bluuebunny/crossref_metadata_2025 huggingface dataset:
Hearing impairment caused by intratympanic pressure changes during general anesthesia
Authors: Patterson Mack E. , Bartlett Philip C.
Published: September 2006

Hearing impairment is not often considered a potential complication of general anesthesia; however, four patients who sustained hearing loss following nitrous oxide inhalation anesthesia have recently come to the authors' attention. The cases are presented and middle ear pressure measurements taken during endotracheal inhalation anesthesia with various agents are reported. Factors predisposing to hearing loss during anesthesia are discussed.
Glomus tympanicum — excision by radical mastoidectomy exposure with autograft reconstruction
Authors: Smith Mansfield F. W. , Shinn John B.
Published: September 2006

Wide surgical exposure, total tumor removal and anatomic and functional reconstruction are the goals of tumor management. These goals are met by radical mastoidectomy exposure for the removal of glomus tympanicum tumors and reconstruction by autograft replacement of the posterior osseous canal, and if the tympanic membrane, malleus and incus are removed for tumor exposure, autograft replacement may also be accomplished. The history, physical findings, X‐rays and details of surgical management of two patients with glomus tympanicum are reviewed. Wide removal of the posterior osseous canal, just lateral to the VIIth nerve with total replacement of this segment gives excellent exposure of the middle ear space and affords total reconstruction of the posterior osseous canal.
Stapedectomy: Gelfoam compared with tissue grafts
Authors: Sheehy James L. , Perkins John H.
Published: September 2006

The commonest causes of failure with the prefabricated wire loop‐gel‐foam pad technique are inferior displacement of the loop in the window, high membrane formation and window fibrosis. As a result of these problems some members of the Otologic Medical Group have abandoned the use of gelfoam in favor of tissue grafts.

A comparison of the results with gelfoam, fat grafts, and fascia grafts in 573 primary cases is made. Tissue grafts yielded a lower incidence of postoperative vertigo, of temporary and permanent sensori‐neural hearing impairment, of fistulas and of long‐term hearing regression. The conclusion is that a tissue graft is preferable to gelfoam as an oval window covering in stapedectomy.
Temporal bone histopathology in experimental hypovitaminosis a
Authors: Chole Richard A. , Quick Cedric A.
Published: September 2006

Twenty‐five years ago hearing loss was observed in some subjects during a comprehensive study of the effects of hypovitaminosis A on human volunteers. Experimental studies documenting histopathological changes in the temporal bone due to hypovitaminosis A are conflicting. Even the recent textbooks of otolaryngology and physiology make no mention of a role of vitamin A in the ear. To explore the role of vitamin A in the ear adult and. weanling rats maintained on a diet totally lacking vitamin A were sacrificed at intervals. Their temporal bones were examined with the light microscope.

After six weeks on a vitamin A free diet weanling rats showed hypertrophy of the periostial portions of the otic capsule. At 16 weeks a narrowing of the internal auditory canal due to bony exostoses was present. The neuroepithelia of the cochlea and the vestibular apparatus were histologically normal even in the longest surviving animals.

Although we have demonstrated marked abnormalities of the otic capsule in hypovitaminosis A, our results do not support those of some earlier investigators who reported that atrophy of the cochlear and vestibular neuroepithelium occurred in the absence of dietary vitamin A.
Technical note: A finger extension tongue depressor
Authors: Delclos Luis
Published: September 2006

The author describes a tongue depressor which can be adapted to the examiner's thumb while performing indirect laryngoscopy. This depressor allows the examiner to pull the tongue and push it downward in patient where otherwise vision is obscured by the dorsum of the tongue.
Basis and some diagnostic implications of electrocochleography
Authors: Naunton R. F. , Zerlin S.
Published: September 2006

Electrocochleography (ECoG) involves the recording of electrical responses to sound from the vicinity of the cochlea. The technique, as we practice it, utilizes a trans‐tympanic recording needle situated on the promontory of the middle ear. Filtered clicks in the frequency range between 500 and 8,000 Hz are presented to the ear under test at a rate of 10/sec. Repetitive clicks of a given frequency are first presented at high intensity and the responses summed (averaged) in a computer. The click is systematically lowered in intensity, and an average is collected at each level until the normal dynamic range of hearing has been explored.

Two major electrical indices are present in the recording: these are 1. the whole‐nerve action potential (AP) derived from the first‐order auditory neurons, and 2. the cochlear microphonic (CM) derived from the hair cells.

