bluuebunny/crossref_metadata_2025 huggingface dataset:
An Evolution of Approach in Vestibular Neurectomy
Authors: Silverstein Herbert , Norrell Horace , Smouha Eric , Jones Raleigh , Rosenberg Seth
Published: November 2015

Since introducing the retrolabyrinthine vestibular neurectomy in 1978, we have performed 78 procedures with good results. In 1985 we introduced the retrosigmoid‐IAC vestibular neurectomy, which allows a more complete transection of the vestibular nerves within the internal auditory canal (IAC). Vertigo control has been excellent; however, in 75% of patients, postoperative headaches have been a significant problem. In 1987, the best aspects of the two procedures were incorporated and the combined retrolab‐retrosigmoid vestibular neurectomy was developed. The procedure is similar to the RVN in that all bone covering the lateral venous sinus is removed. It differs from the RVN in that a limited mastoidectomy is performed and the dura is opened just behind the LVS. The LVS is retracted forward, exposing the cerebellopontine angle. This allows the surgeon the option to section the vestibular nerve in either the CP angle or the IAC, depending upon the presence or absence of a cochieovestibular cleavage plane in the CP angle. The results have been good and the incidence of headache has been reduced to 10%. The technique, results, and complications are reported here.
Intrinsic vasculature of the labyrinthine segment of the facial nerve—Implications for site of lesion in Bell's palsy
Authors: Balkany Thomas , Fradis Milo , Jafek Bruce W. , Rucker Nolan C.
Published: November 2015

Recent studies of the intrinsic vasculature of the cat facial nerve have demonstrated relatively poor blood supply to the labyrinthine segment. In this study, the intrinsic vasculature of the human facial nerve was systematically evaluated in 25 temporal bones and three fresh cadaver nerves. Cross‐sectional vessel counts were obtained for the labyrinthine, tympanic, and mastoid segments. Capillary densities for each segment were derived from these data. The labyrinthine segment of the human facial nerve, like that In the cat, contains fewer and smaller intrinsic blood vessels than do the mastoid and tympanic segments. This may Indicate that the labyrinthine segment of the facial nerve may be more vulnerable to ischemic damage, in conjunction with the previously demonstrated narrowness of the labyrinthine fallopian canal, these findings support the contention that the labyrinthine segment is a likely site of lesion in Bell's palsy.
Polymerase chain reaction identification of human papillomavirus DNA in CO2 laser plume from recurrent respiratory papillomatosis
Authors: Kashima Haskins K. , Kessis Theodore , Mounts Phoebe , Shah Keerti
Published: November 2015

Human papillomavirus (HPV) DNA was identified in the plume produced during CO2 laser vaporization of respiratory tract papillomata. The plume produced from CO2 vaporization was collected on Gelfoam pledgets that were affixed to suction tips evacuating the vapor plume from the operative field. The Gelfoam pledgets were snap frozen in liquid nitrogen, processed, and examined for HPV‐6 and HPV‐11 DNA by a polymerase chain reaction technique. Tissue and vapor‐plume specimens were collected from 22 patients undergoing CO2 laser excision of laryngeal lesions. Seven patients had adult‐onset recurrent respiratory laryngeal papillomatosis (RRP), 12 had Juvenile‐onset RRP, two had laryngeal carcinoma, and one had nonspecific laryngitis. HPV‐6 or HPV‐11 was identified in 17 of 27 vapor‐plume specimens from RRP and in none of three from non‐RRP lesions. All but one RRP tissue specimen contained HPV‐DNA, and none of the non‐RRP tissues contained HPV‐DNA. When HPV was present in vapor, the same HPV type was found in the corresponding tissue specimen. Identification of HPV‐DNA in the laser plume raises concern regarding potential risks from exposure to the plume—particularly to the endoscopic surgeon and the operating team. The practical concerns and effectiveness of the plume scavenging systems are discussed.
A universal ossicular replacement prosthesis: Clinical trials of 152 cases
Authors: Black Bruce
Published: November 2015

An ossicular replacement prosthesis is described that advances implant design in several respects. The head is a flattened egg shape, which eliminates pressure points against the pars tensa and provides balance on the stapes. Dense hydroxylapatite ceramic provides maximal biocompatibility. The shaft, of either Teflon or Plastipore, is easily cut to size and is replaceable to minimize wastage. Interchangeable partial or total shaft variants are provided. Trials in more than 200 patients have produced optimal results. Among 152 mature patients in 85% of the good‐risk cases, the air‐bone gap closed to within 20 dB and in 65% to within 10 dB; in 69% of all cases the gap closed to within 20 dB. Extrusion rates were 5% in good‐risk cases and 7% overall. Long‐term extrusions have not occurred. Inasmuch as cartilage interpositioning is unnecessary, the prosthesis is rapidly prepared and implanted by an easily mastered technique.
Tympanoplasty: To stage or not to stage
Authors: Sheehy James L. , Shelton Clough
Published: November 2015

No unanimity of opinion exists in regard to staged operations in tympanoplasty. The controversy centers around the degree to which one should attempt to obtain hearing improvement in badly diseased ears. The major factor is the extent of the mucous membrane disease. We review the history of staging, the mucous membrane indications for staging, and the variations involved in canal‐wall‐down (CWD) procedures. The opinions of nineteen other otologists also are presented, nine of whom do not regularly or ever stage tympanoplasty.
A functional evaluation of ansa cervicalis nerve transfer for unilateral vocal cord paralysis: Future directions for laryngeal reinnervation
Authors: Green David C. , Berke Gerald S. , Graves Michael C.
Published: November 2015

