bluuebunny/crossref_metadata_2025 huggingface dataset:
Flexible Fiberoptic Bronchoscopy and Pulmonary Cytology in the Evaluation of Patients with Head and Neck Malignancies
Authors: Garfinkle Terry J. , Weisman Robert A. , Denneny James C.
Published: October 2014

In a study involving 107 patients with new primary tumors of the head and neck and normal chest roentgenograms, the information gained from flexible fiberoptic bronchoscopy and pulmonary cytology was analyzed. A small but significant proportion of the patients (14%) had positive cytologies. Contrary to previous reports, contamination of bronchial washings with tumor cells from head and neck neoplasms did take place. In most patients, the source of contamination appeared to be the passage of the bronchoscope adjacent to the endotracheal tube. Two patients with normal chest radiographs and positive cytologic studies were discovered to have pulmonary metastases within one year of bronchoscopy. It is concluded that malignant involvement of the lungs is unlikely in patients with a normal chest radiograph, normal bronchoscopy, and negative bronchial washings. This informaion appears to be of value in staging patients with head and neck cancer. Positive bronchial washings are always associated with malignancy, either in the head and neck or the lungs, and should be considered an indication for further evaluation. Recommendations are made regarding the technique of bronchoscopy as part of panendoscopy in head and neck cancer patients, and diagnostic strategies are proposed for patients with positive bronchial washings and negative chest radiographs.
Bronchoscopic Cryotherapy
Authors: Sanderson David R. , Neel H. Bryan , Fontana Robert S.
Published: October 2014

Bronchoscopic cryotherapy of localized endobronchial tumors can be applied in selected patients who are not candidates for other traditional therapy. Twenty-eight patients were treated on 60 occasions with a closed liquid nitrogen system and a long insulated probe that was specifically designed to be used through an open ventilating bronchoscope. The condition of 15 patients (54 %) was improved, as judged by local tumor control, decreased bleeding, or improved airway patency. Fatal complications that could be ascribed to cryotherapy occurred in 2 of the 60 treatments (3 %). Two patients have experienced complete control of squamous cell cancers four years and five years nine months after cryotherapy.
Inner Ear Pathology following Injury to the Eighth Cranial Nerve and the Laryrinthine Artery
Authors: Sando Isamu , Ogawa Akira , Jafek Bruce W.
Published: October 2014

Inner ear pathology following surgical sectioning of the eighth cranial nerve and labyrinthine artery in humans is compared histologically to the pathology observed following severance of the eighth cranial nerve. The case in which both the eighth cranial nerve and the labyrinthine artery were surgically severed revealed severe pathologic changes in the cochlea, including complete loss of the organ of Corti and moderate pathologic changes in the fairly well-preserved vestibular end-organs. Interestingly, the endolymphatic sac appeared to be normal. However, the second case in which the eighth cranial nerve was sectioned but the labyrinthine artery was preserved revealed the organ of Corti and vestibular end-organs to be well preserved and normal. These findings suggest that the blood supply from the labyrinthine artery plays a major role in maintaining most of the structures in the inner ear except for the endolymphatic sac, and that the vestibular end-organs are more resistant than the organ of Corti to the effects of damage of the labyrinthine artery.
Comparison of Normal Eustachian Tube Function in the Rhesus Monkey and Man
Authors: Cantekin Erdem I. , Doyle William J. , Bluestone Charles D.
Published: October 2014

Employing inflation-deflation and forced-response tests, the eustachian tube (ET) function was evaluated in six adult human subjects with traumatic perforations of the tympanic membrane and otherwise negative otologic histories; and 15 juvenile or adult rhesus monkeys with freshly created myringotomy perforations of the tympanic membrane and otherwise documented normal middle ears. The study findings demonstrated that the rhesus monkey ET functions as a scaled down model of the ET of man, exhibiting a shorter tubal dilation duration and a lesser capacity to pass air. When ET function in the two species was compared using a dimensionless measure expressing the tubal dilation efficiency, the operational biomechanics of both systems were found to be almost identical. These observed functional homologies between man and the rhesus monkey ET systems suggest that the rhesus monkey is a suitable animal model in which to study the pathogenesis of otitis media with effusion, stemming from ET dysfunction.
Laryngeal Sarcoidosis
Authors: Neel H. Bryan , McDonald Thomas J.
Published: October 2014

Of 220 patients with sarcoidosis of the head and neck region, representing 9% of 2,319 patients with sarcoidosis seen at the Mayo Clinic from 1950 through 1981, we identified 13 who had laryngeal sarcoidosis. Edematous, pale, diffuse enlargement of the supraglottic structures was the most common laryngeal manifestation. The diagnosis is made by a group of clinical, radiologic, and laboratory findings, confirmed by the finding of noncaseating granuloma on biopsy. Sarcoidosis is a disease with frequent remissions and exacerbations and generally burns itself out; glucocorticoids may be indicated in particularly severe disease. When laryngeal sarcoidosis is suspected, the laryngologist should collaborate with other clinicians in a thorough evaluation of the patient.
Stapedectomy — A Long-Term Report
Authors: Shea John J.
Published: October 2014

