bluuebunny/crossref_metadata_2025 huggingface dataset:
An Organ Culture System Designed to Study Interaction of Fetal Rat Calvaria with Human Head and Neck Squamous Cell Carcinoma
Authors: Wenig Barry L. , Steinberg Bettie M. , Sciubba James J. , Gomes Blasco C. , Abramson Allan L.
Published: November 2015

The development of permanent cell lines of human head and neck squamous cell carcinoma in culture has enabled these cell lines to be used to investigate the interaction of the tumor cells with bone. after the squamous carcinoma lines on fetal rat skulls were implanted the explants with their added tumor were maintained in longterm tissue culture by use of the procedures developed for growing these tumor cells. Results confirm direct interaction with the bone by the malignant cells. Specific surface and cytoplasmic markers have been demonstrated by use of monoclonal antibodies against the tumor cells. Furthermore, tumor angiogenesis without the addition of any endogenous endothelial components has been verified. Investigations into the degree of bone infiltration and susceptibility of these interacting tumor cells to various factors, radiation therapy, and chemotherapeutic agents have been carried out. The establishment of a model system for bony invasion by squamous cell carcinoma of the head and neck permits the investigation of the mechanism of tumor invasion and the study of various potential treatment modalities.
Traction Suture Tympanoplasty
Authors: Swanson George C.
Published: November 2015

Subtotal tympanic membrane perforations are very common in Micronesia. The great distance between the islands, primitive conditions, and shortages of medical facilities and supplies must all be considered when a technique is designed for the closure of these perforations. Such a technique, using dissolvable sutures to position and support a medial temporalis fascia graft, is presented. A suture is used to place traction on the graft to assure proper placement under the anterior remnant or anterior canal wall skin. The graft is placed medial to the remnant but lateral to the malleus handle, which has been carefully dissected free of epithelium. Two hundred eighty‐one cases were followed for' 6 months or more, with a success rate of slightly more than ninety‐five percent. Complications of blunting, lateralization, reperforation of the graft, and cholesteatoma formation are discussed.
Experience with Surgical Management of Velopharyngeal Incompetence
Authors: Crockett Dennis M. , Bumsted Robert M. , Van Demark Duane R.
Published: November 2015

Accurate mapping of the defect of velopharyngeal closure in patients with velopharyngeal incompetence is paramount to the planning of an operative procedure that will have a successful outcome. Nasoendoscopy and videonasoendoscopy are valuable tools for examination of the abnormal pattern of velopharyngeal movement in patients with velopharyngeal incompetence. On the basis of the knowledge of the observed defect in velopharyngeal closure for the particular patient, a pharyngeal flap operation is planned. The flap width, level of placement of the flap base, and control of the lateral port size vary to suit each individual velopharyngeal closure defect. Postoperative speech results in 86 patients are reported.
In Vitro Photosensitization of Human Head and Neck Squamous Cancer Cells by Dihematoporphyrin‐Ether
Authors: Sprik Sherman A. , Sullivan Michael J. , Carey Thomas E.
Published: November 2015

In vitro experiments were performed to evaluate the direct cytotoxic and photosensitizing effects of dihematoporphyrin‐ether (DHE) on the head and neck squamous cancer cell line, UM‐SCC‐38. Normal fibroblasts, normal cultured keratinocytes, and the UM‐MEL‐1 pigmented malignant melanoma cell line were used as controls. The parameters of duration of light exposure, drug concentration, and incubation periods were studied. Uptake of DHE by squamous cancer cells, as assessed microscopically by intensity of fluorescence, was rapid and reached a dose‐dependent maximum intensity within 10 minutes. Cells were irradiated with polychromatic light with an energy of one milliwatt/cm2 at a distance of 1.5 ft. Cells growing in plastic dishes were incubated in the dark for 1 to 4 hours with DHE in concentrations that ranged from 1.25 to 50 μg/ml. The cell monolayers were washed and irradiated for periods of time ranging from 15 to 120 min. Dose‐dependent loss of cell viability could be detected by trypan blue dye uptake as early as 1 hour after radiation and continued to increase until 4 hours after light exposure. No further loss of cell viability was observed over the next 10 hours. There was no phototoxicity in the absence of DHE. UM‐SCC‐38 cells were more sensitive to the photosensitizing effects of DHE than were either normal fibroblasts or malignant melanoma cells. Recovery from the photosensitizing effects of DHE was observed if the DHE‐containing medium was removed and the cells were incubated in the dark for periods that ranged from 1 to 14 hours before light exposure. UM‐SCC‐38 cells recovered more rapidly than normal fibroblasts, normal keratinocytes, or UM‐MEL‐1 cells.
Vibrotactile Device in Patients with Single‐Channel Cochlear Implant: A Preliminary Study
Authors: Rose Darrell E. , Haymond Joann , Facer George W.
Published: November 2015

Two patients who had been using 3‐M Vienna extracochlear implants were given two‐channel KS Sensoraid vibrotactile units to wear for 1 month. At the end of that period, several tests commonly used to assess cochlear implant function were administered to compare the effectiveness of the vibrotactile system with that of the cochlear implants. The results obtained from the vibrotactile devices were encouraging, although the units had some shortcomings. Overall, the subjects' test scores with the vibrotactile units were comparable to, if not slightly better than, those with the extracochlear implants.
Provocation‐Neutralization: A Two‐Part Study Part I. The Intracutaneous Provocative Food Test: A Multi‐Center Comparison Study
Authors: King William P. , Rubin Wallace A. , Fadal Richard G. , Ward Walter A. , Trevino Richard J. , Pierce William B. , Stewart J. Alan , Boyles John H.
Published: November 2015

