bluuebunny/crossref_metadata_2025 huggingface dataset:
Etiology and Antimicrobial Treatment of Acute Sinusitis
Authors: Gwaltney Jack M. , Sydnor Austin , Sande Merle A.
Published: January 2017

Acute maxillary sinusitis is a disease of varied etiology. Over half of the cases are caused by Streptococcus pneumoniae and Hemophilus influenzae. Anaerobic bacteria account for another 10% of cases and these are usually of dental origin. The rest of the cases are caused by several other bacteria, each of which cause a small proportion. Rhinoviruses, influenza, and parainfluenza viruses also in-vade the sinuses and probably lead to secondary bacterial infection. Diagnosis of acute sinusitis on clinical grounds is difficult. Sinus transillumination and x-ray are the most valuable routine tests available. Ampicillin, amoxicillin, trimethoprim-sulfamethoxazole, and cefaclor have been shown to be effective treatment for most cases of acute sinusitis. Infection persists when there is inadequate or inappropriate treatment. The patient may become relatively asymptomatic in the face of persistent active infection. Follow-up clinical and x-ray examinations are indicated, when possible, to detect treatment failures. Although not a routine diagnostic procedure, sinus puncture and aspiration may be of value in the seriously ill patient or one who has not responded to treatment.
The Optokinetic Test and the Eng Test Battery
Authors: Hart Cecil W.
Published: January 2017

The importance of including optokinetic nystagmus as part of a more comprehensive visual test battery in eng testing is discussed. Useful clinical information may be obtained which not only may confirm the presence of peripheral disease, but also may reveal evidence of disturbed central vestibular function. The technique and some of the diagnostic possibilities are described.
Developing a Computer Laboratory for Neurotologic Diagnosis
Authors: Konrad Horst R. , Templin Don
Published: January 2017

The authors, with the help of a community hospital engineering staff, constructed a modern neurotological testing facility capable of performing on-line computer measurements of vestibulo-oculomotor, visual vestibulo-oculomotor, smooth pursuit, saccade, and optokinetic reflexes. The laboratory was built from component parts and uses a Digital Corporation laboratory computer. Programs from the UCLA Human Vestibular Laboratory were modified to work with the new laboratory. Construction and program modification cost $60,000 and was completed in seven months. The laboratory was working at full capacity six months after construction testing patients with suspected neurotologic and neurologic disorders. The procedures of construction as well as the financial and safety problems are discussed.
Comparison of Subjective Symptomatology and Responses to Harmonic Acceleration in Patients with Menière's Disease
Authors: Olson James E. , Wolfe James W.
Published: January 2017

Vestibular function testing employing caloric stimulation has been of limited value in the evaluation of patients with Menière's disease, with its cardinal shortcoming being poor repeatability. This modality has not been useful in determining appropriate treatment for these individuals. We have used low frequency harmonic acceleration to study patients with vestibular pathology and have noted a high level of repeatability of responses to this type of stimulation. This study was designed to determine if the clinical status of patients with Menière's disease could be correlated with their responses to harmonic acceleration. Thirty-six patients with typical symptoms of Menière's disease were evaluated and divided into four groups based on severity of symptoms. Analysis of variance of the phase shifts in asymmetry (or preponderance) showed a significant difference between the groups. Responses to this type of stimulation correlated with the clinical status of the patients to a significant degree. These data indicate that harmonic acceleration can be of value to the otologist in the evaluation of patients with Menière's disease.
Sinusoidal Harmonic Acceleration Test in Clinical Practice
Authors: Rubin Wallace
Published: January 2017

The author's experience during the first year of use of the Sinusoidal Harmonic Acceleration test in clinical practice is presented. The advantages of this test both in the diagnostic and monitoring areas are illustrated with patient evaluation summaries. Further, use of this test on a daily basis in the office practice of neurotology will define its role in the evolution and follow-up of neurotologic problems.
An Overview of Ocular Motor Neurophysiology
Authors: Troost B. Todd
Published: January 2017

A review of current concepts in ocular motor neurophysiology is presented. Four separate subsystems of eye movements are recognized: saccadic, smooth pursuit, vergence, and vestibular. Each subsystem is characterized by different physiologic characteristics and different anatomic substrates which may be selectively affected in different pathologic states. A further eye movement response, optokinetic nystagmus, is complex and may be considered a separate system. To regard the horizontal optokinetic response as merely a combination of pursuit and saccades is an oversimplification but one which may be useful in clinical localization.
Laryngeal Spaces and Lymphatics: Current Anatomic Concepts
Authors: Welsh John J. , Welsh Louis W. , Rizzo Thomas A.
Published: January 2017

This investigation evaluates the anatomic concepts of individual spaces or compartments within the larynx by isotope and dye diffusion. The authors identified continuity of spaces particularly within the submucosal planes and a relative isolation within the fixed structures resulting from the longitudinal pattern of fibroelastic tissues, muscle bands, and perichondrium. The historical data of anatomic resistance are refuted by the radioisotope patterns of dispersion and the histologic evidence of tissue permeability to the carbon particles. There is little clinical application of the compartment concept to the perimeter of growth and the configuration of extensive endolaryngeal cancers. The internal and extralaryngeal lymphatic network is presented and the regional associations are identified. The normal ipsilateral relationship is distorted by dispersion within the endolarynx supervening the anatomic midline. The effects of lymphatic obstruction caused by regional lymphadenectomy, tumor fixation, and irradiation-infection sequelae are illustrated: these result in widespread bilateral lymphatic nodal terminals. Finally, the evidence suggests that the internal network is modified by external interruption to accommodate an outflow system in continuity with the residual patent lymphatic channels.
Unusual Presentations of Penetrating Foreign Bodies of the Upper Aerodigestive Tract
Authors: Remsen Kenneth , Biller Hugh F. , Lawson William , Som Max L.
Published: January 2017