The long-term results with large fenestra stapedectomy with vein graft and Teflon piston are compared with results with the small fenestra stapedectomy with Teflon piston directly into the vestibule. There were 1,943 operations in the former group and 2,155 in the latter when compared in 1970. One hundred consecutive patients from the beginning of each group with follow-up to present were compared. Results were generally the same with no great change in 15 and 20 years as compared to those at 5 years. The complication of perilymph fistula was caused by creating an opening in the footplate much larger than the prosthesis and was eliminated by interposing a living oval window seal if the opening was much larger than the prosthesis and a flap of lining membrane from the promontory when it was not. Other factors that influence a good result are discussed, including the type and the diameter of the piston used, the type of living oval window seal and the method of attachment to the incus. The small fenestra operation was found to be superior to the large, not only for the hearing gain achieved, but the ease of performance and the freedom from complications due to migration of the prosthesis and/or the oval window seal. At present we have done about all that can be done for the conductive components. What remains is the sensorineural component which our studies indicate may be due to an autoimmune response.
Temporal Bone Histopathology Associated with Occlusion of Vertebrobasilar Arteries
Authors: Schuknecht Harold F. , Kitamura Ken , Berreby Michel
Published: October 2014

We have presented the histological findings in the inner ear of a patient who experienced occlusion of the vertebral and basilar arteries 17 days before death. A large infarction was observed in the medulla and pons on the right side. There was severe degenerative change in the right membranous labyrinth as well as in the right cochlear and vestibular nerves, which was presumably caused by ischemia from occlusion of the right labyrinthine artery. The organ of Corti and sensory epithelia of the vestibular labyrinth showed the most advanced state of degeneration. The histopathological appearance was similar to that observed in the subacute stage following obstruction of the labyrinthine arteries in animal experiments.
Pathology of Jugular Foramen Neurofibroma
Authors: Gacek Richard R.
Published: October 2014

Tumors of jugular foramen may closely resemble glomus jugulare tumors clinically and radiographically. A tissue diagnosis is necessary to make a differentiation of these tumors. This conclusion is supported by the findings in a temporal bone from a patient who was diagnosed clinically as having a glomus jugulare tumor 57 years before her death at the age of 84 years. Compression of the 7th and 8th cranial nerves in the internal auditory canal and the 10th and 11th cranial nerves at the jugular foramen represents the mechanism of neural signs produced by a neurofibroma arising in the jugulare foramen. This case further demonstrates that conservative treatment of benign extradural tumors may be compatible with a long and useful life.
Mesodermal Induction Defect as a Possible Cause of Ear Malformations
Authors: Melnyk Andrew R. , Weiss Lester
Published: October 2014

Deafness due to inner ear anomalies is rarely associated with malformations of the auricles. We describe two brothers with profound congenital sensorineural deafness, abnormal vestibular function, normal ossicles, and delayed motor development. Since the external and inner ear originate from distinctly separate structures, the embryogenesis of this malformation association is less clear than in the more common association of external and middle anomalies, where the latter two structures are derived from the first and second branchial arches. The combination of auricular and inner ear anomalies, with sparing of the middle ear structures, can be explained on the assumption that mesodermal induction is responsible for normal differentiation of both the otocyst and of the branchial arch ectoderm. A recessive mutant gene may lead to a deficiency of a mesodermal inducer substance of a target tissue receptor site. A similar mechanism may be involved in other multiple malformation syndromes, whereby a mutant gene acting during a specific period of organogenesis causes disruption of the normal induction-competence relationship.
Plasma Cell Tumors of the Head and Neck
Authors: Batsakis John G.
Published: October 2014

In order of frequency, the plasma cell lesions affecting the head and neck are multiple myeloma, extramedullary plasmacytoma, plasma cell granuloma, and solitary plasmacytoma of bone. All except plasma cell granuloma are neoplastic and they are interrelated. The solitary plasmacytoma of bone is regarded as a form of multiple myeloma. The extramedullary plasmacytoma may be a lesion of local significance only or may terminate in a disseminated disease, myelomatosis, that differs clinically and prognostically from multiple myeloma.
Role of Esophagoscopy in the Evaluation of Patients with Head and Neck Carcinoma
Authors: Grossman Thomas W. , Toohill Robert J. , Duncavage James A. , Lehman Roger H. , Malin Thomas C.
Published: October 2014

A retrospective study was conducted of 696 patients with squamous cell carcinoma of the head and neck seen over a 10-year period. Special focus was placed on secondary esophageal primaries in this group in an effort to define the role of esophagoscopy in the management of these patients. Second primary esophageal lesions were infrequently encountered (17 of 696, or 2.4% of the patients). Diagnostic accuracy of the esophagogram in a series of patients with index head and neck tumors and in a separate series of patients with index esophageal lesions was found to be high (98 + %). Based upon this study, we do not feel that esophagoscopy is always indicated as part of the initial workup for all head and neck cancer patients. Rather, we consider the barium swallow esophagogram to be a relatively safe and acceptably accurate alternative in most cases, with esophagoscopy reserved for specific indications.
Voice Change in the Pediatric Patient a Differential Diagnosis
Authors: Cohen Seymour R. , Geller Kenneth A. , Thompson Jerome W. , Birns Jeffrey W.
Published: October 2014