Inspection of the whole nerve AP as intensity is lowered allows the estimation of the response threshold, which correlates well with behavioral threshold.

Inspection of the relation between the CM and the AP allows qualitative differentiation to be made between pathology arising in the hair cell (sensory) and in the nerve (neural).
Functional hearing loss
Authors: Nilo Ernest R. , Saunders William H.
Published: September 2006

Functional hearing loss is a rather common entity, although it probably is overlooked more often than not. In most instances, the services of an experienced audiologist are necessary if one is to detect these cases.

First, one must consider carefully the patient's behavior before and during the otologic and audiologic examination, and note the referral source, if any, since patients with certain backgrounds are more apt to exhibit functional hearing loss than others. Second, careful attention is given to certain aspects of the initial basic audiometric examination. Discrepancies here often stand out and point clearly toward functional loss.

A so‐called “modified approach” to conventional audiometry has enabled us to detect almost all cases of functional hearing loss without resort to the special audiometric tests designed for that purpose.
The management of sickle cell patients undergoing surgery
Authors: Spooner Thomas R. , Dark Alison W.
Published: September 2006

Between 10 and 15 percent of blacks have sickle cell disease or sickle cell trait. Either is capable of a sickle cell crisis which could occur during a surgical procedure. Because of this, we as otolaryngologists should be aware of how to diagnose sickle cell disease and what specific measures should be followed in order to avoid a sickle cell crisis. This paper deals with specific diagnostic tests available, their interpretation, and our protocol for management of these patients when they are in the hospital for a surgical procedure.
The osteo‐mucoperiosteal flap in repair of cerebrospinal fluid rhinorrhea
Authors: Mccabe Brian F.
Published: September 2006

Repair of fistulas producing cerebrospinal fluid rhinorrhea, as with any reconstructive operations, should take into account the basic principles of reconstructive surgery for best results: 1. tissue needing replacement should be replaced by like tissue; and 2. a flap is always superior to a graft. In the case of this disease, the tissue sealing the fistula should be a flap containing not only mucosa or mucoperiosteum, but also pedicled bone. Two kinds of regional flaps are described which successfully closed the fistula in each of three patients. Follow‐up is long term.
Nasal obstruction after rhinoplasty: Etiology, and techniques for correction
Authors: Beekhuis G. Jan
Published: September 2006

Of 1,000 consecutive patients who underwent rhinoplasty, about 10 percent had some nasal obstruction postoperatively. The majority of patients in whom the author performed the primary rhinoplasty had an obstructive, vasomotor type of rhinitis that ensued, and which usually could be cured by the injection of corticosteroids into the turbinates. Fifty patients had undergone rhinoplasty by other surgeons, and most of those patients requested surgical correction to relieve the nasal obstruction and/or to improve the external nasal appearance. In those patients the causes of nasal obstruction were; pre‐existent, undetected, or diagnosed but uncorrected, septal deviations; caudal septal dislocation; or turbinate hypertrophy; intranasal adhesions; scar tissue web formation in the nasal vault; inadequate nasal tip support, and alar collapse. The author's technique of surgical repair for each of these conditions is outlined.
Tuberculosis of the larynx
Authors: Travis Lawrence W. , Hybels Roger L. , Newman M. Haskell
Published: September 2006

Tuberculosis of the larynx, once a common disease, has become quite rare with the advent of anti‐tuberculous chemotherapy. In the pre‐antibiotic era two modes of laryngeal infection were recognized; bronchogenic and hematogenous. The literature is briefly reviewed. Thirteen patients in the past 15 years in whom tuberculous laryngitis was diagnosed upon indirect laryngoscopy by members of the University of Michigan Department of Otorhinolaryngology are presented. Bronchogenic infection was present in 11, and in two patients the disease was consistent with hematogenous spread. Tissue biopsy from a case of bronchogenic contamination demonstrated epithelioid tubercles, while numerous subepithelial acid‐fast bacilli without typical tuberculous histological change were present in a case of hematogenous laryngeal infection. A case of cicatricial laryngeal stenosis was successfully treated surgically by laryngofissure, excision of fibrosis with arytenoidectomy, and free mucous membrane grafting. Finally, the initial subtle presentation of many of our patients emphasizes the importance of a consideration of tuberculosis in the differential diagnosis of chronic laryngitis.
Difficult direct laryngoscopy
Authors: Lewy Robert B. , Brusca Peter A.
Published: September 2006

This article reviews some of the problems involved in direct laryngoscopy. It suggests adequate preparation and evaluation of the patient to avoid complications. An evaluation of laryngospasm is given. Solutions of the problems are suggested using gear power assistance and adequate drugs for relaxation. The importance of correct positioning of the patient is emphasized and illustrated.