Only a small number of ingested foreign bodies perforate the esophagus and even a smaller fraction migrate extraluminally. Four such penetrating and migrating foreign bodies of the upper aerodigestive tract are presented. Review of the literature revealed 321 cases of penetrating ingested foreign bodies, of which 252 remained intraluminal and 43 were found extraluminally, with the status of the remainder indeterminate. Analysis revealed that an intraluminal penetrating foreign body carried a higher overall mortality than one that migrated extraluminally. Although intraluminal and extraluminal penetrating foreign bodies may remain quiescent for years before presenting a complication, no correlation existed between mortality and the duration of the foreign bodies' retention. The greatest mortality was seen with vascular complications followed by diffuse and local suppurative processes. The overall mortality was significantly reduced in the postantibiotic era.
Endolymphatic Hydrops: An Overview and Classification
Authors: Schuknecht Harold F. , Gulya Aina J.
Published: January 2017

Endolymphatic hydrops (EH) is a pathological condition which is the final common manifestation of a variety of otologic insults. In this paper we develop a classification which, on the basis of clinical and pathological data, distinguishes symptomatic and asymptomatic forms. Clinical case histories and temporal bone studies are presented to illustrate and substantiate this classification. The symptomatic form becomes evident by the hallmark symptoms of episodic vertigo and fluctuating hearing loss. The asymptomatic form is silent. Inter-conversion from one form to another may occur over time. Each of the forms can be subdivided, according to etiology, into embryopathic, acquired, and idiopathic types. The embryopathic type comprises those cases in which some noxious influence interferes with prenatal labyrinthine development. The acquired type includes those cases in which a documented insult, be it inflammatory or traumatic, is suffered by a previously normal labyrinth. The inflammation may be viral, bacterial, or spirochetal in nature, while the traumatic event may be either accidentally or surgically sustained. The idiopathic type includes cases in which the instigating event precipitating the EH is unknown. Menière's disease represents merely one example of the EH group of disorders, namely symptomatic idiopathic EH.
Prevalence of Otitis Media with Effusion in a Group of Preschool Children in the United States
Authors: Okeowo P. A. , Casselbrant M. L. , Flaherty M. R. , Feldman R. M. , Bluestone C. D. , Hanley T.
Published: January 2017

There is a paucity of information regarding the prevalence and natural history of OME. This makes reaching decisions regarding screening and management difficult. Two longitudinal studies are in progress. One involves the application of strict diagnostic criteria to evaluate OME and hearing in a small population of preschool children. The other follows newborn twins for 3 years to establish the influence of genetics and/or environment on the etiology of otitis media, but will also provide information on the incidence and natural history of the disease.
Cross-Sectional Study of the Growth and Development of the Eustachian Tube System
Authors: Doyle W. J. , Rood S. R. , Crone L. S.
Published: January 2017

The objective of the anatomy studies is to investigate the normal developmental anatomy of humans and laboratory animals, utilizing contemporary techniques to confirm previous observations, to provide new information regarding ET anatomy, and to correlate these findings with the studies of the physiology of the system made up of the nose, palate, nasopharynx, ET, middle ear and mastoid air cells.
Incidence of Organisms in Otitis Media
Authors: Rohn D. D. , Vatman F. , Cantekin E. I.
Published: January 2017

Microbiologic investigation is a cornerstone in the study of otitis media. The incidence of the organisms found in otitis media has been studied; however, there is little, if any, longitudinal information available from prospective studies of subjects who have recurrent otitis media and who have middle ear aspirates obtained when the disease recurs or becomes chronic. The microbiology laboratory produces data regarding the incidence of organisms and provides specimens and isolates for the immunology and biochemistry studies.
Biochemical Studies of Otitis Media in Humans
Authors: Diven W. F. , Glew R. H. , LaMarco K. L.
Published: January 2017

The effect of otitis media on the enzyme system of the middle ear has not been studied extensively. It is logical to assume that the mucosa would be damaged and that the damage would vary with the etiologic agents. We have initiated a group of studies, therefore, which propose to examine various enzyme systems to determine the mechanisms of tissue damage.
Effect of Certain Head and Neck Tumors and Their Treatment on the Ventilatory Function of the Eustachian Tube and Hearing Loss
Authors: Myers E. N. , Beery Q. C. , Bluestone C. D. , Möller M. B. , Sigler B. A. , Bood S. B.
Published: January 2017

The management of patients with middle ear disease should be based on an understanding of the pathogenesis of the disease and its course. In this group of investigations, patients with pathological conditions such as cleft palate, which affects ET function, are studied. Animal models are then developed to simulate the clinical condition, thus providing a method of isolating the variables.
Antibiotic or Myringotomy, or Both, for Acute Otitis Media
Authors: Supance J. S. , Kaleida P. H. , Casselbrant M. L. , Blatter M. M. , Reisinger K. S. , Wucher F. P. , Bluestone C. D.
Published: January 2017

