bluuebunny/crossref_metadata_2025 huggingface dataset:
Neurogenic Tumors of the Skull Base
Authors: Clemis Jack D.
Published: April 2016

This review article summarizes the subject of neurolemmomas in and around the temporal bone and was written as a component paper for a symposium on surgery of the skull base. The paper primarily discusses solitary schwannomas of the facial nerve, vestibular schwannomas, and jugular foramen schwannomas relative to incidence, signs and symptoms, and preferential diagnostic and therapeutic options. General considerations such as multiple neurofibromatosis, current nomenclature, and malignancy are defined.
Evaluation and Management of Primary Petrous Apex Cholesteatoma
Authors: Gacek Richard R.
Published: April 2016

Primary cholesteatoma of the petrous apex is an uncommon congenital lesion that is suspected clinically by such indirect methods of examination as conventional and tomographic radiology, computerized axial tomographic scan, and angiography. If these indirect methods indicate a petrous apex lesion, the area should be investigated by biopsy through the sphenoid, middle fossa, or translabyrinthine routes. Tumor extension, sphenoid pneumatization, and normal labyrinthine function are factors that determine the surgical approach. Once a diagnostic surgical procedure confirms the presence of an epidermoid cyst at the petrous apex, permanent fistulization through the sphenoid or the middle ear is recommended as definitive management.
Surgery for Glomus Tumors at the Skull Base
Authors: Spector Gershon J. , Sobol Steven
Published: April 2016

Glomus tumors of the temporal bone frequently involve the skull base. In the present study, 34% of the tumors occurred with cranial nerve palsies and 15% invaded the CNS.

The procedure for surgical resection of glomus tumors of the skull base is described. Results of the procedure included successful surgical resection of 80% of the glomus jugulare tumors and of 94% of the glomus tympanicum tumors. Tumor recurrence and persistence occurred only in the patients with CNS invasion.
Surgical Therapy of Internal Carotid Artery Lesions of the Skull Base and Temporal Bone
Authors: Fisch Ugo P. , Oldring Derald J. , Senning Åke
Published: April 2016

Five cases of carotid artery lesions at the skull base or temporal bone, treated surgically, are presented. These lesions include mycotic aneurysms and carotid stenosis secondary to angiofibroma and a glomus caroticum. One case demonstrated an anomalous carotid anatomic pattern with a persistent stapedial artery.

A description is provided of the technique of subtotal petrosectomy with permanent anterior displacement of the facial nerve, and middle ear obliteration, thus achieving a safe exposure of the temporal course of the internal carotid artery.

The cases indicate that cooperation between temporal bone surgeons and vascular surgeons is a prerequisite to successful repair of such lesions, as good recovery in all five cases was achieved. The techniques allow maintenance of carotid flow during and after repair, reducing the potential for neurologic complications or mortality.
Management of Cranial Nerves I through VII following Skull Base Surgery
Authors: May Mark
Published: April 2016

Cranial nerve injuries are common with skull base surgery. While injuries to the seventh and tenth cranial nerves can be corrected to satisfactory degrees, rehabilitation of the third, fourth, and sixth nerves is possible to only a limited degree. This study stresses the management of facial paralysis following skull base surgery and is based upon the author's experiences in dealing with 38 patients who suffered such a facial paralysis. The best results of rehabilitative surgical treatment were achieved with techniques that connect the central stump to the peripheral system. The time between nerve injury and repair was the most significant determinant of the success of the surgical procedure: When the nerve was repaired within three months of the injury, the best results were obtained; when the central stump was not available or the injury was more than two years old, repair was not as satisfactory. In the latter case the procedure of choice was the 12th‐7th nerve hookup. Indications and results of facial nerve grafting, cross faciofacial nerve hookups, muscle swings, free muscle implantations, and eye reanimation techniques are discussed.
Effects of Large‐Bore Middle Ear Ventilation Tubes
Authors: Holt James J. , Harner Stephen G.
Published: April 2016

Patients with chronic otitis media that did not respond to conventional treatment were studied for the types and incidence of complications from the use of large‐bore tubes inserted into their ears. The most common complication was otorrhea (41%, 50 of 123 ears). Permanent perforation occurred in 25% (17/68 ears). Use of large‐bore tubes proved effective and continues to be indicated in certain conditions of chronic otitis media that are refractory to other forms of treatment.
Experimental Pneumococcal Otitis Media: A Histopathologic Study
Authors: Meyerhoff William L. , Shea Donald A. , Giebink G. Scott
Published: April 2016

An animal model for pneumococcal otitis media was studied histologically at varying intervals postinoculation. Histologic changes generally associated with acute inflammation (edema, diffuse infiltration with polymorphonuclear leukocytes, and hemorrhage) occurred early in the disease while the ears were culture positive. Changes generally associated with chronic otitis media (lymphocyte infiltration and osteoneogenesis) occurred later in the course of the disease when the ears were culture negative. Metaplasia of middle ear mucosa and middle ear granulation tissue were observed as early as five days following inoculation.