This study investigated the clinical usefulness of the intracutaneous provocative‐neutralization food test (IPFT). Thirty‐seven patients were tested for five identical food allergies by eight physicians in different geographical locations. Throughout the study, comparison was made between the IPFT when interpreted by skin response (IPFT SK) and when interpreted by symptom provocation (IPFT PR). Double‐blind IPFT results were compared with those of previously accomplished oral challenge food tests (OCFT). IPFT reliability was determined by a double‐blind comparison of the initial IPFT, with two subsequent IPFTs performed 7 days apart. Correlation of the IPFT SK and IPFT PR with the OCFT provided validity coefficients of 0.78 and 0.61 respectively, both significant beyond the 0.01 level of confidence. Reliability of the IPFT SK and IPFT PR was shown to be 0.68 and 0.40, respectively. The IPFT SK was significant beyond the 0.01 level of confidence and the IPFT PR was significant beyond the 0.05 level of confidence.
Carbon‐Carbon Middle Ear Prosthesis: A Preliminary Clinical Human Trial Report
Authors: Podoshin Ludwig , Fradis Milo , Gertner Rachel
Published: November 2015

In a variety of structural forms, carbon‐carbon possesses certain properties that render it suitable for implantation in the human body. Twenty‐four patients underwent tympanoplasty in which carbon‐carbon was used as an alloplastic material for reconstructing the ossicular chain; these patients were followed for a period of 9 to 15 months. The good anatomic and hearing results of our clinical trial led us to suggest the carbon‐carbon prosthesis as an alternative alloplastic material to be used in tympanoplasties.
ENG‐MRI Correlates in Cerebellar Oculomotor Dysfunction
Authors: Hamid Mohamed A. , Schneider Lori B. , Hanson Maurice R. , Weinstein Meredith A. , Hahn Joseph
Published: November 2015

This study correlates ENG and MRI findings in six patients with cerebellar eye movements. For each subject, both tests independently support the presence of a cerebellar tract abnormality. In two patients, MRI studies confirmed the site of cerebellar dysfunction previously demonstrated by ENG. Although the number of patients is small, the strong correlation (100%) indicates that ENG remains a sensitive method for detection and localization of the origin of cerebellar eye movements. The physiologic information provided by ENG is supported anatomically by MRI. The cerebellar eye movement abnormalities are briefly reviewed.
Human Skull Vibratory Patterns in Audiometric and Supersonic Ranges
Authors: Dunlap Susan Alderman , Lenhardt Martin Louis , Clarke Alexander Mallory
Published: November 2015

The attenuation of bone‐conducted stimuli across the human skull was determined in audiometric, ultrasonic, and supersonic frequency ranges (250 to 64,000 Hz). An increase in attenuation with an increase in frequency, as well as significant resonance effects, was observed. For the audiometric frequency range, bone conduction stimulation of one side of the head results in almost equal stimulation of the other side. In the ultrasonic and supersonic ranges, the contralateral side is progressively isolated.
Is there Consensus in Perilymph Fistula Management?
Authors: Hughes Gordon B. , Sismanis Aristides , House John W.
Published: November 2015

A perilymph fistula is an abnormal communication between the inner ear fluids and the middle ear space. This article identifies areas of agreement in perilymph fistula management based upon 167 questionnaire responses from active surgeons of the American Otological Society and the American Neurotological Society. The average respondent performed 4.6 fistula explorations among 197 otologic surgeries (some of these were myringotomies) per year. The following statements represent areas of general agreement. The single most important feature of the history is previous trauma or barotrauma. At present no test can replace clinical judgment; however, despite sound judgment and sophisticated testing, it is very difficult to document the presence or absence of a fistula preoperatively. Most often the diagnosis is based on the total clinical picture: history, physical examination, and laboratory testing.
ECoG and Perilymphatic Fistulae: An Experimental Study in the Guinea Pig
Authors: Gulya Aina J. , Boling Lloyd S. , Mastroianni Mary Ann P.
Published: November 2015

Perilymph fistulae present a diagnostic dilemma to the clinician. As yet, there is no readily available, widely accepted diagnostic test. Electrocochleography (ECoG), with the advent of extratympanic recording techniques, has become a clinically applicable probe of cochlear function. Clinical ECoG was used to study guinea pigs (n = 35) both before and after surgical fistulization (n = 18) or fistulization and repair (n = 17) of the round window membrane. The animals were killed, and histopathologic examination of the temporal bones was carried out 0, 1, 3, 4, 7, 10, 14, 21, and 28 days after surgery. Of the 33 animals that survived surgery, 30 demonstrated ECoG waveforms. No significant difference between the preoperative and postoperative waveforms could be detected. Histopathologic study showed rapid healing of the fistulae, with no evidence of hydrops. Although there appeared to be a relatively selective loss of the outer hair cells of the cochlear basal turn, autolysis precluded detailed analysis. ECoG, as performed clinically, does not appear to detect the presence, spontaneous healing, or repair of a round window membrane fistula in the guinea pig.
Histopathologic Evaluation of Adipose Autografts in a Rabbit Ear Model
Authors: Bartynski Jeffrey , Marion Mitchell S. , Wang Tom D.
Published: November 2015