Prevention and safe and effective treatment of otitis media are two of our ultimate research goals. Both of these require that a variety of medical and surgical methods of management be evaluated. The most frequent medical management of otitis media is the administration of antibiotics, decongestants, and antihistamines; therefore, several studies that are either randomized placebo-controlled clinical trials or drug efficacy studies have been undertaken. Also, pharmacokinetic studies either have been performed or are underway to determine the ability of drugs to achieve appropriate blood and middle ear levels. The most common methods of surgical management are myringotomy with or without tympanostomy tube insertion, and adenoidectomy with or without tonsillectomy. Randomized controlled clinical trials are being conducted to determine the efficacy and risk/benefit of these procedures at various stages and levels of severity of otitis media in children. In addition, we are attempting to address the problem of the cost of these methods in relation to their potential benefits.
Technique of Laryngeal Photography
Authors: Benjamin Bruce
Published: January 2017

Many techniques for photography during direct laryngoscopic examination have been described over the years. At present the best quality laryngeal photographs are obtained using a modern 35-mm single-lens reflex camera with the Hopkins telescopes and a synchronized electronic flash generator. This versatile system gives consistently reliable results.
Orientation of Stapedial Nerve Fibers in the Facial Nerve Trunk
Authors: Murakami Shingo , Matsumoto Yasushi , Yanagihara Naoaki , Okamura Hiroshi
Published: January 2017

By staining with toluidine blue and vital staining with methylene blue, the topographical orientation of the stapedial nerve fibers in the facial nerve trunk was visualized in adult guinea pigs. The stapedial nerve with its perineural sheath emerges from the facial nerve trunk in the posteromedial aspect of the upper part of the vertical portion. Toward the horizontal portion, the stapedial nerve fibers gradually ramify, lose their investments, and intermingle with other nerve fibers inside the facial nerve trunk. In the labyrinthine portion, the stapedial nerve fibers are distributed diffusely near the surface along the posterior, medial, and anterior margins of the facial nerve trunk. These findings lead to the conclusion that the stapedial nerve fibers of guinea pigs do not form a single funiculus throughout the intratemporal course of the facial nerve.
Relevance of Otopathological Findings in the Treatment of Dizzy Patients
Authors: Montandon Pierre B. , Häusler Rudolf
Published: January 2017

Dizziness is a common symptom in disorders of the brain and the ear. In a retrospective study of 1,000 cases, dizziness is attributed to a peripheral disorder in 25%, to a CNS disorder in 46%, and to undetermined causes in 29% of the cases. Peripheral disorders can be defined in terms of histopathological changes; the most frequent is cupulolithiasis, followed by endolymphatic hydrops and vestibular neuritis. These vestibular disorders are reviewed and discussed in connection with accepted facts and current hypotheses.
Otoconia in Health and Disease
Authors: Lim David J.
Published: January 2017

Mammalian otoconia are made up of inorganic calcium carbonate crystallites and organic substance, which is thought to be sulfated glycosaminoglycans and glycoprotein. Mouse otoconia are formed in situ, and the primitive otoconia assume spindle, trigonal, dumbbell, or quadrilobed forms. As the otoconia mature, they assume the typical barrel-shaped body with pointed tips formed by three surfaces. A variety of otoconial disorders have been reported. Otoconial degeneration can result from ototoxic drugs, infection, trauma, and aging. Abnormal otoconia are also known to occur as a result of genetic mutation, as well as ototoxicity. Otoconial deficiency may be genetic or caused by certain drugs, such as carbonic anhydrase inhibitors or tetracycline, or manganese deficiency during the critical period of gestation when the otoconia are formed in utero. Otoconial deficiency has been found to produce head tilting, swimming difficulty, and reduction or failure of the air-righting reflexes in animals.
Cupulolithiasis and Posterior Ampullary Nerve Transection
Authors: Gacek Richard R.
Published: January 2017

Schuknecht's description of a degenerated otoconial mass embedded in the cupula of the posterior canal crista of the downmost ear in the Hallpike test has been termed cupulolithiasis to reflect the pathophysiology in the syndrome described by Barany. The hypothesis that the otoconial mass renders the cupula of the posterior canal gravity-sensitive has received considerable experimental and clinical support. Clinical support is provided here by the observation that complete relief of the paroxysmal positional vertigo followed transection of the posterior ampullary nerve (singular nerve) in 31 ears of 29 patients complaining of chronic cupulolithiasis. Two patients in the series exhibited bilateral cupulolithiasis and were relieved by sequential bilateral singular neurectomies. Twenty-seven patients were relieved by unilateral singular neurectomy. Although there were three instances of sensorineural hearing loss following surgery in the first 15 patients, no hearing loss has been observed following surgery in the last 16 operations. This low incidence of sensorineural hearing loss has resulted from modifications in surgical technique.
Pathology of Meniere's Disease
Authors: Paparella Michael M.
Published: January 2017