Middle ear granulation tissue was identified in 82% of all cases; cholesteatoma was seen in only one ear. Tympanic membrane perforation did not occur. Labyrinthitis and endolymphatic hydrops were fairly common findings. The former was identified in 56% of ears examined, and the latter, in 45%. These two conditions coexisted in 34% of ears studied, while endolymphatic hydrops alone occurred in 11%.
Abnormal Brain Stem Potentials in Infants with Threatened Sudden Infant Death Syndrome
Authors: Nodar Richard H. , Lonsdale Derrick , Orlowski James P.
Published: April 2016

Fifteen infants at risk for sudden infant death syndrome by clinical criteria were tested using brain stem auditory evoked potential (BAEP) techniques. All infants demonstrated abnormalities on two or more of the seven criteria employed to assess results. The data indicate that BAEP testing may play a significant role in the identification and monitoring of these children.
Surgical Procedure for the Mastoid Cavity Problem
Authors: Brandow Edward C.
Published: April 2016

When the mastoid cavity infection is the result of breakdown of the skin lining, the cavity should be obliterated. Many types of material have been used, but postauricular tissue has been most effective. Instead of a pedicled flap, a free graft of tissue is recommended because it allows better placement of the graft deep into the cavity. It undergoes a more uniform contracture and does not tend to pull out of the depths of the cavity. The principle of obliteration is not only to obliterate the cavity but also to bring a layer of vascularized subcutaneous tissue between the skin lining and the bone.
Drug Therapy of Aspergillus Otitis Externa
Authors: Lopez Leticia , Evens Ronald P.
Published: April 2016

Chairman's Comments: True mycotic infections of the ear canal are far less common than realized: “swimmer's ear” is often ascribed to a fungus by nonotolaryngologists. However, mycotic infections, especially those due to Aspergillus, are difficult to eradicate and topical drug therapy is an important part of treatment.

Lopez and Evens summarize the available literature related to treatment of Aspergillus external otitis in this drug capsule. Their review is interesting and informative. It is remarkable how many medications have been used for this stubborn condition.
Biologic Response to Sutures
Authors: Salthouse Thomas N.
Published: April 2016

Whenever a foreign object is implanted in living tissue, a cellular response occurs. Sutures usually produce a mild response that varies in character with different materials. The cellular and tissue reaction can be evaluated by both morphologic and enzyme histochemical approaches. Such studies assist in understanding suture absorption and the degree of inertness in tissues associated with the various suture materials. In addition, the in vivo measurement of breaking strength retention provides information on suture safety. Such studies also assist in the development of improved suture materials for various surgical applications.
Intracranial Abscesses Secondary to Ear and Paranasal Sinuses Infections
Authors: Maniglia Anthony J. , VanBuren John M. , Bruce William B. , Bellucci Richard J. , Hoffman Sanford R.
Published: April 2016

The death rate of brain abscesses in a recently reported series is high, ranging from 36% to 50% of all cases. This paper reports experiences with ten cases of intracranial abscesses secondary to ear and sinus infections. Six of these abscesses are secondary to otitic infections with three of them located in the cerebellum. Two of the cerebellar abscesses are surgically drained through the temporal bone by the otologic surgeon, with close neurosurgical cooperation.

Computerized axial tomography has revolutionized the treatment of intracranial abscesses optimizing the timing for medical and surgical management.
Ampicillin‐Resistant H Influenzae Cellulitis and Shock in an Adult
Authors: Shea John P. , Berman Joel M. , McReynolds G.W.
Published: April 2016

Over a three‐day period, pharyngitis, neck swelling, deep voice, dysphagia, fever, and cellulitis of the anterior neck and upper chest developed in a 63‐year‐old woman. Sixteen hours following the institution of intravenous ampicillin, septic shock developed and the patient became comatose. Ampicillin‐resistant Hemophilus influenzae type B was found in a culture taken from her blood and pharynx. In patients who have an upper respiratory tract infection and severe cellulitis of the neck, initial therapy should include chloramphenicol because of the possibility of ampicillin‐resistant Hemophilus influenzae infection.
Indications for Hyperalimentation in the Treatment of Head and Neck Malignancies
Authors: Close Lanny Garth
Published: April 2016

Patients with cancer of the head and neck are often malnourished when first seen by the treating physician. Often, oncologic therapeutic techniques of surgical intervention or radiotherapy or chemotherapy (or combinations thereof) compound this poor nutritional state. Proper evaluation of the patient's nutritional status and the anticipated metabolic stress of the treatment chosen can allow the physician to select the optimal method of nutritional repletion.
Computerized Axial Tomography in the Assessment of Thyroid Cartilage Invasion by Laryngeal Carcinoma: A Prospective Study
Authors: Nathan Marshall D. , Gammal Taher El , Hudson James H.
Published: April 2016

The purpose of this study was to assess the value of computerized axial tomography (CAT) in canine larynges that exhibit controlled surgical defects, and in 18 patients with biopsy‐proved epidermoid carcinoma of the larynx who were studied prospectively.

Five canine larynges with sequential surgical defects of 0 mm, 5 mm, 10 mm, and 15 mm were studied by CAT in order to evaluate our ability to identify defects in the thyroid cartilage. A 5‐mm collimator with overlapping sections at 3‐mm intervals and a 13‐mm collimator with 5‐mm overlapping sections were both used for each stage of the experiment. Results show significantly improved resolution with the 5‐mm collimator compared with the 13‐mm unit. In the human study group, results demonstrated excellent (100%) soft‐tissue tumor site correlation.