Injection of autologous adipose tissue removed via liposuction has been used clinically for facial contouring, the aging face, furrows, facial atrophy, acne scars, nasolabial folds, chin, and various other surgical defects. Survival rates for autografts of fat have been quoted anywhere from 30% to 80%. Our study uses a reproducible rabbit animal model for autotransplantation of adipose tissue and examines the histopathologic changes that occur to the graft over time. Autogenous subcutaneous fat was removed from a dorsal scapular donor site, treated to stimulate cannula damage as in liposuction, then reinjected at the base of the ear. Histologic examination of the grafts were made at 5, 10, 15, 20, 40, and 100 days after transplantation. Hematoxylin‐eosin sections were graded on degree of fibrosis present (0 to 4+), viable fat (1 to 10), degree of inflammation (0 to 4+), and neovascularization (+ or ‐). Viability of fat decreased from 8.5 to 10 at 5 days to 2 viability at 40 days. Acute inflammation peaked at 10 days, followed by the chronic inflammatory response with macrophages and multinucleated giant cells scavenging the dying fat graft. Neovascularization began at 5 days, peaked at 10 days, and remained constant thereafter only at the edge of the graft. Microcysts appeared at 15 days and increased in number in proportion to the decrease in viable fat. In summary, the temporal histologic events are progressive fibrosis; decreased amount of viable fat; inflammation beginning with a neutrophilic response, later a macrophage and giant cell response; and neovascularization at the periphery of the graft insufficient to maintain graft viability. In our animal model, autografts of fat appear to have limited long‐term viability and are replaced by fibrous tissue. This may have clinical implications in autografting of fat in facial plastic and reconstructive surgery.
The “Second” Side of the Neck in Supraglottic Cancer
Authors: Desanto Lawrence W. , Magrina Carlos , O'Fallon W. Michael
Published: November 2015

The purpose of this study was to assess the impact of decisions made at operation for primary neck tumor on survival and cause of death—specifically, whether bilateral dissection, unilateral dissection, or delayed dissection influences eventual outcome. Of 244 patients with primary cancer of the supraglottis who were treated surgically, 22 (9%) had no neck treatment, 188 (77%) had unilateral neck dissection, and 34 (14%) had bilateral simultaneous neck dissection. Dissection on one or both sides of the neck was required later in 6 (27%) of the 22 patients with no neck treatment and in 32 (17%) of the 188 patients who had unilateral dissection. There were no differences among the treatment groups in the incidence of death from any cause or in the incidence of death from cancer, although neck stage did differ from group to group. The influence of delayed metastasis on survival was analyzed to explain these findings. Multivariate analysis demonstrated that death occurred at a rate 1.81 times higher in a person with a positive neck stage than in a person of the same age who had a negative stage. Also, death occurred at a rate 1.5 times higher for a person 10 years older than for a person with the same stage of disease. The influence of stage on the probability of need for a second dissection indicated that a patient with a positive neck stage had a 6.3 times greater likelihood of requiring a subsequent neck dissection than a person with a negative neck stage.
Cochlear nucleus cell size is regulated by auditory nerve electrical activity
Authors: Pasic Thomas R. , Rubel Edwin W
Published: November 2015

Accumulating evidence suggests that sensorineural hearing loss in animals is rapidly followed by degenerative changes in central auditory neurons. For example, cochlear removal in birds and mammals results in a reduction in central auditory neuron cell size within 48 hours. A similar decrease in cell size after pharmacologic blockade of auditory nerve electrical activity with tetrodotoxin has been reported. In the present study, we evaluate the reversibility of central auditory changes after a profound sensorineural hearing loss caused by blockade of auditory nerve action potentials. Tetrodotoxin, which blocks voltage‐sensitive sodium channels, was embedded in a slowrelease vehicle and placed next to the round window membrane of gerbils. Tetrodotoxin diffused into perilymph and unilaterally blocked electrical activity in auditory nerve axons. Electrical activity blockade was confirmed with recordings of auditory brainstem response. Animals were killed immediately after 24 hours of electrical blockade or 7 days after a transient 24‐ or 48‐hour blockade. large spherical cells of the anteroventral cochlear nucleus ipsilateral to manipulation were measured and compared to large spherical cells on the opposite, unmanipulated side of the brain. Animals killed immediately after a 24‐hour blockade of electrical activity showed a mean decrease of 16% in cell size ipsilateral to the blockade (p< 0.05). In animals allowed to recover for 7 days after blockade for 24 or 48 hours, cell size returned to previous levels. There was no longer a consistent difference in cell size between the two sides of the brain in these animals (p> 0.05). Thus changes in size of anteroventral cochlear nucleus large spherical cells were reversible after recovery of electrical stimulation. These data provide evidence that electrical activity is involved in the regulation of cell size in mammalian central auditory neurons. Additionally, cochlear nucleus neurons can return to their former size after brief periods without stimulation.
MRI of the facial nerve during paralysis
Authors: Murphy Terrence P.
Published: November 2015