This summarizes clinical judgment and successful evaluation of the difficult mechanical problems in the exposure of the vocal cords.
Congenital subglottic fibroma in the newborn
Authors: Tsui H. N. , Loréa John M.
Published: September 2006

Congenital subglottic fibroma is a rare clinical entity. A review of references did not disclose any previous report. A case of congenital subglottic fibroma is presented. Embryology, etiology, symptomatology and pathology of congenital anomalies of the larynx are reviewed and management discussed.
Glossopharyngeal neuralgia: Surgical treatment and electron microscopic findings
Authors: Ishii Tetsuo
Published: September 2006

Seven cases of idiopathic glossopharyngeal neuralgia were treated with surgical resection via pharyngeal approach. Two of these cases showed a recurrence of neuralgia and subsequently, one of the recurring cases underwent a IXth nerve section through a cervical approach. The resected nerves were examined with the light and electron microscope. In five of seven cases, degeneration of myelinated fibers was observed. Under electron microscope, disarrangement and disorganization of the myelin sheath were found, while axonal degeneration was relatively rare. The author recommends an initial resection by the pharyngeal approach. In cases of recurrence, a subsequent attempt to resect the nerve should be made by the cervical approach.
Schwannoma presenting as a nasal polyp
Authors: Kaufman Sean M. , Conrad Larry P.
Published: September 2006

An unusual presentation and treatment of an intranasal Schwannoma are discussed. The clinical and pathological features are also reviewed.
Sensori‐Neural hearing loss following radiotherapy to the nasopharynx
Authors: Moretti Joseph A.
Published: September 2006

A retrospective study was done to ascertain the risks of cochlear damage from radiotherapy of the nasopharynx. Audiometric evaluation, pre and post‐radiotherapy, revealed that 7 out of 13 patients had sustained sensori‐neural deafness. Contrary to what is generally believed of the resistance of the cochlea to radiotherapeutic damage, eventual loss of hearing can occasionally be expected in patients undergoing radiation therapy for head and neck tumors.
The otological aspects of palatal myoclonus
Authors: Lyons George D. , Melancon Bradford B. , Kearby Norma L. , Zimny Marilyn
Published: September 2006

Palatal myoclonus with its concomittant objective tinnitus is often a missed diagnosis and poses a problem to the clinician in separating it from other middle ear anomalies. The etiology and symptomatology is outlined, but as suggested by our case presentations are not always diagnostic.

The anatomical pathways of palatal myoclonus are traced, and its etiological complexities are realized when any locus or pathology along these tracks may create the characteristic chronic rhythmic contractions. We have experienced excellent results in determining a differential diagnosis of palatal myoclonus from other middle ear problems by the correlations of impedance audiometry with our clinical findings. Although the etiology is not defined the target structures can be separated from this test method and, therefore, enable more specific therapy.
Laryngeal problems following infant esophageal surgery
Authors: Robertson James R. , Birck Herbert G.
Published: September 2006

This paper focuses on vocal cord paralysis in children after operation for tracheoesophageal fistula and/or esophageal atresia. We reviewed the charts of 65 children who were operated upon for congenital esophageal atresia and/or tracheoesophageal fistula during a period from 1964 to 1974. Ten of these children manifested laryngeal symptoms. Five had laryngeal paralysis. Two were untreated. One was treated with cordectomy and stent. Two were treated successfully with the Thornell arytenoidectomy, one of these being done without a tracheotomy in place. Mention is made of a third case of bilateral vocal cord paralysis due to hydrocephalus treated successfully by the Thornell procedure.

Follow‐up laryngoscopy was done on 21 children without laryngeal symptoms which revealed two previously unsuspected vocal cord paralyses and one vocal cord paresis which cleared.
A new functional approach to the surgical management of pierre robin syndrome: Experimental and clinical report
Authors: Lapidot Abraham , Rezvani Firooz , Terrefe Dessalegn , Ben‐Hur Nahum
Published: September 2006

A functional and simple surgical method for treating the respiratory distress of the neonate affected by Pierre Robin syndrome is described. The base of the tongue is placed in an anterior position via a buried wire suture tied around the body of the hyoid. The method proposed in this paper fulfills the following:

It is physiologic since the infant is able to suckle and maintain its nutrition by preserving the function of the mobile portion of the tongue for deglutition.