There are a variety of methods for treating unilateral vocal cord paralysis, but to date there are few objective studies that evaluate the functional results of nerve transfer from the ansa cervicalis. Six dogs underwent unilateral recurrent laryngeal nerve section with immediate reanastamosis to the sternothyroid branch of the ansa cervicalis. After 5 to 6 months, measurements of vocal efficiency and acoustic parameters, videolaryngoscopy, videostroboscopy, and evoked electromyography were performed. Identical measurements were made in eight control dogs during normal electrically induced phonation and a simulated unilateral recurrent laryngeal nerve paralysis. Histologic analysis of both vocalis muscles, recurrent laryngeal nerves, ansa cervicalis, and the ansa‐recurrent laryngeal nerve anastomosis site was performed. Evidence of reinnervation was found in all of the animals that underwent nerve transfer. The vocal efficiency and acoustic quality after ansa cervicalis nerve transfer were dependent on the degree of electrical stimulation from the transferred nerve to the reinnervated cord during phonation. In the absence of electrical stimulation to the nerve transfer, physiologic vocal cord motion could not be elicited from the reinnervated cord.
Middle meatus anstrostomy: Patency rates and risk factors
Authors: Davis William E. , Templer Jerry W. , Lamear William R. , Davis William E. , Craig Stefan B.
Published: November 2015

Two hundred patients with chronic sinusitis were operated on using functional endoscopic sinus surgery (FESS) techniques. These patients were followed closely over 3 years. Patency of the endoscopic middle meatotomy was recorded using actuarial life‐table methods. The overall patency rate of the endoscopic middle meatotomy was 93.55%, and the actuarial patency rate at 36 months was 87.47%. The presence of seasonal allergy with nasal polyps was the most important variable in predicting closure. Middle turbinectomy was the most important variable in predicting patency. Symptoms were evaluated by questionnaire at 1 year. Questionnaire data indicate that 96% of these patients are improved or asymptomatic.
The effects of adenotonsillectomy on growth in young children
Authors: Williams Edwin F. , Woo Peak , Miller Robert , Kellman Robert M.
Published: November 2015

A history of poor weight gain can often be elicited in young children with chronic upper airway obstruction resulting from adenotonsillar hypertrophy. A series of 41 consecutive children under 3 years of age, who underwent inpatient adenotonsillectomy, were reviewed for changes in weight and height. Thirty‐seven patients had adequate long‐term followup. Of these, many had dramatic improvements in growth after adenotonsillectomy. Indications for surgery in this group were recurrent infection in three patients (7%), unilateral tonsillar mass in one patient (3%), and upper airway obstruction in 37 patients (90%). A clear history of sleep apnea was elicited in 59%. At the time of surgery, 19 of 41 patients (46%) were of the fifth percentile or lower for age‐corrected weight. The inpatient hospital stay averaged 3.2 days. The postoperative complication rate was 27%, with postoperative stridor as the most common complication. After surgery, 28 children (75%) showed a change to a higher percentile for weight. Twenty‐four (65%) had percentile changes of 15% or more. This change is significant according to results of the Wilcoxon signed‐rank test (p < 0.001). We conclude that a relationship exists between improved growth rate and adenotonsillectomy in our study group. The rapid improvement in growth appears to be most obvious in children with upper airway obstruction resulting from adenotonsillar hypertrophy. Upper airway obstruction (including andenotonsillar hypertrophy) should be suspected as a possible cause in the workup of children with suboptimum growth.
Identification of perilymph proteins by two‐dimensional gel electrophoresis
Authors: Paugh Donald R. , Telian Steven A. , Disher Michael J.
Published: November 2015

Perilymph has a total protein component that is quantitatively distinct from serum and cerebrospinal fluid (CSF). The goal of this research was to determine if perilymph contains any qualitatively unique protein constituents that will distinguish it from serum or CSF. To test this hypothesis, matched sets of perilymph, serum, and CSF were obtained from 18 guinea pigs and seven human subjects. The purity of each sample was assured by measurement of the protein concentration of each sample and comparison of this parameter to known normal values for perilymph, serum, and CSF. Each sample was then subjected to two‐dimensional gel electrophoresis, separating proteins by isoelectric point in the horizontal dimension and by relative molecular weight in the vertical dimension. All gels were processed under precisely identical physical conditions by use of a diamine silver stain. A small number of perilymph proteins not found in plasma were identified in both the guinea pig and the human specimens. The finding of unique perilymph proteins may permit the development of a sensitive marker that will aid in the diagnosis of perilymph fistula.
Microsubglottoscopy: An expansion of operative microlaryngoscopy
Authors: Ossoff Robert H. , Duncavage James A. , Dere Huseyin
Published: November 2015