From review of recent findings, the pathology of Meniere's disease is described and correlated with clinical signs. Since Meniere's disease can be seen only in humans, assessing its natural history is important. A recent survey of 500 patients demonstrated the three major symptoms to be vestibular, auditory, and aural pressure. Meniere's disease (idiopathic) is distinguished from Meniere's syndrome (symptoms with likely cause), which accounted for approximately one fourth of the patients. Atypical forms include vestibular and cochlear Meniere's disease. A recent review of our temporal bone collection and detailed study of the pathological conditions of 134 temporal bones described in the literature revealed characteristic pathological findings. Patients with clear-cut histories of Meniere's disease may demonstrate little or no endolymphatic hydrops at death. Nevertheless, hydrops of the pars inferior remains the most significant pathological correlate of Meniere's disease. On the basis of these findings, the pathogenesis of the disease (malabsorption of endolymph) and the pathophysiology of the symptoms (physical and chemical) are discussed.
Streptomycin Treatment for Meniere's Disease
Authors: Silverstein Herbert
Published: January 2017

This paper describes the author's 10-year experience using streptomycin sulfate in the treatment of Meniere's disease in the following: the classical Schuknecht ablation of the vestibular system in bilateral Meniere's disease (eight patients); the classical Schuknecht ablation of the vestibular system in unilateral Meniere's disease in the only hearing ear (five patients); the intratympanic treatment of unilateral Meniere's disease (four patients); and low dose intramuscular outpatient treatment in unilateral Meniere's disease (five patients). The results of bilateral vestibular ablation were similar to those obtained previously by Schuknecht and others: patients developed profound ataxia with a wide-based gait and oscillopsia, which improved rapidly over a period of months; approximately 30% of patients experienced significant improvement in hearing, which usually deteriorated again after several months; and all patients were relieved of vertigo. Patients with unilateral Meniere's disease in the only hearing ear responded similarly, and hearing was preserved in all cases. Intramuscular streptomycin ablation of the vestibular system is strongly recommended in place of surgery in the only hearing ear in Meniere's disease. Controlled intratympanic injection of streptomycin is not successful as yet because of difficulty in controlling the dose. Low dose subototoxic streptomycin treatment on an outpatient basis offers promise for relief of Meniere's attacks, and may improve hearing in some cases without producing the temporary disabling effects of ataxia and oscillopsia. Streptomycin and similar drugs which may reduce endolymph production may eventually be the treatment of choice for Meniere's disease.
Auditory and Vestibular System Findings in Patients with Vascular Loops in the Internal Auditory Canal
Authors: Applebaum Edward L. , Valvassori Galdino E.
Published: January 2017

Many anatomic studies have shown that a loop of the anterior inferior cerebellar artery is frequently found in the cerebellopontine angle and internal auditory canal. The concept of vascular cross-compression has been extended to the eighth cranial nerve, and patients with symptoms of hearing loss, tinnitus, and vertigo have been treated surgically by separating the vascular loop from the nerve. Previous reports have emphasized vascular anatomy, surgical approaches, and treatment results. Our study provides details of audiometric and vestibular system test results in a series of ten patients with prominent vascular loops in the internal auditory canal diagnosed by computerized tomography after subarachnoid space air injection (pneumo-CT). All patients had a unilateral (or asymmetric) hearing loss on the side of the lesion, and no vascular loops were detected on the contralateral sides. Hearing losses ranged from mild to profound. Audiometric findings were generally of a cochlear type, and most patients had excellent speech discrimination. Spontaneous nystagmus was detected in all patients during neurotologic testing, and half of the patients had normal caloric test results. The variability of audiometric and vestibular system test results is probably a reflection of anatomic variations of the vascular loop and its branches. Auditory and vestibular symptoms may be due to a complex interaction between the eighth cranial nerve and the vascular loop, in which the loop compresses the nerve and the nerve compromises circulation to the inner ear. Although symptoms from vascular loops and eighth nerve tumors are similar, the findings of a cochlear type of hearing loss, excellent speech discrimination, and normal caloric test results should raise the suspicion of a vascular loop. Pneumo-CT is effective in diagnosing and differentiating a vascular loop from a tumor.
Rhabdomyosarcoma of the Temporal Bone
Authors: Chasin Werner D.
Published: January 2017

The temporal bone is the primary site for approximately 10% of rhabdomyosarcomas of the head and neck in children. Until recently it has been a uniformly fatal tumor despite treatment with radical surgery and radiation therapy. Although experience with the Intergroup Rhabdomyosarcoma Study protocol-II is of relatively short duration, treatment of these children with radiation therapy and multiple-drug intravenous and intrathecal chemotherapy holds promise of significantly improved control rates.
New Insights in the Evaluation of Cochlear Impairment
Authors: Davis Hallowell
Published: January 2017

A major new insight into cochlear mechanisms is the recognition of an active process, the cochlear amplifier, that contributes energy to the mechanical movement of the basilar membrane at low sound intensities. The extra energy makes possible the great sensitivity of hearing and also the very sharp tuning of individual neural units, ie, the tips of their tuning curves. The inner hair cells are the final receptor cells, but the outer hair cells are essential for the amplifier action. The amplifier is much more sensitive to anoxia, ototoxic drugs, noise, etc, than the inner hair cell system alone. Severe impairment of the amplifier causes a sensorineural hearing loss with recruitment. Only the tails of tuning curves remain. Thus the cochlea is a dual sensory system, a robust but insensitive broadly tuned passive component sided by a vulnerable, sensitive sharply tuned active component.
Factors Inducing Retrograde Degeneration of the Cochlear Nerve
Authors: Spoendlin Heinrich
Published: January 2017