Gadolinium‐enhanced MRI was used to evaluate 10 patients with Bell's palsy and one patient with facial paralysis secondary to Lyme disease. Nine of the eleven patients showed increased signal intensity of their facial nerve with gadolinium‐enhanced MRI. In all nine patients, the facial nerve was involved at the labyrinthine, geniculate ganglion and proximal tympanic portions of the facial nerve, while two of the nine patients also had involvement of the mastoid segment of the facial nerve. Patients whose facial nerve enhancement was limited to the labyrinthine, geniculate ganglion and proximal tympanic facial nerve ultimately had complete return of facial function. Patients whose facial nerve enhanced in the mastoid segment experienced incomplete return of facial function. Gadolinium is effective in localizing the site of inflammation during facial paralysis. Those patients with enhancement localized to the labyrinthine, geniculate ganglion and proximal tympanic segments were more likely to regain complete facial function. In contrast, patients who had enhancement of the mastoid segment of the facial nerve had poorer prognoses for complete return of facial function.
Technique for transmission and immunoelectron microscopy of the human endolymphatic sac and vestibular epithelia
Authors: Wackym Phillip A. , Ward Paul H. , House William F. , Linthicum Fred H. , Micevych Paul E
Published: November 2015

A surgical technique is presented to obtain the entire vestibular aqueduct, containing the endolymphatic duct and sac as well as the vestibular epithelia, from the maculae and cristae during labyrinthectomy. The inner ear tissue was fixed in 3% glutaraldehyde, decalcified in 0.1 mol/L Na‐EDTA, and routinely processed for transmission electron microscopy, including post‐fixation with osmium tetroxide. Postembedding protein A‐colloidal gold immunoelectron microscopy was performed after exposure of cellular antigenic sites by sodium metaperiodate. To validate this technique, thin sections from the crista ampullaris and the endolymphatic sac were incubated with antibodies raised against S‐100, a protein present in specific types of neural tissue. Specific immunoreactivity was observed in the crista ampullaris, but not in the endolymphatic sac. The surgical biopsy technique described provides a means for the neuro‐otologist to collect inner ear tissue from surgical patients that can be used for pathological studies using immunohistochemistry and electron microscopy.
Vestibular autorotation test asymmetry analysis of acoustic neuromas
Authors: O'Leary Dennis P. , Davis Linda L. , Maceri Dennis R.
Published: November 2015

The vestibular autorotation test (VAT) measures the vestibulo‐ocular reflex (VOR) response from 2 to 6 Hz, during 18 seconds of active head movements, while the patient attempts to fixate on a wall‐mounted target. A new method of measuring eye velocity asymmetry from VAT data is presented, based on computer estimation of the 0th harmonics of discrete Fourier spectra over short segments of digital eye and head velocity records. Eye asymmetries greater than a 3% normal range are shown to be directionally correlated with the side of the lesions in patients with unilateral labyrinthectomies. Among patients with a diagnosis of acoustic neuroma, who were tested preoperatively with the VAT, nine of nine patients showed eye asymmetries greater than 3% toward the side of the neuroma. Those patients with acoustic neuromas who have sufficiently vigorous high‐frequency head responses showed mean percentages of eye asymmetry that were linearly correlated with the size of the acoustic neuroma. These results suggest that VAT high‐frequency asymmetry provides a useful method of diagnostic evaluation of the side and extent of unilateral peripheral lesions.
Intratemporal facial nerve hemangiomas
Authors: Shelton Clough , Brackmann Derald E. , Lo William W.M. , Carberry Joseph N.
Published: November 2015

Facial nerve hemangiomas are benign vascular tumors that arise within the temporal bone and have a histologic appearance similar to both cavernous hemangiomas and vascular malformations. In contrast to facial nerve schwannomas, these are extraneural tumors that cause symptoms by compression and tend to produce deficits when very small in size. We report our experience at the House Ear Clinic with 34 patients having these nonglomus intratemporal vascular tumors. Hemangiomas arising in the internal auditory canal tend to produce a progressive sensorineural hearing loss and are demonstrated with magnetic resonance imaging (MRI), whereas those at the geniculate ganglion are usually first seen with facial nerve symptoms and may require high‐resolution computerized tomography (CT) for detection. Facial electromyography is helpful in establishing the diagnosis. Because of their extraneural nature, early diagnosis can permit removal of the tumor with preservation of facial nerves in some patients.
Diagnostic efficacy of in vitro methods vs. skin testing in patients with inhalant allergies
Authors: Corey Jacquelynne P. , Liudahl J.J. , Young S.A. , Rodman S.M.
Published: November 2015

The purpose of our study was to investigate the diagnostic efficacy of two selected methods of in vitro allergy testing. Specifically, the PRIST/modified RAST I125 isotope systems and the Quantizyme/modified EAST alkaline phosphatase method were compared∗. The time, expense, convenience, and diagnostic efficacy of the two procedures are discussed. Special attention is given to the practicality of each method for the practicing physician.
Transantral sphenoethmoidectomy: A procedure for the 1990s?
Authors: Malotte Michael J. , Petti George H. , Chonkich George D. , Rowe Robert P.
Published: November 2015

Currently, among otolaryngologists, much attention is focused on the surgical management of paranasal sinus disease. However, transantral sphenoethmoidectomy is rarely mentioned in the literature of the past several decades. We reviewed a consecutive series of 98 patients over a 12‐year period who underwent transantral sphenoethmoidecfomy in the treatment of severe chronic hyperplastic pansinusitis. The major and minor complications encountered are tabulated, as are the clinical outcomes. A description of the operative technique is followed by a discussion of the indications for this approach. We believe transantral sphenoethmoidectomy has a useful place In modern paranasal sinus surgery.
Parotid sialography with a New Zonarc program
Authors: Herrmann Achim , Eckl Matthias , Maier Heinz
Published: November 2015