The development of the adult subglottiscope has facilitated expansion of the indications for operative microlaryngoscopy to include surgery in the subglottic region of the larynx, as well as in the upper cervical trachea. A set of microlaryngeal instruments with an elongated shaft has been developed to support the use of the subglottiscope in the adult patient population. During the 18‐month period from January 1,1988, through June 30, 1989, sixteen adult patients with subglottic or upper cervical tracheal pathology were operated on a total of twenty‐three times, using the adult subglottiscope to facilitate exposure and treatment. The patients’ pathologic conditions included subglottic stenosis, subglottic granuloma, subglottic extension of laryngeal hemangioma and papilloma, and suprastomal granuloma. Two selected cases are presented to highlight indications for the use of this instrument. We have found the exposure of these subglottic and upper cervical tracheal lesions, using the binocular, microlaryngeal approach facilitated by the adult subglottiscope, to be improved over that obtained with existing microlaryngoscopes or conventional tracheoscopes.
Upper airway obstruction and craniofacial morphology
Authors: Principato Jerold J.
Published: November 2015

Otolaryngologists are being asked with increasing frequency to assess adequacy of the upper airway and to treat upper airway obstructive problems in orthodontic patients. The incentive has been provided by recent studies that purport to relate upper airway obstruction to dental and craniomorphologic changes. It is hypothesized that prolonged oral respiration during critical growth periods in children initiates a sequence of events that commonly results in dental and skeletal changes. In the chronic mouth‐breather excessive molar tooth eruption is almost a constant feature, causing a clockwise rotation of the growing mandible, with a disproportional increase in anterior lower vertical face height. Such increases in anterior lower vertical face height are often associated with retrognathia and open bites. Low tongue posture seen with oral respiration impedes the lateral expansion and anterior development of the maxilla. Otolaryngologists have the ability to objectively and accurately assess upper airway patency. Rhinometric assessment before and after application of topical nasal decongestant, in conjunction with clinical examination, provides valuable information regarding upper airway patency and the cause of any existing obstructive pathologic condition. Studies should be designed carefully to control the numerous variables that have an impact on the growing face of a young child so that meaningful data can be obtained in our own field regarding this challenging topic.
Effects of Chronic Electrical Stimulation on Patients using a Cochlear Prosthesis
Authors: Waltzman Susan B. , Cohen Noel L. , Shapiro William H.
Published: November 2015

Eighteen patients using the Nucleus multichannel cochlear prosthesis underwent annual evaluations for electrical thresholds, dynamic range, and speech recognition abilities for a period of 1 to 5 years. Results revealed no correlation between length of usage of a cochlear implant and electrical thresholds. The dynamic range was initially wider in the patients with open‐set speech recognition, but narrowed in subsequent years. There was a correlation between length of deafness and postoperative performance.
Functional Endoscopic Sinus Surgery in the Immunocompromised Child
Authors: Wiatrak Brian J. , Willging Paul , Myer Charles M. , Cotton Robin T.
Published: November 2015

Fungal sinusitis in the immunocompromised child is an aggressive, invasive process that may result in a fatal outcome if not diagnosed early. As a result of increasing use of bone marrow transplantation and new cytotoxic chemotherapeutic agents resulting in severe agranulocytopenia, more patients have become susceptible to fungal sinus disease. Functional endoscopic sinus surgery has emerged recently as an important surgical modality in the treatment of sinus disease in adults and children. Use of this technique in immunosuppressed children has allowed early diagnosis of fungal sinonasal disease, resulting in earlier surgical intervention. The high‐quality fiberoptic capability of nasal endoscopes allows very detailed visualization of the internal anatomy of the nose and detects early mucosal changes as a result of intranasal fungal disease. Our experience using functional endoscopic sinus surgery in immunocompromised children over an 18‐month period is reviewed. Our philosophy for diagnosis and management of immunocompromised children with suspected fungal sinonasal disease is discussed.
The Patulous Eustachian Tube: Management Options
Authors: Dyer R. Kent , Mcelveen John T.
Published: November 2015

The patulous eustachian tube is a benign, yet annoying condition that may be overlooked or misdiagnosed. It is frequently associated with peritubal atrophy, and usually responds to conservative measures such as weight gain or mucus‐producing agents. In patients not responding to these measures, a variety of surgical options are available. We have been using a technique that avoids elevating a tympanomeatal flap, is reversible, and is effective. This technique, as well as other surgical options, are reviewed. The advantages and disadvantages inherent in them are discussed.
The Effects of Topical Oral Clindamycin Antibiotic Rinses on the Bacterial Content of Saliva on Healthy Human Subjects
Authors: Elledge E. Scott , Whiddon Robert G. , Fraker John T. , Stambaugh Kweon I.
Published: November 2015

The use of systemic antibiotics for major head and neck surgical procedures involving the upper aerodigestive tract is now accepted as an important part of perioperative patient care. Despite knowledge of the high counts of bacteria present in saliva, no preoperative regimen for preparing the mouth has ben standardized. Surgical wounds come in contact with saliva during the course of many head and neck procedures. While wound infection rates have been decreased with the use of prophylactic systemic antibiotics, serious morbidity still exists from postoperative wound infections. Reducing the bacterial counts in saliva preoperatively may further decrease wound infection rates. A prospective randomized pilot study of twenty healthy human subjects compared the effects of an oral rinse with clindamycin vs. a placebo rinse of normal saline. There was a statistically significant reduction in both aerobic and anaerobic colony counts in the clindamycin group at 4 hours after treatment. For the group that rinsed with placebo, there was an actual increase in counts 4 hours after treatment. It is concluded that oral rinses with clindamycin can reduce the bacterial content of saliva for a sufficient length of time to be effective as a preoperative prophylactic measure for head and neck surgery involving the upper aerodigestive tract. Future studies are planned to evaluate other potentially effective agents. A logical continuation is a clinical study of preoperative and postoperative rinses.
The Transcervical Approach to the Superior Mediastinum
Authors: Krespi Yosef P. , Har‐El Gady , Nash Michael
Published: November 2015