This paper reviews the causes of voice change in the infant and child. Symptoms of dysphonia can be very early evidence of a serious problem, either within the larynx or resulting from a systemic disease. The need to investigate the cause of voice disturbances is stressed. The large number of diseases in which voice change occurs makes a complete examination of the child, both local and systemic, absolutely necessary in order to arrive at a specific diagnosis. The mechanism of voice change is described in each category of the numerous causes of dysphonia.
Adenoid Cystic Carcinoma of the Subglottic Region
Authors: Donovan Donald T. , Conley John
Published: October 2014

Adenoid cystic carcinoma is one of the most common malignancies of the minor salivary glands in the head and neck. However, adenoid cystic carcinoma of the larynx is very rare, with less than 75 cases reported in the literature. We present three cases of adenoid cystic carcinoma of the subglottic region with 6-year, 9-year, and 18-year follow-up, respectively. The literature on adenoid cystic carcinoma of the subglottic area is reviewed. Symptoms of long duration, slow progressive growth with tendency for local recurrence, and eventual development of pulmonary metastasis is common. Five-year survival statistics do not appear as relevant as 10- and 20-year survival rates in this entity because of the often slow but pernicious nature of adenoid cystic carcinoma of the subglottic area. Despite aggressive therapy, the disease often leads to the eventual death of the patient. In our series one patient died, and two patients are alive and free of disease. The evaluation, treatment, and clinical course of this disease is discussed.
Prolonged Middle Ear Ventilation: The Right Tube in the Right Place
Authors: Armstrong B. W.
Published: October 2014

Premature extrusion of ventilating tubes continues to plague both doctor and patient. Migrating epithelium on the lateral surface of the drum has been identified as the principal cause of tube migration and extrusion. This information dictates insertion of a tube in an area where the migrating forces tend to keep the tube in place instead of encouraging rejection. When optimally placed, tubes specifically designed for long-term ventilation will function four times longer than randomly placed conventional tubes. The long-term ventilating tube in use since 1965 has been further refined. A notch and tab on the tube mate with a new inserter/suction device, and this combination permits precise placement through a small incision without tilting and twisting during insertion. Suction may be applied as desired to clear the lumen as the insertion tool is withdrawn.
Histologic Evaluation of Temporal Bones with Cochlear Implants
Authors: Linthicum Fred H. , Galey Frank R.
Published: October 2014

Ectopic bone in the scala tympani is characteristic of cochlear otosclerosis and meningitis, which are the two most frequent etiologies of deafness in cochlear implant patients. The ectopic bone in a multiple-electrode implanted bone is probably caused by disease (syphilis) rather than by the electrode or electrical stimulation. The sensory elements being stimulated by intracochlear electrodes probably are the ganglion cells.
Gas Scavenging during Bronchoscopy under General Anesthesia
Authors: Ostfeld Ervin , Szeinberg Arieh , Blonder Judith , Dagan Jacob
Published: October 2014

Prevention of exposure of the endoscopist to high levels of anesthetic gases during bronchoscopy was attempted experimentally in dogs by a scavenging system. Results were compared with exposure during the conventional technique of anesthetic gas administration for clinical bronchoscopy using the rigid open ventilating bronchoscope. The scavenging system consisted of a vacuum pump applied to the open ventilating rigid bronchoscope sidearm connection during intratracheal administration of nitrous oxide, oxygen, and halothane gas mixture. Gas samples were taken from the trachea, the proximal end of the bronchoscope, and the endoscopist's breathing zone, and analyzed by gas chromatography. Findings indicate that halothane anesthesia for bronchoscopy administered by conventional techniques is a source of air pollution in the operating room and exposes the endoscopist to subanesthetic levels of halothane that may affect psychomotor functioning. The use of the gas scavenging system lowered the concentrations of halothane and nitrous oxide at the endoscopist's breathing zone to a level at which inhalation for short periods has no clinical effects, while the concentrations of the anesthetics and oxygen in the trachea were maintained at a satisfactory level.
Action of Glutamate in the Cat Labyrinth
Authors: Dechesne C. , Raymond J. , Sans A.
Published: October 2014

Glutamate solutions of either 50 m M applied on the membranous labyrinth or 1 m M perfused into the lateral canal in cats increased spontaneous and stimulus-evoked activity of vestibular neurons. Kainic acid (10−4 M) perfused into the labyrinth produced a depolarizing action on vestibular afferents. These results indicate that glutamate could be an excitatory neurotransmitter at the synapse between vestibular hair cells and afferent nerve fibers in the cat.
Endolymphatic Sac: Possible Role in Autoimmune Sensorineural Hearing Loss
Authors: Leone Carlo A. , Feghali Joseph G. , Linthicum Fred H.
Published: October 2014

Histologic examination of the temporal bone of a patient with Wegener's granulomatosis showed involvement of the vessels of the endolymphatic sac (ELS) but no involvement of the vasculature of the rest of the inner ear. Autoimmune sensorineural hearing loss in this patient may have been due to interference of antigens and antibodies with the filtering capacity of the ELS, leading to imbalance of inner ear fluids. Histologic findings reemphasize that the cochlea and ELS have different blood supplies.
Anesthesia for Laryngoscopy
Authors: Benjamin Bruce
Published: October 2014