Maintenance of the “pushing” action of the tongue stimulates growth of the mandible.

The anchoring wire is not exposed in the oral cavity and the risk of tissue breakdown and infection is eliminated.

This technique utilizes the stronger fibrous portion of the mid‐tongue rather than muscle which “gives” more readily under pressure.

The shortest distance from the base of the tongue to the mid‐hyoid provides the best mechanical advantage.

The suture, if need be, may be tightened at subsequent periods of time.

Under Ketamin (Ketalan) anesthesia the tip of the tongue was held in the forward position. An 18 gauge stainless steel wire was inserted via a large curved needle through the midline of the posterior‐most portion at the base of the tongue. The needle was directed anteriorly and inferiorly to emerge below the mid point of the inferior border of the hyoid bone. The opposite end of the wire was then tunneled submucosally to the anterior portion of the base of the tongue at foramen caecum, and directed inferiorly to emerge above the superior border of the mid‐portion of the hyoid bone. Through a small skin incision opposite the body of the hyoid bone, both free ends of the wire were tied under tension around the body of the hyoid while pulling the base of the tongue forward. The skin incision was closed with a single nylon suture. A prosthetic obturator was used to close the cleft palate. The outcome was satisfactory with no morbidity.
Microscopic characteristics of the acoustic tumor in relationship of its nerve of origin
Authors: Neely J. Gail , Britton B. Hill , Greenberg S. Donald
Published: September 2006

The microscopic characteristics of a 0.9 cm vestibular schwannoma en bloc resected with its nerve of origin which occurred in a 54‐year‐old white woman presenting with a two‐year history of a unilateral progressive sensori‐neural hearing loss is described. The tumor originated in the inferior vestibular portion of the vestibular division of the VIIIth cranial nerve just medial to the internal auditory canal meatus at approximately the level of the glial‐non‐glial junction. The tumor demonstrated two distinctly different, yet simultaneous, modes of involvement with its nerve of origin: 1. inseparable cellular continuity; and 2. peripheral compression of the remainder of the nerve within the tumor capsule. Despite only slight microscopic continuity of the nerve histologically, electronystagmography showed no unilateral weakness on bithermal caloric testing, and pure tone and speech audiometry was only moderately depressed.
Tonsillectomy and infectious mononucleosis — a possible relationship
Authors: Goode Richard L. , Coursey Donald L.
Published: September 2006

A review of 1,192 student medical records shows a prior history of tonsillectomy in 41 percent of a control group and 22 percent of an infectious mononucleosis group — a significant difference (p <0.01). Nine hundred eighty‐nine Stanford University students (421 females, 568 males) who visited Cowell Student Health Center between April and September, 1973, comprise the control group. Two hundred three students with positive monospot tests and clinical mononucleosis diagnosed between June, 1968, and May, 1973, comprise the experimental group.

The lower incidence of tonsillectomy in the infectious mononucleosis group implies that the tonsillar lymphoid tissue serves as a reservoir and possible replicating milieu for the Epstein‐Barr virus. Prior tonsillectomy may reduce the possibility of contracting infectious mononucleosis.
Sjögren's syndrome and serous otitis media
Authors: Michel Randall G. , Hughes Lynn A. , Hudson William R.
Published: September 2006

Extrasalivary lymphoid abnormalities in Sjögren's syndrome are well described. Patients have been found to have lymphoid infiltration of many organ systems. The nature of the lymphoid abnormalities constitutes a spectrum ranging from benign to malignant disease. A case of an elderly patient with long standing Sjögren's syndrome is presented because of the unusual manifestation of a benign lymphoid mass in the nasopharynx producing unilateral eustachian tube obstruction and serous otitis media. Serous otitis media associated with Sjögren's syndrome is recognized, but to our knowledge in previous cases an extrasalivary lymphoid abnormality has not been implicated as the underlying pathology.
The importance of panographic and dental evaluation for lesions of the antrum
Authors: Eisenbud Leon , Kameros Jonathan , Blum Bertram , Glass Walter
Published: September 2006