We describe our experience with the transcervical approach for the surgical treatment of nonthyroidal superior mediastinal masses. With careful patient selection, proper preoperative workup, and proper operative positioning and technique, the entire superior mediastinum may be explored, thus avoiding the significant morbidity associated with the transsternal route. The transcervical approach requires a thorough knowledge of the surgical anatomy. Nine patients underwent transcervical exploration of the superior mediastinum. The indications included parathyroid adenoma, thymoma, congenital cyst, hemangioma, adenocarcinoma, and thymectomy for myasthenia gravis. We specifically discuss the role of thymectomy in the treatment of myasthenia gravis.
Clinical Experience with Lingualplasty as Part of the Treatment of Severe Obstructive Sleep Apnea
Authors: Woodson B. Tucker , Fujita Shiro
Published: November 2015

Because uvulopalatopharyngoplasty (UPPP) as the sole procedure for severe obstructive sleep apnea syndrome (OSAS) is often inadequate, multiple other procedures have been developed. These have been directed at other sites of potential collapse of the upper airway. Initial experience with midline glossectomy (MLG) has shown direct modification of the tongue base to be an effective procedure in a subset of patients with OSAS. Lingualplasty, a modification of MLG, is demonstrated to provide an improved response rate. Twenty‐two consecutive patients with severe OSAS and Fujita type II airway classification (retropalatal, oropharyngeal, and hypopharyngeal compromise) underwent lingualplasty. Fourteen patients had previously undergone unsuccessful UPPP. Eight had synchronous lingualplasty and UPPP. All were selected for lingualplasty because of obstructive tongue base anatomy. Responders were defined as having a respiratory disturbance index (RDI) of less than 20 events/hour. For the entire group, 17 of 22 (77%) were classified as responders, with RDI decreasing from 58.8 ± 39.5 events/hour to 8.1 ± 6.2 events/hour. Lingualplasty, as an isolated procedure, resulted in a 79% responder rate, with RDI decreasing from 50.2 events/hour to 8.6 events/hour. There were no significant changes in the RDI of the nonresponder groups. No differences were identified that discriminated responders from nonresponders, including age, body mass index, or cephalometry. There were six complications (27%), including bleeding (3), tongue edema (1), prolonged odynophagia (1), and subcutaneous emphysema related to tracheotomy (1). All resolved with treatment. These results indicate that in appropriately selected patients who do not respond to UPPP, lingualplasty Is a significant improvement over MLG.
Contemporary Evaluation of Unilateral Vocal Cord Paralysis
Authors: Terris David J. , Arnstein David P. , Nguyen Henry H.
Published: November 2015

Unilateral vocal cord paralysis is a common finding in the practice of otolaryngology. Multiple etiologies have been described and have not changed appreciably in the last century. We attempted to characterize the contemporary evaluation of unilateral vocal cord paralysis, with consideration given to cost‐effectiveness. Thirty‐one board‐certified otolaryngologists were interviewed to determine their typical evaluation protocol. The average cost of an evaluation totaled $1706.18, with a range of $112.56 to $3439.52. Otolaryngologists with more years of experience tended to pursue briefer and less expensive evaluations. The charts of 187 patients with a diagnosis of vocal paralysis from 1983 to 1991 were reviewed, of which 113 were evaluable. Eighty‐four of these 113 (74%) were unilateral. In 48 of 84 cases (57%), the cause was apparent at the time of diagnosis. In 36 of 84 cases (43%), an evaluation was necessary. A diagnosis was achieved in 27 of these 36 instances (75%), with the most useful test being a chest roentgenogram (n = 13, 48%). The most common cause of unilateral vocal cord paralysis in our series was neoplasm (n = 34, 40%), followed by surgical trauma (n = 29, 35%). In no instance was a malignancy discovered subsequent to the initial evaluation. The most cost‐efficient, inclusive diagnostic evaluation of unilateral vocal cord paralysis involves a stepwise progression through the tests that are most likely to yield a diagnosis, with endoscopy reserved for those cases in which simpler, less invasive tests have not indicated a cause.
Early Mucosal Changes in Experimental Sinusitis
Authors: Hinni Michael L. , McCaffrey Thomas V. , Kasperbauer Jan L.
Published: November 2015

Normal mucociliary flow is a significant defense mechanism in the prevention of acute sinusitis. We have undertaken a study to examine the early sinus mucosal and mucociliary changes that occur in response to acute infection. Twenty rabbits were evaluated for 5 days after an obstructed maxillary sinus was inoculated with either Streptococcus pneumoniae, Hemophilus influenzae, Pseudomonas aeruginosa, or a sterile saline solution. Data collected included measurements of sinus mucosal ciliary beat frequency, quantitation of ciliated cell losses, and electron microscopic observations. Results demonstrate statistically significant (p < 0.05) changes in mucosal ciliary beat frequency that were either excitatory or inhibitory, depending both on the length of the infection and the specific organism. No changes in ciliary beat frequency were observed in the control animals (p > 0.55). Control animals likewise demonstrated no loss of ciliated cells from mucosal epithelium; however, dramatic losses of ciliated cells from the sinus mucosa of the experimental groups were observed. These losses occurred at different rates, depending on the infecting organism, but all infected groups demonstrated a >86% decrease in the number of viable ciliated cells from the sinus mucosa after sinusitis of 5 days duration. We conclude that a significant loss of ciliated cells from sinus mucosa and a corresponding disruption of normal mucociliary flow occurs early after exposure to pathogenic organisms and is a significant predisposing factor in the development of acute sinusitis.
Comparison of Electroglottographic and Acoustic Analysis of Pitch Perturbation
Authors: LaBlance Gary R. , Maves Michael D. , Scialfa Theresa M. , Eitnier Claudia M. , Steckol Karen F.
Published: November 2015