The requirements of anesthesia for laryngoscopy and microlaryngeal surgery must be compatible with maximum safety and minimum patient discomfort. Some techniques require the use of an endotracheal tube while some do not. Others use a modified tube or a jetting system. In general, for pediatric endoscopy we prefer spontaneous respiration with inhalational anesthesia supplemented by topical lignocaine (lidocaine), and in adults, a relaxant technique with controlled jet ventilation supplemented by topical lignocaine. A new pediatric microlaryngoscope and a new tube for jet ventilation in older children and adults are described.
Congenital Laryngeal Stridor (Laryngomalacia): Etiologic Factors and Associated Disorders
Authors: Belmont Judson R. , Grundfast Kenneth
Published: October 2014

Congenital laryngeal stridor (CLS) and laryngomalacia are terms used to describe a common disorder characterized by onset, at or soon after birth, of a harsh respiratory sound mostly audible during inspiration. Typically, laryngoscopy reveals flaccid supraglottic structures which tend to prolapse medially toward the glottis during inspiration. Despite reports of this disorder dating back to the mid-19th century, specific etiology and pathogenesis remain nebulous. Analysis of findings in 30 infants indicate that there are often associated manifestations of delayed development in neuromuscular control. Associated findings include gastroesophageal reflux, obstructive and central apnea, hypotonia, failure to thrive, and pneumonitis. A retrospective review of relevant medical literature along with results of laryngeal dissections and analysis of clinical findings in the 30 cases leads to the conclusion that CLS may be a mild form of localized hypotonia rather than an isolated idiopathic type of anatomic abnormality.
Surgical Management of Strictures of the Cervical Esophagus
Authors: Geller Kenneth A. , Pierce Max K.
Published: October 2014

Strictures of the esophagus are difficult and challenging problems. Whether a result of caustic ingestion, trauma, or surgery, or a congenital abnormality, the patient suffers a disruption of the fundamental act of swallowing. The seven cases of stricture of the cervical esophagus presented here were not alleviated by the usual methods of antegrade and retrograde dilation. Each patient underwent a two-stage reconstruction of the esophagus. The strictures in four patients were secondary to a caustic agent, two were congenital, and one was of unknown etiology. All patients no longer require dilation and are essentially cured. This procedure will add to the armamentarium of the surgeon who deals with “hopeless” strictures of the cervical esophagus and, in properly selected cases, should be successful.
Sir Astley Cooper and His Otological Papers
Authors: McGovern Francis H.
Published: October 2014

In 1800, the year of his election as Surgeon to Guy's Hospital (London), and the following year, Astley Cooper presented two communications to the Royal Society based on his tympanic membrane observations and his treatment of certain forms of deafness by myringotomy. For these contributions he was awarded the Copley Medal of the Royal Society. The first paper concerned itself with the effect of a perforated tympanic membrane on hearing. Contrary to the then accepted opinion, Cooper found the patient to have excellent hearing. The second paper reported on myringotomy in patients who appeared to lack sufficient atmospheric pressure within the tympanic cavity because of closure of the eustachian tube. The relevance of Cooper's observations 184 years ago is of some significance in relation to the practice of modern otology.
Lymphoma Invading the Anterior Eustachian Tube
Authors: Takahara Tetsuo , Bluestone Charles D. , Sando Isamu , Myers Eugene N.
Published: October 2014

The temporal bones of a man with poorly differentiated lymphocytic lymphoma, who had had a bilateral conductive hearing loss and incomplete left-sided facial palsy, were obtained. Sections were prepared for histologic study by staining with hematoxylin and eosin and were examined under the light microscope. The left temporal bone showed marked tumor cell involvement, not only of the lateral part of the cartilaginous portion of the eustachian tube (ET) where the tensor veli palatini muscle had been partially destroyed, but also in the anterior part of the temporal bone. A serous middle ear effusion was present, but the lumen of the ET was unaffected by tumor or inflammation. The pathological findings in the right temporal bone were similar to those in the left, although the cartilaginous part of the ET and its surrounding structures were not available for study. The pathogenesis of otitis media with effusion appeared to be secondary to functional ET obstruction, due to the dysfunction of the tensor veli palatini muscle as a result of the tumor destruction. This case is the first to be reported in which functional ET obstruction, secondary to tumor invasion of the active muscle dilator of the ET, has been histologically confirmed.
Temporal Bone Histopathologic Findings in Oculoauriculovertebral Dysplasia
Authors: Sando Isamu , Ikeda Minoru
Published: October 2014

The right temporal bone of a 6-month-old patient with oculoauriculovertebral dysplasia (Goldenhar's syndrome) was examined histopathologically. The most striking abnormalities were deformity of the auricle, atresia of the external auditory canal, severe malformation of middle ear structures, and incomplete development of the oval window. No inner ear abnormalities were identified in this case.
Stapedectomy Results in a Residency Training Program
Authors: Vernick David M.
Published: October 2014

As the total number of stapedectomy procedures has declined, the adequacy of residency training for this procedure must be evaluated. Results of 5 years of stapedectomies performed by the resident otology service at the Massachusetts Eye and Ear Infirmary from Oct 1, 1979, through Sept 30, 1984, are reviewed and compared with other published results. A suggestion is made for improving the residency teaching program.
Diagnosis and Management of Anomalies of the Craniovertebral Junction
Authors: Kumar Arvind , Jafar Jafar , Mafee Mahmood , Glick Roberta
Published: October 2014

