tumors with brain stem compression had significant impairment of smooth pursuit. Patients with peripheral vestibular lesions and C-P angle tumors without brain stem compression did not have impaired smooth pursuit. These preliminary findings suggest that quantitative measurement of pursuit eye velocity can be a sensitive test for brain stem dysfunction.
Some Electronystagmographic Manifestations of Central Nervous System Disease
Authors: Parker Stephen W. , Weiss Alfred D.
Published: October 2014

A battery of tests with electronystagmography were performed on two groups of patients, one in which posterior fossa abnormalities had been confirmed independently by neurologic findings, contrast studies, or surgery; the other group consisted of what seemed clinically clear cut peripheral VIII nerve or labyrinthine disturbances. The two groups were compared statistically for the incidence of factors thought to indicate the presence of brain stem lesions. No single factor is absolutely reliable by itself as an indicator of brain stem disease, but the use of a test battery permits a much more accurate indication of probability of the presence of brain stem lesions.
Fluorocitrate Ototoxicity
Authors: Spector Gershon J. , Carr Charles D.
Published: October 2014

Fluorocitrate, an inhibitor of the tricarboxylic acid cycle at the aconitase reaction, produces a time and dose related neural dystrophy in the guinea pig cochlea. There is direct inhibition of succinic dehydrogenase activity but not nicotinamide adenine dinucleotide dehydrogenase and cytochrome oxidase via cytochrome c activities. The dystrophic neural changes morphologically are similar to those noted in primary neural degeneration and neural presbycusis in man. Neural degeneration in aging appears to be the result of a dissociation of biochemical reactions preventing the proper utilization of organic fuel molecules for generation of energy and direct or indirect inhibition of respiration.
Single Mitotic Center for Rodent Cochlear Duct
Authors: Marovitz William F. , Shugar Joel M. A.
Published: October 2014

The pattern of terminal mitosis in mouse otocyst observed by Ruben led him to postulate the existence of a growth zone at the junction of saccular and cochlear primordia. With the use of colchicine, an antimitotic drug, a localized zone of mitotic activity has been demonstrated at this predicted site.
Caloric-Eye Tracking Pattern Test: I. Visual Suppression and the Possibility of Simplified Differential Diagnosis between Peripheral and Central Vertigo
Authors: Sakata E. , Umeda Y.
Published: October 2014

During the examination of patients who complain of vertigo or who have equilibrium disorders, it is often difficult to determine the etiology of the disorders, that is, to determine whether it is dependent on a peripheral or central vestibular disorder. To attempt to guess the etiology in these cases, we devised a new method: the caloric eye-tracking pattern test. In normal subjects and in patients with peripheral disorders, as is well known, caloric nystagmus has little influence on the eye-tracking pattern. In contrast, in patients with central vestibular disorders, caloric nystagmus evoked abnormalities on the eye-tracking pattern, either superimposed or saccades, in spite of the fact that the eye-tracking pattern before the caloric stimulation is normal. These findings result from the visual suppression mechanism to the vestibular nystagmus. We can say that the visual suppression to the vestibular nystagmus is evoked more strongly by pursuing a moving visual stimulus than by gazing at a stationary target. These results are interesting, not only from the physiological view point, but also from the clinical view point. There is a possibility of the differential diagnosis between peripheral and central vertigo.
The Temporal Bone in the Preauricular Pit, Cervical Fistula, Hearing Loss Syndrome
Authors: Fitch Naomi , Lindsay John R. , Srolovitz Herbert
Published: October 2014

Histological study of the temporal bones of an infant with the preauricular pit, cervical fistula, hearing loss syndrome revealed abnormalities in the middle ear, the vestibular system, and the cochlea. There is a gross bilateral abnormality in the form and relationship of the middle ear spaces, the middle cranial fossa and the inner ear. The horizontal canal lacks ampulla and crista; the posterior canal terminates a short distance from the ampulla. The cochlear cavity is approximately four fifths of normal size. The modiolus of the cochlea shows minor abnormalities. Spiral ganglion cells and peripheral nerve fibers are present in all coils, but are below normal in population in the basal and apical coils. The stria vascularis is slightly deformed and partly atrophic in the upper apical coil. An occasional concretion is present in the base of the stria vascularis in the middle and apical coils.