Pitch perturbation is a measure of the cycle‐to‐cycle variation in vocal fold vibration. Perturbation can be assessed by means of electroglottographic or acoustic signals. The purpose of this study was to determine if these two analysis techniques are equivalent measures. The Laryngograph, an electroglottograph, and the Visi‐Pitch, an acoustic analyzer, were used to measure pitch perturbation in 80 dysphonic subjects. Both instruments use Koike's formula to calculate relative average perturbation. While intrasubject variability appeared erratic, statistical analysis of intersubject data indicated that the two instruments provided an equivalent measure of pitch perturbation.
Head and Neck Synovial Cell Sarcoma
Authors: Amble Finn R. , Olsen Kerry D. , Nascimento Antonio G. , Foote Robert L.
Published: November 2015

Our experience with 14 patients treated for synovial cell sarcoma during the past 30 years is described. These tumors were manifested in young people whose ages ranged from 12 to 43 years. The diagnosis of synovial cell sarcoma proved difficult because approximately one third of the patients initially received incorrect pathologic diagnoses. A painless neck mass was the most common presenting symptom. Initial treatment included surgical excision in five patients and surgical excision and radiation therapy in nine. Recurrent or metastatic tumor occurred from 4 months to 62 months later; thus, long‐term followup is important. Four of the nine patients who were followed more than 5 years died of their disease. Favorable prognostic findings included early diagnosis and the performance of wide surgical removal.
A Multisensor Solid‐State Pressure Manometer to Identify the Level of Collapse in Obstructive Sleep Apnea
Authors: Woodson B. Tucker , Wooten Marvin R.
Published: November 2015

The cause of failure after uvulopalatopharyngoplasty (UPPP) in idiopathic obstructive sleep apnea (OSA) is poorly understood, but has been speculated to be due, in part, to persistent collapse in the lower oropharynx. In order to determine the specific level of upper airway obstruction during sleep, a multisensor pressure catheter has been developed with five solid‐state ultraminiature sensors. Four sensors in the pharynx simultaneously measure multiple pressure levels, with no need to move the catheter during sleep. One distal esophageal port measures the respiratory effort. To evaluate the use of this catheter, manometry in twelve patients was reviewed and compared to simultaneous videoendoscopy. The initial site of obstruction was the palate in nine patients (75%) and the tongue base in three (25%). Three patients with initial obstruction at the palate manometrically demonstrated distal obstruction on subsequent occluded breaths. Furthermore, simultaneous videoendoscopy in four patients with a palatal level of obstruction also identified marked near‐total visual collapse without obstruction of the lower oropharynx that was not identified by pharyngeal manometry. The endoscopy revealed that at the initial site of obstruction, collapse appeared to have occurred passively during expiration and not on inspiration. Inferior to the site of mano‐metric obstruction, collapse occurred during inspiration associated with increased negative inspiratory pressures. These results demonstrate that a multisensor pressure catheter can objectively identify the level of obstruction during sleep. However, manometry does not identify visually observed collapse at nonobstructive segments of the upper airway. Because such collapse and the associated increases in resistance may contribute to the pathology of airway obstruction in OSAS, manometry may miss pathologic segments of the upper airway in OSAS.
Clinical Evaluation of the Monothermal Caloric Test
Authors: Linstrom Christopher J. , Stockwell Charles W.
Published: November 2015

The Torok monothermal Caloric Test has been described as offering a strong advantage over bithermal caloric testing because it can distinguish labyrinthine from retrolabyrinthine lesions. Weak and strong irrigations of room‐temperature water are administered to each ear and the ratios of strong to weak nystagmus responses compared to those of normal individuals. Ratios that fall below normal are said to represent decruitment and to denote retrolabyrinthine disease. Ratios that exceed normal are said to represent recruitment and to denote labyrinthine lesions. We attempted to verify the clinical value of the Monothermal Caloric Test by examining patients with known labyrinthine (N = 9) and retrolabyrinthine (N = 25) lesions. Ten patients with dysequilibrium and nonlocalizing testing were also examined. The test was performed exactly as described by the originator. Decruitment was found either unilaterally or bilaterally in 56% of patients with retrolabyrinthine lesions. However, it occurred on the side of the lesion in only 42%. Decruitment was also found in 47% of patients without retrolabyrinthine lesions, including 63% of those with unilateral Meniere's disease. Recruitment was never found on the side of a labyrinthine lesion. A description of the test and a summary of our results are presented. We conclude that the Monothermal Caloric Test is moderately sensitive to the presence of retrolabyrinthine lesions, but lateralizes poorly and is not highly selective. The test was found to be insensitive to the presence of labyrinthine disease.
Arterial Supply of the Human Endolymphatic Duct and Sac
Authors: Gadre Arun K. , Fayad Jose N. , O'Leary Michael J. , Zakhary Rizkalla , Linthicum Fred H.
Published: November 2015