The term craniovertebral junction refers to an area comprising the inferior portion of the occipital bone surrounding the foramen magnum and the first two cervical vertebrae. A variety of anomalies of bony, meningeal, and neural elements are known to occur in this region, producing a wide spectrum of clinical symptoms. These can range from dizziness, ataxia, and nuchal headaches to obvious quadriparesis and cranial nerve palsies. Often the symptoms are vague with an evolution marked by temporary exacerbations and remissions. The diagnosis can be difficult, and in our experience is best achieved by combining a neurotologic and neurologic evaluation. We discuss here the symptoms and diagnosis in ten patients with lesions at the craniovertebral junction. The surgical management of two cases of basilar invagination is described, and the controversies regarding the technique are discussed.
Auditory Evoked Potentials in Audiometric Assessment of Compensation and Medicolegal Patients
Authors: Hyde Martyn , Matsumoto Noriaki , Alberti Peter , Li Yao-Li
Published: October 2014

The clinical utility of auditory evoked potentials for validation of the pure tone audiogram in adult compensation claimants and medicolegal patients is examined. Large sample comparisons of evoked potential and conventional pure tone thresholds showed that the slow vertex response can estimate true hearing levels within 10 dB in almost all patients. Given adequate tester skills, it is the tool of choice, and it merits more widespread implementation. Properly used, it can improve and abbreviate the assessment battery for detection and quantification of nonorganic hearing loss. The 40-Hz middle latency response is useful as a secondary tool, but at present, cochlear nerve and brain stem potentials have limited audiometric value in this population.
Synergistic Effects of Sequential Carbon Dioxide and Neodymium: Yttrium Aluminum Garnet Laser Injuries
Authors: Primrose William J. , McDonald Graeme A. , Vaughan Charles W. , O'Brien Michael J. , Strong M. Stuart
Published: October 2014

The carbon dioxide and neodymium:yttrium aluminum garnet lasers have well documented but characteristically different biological effects, yet little is known about their cumulative, synergistic, or paradoxical effects when used sequentially on living tissue. Using a Merrimack ML 880 laser, a series of superimposed CO2 and Nd:YAG lesions in various combinations were produced on the undersurface of dog tongues. Therapeutic time and power settings were chosen and the number of applications varied, with suitable controls. Observations and measurements were made on acute, healing, and healed lesions. All lesions were excised and submitted for routine hematoxylin and eosin histology. Acute lesions were also assessed for cell viability using rhodamine 123 as a supravital marker. The results show that, even though all the lesions eventually heal, the actual cell damage produced by the Nd:YAG laser is much more than is suggested by the size of the acute lesion. This cell damage can be reduced by the surface carbonization produced by initial application of the CO2 laser. Higher surface temperatures are reached in this combination with less fibrosis and scarring than equal energy counterparts where the Nd:YAG laser was applied first. The knowledge of these synergistic effects can be used to advantage in the clinical setting. The rhodamine 123 technique also appears to be a valid measure of acute thermal tissue injury.
Infantile Lobar Emphysema
Authors: Berlinger Norman T. , Porto Dennis P. , Thompson Theodore R.
Published: October 2014

Infantile lobar emphysema is a symptom complex representing a spectrum of diseases characterized by overdistention of a pulmonary lobe by a check valve mechanism. The earlier in life infantile lobar emphysema presents, the more severe are the symptoms. Half of the cases appear in the first 4 weeks of life. The chest radiograph is the best diagnostic tool but can be misinterpreted. Computed tomography sometimes discloses the cause, which appears to be bronchial obstruction in 25% of cases. The bronchial obstruction may be due to intrinsic defects or to extrinsic compression. Bronchoscopy should be performed only in certain cases and then only with careful anesthetic management.
Flexible Minibronchoscopy in Children
Authors: Ward Robert F. , Arnold James E. , Healy Gerald B.
Published: October 2014

Flexible endoscopy is assuming a role of increasing importance in the evaluation and diagnosis of upper aerodigestive tract disorders. With improved fiberoptic capabilities and miniaturization, these techniques are gaining in applicability to the pediatric population. At Children's Hospital, Boston, a newly designed Machida 1.9-mm bronchoscope has been employed in the evaluation of the upper airway. The use of this small caliber instrument has been investigated in 1) evaluation of endotracheal or tracheotomy tube position, thus decreasing the need for repeated chest radiographs to confirm location; 2) bedside evaluation of possible tracheal disease (eg, mucous plug, granuloma, tracheitis) in the intensive care unit patient to determine treatment plans and/or need for further rigid bronchoscopy, and 3) evaluation of airway dynamics in the awake patient. Our experience with the flexible fiberoptic minibronchoscope is reviewed, with a discussion of indications for its use, as well as possible limitations. Case studies are presented to demonstrate the usefulness of the instrument.
Effect of Anti-Inflammatory Drugs on Collagen-Induced Autoimmune Inner Ear Disease
Authors: Sudo Naohiro , Yoo T. J.
Published: October 2014