The process of retrograde secondary degeneration is described and its mechanism discussed. The extent of degeneration following transection of the central or peripheral axon and following various types of damage to the organ of Corti, including the time course of degeneration, is presented in animal experimentation and human temporal bones. Of greatest practical importance is secondary neuronal degeneration induced by alteration in the organ of Corti. The effect of damage to the outer hair cells, inner hair cells, supporting structures in the Corti, and nerve endings or peripheral dendrites is analyzed and related to different types of inner ear disease.
Electrically Induced Auditory Brainstem Response as a Clinical Tool in Estimating Nerve Survival
Authors: Simmons F. Blair , Meyers Tom , Lusted Hugh S. , Shelton Clough
Published: January 2017

Nerve survival estimates in totally deaf ears of cats and humans can be easily obtained by auditory brainstem responses to electrical stimulation at the round window. In humans, electrically induced auditory brainstem responses require considerably more current than concurrently observed perceptual thresholds and “maximum loudnesses,” and there is much variability from patient to patient. In cats, in which we also compared efficacy of stimulation sites, preliminary data analysis suggests that the scala tympani is clearly much more efficient than the round window, and the round window better than the promontory in ears with large populations of ganglion cells. In ears with no or nearly no ganglion cells, scala tympani and round window stimulations are about equal.
Congenital Anomalies of the Inner Ear
Authors: Sando Isamu , Takahara Tetsuo , Ogawa Akira
Published: January 2017

This study investigated congenital anomalies occurring in the inner ear, with particular attention to their features, localizations, and frequencies. Seventy-seven human temporal bones obtained from 53 individuals, aged one day to 39 years, each of whom had anomalies of the external ear, middle ear, and/or inner ear, were used for this study. The temporal bones had been removed at autopsy, fixed, dehydrated, embedded in celloidin, and sectioned horizontally or vertically at 20 μm. Every tenth horizontal section or every 20th vertical section was stained with hematoxylin and eosin, mounted, and studied under a light microscope. There were 206 inner ear anomalies (117 in the vestibular system, 79 in the cochlea, 10 in the internal auditory meatus) in the 51 bones studied. Fifty-four different features of anomalies were present at 33 different locations in the inner ear. The most frequent anomalies observed were shortened cochlea (23 bones), enlarged vestibule (17 bones), wide cochlear aqueduct (16 bones), absence of lateral semicircular canal (14 bones), and large osseous lateral semicircular canal (10 bones). The most common site of inner ear anomalies was thus the lateral semicircular canal, which was involved in 46 of the 206 anomalies observed; the anomalies in this organ were variable in type. The implications of inner ear anomalies are discussed as they relate to fetal development, inner ear dysfunction, and clinical interpretation of polytomographic studies.
Cholesterol Metabolism in Cholesteatoma and Cholesterol Granuloma
Authors: Nomura Yasuya
Published: January 2017

Based on biochemical and morphological studies, the significance of cholesterol in cholesteatoma and cholesterol granuloma is discussed. In cholesteatoma, cholesterol is synthesized through desmosterol and Δ7-cholestenol (lathosterol), possibly in the matrix. Cholesterol crystal might have educed from keratin layers or a cell-disintegrated layer adjacent to the matrix by a physicochemical rather than by a biochemical process. Production of cholesterol in the matrix may differ depending on the cell cycle. In cholesterol granuloma, cholesterol may be derived from blood with some other compositions such as albumin and cholestanol. although other sources cannot be denied. Crystallized cholesterol is treated by the surrounding tissue as a foreign body; this results in formation of granuloma. The Δ7-cholestenol is not involved in the biosynthesis of cholesterol in cholesterol granuloma.
Complications of Acute Middle Ear Infections
Authors: Pfaltz C. R. , Griesemer C.
Published: January 2017

Although acute mastoiditis and intracranial otogenic complications occur less frequently in our time than in the preantibiotic period, the disease is nevertheless still a rather severe medical problem. Its mortality rate remains relatively high and the severity of its symptoms is ofter underrated or misinterpreted by the inexperienced physician. On the basis of some personal clinical observations made during the last decade, attention has been drawn to the most common intracranial and extracranial otogenic complications in adults and children. It may therefore be concluded that otitis media must still be considered a dangerous disease, necessitating fundamental knowledge of its underlying pathology, which provides a basis of early correct diagnosis and adequate intensive therapy.
Antibody Activity in Perilymph from Rats with Type II Collagen-Induced Autoimmune Inner Ear Disease
Authors: Yoo T. J. , Floyd R. , Yazawa Y. , Tomoda K.
Published: January 2017

Rats were immunized with native type II bovine collagen to induce antoimmune inner ear disease, and the antibody activity in the inner ear fluid was measured. Antibody activity against type II collagen was detected in the perilymph at about 10% to 20% of serum level. Thus, the presence of antibody against type II collagen in inner ear fluid may imply an immune injury mechanisn in inner ear diseases.
Etiopathogenesis of Meniere's Disease: A Hypothesis
Authors: Yoo T. J.
Published: January 2017