It appears from this study that we still lack a highly reliable radiographic technique for evaluating preoperatively with accuracy the integrity of the thyroid cartilage in the patient with carcinoma of the larynx.
Squamous Cell Carcinoma in Solitary Laryngeal Papilloma
Authors: Yoder Milton G. , Batsakis John G.
Published: April 2016

This case report of a 20‐year‐old white woman is the youngest patient with a documented squamous cell carcinoma in a solitary nonirradiated laryngeal papilloma. It is rare for malignant degeneration of solitary squamous cell papilloma to occur in a patient under the age of 40.

This case is also unique in that most solitary laryngeal papilloma with or without neoplasm occur in males. Most reported malignant neoplasms in squamous papilloma have been previously treated with irradiation. Because approximately 2% to 3% of solitary laryngeal papilloma have malignant neoplasms, adequate biopsy of the lesion and thorough histologic examination must always be done.
Collagenase and Protease Activities in Head and Neck Tumors
Authors: Huang Cheng‐Chun , Blitzer Andrew , Abramson Maxwell , Wu Chen‐Hsiung
Published: April 2016

An analysis of specimens of 43 head and neck tumors revealed that collagenase and protease activities paralleled each other and varied according to the anatomic site; highest activities were in tongues and tonsils, which are known to have low five‐year survival rates. The greatest differences in both enzyme activities were observed in the studies of histologic patterns and tumor differentiation. The ulcerated tumors with inflammatory infiltrates having high enzyme activities suggest that collagenase and protease may be derived from inflammatory cells.
Four Unusual Neoplasms of the Nasopharynx
Authors: Wolff Allan P. , Ossoff Robert H. , Clemis Jack D.
Published: April 2016

Epidermoid carcinoma and angiofibroma are the commonly diagnosed lesions of the nasopharynx. Less common are unusual tumors of epithelial origin as well as those from endothelial and mesenchymal precursors. Otolaryngologists must be knowledgeable in the literature associated with these tumors to facilitate early diagnosis and to institute appropriate therapy. Cases of verrucous carcinoma, inverted papilloma, adenoid cystic carcinoma, and extramedullar plasmacytoma are presented. Current literature is reviewed and accepted modes of treatment are outlined.
Current Status of Muscle Biopsy in Facial Paralysis
Authors: Crumley Roger L.
Published: April 2016

The six abnormalities found in pathologic muscle biopsies are described and discussed. Those changes which are indicative of nerve denervation or muscle regeneration are tabulated.

Muscle biopsy, as it relates to facial paralysis, must still be considered, for the most part, an experimental tool. In certain puzzling situations, eg, neonatal facial paralysis, it can be of value as an adjunct to nerve excitability and electromyographic tests.
Posterior Glottic Laryngeal Stenosis
Authors: Bogdasarian Ronald S. , Olson Nels R.
Published: April 2016

Posterior glottic laryngeal stenosis most commonly results from endotracheal intubation and less commonly from external trauma or from infection. Following extubation, the patient may have immediate or delayed onset of symptoms of airway obstruction. Often, as in bilateral vocal cord paralysis, voice symptoms are minimal.

Indirect laryngoscopic examination usually establishes the diagnosis. Movement of the arytenoids is seen but is limited, and is reflected in poor mobility of the vocal cords. Direct laryngoscopic examination and palpation of the arytenoids for passive mobility confirms the diagnosis and rules out vocal cord paralysis from recurrent laryngeal nerve injury. With the establishment of stenosis, scarring and web formation occurs over the posterior cricoid lamina and may extend into one or both cricoarytenoid joints and into the interarytenoid muscle. Scar contracture in the posterior commissure causes medial fixation of the vocal processes of the arytenoid cartilages. When caused by endotracheal intubation, the initial injury is usually to the mucosa of the posterior cricoid lamina, vocal processes of the arytenoids, or both. Perichondritis may ensue, its location and severity determining the ultimate functional extent of scarring. When airway obstruction results, treatment is by laryngofissure, scar resection, grafting, and stenting. If bilateral cricoarytenoid joint fibrosis is discovered, arytenoidectomy, and in some cases laryngeal lumen augmentation, is invariably required to reestablish the airway, with probable detrimental effects on voice quality. Five of ten patients are presented to illustrate the etiology, pathogenesis, symptoms, management, and sequelae of this problem.
Olfactory Detection Thresholds Using Pyridine, Thiophene, and Phenethyl Alcohol
Authors: Perry James D. , Frisch Shelley , Jafek Bruce , Jafek Mary
Published: April 2016

An objective examination of olfactory function is needed for evaluation and clinical progression of patients with olfactory deficits. Two hundred sixty‐eight healthy subjects were studied in order to establish olfactory thresholds for three test odorants. Subjects were required to simply detect the presence of an odor when comparing various log dilutions of test odorant against two “blank” flasks. These data have provided a means of quantitating existing olfactory deficits in affected patients. Olfactory function was found to be diminished in elderly subjects and should be considered a factor when evaluating older patients.
Myringotomy Tube Materials: Bacterial Adhesion and Infection
Authors: Karlan Marc S. , Skobel Barry , Grizzard Michael , Cassisi Nicholas J. , Singleton George T. , Buscemi Paul , Goldberg Eugene P.
Published: April 2016