Animals that had collagen-induced autoimmune inner ear disease were treated with anti-inflammatory drugs: Solu-Medrol (steroid), sulindac (nonsteroid), or a combination of both. Temporal bones from drug-treated animals were examined for histopathologic and immunohistochemical changes, and sera were examined for levels of circulating antibody to type II collagen. Therapy was beneficial to the animals whether the drugs were administered alone or in combination; however, fewer lesions were observed in animals given either drug alone. Further, animals treated with steroid alone showed the least amount of inner ear damage. Immunohistochemical changes and serum levels of antibodies against type II collagen correlated with the pathologic changes. These findings suggest that both steroidal and nonsteroidal anti-inflammatory drugs may have potential therapeutic value in the treatment of autoimmune ear disease.
Respiratory Activity of the Cricothyroid Muscle
Authors: Mathew Oommen P. , Woodson Gayle E. , Sant'Ambrogio Franca B. , Sant'Ambrogio Giuseppe
Published: October 2014

Single motor units of the cricothyroid muscle (CT), the contralateral CT electromyogram, and the posterior cricoarytenoid muscle (PCA) electromyogram were recorded in anesthetized, spontaneously breathing dogs. In quiet breathing the CT was active predominantly in inspiration, and distinct phasic expiratory activity was observed at lighter levels of anesthesia. Both the CT and PCA increased their inspiratory and expiratory activity with hypercapnia, whereas only their inspiratory activity increased in response to negative pressure and/or absence of volume feedback. Cold blockade of either the recurrent laryngeal nerves or the external branch of the superior laryngeal nerves did not modify CT or PCA activity. In general, activity of CT motor units reflected the behavior of the whole muscle, but different units were recruited at different levels of CT activity. Even though the majority exhibited similar thresholds for inspiration and expiration, some units showed a lower threshold for either one, suggesting some degree of specialization. However, for a few units with high threshold for inspiration the expiratory threshold could not be determined, since a comparable level of CT activity was not achieved in expiration.
Interleukin-2 Release from Lymphocytes of Patients with Head and Neck Cancer
Authors: Wustrow Thomas P. U. , Kabelitz Dieter
Published: October 2014

Interleukin-2 (IL-2) plays a central role in cellular immune regulation. In vitro this cytokine is secreted after mitogenic stimulation with phorbolester (PMA), phytohemagglutinin A (PHA), or the monoclonal T cell antibody OKT3. In our experiments the IL-2 concentration was measured in a biologic system using an IL-2-dependent murine cytotoxic T cell line. Control subjects who were age-matched to patients with head and neck cancers did not show an altered IL-2 production in vitro, irrespective of whether they were accustomed to high alcohol consumption or cigarette smoking. Patients with cancer of the larynx did not differ significantly from control subjects. Most prominent was the significant reduction in IL-2 release of patients with cancer of the oropharynx and in patients with positive lymph nodes in the neck. Impaired IL-2 secretion in head and neck cancer patients may therefore be an additional prognostic indicator worthy of further investigation.
Auditory Nerve and Brain Stem Evoked Response Thresholds in Infants Treated with Gentamicin as Neonates
Authors: Adelman Cahtia , Linder Nejama , Levi Haya
Published: October 2014

Thirty-two infants (18 full-term and 14 premature) who had been treated with gentamicin as neonates were examined to ascertain whether this drug induced hearing loss, even of low severity. Objective thresholds to clicks were obtained using auditory nerve and brain stem evoked responses. In addition, behavioral audiometry was performed. Serum concentrations before and after gentamicin treatment were at therapeutic levels. All infants were examined at least 1 1/4 months after cessation of therapy. Normal thresholds were obtained in all ears, with the exception of two with demonstrable middle ear effusion. It appears that gentamicin in therapeutic doses and serum concentrations, in the absence of renal insufficiency, does not cause hearing loss in neonates.
Microbiology of Wound Infection after Head and Neck Cancer Surgery
Authors: Brook Itzhak , Hirokawa Ronald
Published: October 2014

Specimens of pus were obtained from 24 patients who developed postoperative wound infection after head and neck cancer surgery. Aerobic bacteria only were isolated in two instances (8%), anaerobic bacteria only in one (4%), and mixed aerobic and anaerobic bacteria in 21 (88%). A total of 146 isolates were recovered (66 aerobic and 80 anaerobic), an average of six isolates per specimen (2.7 aerobic and 3.3 anaerobic). The most frequently recovered isolates were Peptostreptococcus sp, Staphylococcus aureus, Bacteroides sp, Fusobacterium, and enteric gram-negative rods. Twenty-two isolates recovered from 17 wounds (71%) produced β-lactamase. These included all five isolates of S aureus and nine of 17 (53%) of the Bacteroides melaninogenicus group. The polymicrobial aerobic/anaerobic nature of postoperative wound infections after head and neck cancer surgery and the presence of β-lactamase-producing bacteria may have important implications for the management of these infections.
Ewing's Sarcoma of Bone and Soft Tissues
Authors: Sneige Nour , Batsakis John G.
Published: October 2014

Ewing's sarcoma is a distinctive clinical and pathologic entity that may be intraosseous or of soft-tissue origin. In the facial bones, the incidence of the sarcoma is estimated at 2.5% of all Ewing's sarcoma of bone. The soft tissues of the head and neck account for 11% of extraskeletal sites of the neoplasm. Combined modality treatment has modified its high-grade malignancy.
Biochemical Study of Protease Inhibitors in Normal Chinchilla Middle Ear
Authors: Hamaguchi Yukiyoshi , Juhn Steven K. , Sakakura Yasuo
Published: October 2014