A new hypothesis of etiopathogenesis of Meniere's disease proposes that an autoimmune response to type II collagen could induce idiopathic endolymphatic hydrops. This hypothesis is extended to provide a rational explanation for Meniere's attacks.
Effect of Certain Head and Neck Tumors and Their Management on the Ventilatory Function of the Eustachian Tube
Authors: Myers Eugene N. , Beery Quinter C. , Rood Stewart R. , Bluestone Charles D. , Sigler Barbara A.
Published: January 2017

A prospective study was carried out which tested three hypotheses: 1) certain tumors of the head and neck that originate in sites other than the nasopharynx may cause middle ear effusion; 2) middle ear effusion is a predictable sequela of radical maxillectomy as well as total or partial resection of the soft palate; and 3) middle ear effusions that follow surgery to remove head and neck lesions are due to disturbances in palatal function, specifically to tensor veli palatini muscle dysfunction. Our results indicate that one fourth of all subjects had some evidence of middle ear abnormality prior to entering into treatment although they were asymptomatic. The treatment process influenced the function of the middle ear, as 79% of the subjects experienced middle ear-eustachian tube dysfunction following treatment, and 23% were found to have developed a perforation of the tympanic membrane or required myringotomy and tube insertion to relieve middle ear effusion. The results of these studies indicate that surgery that is adequate to remove cancer of the maxilla, tonsil, or palate in most cases interferes with the function of the tensor veli palatini muscle, resulting in functional eustachian tube obstruction. The need for attention to and the treatment of middle ear effusion in such patients is emphasized in light of other sensory deficits in this patient population.
Meniere's Disease: A Long-Term Follow-up Study of Hearing Loss
Authors: Eggermont J. J. , Schmidt P. H.
Published: January 2017

Twenty patients suffering from Meniere's disease or Lermoyez syndrome were studied with respect to the time course of their hearing loss. Careful history-taking as well as repeated audiometry over long time spans (5–20 years) resulted in a longitudinal study of hearing loss at the standard audiometric frequencies. From these time series, correlation coefficients were computed between the changes in both ears at identical frequencies, and for changes in the same ear at different frequencies. Correlations between changes in hearing loss in both ears were more obvious in bilateral Meniere's disease than in unilateral disease. Correlations between changes in hearing loss at different frequencies were also more pronounced in Meniere's disease ears than in normal ears. If was found that recovery of hearing loss after an attack was nearly identical each time it occurred in the same ear, but differed between ears and patients. This deterministic finding in the otherwise random course of the hearing loss as a function of time may be important in deciding what mechanisms cause fluctuating hearing loss in Meniere's disease.
Inefficacy of Penicillin V in Acute Laryngitis in Adults
Authors: Schalén Lucyna , Fex Soren , Christensen Poul , Kamme Carl , Eliasson Ingvar , Schalén Claës
Published: January 2017

Patients with acute laryngitis following an upper respiratory tract infection are often treated with antibiotics for their voice complaints, although, to our knowledge, the effect of such therapy has not been examined. In the present study, comprising 100 adults with laryngitis, the rate of resolution of vocal symptoms, as estimated from voice recordings or subjectively by the patients, was the same in patients who received penicillin V (pcV) as in those who received placebo. Similarly, the degree of rhinorrhea/nasal congestion and cough was not significantly influenced by pcV treatment. At the acute visit, nasopharyngeal cultures revealed Branhamella catarrhalis in 50%, Hemophilus influenzae in 15% and Streptococcus pneumoniae in 1% of the patients; the rate of elimination of these bacteria was the same in the pcV as in the placebo group. Thus, while suggesting that B catarrhalis and H influenzae are important for the pathogenesis of the disorder, our results do not provide support for the use of pcV in acute laryngitis.
Endotracheal Tube Movement in the Preterm Neonate: Oral versus Nasal Intubation
Authors: Donn Steven M. , Blane Caroline E.
Published: January 2017

Endotracheal intubation of a preterm infant cadaver was performed both orally and nasally to assess the relative movement of the endotracheal tube with changes in head position. For each method of intubation, anteroposterior radiographs were obtained with the head in neutral, flexed, extended, and laterally rotated positions. The results indicate slightly increased movement of the nasotracheal tube with flexion and rotation, and markedly increased movement with extension. The possible relationship between tube movement and the development of subglottic stenosis is discussed.
The Arcuate Eminence
Authors: Kartush Jack M. , Kemink John L. , Graham Malcolm D.
Published: January 2017

The superior semicircular canal (SSC) is an important landmark in the middle cranial fossa approach to the temporal bone. This landmark is frequently located by its topographic association to the arcuate eminence. An anatomic study is reported which examines the relationship of the arcuate eminence to the SSC. Techniques for orientation to the internal auditory canal by the middle cranial fossa approach are reviewed and a technique for localizing the SSC when no arcuate eminence is discernible is presented. 1) In 15% of temporal bone specimens, no arcuate eminence was discernible. 2) Of those specimens with an arcuate eminence, 50% demonstrated that the arcuate eminence was rotated posteriorly from the SSC. 3) Despite displacement of the arcuate eminence, the SSC tended to remain perpendicular to the petrous ridge and 60° from the internal auditory canal. 4) Because of their variable relationship, the arcuate eminence should not be used as a substitute for the SSC in the topographic orientation to the internal auditory canal. 5) A technique for locating the SSC when the arcuate eminence is indiscernible is presented.
Cerebellopontine Angle Meningiomas: Clinical Manifestations and Diagnosis
Authors: Granick Mark S. , Martuza Robert L. , Ojemann Robert G. , Parker Stephen W. , Montgomery William W.
Published: January 2017