Postoperative infection after placement of myringotomy tubes is common. Surgeons and manufacturers of surgical devices have frequently substituted one material for another in middle ear prostheses without analyzing the interaction of material and infection. Implant material attributes are reviewed. Scanning electron micrographs are presented that demonstrate characteristic surface differences between materials and between the same material of different manufacturers. A preliminary clinical controlled study of the covariance of purulence with silicone vs fluorocarbon tubes demonstrates statistically significant differences. The implications of this information are discussed.
Auditory Evoked Responses Obtained by Cross‐Correlation: A Preliminary Report
Authors: Dobie Robert A. , Clopton Ben M.
Published: April 2016

In linear systems analysis, a system is often studied by determining its response to impulsive stimulation. Alternatively, the system's response to continuous noise may be measured; cross‐correlation of input and output then yields a function identical to the impulse response. This approach has been extended to auditory evoked responses, using vertex potentials as the system output. Although the auditory system, viewed as a brain stem evoked response generator, is highly nonlinear, replicable cross‐correlograms were obtained in a series of guinea pigs. Stimulus artifact was ruled out by comparison of these responses with autocorrelograms of the noise stimulus. Responses decreased in amplitude with decreasing stimulus intensity. Experiments involving brain stem lesions and anoxia suggested that the short‐latency cross‐correlogram reflects cochlear microphonic, auditory nerve, and brain stem contributions.

Study of bioelectric potentials by cross‐correlation with noise input allows data acquisition continuously, without the limitations in stimulus repetition rate and dynamic range imposed by impulse (eg, click) analysis. This approach may prove useful in both experimental and clinical settings.
Hypothyroidism following Radiotherapy for Head and Neck Cancer
Authors: Liening Douglas A. , Duncan Newton O. , Blakeslee Don B. , Smith Dale B.
Published: April 2016

Hypothyroidism is not commonly considered a complication of radiotherapy for head and neck cancer. A series of 96 patients treated with radiotherapy alone or combined with surgery for head and neck cancer was retrospectively studied. All patients had radiation ports that included the thyroid gland. Hypothyroidism after radiotherapy was documented in 26% of all patients. The majority of patients had subclinical hypothyroidism manifested by elevated thyroid‐stimulating hormone (TSH) levels. The incidence of hypothyroidism dramatically increased to 65% when radiotherapy was combined with surgery that included a partial thyroidectomy. In addition, we report the unusual occurrence of massive head, neck, and hypopharyngeal edema caused by severe hypothyroidism in two patients. We advocate routine monitoring of head and neck cancer patients for hypothyroidism after radiotherapy involving the thyroid gland and recommend levothyroxine replacement therapy for subclinical hypothyroidism.
Survival Statistics for Multiple Primaries in Head and Neck Cancer
Authors: Larson Jeannie T. , Adams George L. , Fattah Hesham Abdel
Published: April 2016

The recognition of a second primary carcinoma in a patient with known head and neck cancer is considered a poor prognostic sign. However, its true implication for patient survival is not known. A retrospective 10‐year study showed that second primary malignancies developed in 207 of 875 patients. Second primary malignancies were most commonly associated with glottic index tumors, followed by floor of mouth tumors. The second primary was most likely to occur at a time interval of 1.5 years from diagnosis of the index tumor. Second primary neoplasms were more likely to develop in patients whose original head and neck tumor was stage I or II, or whose histopathology showed well or moderately well differentiation. Patients with head and neck cancer in whom a second upper aerodigestive tract tumor develops have a 75% chance of 1‐year survival, but only a 25% chance of 5‐year survival. The average time from diagnosis of second primary to the time of death was 2.3 years. If we are to increase the survival time of our patients with head and neck cancer, we must consider that a second primary will develop in one of four patients. We must therefore consider the high risk of second primary malignancy when formulating the original treatment plan for a patient manifesting his or her first head and neck cancer.
Canal Electrode Electrocochleography in Patients with Absent Wave | ABRs
Authors: Musiek Frank E. , Baran Jane A.
Published: April 2016

Fifteen patients (23 ears) who demonstrated no recordable wave I at the time of clinical auditory brainstem response testing were subsequently retested under three auditory brainstem response‐electrocochleography conditions. One condition was the traditional auditory brainstem response, another was the auditory brainstem response with electrocochleography filtering, and the third was an electrocochleographic condition using a canal electrode (Tiptrode). The electrocochleographic recording condition provided more readable wave I responses than the other conditions. In addition, the electrocochleographic condition provided wave I amplitudes that were greater than those of the traditional auditory brainstem response. The later waves of the auditory brainstem response (III and V) were similar in wave presence amplitudes and latencies for all three test conditions.
Allergic Fungal Sinusitis Secondary to Dermatiaceous Fungi—Curvularia Lunata and Alternaria
Authors: Bartynski Jeffrey M. , McCaffrey Thomas V. , Frigas Evangelos
Published: April 2016