The arterial anatomy of the endolymphatic duct and sac was studied in vascular casts of methyl methacrylate of six human heads. The chief source of arterial blood supply to the endolymphatic duct and sac appeared to be the occipital artery. Arterioles entered the bone of the mastoid process. Arterioles in bone, the walls of the sigmoid sinus, and the posterior fossa dura coursed medially to supply the endolymphatic sac. The orientation of arterioles tended to be along the long axis of the endolymphatic duct and sac, whereas venules were more likely to be circumferentially oriented. Arterioles arising from dural vessels divided into deeper branches, which supplied periductal connective tissue, and superficial branches, which entered canaliculi of the vestibular aqueduct. Gross anatomic findings were confirmed by histologic examination of temporal bones.)
Predicting Long‐Term Facial Nerve Outcome after Acoustic Neuroma Surgery
Authors: Arriaga Moises A. , Luxford William M. , Atkins James S. , Kwartler Jed A.
Published: November 2015

Although anatomic preservation of the facial nerve is achieved in nearly 90% of reported cases after acoustic neuroma surgery, postoperative long‐term facial function is of most concern to the patient. This study examines long‐term facial nerve function in relation to the immediate postoperative function and the function at time of discharge from the hospital. Subjects included 515 patients who underwent primary acoustic neuroma removal at House Ear Clinic from 1982 through 1989 and who had normal preoperative facial function, an intact facial nerve after surgery, and a House‐Brackmann facial nerve grade available immediately postoperatively, at time of hospital discharge, and at least 1 year postoperatively. Rate of acceptable facial function (House grades I‐IV) differed significantly (p < 0.001) at the three postoperative time intervals: 85.2%, immediate; 73.6%, discharge; 93.8%, long‐term. Of those with good immediate function (grades I‐II), 98.6% had acceptable long‐term function. Of those with poor immediate function (grades V‐VI), 69.8% had acceptable long‐term function. We conclude that facial nerve recovery after acoustic neuroma surgery is characterized by slight deterioration in the immediate postoperative period, but subsequent improvement in the long‐term. Patients can be reliably counseled that acceptable function immediately after surgery is associated with a favorable long‐term outcome; poor function immediately after surgery, despite an intact nerve, has a more guarded prognosis.
Epidermoid Carcinoma of the Oral Cavity and Oropharynx: Validity of the Current AJCC Staging System and New Statistical Tools for the Prediction of Subclinical Neck Disease
Authors: Ghouri Ahmed F. , Zamora Rene L. , Harvey Joseph E. , Spitznagel Edward L. , Sessions Donald G.
Published: November 2015

The 1983 and 1988 AJCC T‐ and N‐staging systems were compared using the case records of 531 patients with primary epidermoid malignancies of the oral cavity. All patients had a minimum followup of 5 years. There were 390 patients with early stage (T1, T2) disease and 141 with advanced stage (T3, T4) lesions according to both the 1983 and 1988 T‐definitions: 342 patients manifested no clinical nodes (NO), 189 had clinically evident nodes (N1‐N3), and none had metastatic disease. Cox regression analysis demonstrated that the 1983/1988 T‐stage definitions differentiated survival successfully (p < 0.001). The 1988 staging system for nodal disease showed a highly significant separation of N2 and N3 when compared with the 1983 system (p < 0.001). Of the 342 patients who were staged NO, 154 had primary neck dissection. Logistic regression predicted the incidence of subclinical disease according to the site and the T‐stage of the primary tumor with a sensitivity of 78% and a specificity of 95%. We conclude that the 1988 N‐stage definition is a better prognosticator of survival than the 1983 definition. Furthermore, a logistic regression model can be used to predict the probability of subclinical disease in primary oral cavity cancers.
Intraoral Ultrasonography in the Diagnosis of Peritonsillar Abscess
Authors: Haeggström Arvid , Gustafsson Ove , Engquist Stefan , Engström Carl‐Fredrik
Published: November 2015

The diagnosis of quinsy is traditionally established on the basis of clinical observations and sometimes several diagnostic punctures. The present study has focused on the possible usefulness of intraoral ultrasonography (IOU) as a diagnostic tool when a peritonsillar abscess is suspected. The results show that it is possible to demonstrate, with a high degree of accuracy, the presence of an abscess, its volume, location, and its relation to the carotid artery. With this information an exact and safe diagnostic puncture can be performed when necessary and avoided in cases with clinical signs of quinsy with no abscess.
Hearing Levels of Patients with Otosclerosis 10 Years after Stapedectomy
Authors: Vartiainen Eero , Virtaniemi Jukka , Kemppainen Markku , Karjalainen Seppo
Published: November 2015