Cerebellopontine angle (CPA) meningiomas constitute about 1% of intracranial meningiomas. The clinical aspects of a series of 32 patients with surgically confirmed CPA meningiomas are analyzed. The most common symptoms at the time of the initial evaluation were from the eighth cranial nerve (unilateral hearing loss — 24 patients, vertigo or imbalance — 19 patients, tinnitus — 11 patients), and the fifth cranial nerve (altered sensation — 9 patients, facial pain — 5 patients). On examination, the most common findings were absent caloric response (19 patients), nystagmus (16 patients), diminished facial sensation (14 patients), ataxia (13 patients), reduced hearing (9 patients), and facial weakness (9 patients). There was often a long interval from the onset of symptoms to the correct diagnosis of a tumor. Brain stem auditory evoked potentials, blink reflex testing, posterior fossa myelography, computerized tomographic scanning, and angiography were abnormal in all patients in whom the test was done, but all tests were not performed on all patients. Computerized tomographic scanning and angiography are important for definitive diagnosis and for planning surgical treatment. The histopathology of the temporal bone was studied in three patients with meningiomas in the region of the internal auditory meatus.
Histopathology of Otitis Media in Infants with Cleft and High-Arched Palates
Authors: Kitajiri Masanori , Hashida Yoshie , Sando Isamu , Doyle William J.
Published: January 2017

The middle ear and the bony and cartilaginous portions of the eustachian tube (ET) were studied histopathologically in 20 temporal bones from 19 infants, aged 45 minutes to 12 months. Otitis media (OM) was observed in 17 of 20 bones, and 16 bones with OM had an effusion. Otitis media was more severe in the ears of cleft palate infants compared to those with high-arched palates. Inflammation was present in the bony portion of the ET in 15 of 17 temporal bones with OM, but appeared to be less marked than that present in the middle ear. In addition, inflammation of the cartilaginous portion of the ET appeared to be less severe than in its bony portion. Inflammation of the middle ear and the ET appeared to be more pronounced in older infants, particularly in those with cleft palates.
Symptom Improvement of Spastic Dysphonia in Response to Phonatory Tasks
Authors: Bloch Carole S. , Hirano Minoru , Gould Wilbur J.
Published: January 2017

It has been acknowledged that for many patients with spastic dysphonia, reflexive phonation remains essentially free of the spasticity that characterizes this disorder. The purpose of this paper is to document the extent to which various phonatory tasks change the patient's voice. We retrospectively reviewed 37 patients with spastic dysphonia evaluated at the Center for Communication Disorders of Lenox Hill Hospital, New York, between 1977 and 1981. The patients' responses to various phonatory tasks were observed. These tasks were grouped into the following ten categories: noncommunicative vocalization, primitive communication, speech superimposed on noncommunicative phonation, communicative phonation with varied mode of vocal fold vibration, normal communicative phonation with unusual pitch, normal communicative phonation with unusual emphasis, normal communicative phonation with normal laryngeal adjustments, use of the vocal folds in an artistic manner, speech in which normal auditory feedback was eliminated, and speaking with whisper which was not associated with vocal fold vibration. The results are summarized as follows: 1) whispered speech always resulted in an improvement of the symptom, in most cases markedly; 2) there was a tendency for a task that was more effective in reducing spasticity to be reduced in communicative function; 3) there was a tendency for a task that was more effective in reducing the spasticity to deviate more from the normal mode of phonation; and 4) there were some patients in whom an improvement occurred with elimination of auditory feedback.
Banded Intracochlear Electrode Array: Evaluation of Insertion Trauma in Human Temporal Bones
Authors: Shepherd R. K. , Pyman B. C. , Clark G. M. , Webb R. L.
Published: January 2017

A banded free-fit scala tympani array was inserted into the basal turn of nine human cochleas to evaluate the trauma produced by the procedure. These nine cochleas, together with five nonimplanted controls, were serially sectioned and examined microscopically for damage to the membranous labyrinth, in particular the spiral ligament, the basilar and Reissner's membranes, the stria vascularis, and the osseous spiral lamina. The severity and location of any trauma along the cochlear spiral were recorded. The results indicate that the insertion of the banded scala tympani array resulted in minimal mechanical damage, occurring primarily to a localized region of the spiral ligament. This would not result in significant neural degeneration, and therefore would not compromise the efficacy of the multichannel cochlear prosthesis.
Effects of Pressure on Bone Resorption in the Middle Ear of Rats
Authors: Moriyama Hiroshi , Kato Michimasa , Huang Cheng C. , Abramson Maxwell
Published: January 2017