Allergic fungal sinusitis is a newly recognized entity consisting of a pansinusitis with allergic mucinous infiltrates in all involved sinuses. The disease process itself is very different from all other types of rhinosinusitis. Pathophysiologically the disease is a combination of both IgE‐mediated and antibody‐antigen reactions to the specific fungal antigens. Here we present two cases of allergic fungal sinusitis—one caused by Curvularia lunata species (an ubiquitous soil fungi), another caused by Alternaria. Only one other case of allergic fungal sinusitis caused by curvularia in which extensive immunologic testing was done has appeared in the literature. No reports of alternaria causing allergic fungal sinusitis have appeared in the literature. Diagnostic criteria for allergic fungal sinusitis include radiologic evidence of pansinusitis in an atopic individual; findings at surgery of allergic mucin; positive fungal cultures; and specific immunologic testing, including both humoral and cellular arms of the immune system. Treatment options for allergic fungal sinusitis are discussed and include surgery alone, surgery and steroids, or steroids alone. The role of allergy immunotherapy injections remains to be defined. In general, fungal infections—and especially phaeohyphomycosis—are very rare, but appear to be increasing in frequency, especially in the paranasal sinus region.
Retrosigmoid Removal of Acoustic Neuroma: Experience 1978–1988
Authors: Harner Stephen G. , Beatty Charles W. , Ebersold Michael J.
Published: April 2016

The need to preserve hearing during acoustic neuroma removal has rekindled interest in labyrinth‐sparing procedures. This review of 11 years' experience with the retrosigmoid approach to acoustic neuroma removal includes 335 procedures in 332 patients. There were no intraoperative deaths; two patients died in the postoperative period. The facial nerve was preserved in 86.3% of procedures, and auditory function was preserved in 45 procedures (34% of those tumors were 2 cm or smaller). Postoperative complications occurred in 101 procedures, the most common being cerebrospinal fluid otorhinorrhea in 40 cases; 25 of these required secondary surgery. Meningitis occurred 16 times and aspiration 8 times; all other complications were less frequent. Tumor removal was incomplete in eight procedures; In only one of these cases has tumor recurred. The six recurrences usually were identified 5 or more years postoperatively. This has prompted us to follow patients for 7 years postoperatively. Major changes in our management include the use of the supine position and of electrophysiologic monitoring. Advantages of the approach are: (1) wide access to the tumor, (2) applicability to all tumor sizes, (3) potential to preserve facial and auditory function in all cases, and (4) ability to change procedure without sacrificing labyrinth. This review confirms our confidence in this approach to acoustic neuroma removal.
The Perioperative Management of the Petrous Carotid Artery in Contemporary Surgery of the Skull Base
Authors: Leonetti John P. , Smith Peter G. , Grubb Robert L.
Published: April 2016

Optimal techniques for the preoperative assessment and intraoperative management of the petrous carotid artery remain undefined. While purposeful “avoidance” of this structure may result in partial tumor removal, limited exposure of the petrous carotid artery may lead to inadvertent injury with life‐threatening neurovascular sequelae. Twenty‐five cases are reported in which surgical manipulation of the petrous carotid artery was necessary to accomplish total tumor removal or gain operative exposure to the skull base. A standard diagnostic radiographic assessment consisted of high‐resolution computed tomography, magnetic resonance imaging, and a 4‐vessel angiography. Preoperative balloon occlusion of the involved internal carotid artery was performed in four patients. Surgical approaches used in this series were broadly classified as: Infratemporal‐anterolateral (14), pterional‐infratemporal (6), or pterional‐anterolateral (5). Intraoperative management of the carotid artery consisted of total decompression in 19 cases, decompression with mobilization in four patients, and resection in two instances. Major neurovascular complications included one stroke and death caused by arterial occlusion, one stroke and death caused by arterial spasm, one stroke caused by brain edema, and one death related to a postoperative carotid hemorrhage. Other nonvascular complications included brain swelling, cranial nerve palsies, dysphagia, ataxia, cerebrospinal fluid fistulae, flap necrosis with wound infection, and pneumocephalus. Invasive and noninvasive methods are outlined for the preoperative assessment of the petrous carotid in cases of advanced skull base disease and intraoperative management options are detailed.
Asymmetric Pneumatization of the Petrous Apex
Authors: Roland Peter S. , Meyerhoff William L. , Judge Linda O. , Mickey Bruce E.
Published: April 2016

Three patients with high‐intensity MR signals from one petrous apex, but nonpathologic fine‐cut computed tomography are reported. In two of the three patients, normal bone marrow within the petrous apex on one side is believed to have generated the high‐intensity signal. In one of the three patients, the etiology of the MR image remains obscure, but may represent the earliest stages of petrous cholesterol granuloma or mucocele. We have reviewed 500 head CT scans performed for non‐otologic reasons, in an attempt to establish the frequency of this finding. The literature on MR and CT imaging of the petrous apex and asymmetric pneumatization of the petrous apex is reviewed.
Habituation Therapy for Chronic Vestibular Dysfunction: Preliminary Results
Authors: Telian Steven A. , Shepard Neil T. , Smith‐Wheelock Michael , Kemink John L.
Published: April 2016