Protein concentration and inhibitory capacity of both α1-antitrypsin (α1-AT) and α2-macroglobulin (α2-M) were measured in plasma and middle ear bulla (MEB) washings of chinchillas by use of specific antisera against chinchilla α1-AT and α2-M. Low molecular weight (LMW) trypsin inhibitor also was analyzed in MEB washings. Chinchilla α2-M showed a common antigenicity with human α2-M. The mean value of α1-AT in chinchilla plasma was 412.0 ± 87.8 and that of α2-M was 435.0 ± 117.1 mg/dL. There was a significant relationship between α-AT level and antitryptic activity, and between α2-M level and trypsin binding activity in plasma. The majority of α1-AT and α2-M in plasma is present as free inhibitors unsaturated with proteases. The MEB washings had significant antitryptic activity, which is attributed to both α1-AT and LMW trypsin inhibitors. Inhibitory functions of α1-AT and LMW trypsin inhibitors appear to play an important role in the defense of the normal middle ear mucosa.
Selective Reinnervation of the Abductor and Adductor Muscles of the Canine Larynx after Recurrent Nerve Paralysis
Authors: Marie Jean Paul , Ducastelle Thierry , Dehesdin Danielle , Senant Jacques
Published: October 2014

Functional rehabilitation of the larynx after unilateral vocal cord paralysis was attempted in the dog by selective reinnervation of the laryngeal muscles. The intralaryngeal branches of the right recurrent nerve were dissected. The adductor branch was anastomosed with the ansa cervicalis; the abductor branch was anastomosed with the trunk of the phrenic nerve either within the larynx or through the recurrent nerve, the adductor branch of which was sectioned. Results could be analyzed in seven dogs: Mobility of the vocal cord was checked and electromyography, stimulation of the nerves, and histologic studies were performed. Functional reinnervation of both the adductor and abductor muscles was obtained in only one case, with good abduction. Adduction was recorded in five cases. False-positive results emphasize the necessity of collecting several types of data before concluding that functional reinnervation has been accomplished. The reliability of the procedure can and must be improved.
Chondromyxoid Fibroma
Authors: Batsakis John G. , Raymond A. Kevin
Published: October 2014

Approximately 2% of chondromyxoid fibromas of bone present in the jaws, preponderantly in the mandible, where they must be distinguished from low-grade chondrosarcomas. A recurrence rate of 25% dictates careful complete removal of this histologically benign lesion.
Laryngotracheal Reconstruction with Composite Nasal Septal Cartilage Grafts
Authors: Duncavage James A. , Ossoff Robert H. , Toohill Robert J.
Published: October 2014

The composite nasal septal graft has been used successfully by us to reconstruct patients with high tracheal and laryngotracheal stenosis. We have treated ten patients and have been able to decannulate seven of these patients. When these ten cases are added to the six original cases presented in an earlier report (1981), certain conclusions can be drawn. The success or failure of these procedures, which is judged by the ability to decannulate the patient, appears to be related to the extent of the initial injury. We discuss the indications for the composite nasal septal graft and the use of additional treatment, including stents, steroid injections, dilatations, and flaps. In conclusion, the addition of these ten cases to the original six cases of composite nasal septal grafts now provides the opportunity to review indications and contraindications for the use of this graft in the management of advanced laryngotracheal stenosis.
Improved Surgical Technique for Epidermoid Cysts of the Vocal Fold
Authors: Hirano Minoru , Hirade Yoshio , Yoshida Tetsuji , Sanada Tomoaki
Published: October 2014

An improved surgical technique for epidermoid cysts of the vocal fold is presented. This technique employs a specially designed double-bladed elevator. Following betamethasone injection around the cyst, an incision is made posterior to the cyst at its mediolateral midpoint. The incision is extended anteriorly over the cyst with the use of a double-bladed elevator. The cyst then is elevated carefully from the surrounding tissue and removed. A single incision line on the upper aspect of the vocal fold should be the result. Eight patients were operated on with the present technique. The voice was improved postoperatively in all patients. The voice improvement was reflected objectively in stroboscopic findings, maximum phonation time, airflow rate, fundamental frequency and intensity of phonation, and results of acoustic analyses of voice.
Sliding Flap Tracheoplasty
Authors: Gates George A. , Tucker John A.
Published: October 2014

The optimal method for surgical management of subglottic stenosis is based upon careful assessment of the location, caliber, length and maturity of the stenotic segment, as well as associated conditions. For patients with a mature stenosis of short length, excision of the anterior arch of the cricoid and first ring and immediate reconstruction by means of a sliding flap of the next two to three rings of trachea offer a one-stage definitive treatment without the need for grafting. We report four cases of subglottic stenosis and one case of cricoid chondroblastoma in which reconstruction of the airway was successful and prompt. For carefully selected cases, sliding flap tracheoplasty may be a useful alternative to procedures in which the airway is expanded by means of grafting.
Effects of Lateral Manual Compression upon Glottic Incompetence: Objective Evaluations
Authors: Blaugrund Stanley M. , Lin Pi-Tang , Taira Tatsuzo , Isshiki Nobuhiko , El-Assuooty Ashraf , Gould Wilbur J.
Published: October 2014