A large dentigerous cyst which displaced the antrum and partly eroded its bony walls was interpreted as a malignant neoplasm in routine sinus films. The true nature of the process was readily apparent in a panographic view which showed an unerupted third molar lying horizontally above the apices of the first and second molars. This case is an excellent demonstration of the important role of panographic views in the differential diagnosis of maxillary sinus lesions.
Paget's disease and sensori‐neural deafness: Temporal bone histopathology of paget's disease
Authors: Lindsay John R. , Suga Fumiro
Published: September 2006

Four cases with Paget's disease of the temporal bone are presented to illustrate the pathogenesis of the associated deafness.

One case illustrates the combination of severe deafness due to bilateral otosclerosis with probably asymptomatic bilateral Paget's disease.

One case with advanced Paget's disease presents features to explain early stages of sensori‐neural deafness before actual cellular invasion of the inner ear.

One case of profound deafness due to Paget's disease presents a different stage of cellular invasion of the inner ear by the disease on each side.

One case illustrates invasion of the internal auditory meatus by Paget's disease with infiltration of the acoustic division of the nerve and profound deafness.
Otitis media with effusion: Specific antibody activities against exotoxins in middle ear effusions
Authors: Mogi Goro , Maeda Shoichi , Yoshida Toyoharu , Watanabe Noritake
Published: September 2006

Findings of recent immunologic studies on otitis media with effusion indicate that antibodies in middle ear effusions can either originate from serum and/or from local production in the middle ear cavity and Eustachian tube. Determination of specific antibody activity of different immunoglobulin classes in effusions and sera against certain bacterial antigens may aid in a better understanding of the pathogenesis of otitis media with effusion. A radioimmunosorbent assay was employed in the present study to determine specific antibody activity against streptolysin or staphylolysin. Although these antibody activities were mainly limited to IgG and IgA class antibodies in effusion as well as in serum, it was also found that SIgA of various types of the effusion possesses the antibody activity against these exotoxins. Findings of this study suggest that a local immunity functions in the middle ear cavity of patients with otitis media with effusions and that bacterial infection may contribute to the development of middle ear effusion in certain cases.
Investigation of acoustic trauma from the airbag
Authors: Richter Harry J.
Published: September 2006

Since the automobile‐airbag passive restraint system may be in general use in early 1976, and, in fact, is now an option on some automobiles, its potential biomedical hazards need to be examined.

The objective of this study was to investigate the effects of local slap pressure of airbag deployment against the external ear and tympanic membrane and to measure its effects on subsequent hearing acuity. Adult and infant squirrel monkeys were used as experimental subjects. To create an adequate simulation of the airbag trauma, a small airbag was fabricated and mounted on a pneumatic impact facility. This device was designed to produce a specific velocity to determine the behavior of objects under impact conditions simulating accident kinematics.

Cochlear nerve action potentials were measured in both ears of 10 subjects prior to blast, immediately post‐blast, and several weeks post‐blast. High‐speed photography recorded the events of the blast as well as the technique of recording the electrical potential from the cochlea. No permanent hearing damage, eardrum perforation, disruption of ossicles, or loss of hair cells occurred at airbag velocities up to 100 mph and a sound intensity level of 150 db.
Epitympanic malleus fixation: Correction without disrupting the ossicular chain
Authors: Armstrong B. W.
Published: September 2006

The preoperative diagnosis of malleus fixation can be made consistently with a pneumatic otoscope. Nontympanosclerotic epitympanic malleus fixation, for the most part, has been corrected by disrupting the ossicular chain and then reconstructing the sound‐conducting mechanism. Once the diagnosis of malleus fixation is established, the surgical approach should be modified to cope with the fixed malleus.

A wide, inferiorly based tympanotomy flap affords ample access to the epitympanum and permits definitive resolution of the associated conductive hearing loss. Atticotomy and discreet osteotomy can free the fixed malleus and preserve continuity of the ossicular chain in over 90 percent of the patients with this syndrome.

Experience for 46 patients having bony epitympanic malleus fixation, both congenital and acquired, was examined in concluding that the anatomical continuity of the ossicular chain can and should be maintained in most patients. The residual air‐bone gap is less with an intact, though modified, ossicular chain than it is with a chain that has been reconstructed.
Isolated laryngeal lymphoma
Authors: Anderson H. Allen , Maisel Robert H. , Cantrell Robert W.
Published: September 2006

Isolated laryngeal lymphoma is a rare occurrence. We found a total of 14 previously reported cases. These plus our additional case are reviewed in order to make recommendations for diagnosis, therapy, and follow‐up.