Chronic vestibular dysfunction is often a frustrating problem for both patient and physician. A program of customized vestibular habituation therapy is introduced and its efficacy in a group of 65 patients is evaluated. Preliminary findings suggest that 59% of patients will have a dramatic improvement, after which their vestibular symptoms no longer cause any restriction in their lifestyles. An additional 23% of patients note considerable improvement, but have persistent symptoms that continue to restrict their activities. Vestibular habituation therapy is a rational, multidisciplinary approach to the treatment of chronic vestibular dysfunction that is a significant alternative to traditional pharmacologic management. Failure of vestibular compensation after involvement in a disciplined program of habituation therapy constitutes a much stronger indication for vestibular surgery in patients with unilateral peripheral lesions.
Dynamic Posturography Findings in Central Nervous System Disorders
Authors: Voorhees Richard L.
Published: April 2016

Dynamic posturography provides functional, selective testing of three sensory modalities for maintenance of balance: Vestibular, visual, and somatosensory. Sensory receptors in vertical semicircular canals and utricles, via the vestibulospinal tract, mediate a disconjugate response to the legs, enabling synchronized reciprocal stabilization of the body for control of motion. The patient is systematically exposed to different combinations of useful and conflicting visual, vestibular, and support surface input. The effect of each on stability is appraised. Early posturography reports dealt primarily with sensory organization test (SOT) results. Improved software for movement coordination (MC) tests offer greater identification of problems involving the central nervous system. One hundred fifty‐one patients were studied over a 9‐month period. Central disorders were present in 31 cases (20.5%) and 90.3% of these were abnormal in sensory organization tests (SOTs). Abnormal movement coordination (MC) results occurred in 80.6% of central nervous system (CNS) disorders. SOTs 4, 5, and 6 in combination were abnormal in 35.5%, and 70% of these cases were also abnormal in MC responses. False‐positive responses occurred in less than 4% of cases. Posturography offers a significantly high detection rate in CNS disorders causing dysequilibrium. Long loop latency reflexes, as they relate to maintenance of balance, appear important in the pathophysiology of abnormal SOT and MC responses.
Otosclerosis Involving the Vestibular Aqueduct and Meniere's Disease
Authors: Yoon Tae H. , Paparella Michael M. , Schachern Patricia A.
Published: April 2016

The coexistence of otosclerosis and endolymphatic hydrops in the temporal bone have been described; however, the mechanism for the development of endolymphatic hydrops in otosclerosis remains unknown. Among 128 temporal bones with otosclerosis, involvement of the vestibular aqueduct by otosclerosis was observed in four temporal bones from two patients. In all four, the vestibular aqueduct was filled with active otosclerotic foci; the lumen of the endolymphatic duct and sac was narrowed as a result of fibrosis, and endolymphatic hydrops, more severe in the pars inferior than the pars superior, was observed. Collapse of the ductus reunions and dilated saccule was seen in three temporal bones. Our study indicates that otosclerotic obstruction of the vestibular aqueduct may create a disturbance of the outflow and/or absorption of endolymph, leading to the development of endolymphatic hydrops and Meniere's disease, thus supporting the theory of longitudinal flow of endolymph.
Laser Epiglottectomy: Endoscopic Technique and Indications
Authors: Zeitels Steven M. , Vaughan Charles W. , Domanowski Gerard F. , Fuleihan Nabil S. , Simpson George T.
Published: April 2016

Endoscopic epiglottectomy (epiglottidectomy) may be performed with relative ease and minimal morbidity by using standard microlaryngoscopy techniques and the CO2 laser. Depending on the indications, the removal may be partial or complete. Indications for 51 epiglottectomies included treatment of supraglottic airway obstruction— 30 cases; discovery of benign or malignant neoplasm (diagnosis and staging)—20 cases; treatment of malignant neoplasm—7 cases; glottic visualization—4 cases; and treatment of chronic inflammatory conditions—1 case. It is not unusual for a patient to have more than one indication for this procedure. Some epiglottic cancers invade the pre‐epiglottic space. This crucial information may not be detectable by MRI or CT scanning techniques. Laser epiglottectomy provides a method to explore and perform a biopsy of the pre‐epiglottic space and thereby stage these lesions accurately. There are no significant problems with postoperative alimentation, airway, or voice. Any form of primary or adjuvant therapy can be started without delay.
Combined Pterional‐Anterolateral Approaches to Cranial Base Tumors
Authors: Smith Peter G. , Grubb Robert L. , Kletzker G. Robert , Leonetti John P.
Published: April 2016

Advanced tumors of the paranasal sinuses, parotid gland, orbit, para pharynx, and cranial cavity may invade the infratemporal fossa by direct extension or through natural anatomic pathways. The inability to control disease involving this region is reflected by the unacceptably high recurrence rates for both intracranial and extracranial neoplasms. Between 1983 and 1986, a pterional (or subtemporal) approach was combined with such conventional anterolateral procedures as a mandibulo‐pharyngectomy, maxillectomy, orbitectomy, and parotidectomy in 13 patients with advanced skull base lesions. The tumor origin was extracranial in ten cases and intracranial in three patients. Seven of the neoplasms were malignant and six were histologically benign. Complete tumor removal was achieved in all patients. Repair of the ablative defect was achieved with a temporalis myogenous flap in ten patients, and primary closure or distant myocutaneous flaps in the remaining three patients. Postoperative complications included three lateral nasocutaneous fistulae secondary to temporalis myogenous flap necrosis and isolated cases of stroke, cerebral edema, pneumocephalus, and cerebrospinal fluid rhinorrhea. Twelve patients are alive without evidence of disease at a mean interval of 25 months. The remaining patient died from lung metastases 11 months after surgery.
The Effects of Phonosurgery on Laryngeal Vibration: Part I. Theoretic Considerations
Authors: Smith Marshall E. , Berke Gerald S.
Published: April 2016