The use of panoramic zonography with the Zonarc‐MLA and LAT‐PA program for parotid sialography is presented. It provides curved layer tomograms, and shadows of the bony structures are therefore not disturbingly superimposed on the image of the sialogram. The visibility in the retromandibular region tended to be better. Radiation doses in plain film radiography are up to 60 times higher than in Zonarc radiography.
Endoscopic diverticulotomy for the treatment of zenker's diverticulum
Authors: Wayman Daniel M. , Byl Frederick M. , Adour Kedar K.
Published: November 2015

First described by Mosher in 1916, endoscopic treatment of Zenker's diverticulum has since been reported infrequently in the surgical literature and continues to engender controversy. Between 1978 and 1989, we treated 11 unselected patients surgically for pharyngoesophageal diverticula. Endoscopic diverticulotomy was used in 11 patients and an external approach was used in the others. The endoscopically treated patients had no serious complications, resumed oral intake early, and were discharged from the hospital earlier. Our review of the surgical literature confirmed our experience with the efficacy and safety of the procedure. We therefore recommend endoscopic diverticulotomy as being equal to external approaches with regard to effectiveness; and it affords the patient a shortened hospital stay and more rapid return to the premorbid State.
Blindness resulting from orbital complications of sinusitis
Authors: Patt Bradford S. , Manning Scott C.
Published: November 2015

Loss of vision remains a potential complication of orbital infection. Appropriate evaluation and management of the patient with signs and symptoms of orbital inflammation may prevent progression to blindness. Evaluation of patients with orbital inflammation from sinusitis includes a comprehensive clinical examination and radiographic studies. Clinical examination should test for changes in visual acuity, pupillary reactivity, and extraocular motion. Computerized tomography (CT) has facilitated the diagnosis of orbital infections and aids in diagnosis. However, CT can be misleading in patients with acute orbital infections and should not be relied on to determine the need for surgical intervention. We reviewed the records of all patients admitted to Parkland Memorial Hospital from 1978 to 1988 with orbital complications resulting from sinusitis. Four of 159 patients in this group had permanent blindness. The presence of an abscess, which was ultimately found at surgical exploration, was not diagnosed by CT in any of these four patients. Clinical examination remains the most important indicator for surgical intervention in patients with orbital complications of sinusitis. We present our findings and give guidelines for surgical intervention in patients with orbital infections resulting from sinusitis.
Unilateral Sensorineural Hearing Loss Rehabilitation
Authors: Welling D. Bradley , Glasscock Michael E. , Woods Charles I. , Sheffey Ronald C.
Published: November 2015

The Audiant Bone Conductor has been heralded as an aid for use in conductive hearing loss; however, its possible use in unilateral sensorineural hearing loss (SNHL) has also been proposed. Between July 1987 and July 1989, profound unilateral sensorineural hearing loss has been rehabilitated In 43 patients using the Xomed Audiant Bone Conductor. Patients who were willing to participate in this clinical trial and who were felt to be good contralateral routing of signals (CROS) aid candidates were selected preoperatively. Audiometric followup, selection criteria, patient satisfaction, and complications are discussed.
Laser VS. Suture Nerve Anastomosis
Authors: Huang Thomas C. , Blanks Robert H.I. , Berns Michael W. , Crumley Roger L.
Published: November 2015

The repair of injured or transected nerves is frequently encountered in head and neck surgery. Recently, CO2 lasers with milliwatt capability and micrometer spot sizes have been developed that may be used in nerve anastomosis. A comparative study was performed between microsuture and CO2 laser repair of transected sciatic nerves in rats. Nerve regeneration was measured in terms of morphology, electrophysiology, and function. Histologic studies revealed no difference in the size and number of regenerated axons, although there was less scar tissue formation at the anastomotic site with the laser repair. EMG and nerve conduction velocity were similar for the two repair methods. Functional recovery, as determined objectively using measurements of gait footprints, showed no difference between suture and laser repair. Laser‐repaired nerves did have a higher dehiscence rate, although this problem can probably be prevented by splinting the rats postoperatively. However, laser repair was faster and simpler than suture repair and required less manipulation of the nerve. This study shows laser repair of peripheral nerves is possible with results comparable to conventional microsuture neurorrhaphy. Laser nerve anastomosis may be an effective alternative to suture nerve repair.
Neurotologic Considerations in the Treatment of Advanced Clival Tumors
Authors: Leonetti John P. , Reichman O. Howard , Al‐Mefty Ossama , John LI , Smith Peter G.
Published: November 2015

Head and neck manifestations of advanced clival tumors result from subtle, yet progressive mass effect or direct involvement of multiple cranial nerves. Misinterpretation of clinical or radiographic findings in these patients may result in inappropriate treatment planning, increased patient morbidity, and probable tumor recurrence. Our combined experience in managing 21 patients with advanced clival tumors has shown that preoperative loss of vision, diplopia, or facial hypesthesia suggests superior parasellar disease. Facial twitching or neurotologic symptoms result from posterior central tumor growth, while inferior extension of disease leads to basal cranial nerve deficits with associated speech, voice, and swallowing dysfunctions. The purpose of this article is to correlate the complex anatomy of the clivus, brainstem, and cranial base and the various n eurotologic findings associated with neoplasms in this region. Lateral skull base surgical procedures, based on preoperative clinicoradiographic assessment, will be detailed with particular emphasis on preservation of critical neurovascular structures.
Immunologic Abnormality in Meniere's Disease
Authors: Suzuki Mikio , Kitahara Masaaki
Published: November 2015