Hearing levels of 174 patients (213 ears operated on) with otosclerosis undergoing stapedectomy were analyzed. All patients had followup of 10 years or more, the mean follow‐up period being 13.4 years. Eighty‐seven ears (41%) underwent posterior crus stapedectomy, and in the remaining 126 ears (59%) a prosthesis was inserted. Large fenestra technique was used in all cases. In the long run, both air conduction and bone conduction thresholds of ears operated on showed remarkable deterioration from the best values obtained 6 to 12 months postoperatively. Ten years after surgery both air conduction and bone conduction thresholds of ears operated on were significantly worse than those of normal controls. At 10 years, 70 percent of the ears operated on had hearing levels (at 0.5 to 2.0 kHz) of 30 dB or better and 88 percent had 40 dB or better. At the last follow‐up examination, in 90% of the patients the better hearing ear had a hearing level of 40 dB or better. In 90% of patients with bilateral otosclerosis who had operations in only one ear, the ear operated on had better hearing function than the opposite ear that had not been operated on.
Laser Welding of Fascial Grafts and its Potential Application in Tympanoplasty: An Animal Model
Authors: Hanna Ehab , Eliachar Isaac , Cothren Robert , Ivanc Thomas , Hughes Gordon
Published: November 2015

This study evaluates the welding effect of argon laser on fascial grafts and its potential application in tympanoplasty. An animal model was designed so that surgically induced perforations of the lumbar fascia of the animals were grafted in an underlay fashion. Each graft was “spot welded” around the circumference of the perforation using a hand‐held argon laser. Various lasing parameters were used on different grafts. Control perforations were grafted but not welded. A total of 96 perforations was studied. Weld sites were evaluated both histologically and by tensile strength measurement at the end of surgery, and at 7, 14, and 21 days postoperatively. Comparison with controls showed a higher tensile strength for welded grafts, which was most significant in the early postoperative period (p < 0.001). Histologically, it seems that the basic mechanism of fascial welding involves liquification and denaturation of extravasated proteins at the weld sites. Correlation between the extent of thermal damage on the tissues and the various lasing parameters is described. Based on the well‐documented safety of argon laser in otologic surgery, and the successful welding of fascial grafts in this study, argon laser may prove beneficial in welding temporalis fascia grafts in tympanoplasty.
Pathogenesis of tympanosclerosis
Authors: Bhaya Mahesh H. , Schachern Patricia A. , Morizono Tetsuo , Paparella Michael M.
Published: November 2015

In spite of the wealth of information on the clinical, histologic, and pathologic aspects of tympanosclerosis, the pathogenesis of tympanosclerosis is still unclear. In an attempt to understand the pathogenesis, 319 human temporal bones from 196 individuals with otitis media were studied. The extent and nature of tympanosclerosis and the characteristics of the otitis media associated with it were studied. Forty‐five temporal bones from 35 individuals with otitis media were found to have tympanosclerosis, giving an incidence of 14.1%. It was seen most commonly in individuals over 40 years of age (86.7%). The male‐to‐female ratio was 1.6:1. The most common site of occurrence was the tympanic membrane (88.9%). Tympanosclerosis was seen more often in the anterior and posterior inferior quadrants of the tympanic membrane and that, too, in a central position. Tympanosclerosis was seen more commonly in temporal bones with irreversible inflammatory changes, and in this group, late plaques were more commonly seen than early or intermediate plaques. Audiometric charts failed to show any direct relationship between extent of tympanosclerosis and the severity of hearing loss. The only audiometric finding of any consequence was a mixed hearing loss in the presence of middle ear tympanosclerosis. (OTOLARYNGOL HEAD NECK SURG 1993;109:413‐20.)
The surgical workstation: Surgical planning using generic software
Authors: Wiegand David A. , Page Robert B. , Channin David S.
Published: November 2015

Computer software for rendering and display of three‐dimensional data is becoming readily available for all types of computers. Such programs typically accept data from any source, compute a three‐dimensional volume of data, and display it with a variety of rendering options. Although not specifically designed for medical image processing, these programs can provide very detailed and finely rendered images that are useful for surgical planning. We use one such program to display data from standard computed tomography scans, which gives us a photorealistic three‐dimensional view of patient anatomy. This view can be modified to render tissues transparent, translucent, or opaque, and thus allows the surgeon to selectively enhance bony architecture, tumors, or other details. Images can be rotated, sliced, and displayed in the surgical position. Image animation can be added to facilitate the display of complex anatomic relationships. Our experience with this technology suggests that such programs can provide the basis for personal surgical workstations for medical image analysis and surgical planning. Further development of such generic imaging systems should allow this useful technology to become widely available for surgical planning and education. We discuss our experience with a typical generic imaging workstation. (OTOLARYNGOL HEAD NECK SURG 1993;109:434‐40.)
Management of laryngotracheal stenosis on the basis of site and severity
Authors: McCAffrey Thomas V.
Published: November 2015

Seventy‐five cases of laryngotracheal stenosis treated between 1981 and 1991 were reviewed to determine the effectiveness of surgical treatment on the basis of site and severity of stenosis. Decannulation and absence of exertional dyspnea were the criteria of successful management. The treatment methods used were endoscopic laser incision and dilatation, expansion laryngotracheoplasty, and segmental resection. Endoscopic procedures were effective in treating thin (< 1 cm) stenoses in the subglottis and trachea. Laryngotracheoplasty was most effective in treating thick stenoses of the glottis and subglottis. Tracheal stenoses were most effectively treated by segmental resections. The probability for decannulation decreased with longer narrower stenoses and with increasing clinical stage. (OTOLARYNGOL HEAD NECK SURG 1993;109:468‐73.)
Injuries of the hard palate and the horizontal buttress of the midface
Authors: Rimell Frank , Marentette Lawrence J.
Published: November 2015