Surgical manipulation of the laryngeal framework (phonosurgery) is rapidly gaining interest and attention. To date, however, a comparative objective evaluation of the various phonosurgical techniques has not been reported. A theoretic model of the larynx, a four‐mass model based on the work of ishizaka (J Acoust Soc Am 1976;60:1193–8) and Koizumi et al. (J Acoust Soc Am 1987;82:1179–92), was developed and adapted to simulate laryngeal biomechanical behavior, as understood by current research. The model was then applied to a comparative evaluation of phonosurgical techniques. Input parameters that correlate laryngeal function and model simulation were developed. Surgical procedures were categorized according to their effect on these parameters. A model simulation of these techniques allowed comparison and prediction of the results of phonosurgery and a better understanding of the issues involved with surgical alteration of the voice.
Facial Translocation: A New Approach to the Cranial Base
Authors: Janecka Ivo P. , Sen Chandra N. , Sekhar Laligam N. , Arriaga Moises
Published: April 2016

Nasopharynx, clivus, and cavernous sinus are difficult regions of the cranial base in which to perform oncologic surgery. We have developed an approach to this area by using facial soft tissue translocation and craniofacial osteotomies. Surgical field obtained at the skull base can extend from the contralateral eustachian tube to ipsilateral geniculate ganglion. It includes the nasopharynx, clivus, sphenoid, and cavernous sinus, as well as the entire infratemporal fossa and superior orbital fissure. Our experience with this technique in 12 patients is reported. All patients healed primarily.
Measurement of Human Nasal Ciliary Motility Using Computerized Microphotometry
Authors: Phillips P. Perry , McCaffrey Thomas V. , Kern Eugene B.
Published: April 2016

A new computerized technique for the assessment of human nasal ciliary beat frequency is described. Thirty normal volunteers underwent nasal cytologic brushing to obtain ciliary samples. In each subject, 150 ciliary beats were analyzed from each of 50 separate ciliated cell clusters. The ciliary beat frequency for each area was determined with fast Fourier transformation. The results were plotted on a histogram to determine the ciliary beat distribution. The mean frequency for these samples was 11.29 Hz, with a standard deviation of 0.96 Hz. The median frequency for these samples was 11.25 Hz. These results show a marked improvement over hand‐counting microphotometry techniques because of the much larger sampling size and elimination of much human error. We believe this method of ciliary analysis represents a significant advancement in the evaluation of ciliary function and should assist in the diagnosis of patients with congenital and acquired forms of ciliary dysmotility.
Physiologic Status of Regenerated Hair Cells in the Avian Inner Ear following Aminoglycoside Ototoxicity
Authors: Tucci Debara L. , Rubel Edwin W
Published: April 2016

Regeneration of avian inner ear hair cells has been demonstrated after administration of aminoglycoside and after acoustic trauma. However, no published study to date has documented functional recovery of these regenerated sensory receptor cells. Newborn chicks were treated with gentamicin sulfate (50 mg/kg/day) for a total of either 5 (n = 10) or 10 (n = 76) days. Evoked potential thresholds were obtained one day after the 5‐day treatment, or at intervals between one day and 20 weeks after the 10‐day treatment course, and compared to thresholds of age‐matched control animals. A significant hearing loss, predominantly in the high frequencies, was present after as few as 5 days of drug administration. The magnitude of hearing loss continued to increase, especially at lower frequencies, as survival increased from 1 day to 5 weeks after gentamicin treatment. Sixteen‐to‐20 weeks after treatment, partial recovery of thresholds was evident. These findings demonstrate that functional recovery does occur in the avian inner ear following aminoglycoside administration. Recovery occurs at all frequencies, but predominantly at low and middle frequencies, leaving significant residual high‐frequency threshold elevation. Recovery lags 14 to 18 weeks behind anatomic evidence of hair cell regeneration, which was demonstrated in one study by 2 weeks after comparable administration of gentamicin.
The Adjustable Supraglottiscope
Authors: Zeitels Steven M. , Vaughan Charles W. , Johns Michael E.
Published: April 2016

Transoral surgery in the supraglottic larynx is facilitated by the use of a new instrument, an adjustable supraglottiscope. Conventional adjustable laryngoscopes are not designed for supraglottic surgery and are therefore difficult to use in this area. The adjustable supraglottiscope: (1) provides wide exposure of the supraglottis and much of the lower pharynx, (2) allows instruments to be introduced from the side (between the blades), (3) allows for true suspension, and (4) retracts the endotracheal tube out of the way. These factors provide greater visualization and control of the surgical field and thus improve hemostasis and precision. The adjustable supraglottiscope has been used successfully in a variety of clinical situations. Transoral supraglottic surgery now takes considerably less time and is done with much greater ease. The adjustable supraglottiscope is a valuable instrument in our armamentarium and extends our versatility for endoscopic management of lesions of the supraglottic larynx and lower pharynx.
Intraoperative monitoring of facial nerve function in cerebellopontine angle surgery
Authors: Hammerschlag Paul E. , Cohen Noel L.
Published: April 2016