Patients with Meniere's disease were investigated for possible immunologic abnormalities. A total of 104 cases—55 bilateral and 49 unilateral—were examined. Immune activity was assessed using four types of immune parameters: (1) the erythrocyte sedimentation rate (ESR) and C‐reative protein levels (CRP); (2) serum immunoglobulin levels (IgG, IgM, and IgA); (3) complement levels (C3, C4, and CH50); and (4) autoantibody levels (rheumatoid factor, anti‐DNA antibody, and antinuclear antibody). Patients with severe immunologic abnormalities (16% of the bilateral cases and 2% of the unilateral cases) typically displayed bilateral severe hearing loss, bilateral decreased vestibular response, and excellent responsiveness to steroid treatment. As patients with bilateral involvement account for approximately 30% of all cases of Meniere's disease in Japan, immunologic involvement may be assumed in about 6% of the total. The severity of these patients' symptoms and their responsiveness to steroid treatment suggest that the possibility of immunologic involvement is well worth investigation in Meniere's disease.
Superficial Siderosis of the Central Nervous System: A Neglected Cause of Sensorineural Hearing Loss
Authors: Parnes Steven M. , Weaver Susan A.
Published: November 2015

Superficial siderosis of the central nervous system is a rare, often unrecognized condition in which there is a deposition of intracellular and extracellular hemosiderin in the leptomeninges, subpial tissue, spinal cord, and cranial nerves as a result of chronic bleeding in the subarachnoid space. On the basis of our cases and a review of the literature, the majority of patients manifest sensorineural hearing loss in addition to cerebellar dysfunction, pyramidal tract signs, and progressive mental deterioration. Recent imaging techniques—particularly CT and MRI—can define the presence of iron deposition, confirming the diagnosis ante mortem. From post mortem specimens, histologic sections demonstrate severe damage to the eighth nerve, with microglial metabolism of iron. Cases will be presented to illustrate these points.
Low Doses of Animal Antigen Attenuates the Late Asthmatic Reaction
Authors: Schiff Mark J. , Boris Marvin , Weindorf Stanley
Published: November 2015

Five subjects with a history of asthma after exposure to cat or dog underwent a trial of low‐dose antigen injection followed by bronchoprovocation with the relevant antigen. The neutralization dose of antigen was determined by serial and point dilution skin testing. In a crossover protocol, patients received this antigen or placebo injections. They then underwent bronchoprovocation with the same antigen. The results of the early and late reaction to bronchoprovocation were compared, with each patient serving as her own control. As measured by the number of breath units to lower the FEV, by 20%, placebo group tolerated only 6.9 ± 2 breath units, whereas the neutralization group tolerated 29 ± 3 breath units (p < 0.05). The maximum decline in FEV, during the late reaction was 27 ± 13% after injection of placebo and 12 ± 12% after injection of antigen (p < 0.05). In this model of antigen‐induced asthma, injection of low doses of allergen immediately preceding bronchoprovocation blunted the immediate and delayed asthmatic reaction.
Rehabilitation Therapy for Patients with Disequilibrium and Balance Disorders
Authors: Konrad Horst R. , Tomlinson David , Stockwell Charles W. , Norré Marcel , Horak Fay B. , Shepard Neil T. , Herdman Susan J.
Published: November 2015

Vestibular rehabilitation is based on the use of adaptive and compensatory mechanisms already existing in the human brain. Research using animals provides a great deal of information on the neural mechanisms responsible for these functions and suggests strategies that should be helpful in rehabilitation of patients with disequilibrium and balance disorders. Research in animals and human beings suggests that rehabilitation should be specifically designed, depending on the patients' deficits. It also suggests that to be effective it needs to be started soon after impairment and that vestibulosuppressive medication may reduce recovery. Studies are now underway to evaluate the effectiveness of vestibular rehabilitation on several groups of patients and to answer some fundamental questions about the mechanisms and the effectiveness of these treatment methods. Current information suggests that vestibular rehabilitation is an effective method of therapy for many patients with disequilibrium and balance disorders and that for some patients it is the best therapy available.
Head‐Upright Tilt‐Table Testing: A Useful Tool in the Evaluation and Management of Recurrent Vertigo of Unknown Origin Associated with Near‐Syncope or Syncope
Authors: Grubb Blair P. , Rubin Allan M. , Wolfe Douglas , Temesy‐Armos Peter , Hahn Harry , Elliott Laura
Published: November 2015