Traumatic injuries to the hard palate occurred In 20% of all Le Fort midfacial fractures. The side of a palatal split was directly related to the side that received the highest Le Fort injury. In a symmetric midfacial injury, the palate had a true midline split. Repair of palatal injuries from blunt trauma involved either wire and splinting (eight patients) or miniplate fixation without a splint (11 patients). There were fewer complications in those treated by the miniplate fixation technique (two of 11), as compared to those treated with wire and splinting (four of eight). In miniplate fixation of midfacial fractures, attention is focused on the reconstruction of the supporting buttresses of the midface, both vertical and horizontal. In regard to the palate, this requires union of the inferior horizontal buttress. Gunshot wounds accounted for 21% of the patients and resulted in large bony disruption of the palate, which required free soft tissue and bone grafts for repair of the inferior horizontal buttress. (OTOLARYNGOL HEAD NECK SURG 1993;109:499‐505.)
Ingestion of caustic cosmetic products
Authors: Stenson Kerstin , Gruber Benjamin
Published: November 2015

Twelve children over a 6‐year period (1985 to 1991) underwent aerodigestive tract endoscopy after ingestion of lye‐containing cosmetic products. All children were less than 2 years of age and had facial and/or oral cavity burns. Eleven of these patients ingested alkaline hair products such as “activators” or “relaxers.” Endoscopy revealed pharyngeal burns in five patients but no laryngeal or esophageal burns in any patient. Erythema of the esophageal mucosa was seen in one patient. One patient ingested a solution used in fingernail decorating. This patient sustained extensive superficial burns of the pharynx, larynx, and esophagus and required intubation and admission to the intensive care unit. No long‐term sequelae developed. Cosmetic products containing caustic chemicals represent a significant health risk to small children, especially because child‐proof packaging is not standard for these products.
Extramedullary plasmacytomas of the head and neck
Authors: Wax Mark K. , Yun K. John , Omar Rawhi A.
Published: November 2015

Extramedullary plasmacytomas are solitary tumors consisting of neoplastic plasma cell proliferations that occur in locations other than bone. On initial presentation they must be differentiated from multiple myeloma. This may prove to be difficult because a varying percentage may be associated at a later date with the development of multiple myeloma. Solitary extramedullary plasmacytomas represent up to 4% of nonepithelial lesions of the upper respiratory tract. From 1970 to 1990, at West Virginia University Hospitals, seven patients with solitary extramedullary plasmacytoma were identified. In four of these patients the tumor was located in the head and neck, with one tumor located in each of the following sites: temporoparietal scalp, maxillary sinus, nasopharynx, and cervical region. One patient had extensive destruction of the temporal bone, with extension intracranially to the middle cranial fossa. No patient had multiple myeloma, nor did any develop. Diagnosis was based on a combination of histology along with special immunoperoxidase staining for Ig lambda and kappa light chains. This will be demonstrated and discussed. Treatment consisted of radiotherapy in three cases, with doses ranging from 3175 to 6000 rad. One patient, treated with surgical excision, experienced a relapse at a distant site 6 years later. All patients have maintained local control and have been followed for a minimum of 1 1/2 years, with an average of 3 years. We describe our experience with these tumors and present a pertinent review of the literature. While these tumors may present as aggressive locally destructive lesions, their management should be as organ‐sparing as possible because excellent control can be achieved in the majority of cases. Patients should be followed for life because multiple myeloma may develop in a significant number.
Sex hormones regulate abr latency
Authors: Elkind‐Hirsch Karen E. , Wallace Elizabeth , Malinak L. Russell , Jerger James J.
Published: November 2015

In an effort to characterize more completely the influence of sex hormones on auditory brainstem response (ABR) latency, we evaluated the ABRs of normal male and female subjects and women with previously diagnosed endocrinologic syndromes. We describe ABR latency results from the following subjects: five normal males, nine normally cycling females on no hormonal therapy, nine females using oral contraceptive pills, five females with premature ovarian failure (POF) undergoing cyclic estrogen‐progesterone replacement therapy, and five hyperandrogenized females with polycystic ovarian disease (PCOD) treated with the gonadotropin‐releasing hormone agonist, Lupron depot, to suppress ovarian steroid production. All subjects were between 23 and 40 years of age. Serum levels of estradiol, progesterone, testosterone, prolactic, and gonadotropins (lutienizing hormone and follicle stimulating hormone) were measured to document the hormonal status of each of the subjects at the time of the ABR evaluation. Normal cycling females and females with POF underwent ABR testing during different phases of the same cycle. Male subjects and females using birth control pills were studied four times in the same month at 1‐week intervals. Females with PCOD were also studied four times; baseline and then at 2‐week intervals after the initiation of Lupron depot therapy. Increased ABR wave V peak latencies were found to be associated with elevated levels of estrogen or testosterone. We have previously reported a lengthening of ABR wave V peak latencies coincident with peak estrogen levels during the female cycle. Because testosterone is converted to estrogen by central neuroendocrine tissue to exert its effect on brain function, we postulated that increased latency in males is a result of the effect of aromatization of testosterone to estrogen in the central auditory pathway. This hypothesis would account for the slightly increased wave V peak latencies found in the PCOD females with elevated testosterone before treatment with Lupron to suppress ovarian androgen secretion. These findings suggest that neural conduction time is modified by changes in estrogen concentrations in the brainstem auditory pathway of both sexes.