Facial nerve paralysis associated with cerebellopontine angle surgery has been reported to range up to 26% in a recent series. Various methods of intraoperatively monitoring the facial nerve have been developed to reduce the incidence of facial paralysis. We report our experience with an intraoperative monitoring technique using intramuscular EMG electrodes to detect subclinical electrical responses that were amplified and made audible to the operating surgeon after gating stimulus artifacts. A 3.6% incidence of facial paralysis in 111 consecutive cases with this intraoperative monitoring method compared with 14.5% in 207 previously unmonitored cases indicates significant reduction of this complication in cerebellopontine angle surgery (p < 0.001). Along with this reduction in facial paralysis, an increase in the percentage of partial facial paresis was observed in the monitored group (p < 0.05). The percentage of those with intact facial function was similar in the monitored (82.0%) and unmonitored groups (78.3%).
Endolymph pressure in Meniere's disease
Authors: Shea John J.
Published: April 2016

During the streptomycin perfusion/shunt of the lateral semicircular duct operation for Meniere's disease, the lateral semicircular duct is exposed by removal of the bone of the lateral semicircular canal. Before perfusion with streptomycin and creation of a shunt in the lateral semicircular duct, the pressure in the lateral semicircular duct is measured while eiectrocochieography is being recorded. In most ears with Meniere's disease, the pressure necessary to indent the lateral semicircular duct is 2 to 3 mm of water. The pressure is more in those ears with a large negative summating potential than in those with a normal negative summating potential. The pressure is less after the shunt in the lateral semicircular duct is created and the negative summating potential returns to normal. In some ears with the classic picture of Meniere's disease, the endolymph pressure is normal and there is a normal negative summating potential. Presumably, one should not create a shunt in the lateral semicircular duct in ears with normal pressure.
The dorsal rat flap: A discussion of the model and the salutary effect of cimetidine on flap survival
Authors: Angel Michael F. , Wanebo John , Bardakjian Vatche , Amiss Lester R. , Morgan Raymond F.
Published: April 2016

Failure of skin flaps remains a significant clinical problem. The dorsal rat flap, a reliable experimental model, was used to test the efficacy of cimetidine in treating a falling flap. Flaps were elevated in 45 rats divided into three equal groups. Group 1 was a saline control group. Group 2 received cimetidine 250 mg/kg three time a day for 7 days postoperatively, and Group 3 received cimetidine for 1 day before surgery, and then as in Group 2. Necrosis was assessed on the seventh postoperative day. Group 2 had 31.1 ± 1.3 (mean % ± SEM) necrosis, significantly better than saline control animals (p < 0.01) and pretreated animals (p < 0.05). These results suggest the usefulness of cimetidine in ischemic flap surgery.
Three‐dimensional x‐ray computed tomography of the temporal bone as an aid to surgical planning
Authors: Larouere Michael J. , Niparko John K. , Gebarski Steven S. , Kemink John L.
Published: April 2016

Three‐dimensional x‐ray computed tomography (3DCT) has been useful in planning surgical procedures involving craniofacial reconstruction, the pelvis, hip, spine, knee and shoulder. The clinical use of 3DCT in temporal bone surgery has not been evaluated. We used 3DCT to assess temporal bone anatomy in 9 patients. These cases evaluated two encephaloceles, two postinfiammatory dehiscences, two temporal bone fractures, one glomus jugulare tumor, one acoustic neuroma, and one meningioma. We found 3DCT useful in these temporal bone applications as a supplement to standard two‐dimensional CT scanning (2DCT). While 3DCT provided a better preoperative understanding of the underlying anatomy, no treatment was modified solely on the basis of the information derived from the 3‐D presentation of data. We conclude that, although 3DCT images have some qualitative advantages over 2DCT techniques, their value in further defining temporal bone morphology must be evaluated against the cost entailed by their use.
Indirect laryngoscopic approach for injection of botulinum toxin in spasmodic dysphonia
Authors: Ford Charles N. , Bless Diane M. , Lowery James D.
Published: April 2016

Spasmodic dysphonia is a focal dystonia that causes a loss of the fine control of intrinsic laryngeal muscles and produces a strained staccato voice. Temporary relief from symptoms has been reported in patients treated with botulinum toxin percutaneously injected into the thyroarytenoid muscle. A newly developed method of treatment differs from reported methods by increasing the accuracy of botulinum toxin placement, reducing soft tissue trauma, and applying basic scientific information about the functional histology of intrinsic laryngeal musculature. Sixteen patients with primarily adductor spasmodic dysphonia were treated. Initial assessment included laryngeal examination by indirect laryngoscopy, videoendoscopy, and stroboscopy, neurology examination (Including laryngeal EMG), and vocal function studies with acoustic analysis and aerodynamic studies. A device originally designed for collagen injection allowed the precise microdelivery of toxin to the thyroarytenoid muscle. Indirect laryngoscopy was used to direct the needle, in an attempt to cover a broad area of motor end plates. The minimally effective dose was titrated for each patient, to avoid paralysis and preserve laryngeal function. All patients showed improved voices after treatment. There were no major complications. The basic technique can be performed in the otolaryngologist's office and does not require electromyography equipment or expertise.