Recurrent idiopathic vertigo associated with near‐syncope and syncope is a common perplexing problem, some cases of which are considered autonomically mediated (vasovagal). Upright‐tilt‐table testing has emerged as a potential method to test for vasovagal episodes. This study evaluated the use of this technique in the evaluation and management of patients with recurrent idiopathic vertigo associated with near‐syncope or syncope. Twenty‐one patients with recurrent unexplained vertigo and syncope/near‐syncope and 11 control subjects were evaluated by use of an upright‐tilt‐table test for 30 minutes, with or without a graded isoproterenol infusion (1 to 4 μg/min given intravenously), in an attempt to provoke hypotension, bradycardia, or both, which reproduced the patient's symptoms. The patients included 10 men and 11 women (mean age, 51 ± 16 years). Eleven controls with no history of vertigo were also studied. Transcranial Doppler sonography was used to assess cerebral arteriolar blood flow during tilt. All tilt‐positive patients were placed on therapy with either β‐blockers, disopyramide, or transdermal scopolamine, the effectiveness of which was determined with another tilt‐table study. Symptoms occurred in seven patients (33%) during the baseline tilt and in eight patients (38%) during isoproterenol infusion (total positives, 71%). Transcranial Doppler sonography demonstrated a 225% ± 192% increase in pulsatility index and a 70% ± 29% increase in resistance index (indicative of cerebral arteriolar vasoconstriction) at the time of vertigo. No control subject experienced syncope during this test. Each tilt‐positive patient eventually became tilt‐negative with therapy, and over a mean follow‐up period of 26 months, no further episodes have occurred. We conclude that head‐upright tilt‐table testing may be a valuable tool in the evaluation of recurrent idiopathic vertigo associated with near‐syncope or syncope and in the evaluation of pharmacotherapy.
Nasal Reconstruction Using Split Calvarial Grafts
Authors: Romo Thomas , Jablonski Robert D.
Published: November 2015

The reconstruction of nasal deformities after trauma or surgical procedures presents an arduous task for the reconstructive surgeon. The anatomic alteration of supporting cartilage and nasal bones, as well as scar formation, compound the difficult nature of this type of reconstruction. In the past, multiple autogenous and alloplastic implants have been used in nasal reconstruction. Autogenous implants include auricular and septal cartilage as well as rib and iliac crest bone grafts. Alloplastic materials include acrylic, supramid mesh, Gortex, and silicone rubber. Autogenous grafts have been shown to provide excellent long‐term reliable results in nasal reconstruction. In our study, autogenous split calvarial bone grafts were used in the nasal reconstruction of 17 patients. Among the corrective procedures were dorsal augmentation for saddle‐nose deformities, insertion of columella struts for nasal tip ptosis, and insertion of nasal battens for nasal valve collapse. Patient followup has been from 1 to 5 years, with no significant resorption noted during that time. Complications were limited to one seroma at the donor site before wound drains were routinely used. No major complications, including hematoma formation, CSF leak, or infection, have been observed.
Bilateral Thyroarytenoid Denervation: A New Treatment for Laryngeal Hyperadduction Disorders Studied in the Canine
Authors: Sercarz Joel A. , Berke Gerald S. , Ming Ye , Rothschiller James , Graves Michael C.
Published: November 2015

Adductor spasmodic dysphonia is a vocal disorder of uncertain etiology with no satisfactory long‐term treatment. Recently, injection of botulinum toxin (Botox) into the thyroarytenoid (TA) muscle has been used as an effective temporary treatment. A surgical counterpart to bilateral TA Botox injection is described in this article. Bilateral thyroarytenoid denervation was performed through a window in the thyroid cartilage in seven canines, including four that were studied 3 months after the procedure. No serious complications occurred in the animals, each maintaining full vocal fold abduction and adduction. In all cases, anticipated physiologic changes in laryngeal function were observed, including the inability to generate high subglottic pressures during high levels of laryngeal nerve (RLN) stimulation. In two of the surviving animals, the ansa cervicalis was used to reinnervate the TA muscle, thereby preventing the possibility of reinnervation from the proximal RLN stump while limiting TA atrophy and fibrosis. Bilateral TA denervation represents a hopeful new long‐term approach to spasmodic dysphonia treatment.
Paratracheal Lymph Node Dissection for Carcinoma of the Larynx, Hypopharynx, and Cervical Esophagus
Authors: Weber Randal S. , Marvel Jeffrey , Smith Patrick , Hankins Patti , Wolf Pat , Goepfert Helmuth
Published: November 2015

Paratracheal lymph node (PTLN) metastasis has been implicated as an etiologic factor in peristomal recurrence after laryngectomy. To determine the relationship between the primary site, the risk of peristomal recurrence, and the prognostic significance of PTLN metastasis, the medical records of 645 patients who underwent total laryngectomy between 1978 and 1990 for squamous cell carcinoma of the larynx, hypopharynx, and cervical esophagus were reviewed. Criteria for inclusion were the surgeon's description of PTLN dissection and hemi‐ or total thyroidectomy, as well as gross and microscopic pathologic identification of PTLNs. These requirements were fulfilled in 141 patients, who composed the cohort analyzed. There were 117 males and 24 females, with a median followup of 20 months (range, 1 to 94 months). Fifty‐three patients were treated previously; among these, 21 underwent tracheostomy before laryngectomy. The primary site of origin was the larynx in 64.5% of patients, the hypopharynx in 25.5%, and the cervical esophagus in 9.9%. Of the patients with endolaryngeal primary tumors, 33% had subglottic extension. Postoperative stomal irradiation was administered to 61 patients. The mean number of PTLNs removed was 3.9 (range, 1 to 30), and metastasis was present in 29 patients (20.5%). PTLN metastasis by primary tumor site was the cervical esophagus, 10 of 14 (71.4%) (p < 0.001); the larynx, 16 of 91 (17.6%); and the hypopharynx, 3 of 36 (8.3%). Of the 30 patients with subglottic extension, eight (26.7%) had PTLN metastases. Peristomal recurrences developed in six of 141 patients (4%), and metastasis to PTLNs was identified in one third of these patients. No peristomal recurrence developed in any of the patients who received postoperative radiotherapy to the stoma (p = 0.057). Survival was significantly reduced by the presence of PTLN metastases. For patients with neither regional nor PTLN metastasis, the overall survival was 87%, whereas none of those with paratracheal metastasis survived beyond 42 months (p < 0.001). PTLN dissection provides prognostic information in patients who are undergoing total laryngectomy. Patients with carcinomas of the larynx, hypopharynx, and cervical esophagus may harbor occult metastasis in the PTLN, and for this reason we recommend elective dissection of these lymph nodes to reduce the risk of peristomal recurrence.
Short Latency Vestibular Evoked Potentials
Authors: Knox Glenn W. , Isaacs John , Woodard Daniel , Johnson Linda , Jordan Douglas
Published: November 2015