Forceful manual compression of the thyroid and cricoid cartilages modifies the position, shape, and tension of the vocal folds. This is the basis of the four laryngeal manual compression tests, adjunctive examinations used as a means of preoperative assessment of patients for medialization laryngoplasty, ie, Isshiki thyroplasty types I and IV and arytenoid adduction. The laryngeal manual compression tests are simple to perform and noninvasive. Each of the four examinations yields valuable information on the effects on the voice of changes in vocal cord characteristics produced by manual compression. In this report, one of the four tests, lateral manual compression, is evaluated objectively with well-attested methods of videostroboscopic, aerodynamic, and acoustic analysis. The technique of performing lateral manual compression is described, and advantages and disadvantages are noted and compared in 10 patients. Preliminary findings in 4 patients in this group indicate that medialization laryngoplasty should be considered when test results are conclusive of effective glottic closure. Data derived in this preliminary study will be augmented as patients are added to the series.
Biopsy of the Lip and Sjögren's Syndrome
Authors: Cleary Karen R. , Batsakis John G.
Published: October 2014

The degree of focal chronic sialadenitis in a labial salivary gland biopsy specimen, expressed in terms of a semiquantitative focus score, is the best contemporary assessment of the salivary component in Sjögren's syndrome. A labial salivary gland focus score of >1 focus per 4 mm2 serves as an acceptable threshold for the diagnosis.
Sebaceous Lesions of Salivary Glands and Oral Cavity
Authors: Batsakis John G. , El-Naggar Adel K.
Published: October 2014

Sebaceous differentiation in the oral mucosa and major salivary duct epithelium is an expected normal finding in humans. These usually asymptomatic and incidental collections of sebaceous cells can also be found in intimate or close relationship with definable classes of salivary gland neoplasms, or as sebaceous neoplasms of salivary glands. The neoplasms are uncommon and are classified as sebaceous lymphadenoma, sebaceous adenoma, and sebaceous carcinoma. The two adenomas have a low recurrence potential; the carcinomas have a biologic behavior like that of ocular sebaceous carcinomas.
Medical Complications in Total Laryngectomy: Incidence and Risk Factors
Authors: Arriaga Moises A. , Johnson Jonas T. , Kanel Keith T. , Myers Eugene N.
Published: October 2014

The prevention and management of medical complications are important components in the surgical treatment of head and neck malignancies. We retrospectively evaluated the postoperative medical complications in 414 patients who underwent total laryngectomy between 1973 and 1987. The mortality rate was 1.2% (five deaths); while major, nonfatal medical complications occurred in 6.3% (24 of 384 patients) — Seven strokes, three myocardial infarctions, two pulmonary emboli, and 12 respiratory failures requiring mechanical ventilation. Elderly patients did not experience more frequent or more severe medical complications, and the overall pattern of complications was different from that of other surgical specialties. Only specific cardiovascular and pulmonary risk factors were associated with these complications. We conclude that medical complications are a significant cause of morbidity in total laryngectomy; a focused preanesthetic risk factor analysis by a medical team familiar with head and neck cancer patients assures prompt identification and management of these complications.
Aryepiglottic Fold Excision for the Treatment of Severe Laryngomalacia
Authors: Polonovski Jean-Michel , Contencin Philippe , Francois Martine , Viala Paul , Narcy Philippe
Published: October 2014

Laryngomalacia is the most common laryngeal anomaly. Clinical presentation is most often associated with stridor, which usually resolves spontaneously by the second year of life. Infrequently, laryngomalacia can be severe and cause dyspnea and feeding difficulties. These children require surgical treatment, including tracheostomy. A new procedure has been recently described for the endoscopic excision of the aryepiglottic folds. The authors report results in 39 patients who have been treated with this procedure. One failure required tracheostomy. No recurrence of dyspnea was noticed in the other children. Gastroesophageal reflux, associated with 50% of our cases, was also noted in our only failure. We advocate endoscopic treatment in children with severe laryngomalacia.
Pressure Relationship between Perilymph and Endolymph Associated with Endolymphatic Infusion
Authors: Takeuchi Shunji , Takeda Taizo , Saito Haruo
Published: October 2014

The pressure difference between the perilymph and the endolymph following infusion of artificial endolymph into the endolymphatic space was studied in guinea pigs. Both the perilymphatic and the endolymphatic pressures were measured simultaneously with use of two sets of a servo-nulling system. Endolymphatic infusion caused pressure increases in both the endolymphatic and the perilymphatic spaces, but no measurable pressure difference between them. Soon after the endolymphatic infusion, both pressures returned nearly to the initial levels. We conclude that 1) the endolymphatic and the perilymphatic pressures are very closely related, and 2) if a physiologically significant pressure difference exists between endolymph and perilymph in endolymphatic hydrops, it is below the resolving power of the methods used in this study (± 0.1 mm Hg).
Sixteenth Daniel C. Baker, Jr, Memorial Lecture
Authors: Bocca Ettore
Published: October 2014

Supraglottic laryngectomy combined with functional elective or curative neck dissection is a priceless contribution toward treatment of supraglottic cancer and its lymph node metastases. The history and background of this conservative approach is reviewed. Results related to staging are presented. Irradiation as a combined or alternative therapy is considered.