Laminaria, a hygroscopic seaweed, was used to induce pressure within the rat tympanic cavity. Resorption of the bulla and cochlear walls occurred in all animals within 2 weeks. Cochlear fistulas were observed in four of nine animals after 2 weeks and in nine of 11 aminals after 3 weeks. Preswelled laminaria inserted in the same area induced minimal bone resorption after 2 and 3 weeks. In animals given indomethacin following insertion of laminaria, both granulation-tissue formation and bone resorption were inhibited. Collagenase appeared localized in the inflammatory granulation tissue in the bone-resorption area, especially in fibroblasts, mononuclear cells, and osteoclasts. Results of this study suggested that pressure created by laminaria caused bone resorption by stimulating osteoclasts and granulation tissue.
Reimplantation of a Molded Scala Tympani Electrode: Impact on Psychophysical and Speech Discrimination Abilities
Authors: Hochmair-Desoyer Ingeborg J. , Burian Kurt
Published: January 2017

Revision surgery was successfully performed on two Vienna cochlear implant patients. Twenty months and 40 months, respectively, after initial insertion into the cochleas of two bilaterally deaf patients, electrodes were removed from the scala tympanis and replaced by electrodes of the same design. Psychophysical and speech data gathered before and after the revision surgery were compared. These were thresholds, loudness scalings, amplitude difference limens, pitch scalings, frequency difference limens, and speech tests in the “stimulation only” modality. No negative changes were found. The data available demonstrate a continuous improvement in performance over many months of practice with the sound processor. This development was not impeded by the revision surgery. Thus, it was demonstrated that the removal and replacement of a molded scala tympani electrode is feasible.
Effect of Propranolol on Peroxidase in Tracheal Epithelial Cells
Authors: Watanabe Kensuke , Harada Hiromi
Published: January 2017

Propranolol (β-blocker) was administered to five guinea pigs in doses of 6 mg/day for ten days; five uninjected animals were used as controls. The first or second tracheal ring was cut in round slices. The number of overall epithelial cells facing the airway and the epithelial cells with peroxidase were counted. The mean percentage of peroxidase-positive cells to total epithelial cells was 49% in the control and 11% in animals after the administration of propranolol. This result apparently meant that the peroxidase activity was decreased by the administration of propranolol. The relationship between allergic diseases and the synthesis of peroxidase is discussed.
Age-Related Cochlear Hair Cell Loss in the Chinchilla
Authors: Bhattacharyya Tapan K. , Dayal Vijay S.
Published: January 2017

The spiral organ of the chinchilla was studied by the surface-preparation technique in four different age groups: 1 month, 6 months, 1 year, and 4 years, to assess age-related hair cell loss. Decrease in hair cell population is linearly related to age, and damage rate of outer hair cells is greater than that of inner hair cells. The mean percentage of damaged total outer hair cells was 0.60%, 1.16%, 1.71%, and 7.07% in animals in 1 month, 6 months, 1 year, and 4 years of age, respectively. Outer hair cell loss was greatest in the apex of the cochlea and, of these cells, the outermost row was the most affected. Damage to inner hair cells also increases with age. Age-related apical cochlear cell loss in the chinchilla is comparable to that observed in other laboratory animals.
Effect of High Intensity Impulse Noise on the Vascular System of the Chinchilla Cochlea
Authors: Shaddock Lynn Carlisle , Hamernik Roger P. , Axelsson Alf
Published: January 2017

Changes in the vasculature of the chinchilla cochlea were quantitatively assessed 45 days after impulse noise exposure of either 155- or 160-dB peak sound pressure level. The condition of the vessels in the lateral wall and spiral lamina of each cochlea was evaluated in terms of 20 morphological parameters. Multivariate statistical analysis identified the parameters that were significantly affected by the noise exposure. Evaluation of these significant parameters indicated a net reduction in blood flow to the cochlea. All of the noise-exposed cochleas showed vascular changes when compared to controls, and the magnitude of these changes was related to the amount of hair cell loss. The vascular changes are presumed to be permanent.
Angiosarcoma of the Larynx
Authors: Ferlito Alfio , Nicolai Piero , Caruso Giuseppe
Published: January 2017

Angiosarcoma of the larynx is an uncommon malignant tumor of mesenchymal origin. A case of angiosarcoma of the epiglottis was followed for about 6 years. Diagnostic and clinicopathologic findings outline the importance of a correct differential diagnosis from other vascular malignant tumors (malignant hemangiopericytoma and Kaposi's sarcoma). A critical review of the literature is included.
Otospongiosis and Sodium Fluoride
Authors: Bretlau Paul , Hansen Hans Jørgen , Causse Jean , Johnsen Niels Jon , Causse Jean-Bernard , Salomon Gerhard
Published: January 2017

The effect of sodium fluoride treatment in patients with otospongiosis has been evaluated blindly in a morphological and microchemical element analysis of otospongiotic specimens together with a prospective clinical double-blind, placebo-controlled study. The results show that using the calcium phosphorus ratio as an indication for bone maturity, the sodium fluoride treatment can stabilize otospongiotic lesions in retaining calcium relative to phosphorus. The clinical double-blind, placebo-controlled study of 95 patients showed a statistically significant worse deterioration of the hearing loss in the placebo group than in the active treated (40 mg sodium fluoride daily) group, supporting the view that sodium fluoride can change otospongiotic, active lesions to more dense, inactive otosclerotic lesions. We have postulated in the past that the actual mechanism of the cochlear loss is toxic enzymes produced by histiocytes at the periphery of the microfoci, and it may be that sodium fluoride has some effect on these enzymes.