Auditory responses, including the well‐characterized auditory brainstem response, have been used extensively in clinical investigations. Evoked responses have not been adequately developed to investigate the vestibular system. The purpose of this study is to describe a new method for the evaluation of short‐latency vestibular evoked potentials in human subjects. Standard ABR equipment is used, with a customized solid‐state modification of the triggering mechanism. Signal averaging is used to record responses to multiple linear decelerations. Results indicate the presence of a short‐latency wave, which is absent in vestibular‐deficient subjects. The literature is reviewed and illustrative cases are presented. We believe vestibular evoked potentials are a promising new modality in investigation of vestibular physiology.
Possible Methods of Creating a Functional Neoglottis and of Constructing a Functionally Adequate Neolarynx
Authors: Schmid Eduard
Published: November 2015

The intention of the following report is to present a concept for constructing a substitute glottis (neoglottis). The concept evolved over the years on the basis of anatomic studies and in the course of plastic reconstructions on patients. It is based on pedicled grafting of a voluntarily controllable—and hence trainable—musculature that might be transplanted into the larynx attached to a neurovascular pedicle. A rima glottidis might be imitated that could be opened and closed from a neutral position. During sleep the neoglottis would be in a relaxed, spasm‐free position. A sensitive and tactile stimulus response ought to be possible, as should variations of the state of tension of the substitute vocal muscles.
Fluorescein Use in the Detection of Perilymphatic Fistula: A Study in Cats
Authors: Bojrab Dennis I. , Bhansali Sanjay A.
Published: November 2015

A stained or colored perilymph would be a valuable tool to otologists for the detection of a perilymph fistula. We studied the effect of intravenously injected fluorescein on the inner ear in seven cats. Still and video photography was used to clearly document our findings. Intravenously injected fluorescein appeared within the soft tissue in less than 1 minute and stayed there for at least 31/2 hours. Fluorescence around the round window niche resulted from soft tissue (mucosal) fluorescence and extravasation of interstitial fluid (transudate). No fluorescence of perilymph was detected. Because of this, we do not believe intravenously injected fluorescein is useful in the detection of perilymph fistula. Intrathecal injection caused quick and intense staining of labyrinthine fluid.
Is the vestibular system affected by middle ear effusion?
Authors: Ben‐David J. , Podoshin L. , Fradis M. , Faraggi D.
Published: November 2015

The association between middle ear effusion (MEE) and vestibular pathology is controversial. To investigate this point, 50 children with MEE scheduled for myringotomy and grommet, and 20 normal hearing children without MEE scheduled for adenotonsillectomy, underwent vestibular investigations by craniocorpography and rotatory chair, preoperatively and postoperatively. Most of the correlations, preoperative vs. postoperative, and study vs. control groups, were nonsignificant. Assuming that serous labyrinthitis is responsible for vestibular involvement in MEE, the lack of significant vestibular pathology in our study could probably be explained by the fact that no children with acute otitis media episodes or otalgia were included. (OTOLARYNGOL HEAD NECK SURG 1993;109:421‐6.)
Middle ear air injection after chronic ear surgery
Authors: Silverstein Herbert , Gordon Michael , Rosenberg Seth I. , Seidman Michael , Willcox Thomas O. , Silverstein Julie
Published: November 2015

In the early period after chronic ear surgery, the reasons for conductive hearing loss may be difficult to determine. Patients who cannot autoinflate the middle ear after 3 weeks, or who have a negative Rinne test result with the 512 Hz tuning fork, are treated with a transtympanic injection of 0.5 cc of air with a 27‐gauge needle and tuberculin syringe. This represents 20% of patients who had chronic ear surgery. Results show that hearing may be immediately improved, the sensation of pressure in the ear may be reduced, and fluid may be cleared from the middle ear. Other benefits may include the release of adhesions. The surgeon is better able to assess the thickness of the graft, and the status of the ossicular chain reconstruction can be determined. There have been no complications of middle ear infection or failure of the micropuncture site to heal. In our practice, middle ear air injection is a routine procedure in patients with inadequate eustachian tube function after chronic ear surgery. This report describes the results of 100 patients over 14 years who received middle ear air injections after chronic ear surgery compared with a control group of 100 patients who did not meet the criteria for requiring air injection. Hearing was immediately improved in 74% of patients as determined by Rinne testing. Audiograms were performed in 25 of these patients, documenting a mean improvement in pure‐tone average of 16 dB. The long‐term hearing results in patients undergoing air injection, who by definition had evidence of poor eustachian tube function, are similar to the results in the control group. This may indicate a lasting benefit of air injection. (OTOLARYNGOL HEAD NECK SURG 1993;109:488‐92.)