Histologic classification and clinical staging of lymphomas have limited usefulness, because the tumor can change cell type during the clinical course of the disease.

Once histologic proof of the tumor exists, adequate evaluation consists of physical examination to detect adenopathy elsewhere, bone marrow biopsy, urinalysis, blood uric acid levels, liver biopsy, and liver and kidney function tests. The search must continue in the chest by X‐ray, the retroperitoneal nodes by lymphangiography and the abdominal visera by contrast radiography.

Radiation therapy is the best initial treatment for isolated laryngeal lymphoma. If the tumor does not respond to irradiation, then operation to remove the lesion is required. This tumor has a tendency to recur at distant sites many years later. As with all cancer patients life‐long follow‐up is required.
Cervical hibernoma
Authors: Lawson William , Biller Hugh F.
Published: September 2006

The hibernoma is a rare neoplasm derived from vestigial remnants of brown fat left from early embryologic development. Review of the world literature reveals only 40 cases to which we are adding a report of a tumor arising in the posterior cervical triangle of a 20‐year‐old man. The distribution, histology and cytochemistry of brown fat and the hibernoma are discussed, and evidence supporting its histogenesis is presented.
Treatment of tracheal stenosis: An unusual complication
Authors: Marlowe F. I. , Eliachar I.
Published: September 2006

Reports on the subject of tracheal stenosis and its treatment have appeared with increasing frequency of late. Such treatment, in a recent case resulted in an unusual complication, and necessitated management of an unusual foreign body.
Human cochlear changes in noise induced hearing loss
Authors: Mcgill Trevor J. I. , Schuknecht Harold F.
Published: September 2006

The temporal bone histopathological findings in 14 ears with noise induced hearing loss are presented. The morphological changes consist mainly of hair cell loss, which is more severe in the 9 mm to 13 mm region of the cochlear duct. Within the area of maximum hair cell loss, there is a greater loss of outer hair cells than of inner hair cells. There is a good correlation between the permanent auditory threshold shifts and the spatial location of the sensory lesion according to the anatomical frequency scale.
Chondrodermatitis helicis: A clinical re‐evaluation and pathological review
Authors: Metzger Steven A. , Goodman Max L.
Published: September 2006

Chondrodermatitis helicis, or painful nodule of the ear, is an uncommon benign aural lesion which is seen and treated by dermatologists and otolaryngologists. Because of the sparcity of reports in the recent literature, our experience with 50 patients over a 10‐year period is presented.

The diagnosis is based on history and physical examination and biopsy need be performed only to confirm the diagnosis in atypical cases. Patients are generally middle‐aged or elderly males. There are no associated systemic disorders with this condition. The lesions are discrete, grey to red in color, oval shaped with raised rolled edges, and a central ulcer or depression which often contains a crust or scale. The lesion is typically painful and tender and, for this reason, the patient seeks help shortly after the onset of symptoms. The characteristic histopathologic features are epithelial hyperplasia, collagen degeneration, focal fibrinoid necrosis, and inflammatory components.

Clinically, the lesion is misdiagnosed in the majority of instances and is presumably, therefore, treated inappropriately. It should be stressed that this is a benign condition and initial management should be aimed at conservative therapy with local steroid injection or conservative non‐deforming surgery. Wide excision, including removal of the underlying cartilage with appropriate reconstructive closure should be reserved for the conservative treatment failures.
Surgical treatment of the ptotic eyebrow
Authors: Parkes Morby L. , Kamer Frank M. , Bassilios Maurice
Published: September 2006

Surgical management of the ptotic eyebrow is reviewed and discussed. A simple and effective office procedure to correct this problem by direct approach is presented.
Bifid epiglottis: A rare laryngeal anomaly
Authors: Healy Gerald B. , Holt Gordon P. , Tucker John A.
Published: September 2006

Two cases of bifid epiglottis are presented: one with an associated laryn‐geal cyst and another with an associated cricoid stenosis. The occurrence of multiple laryngeal anomalies in association with bifid epiglottis has not previously been described. The occurrence of an extra digit is noted to be statistically significant both in the current series and in a review of the literature. A brief review of the embryologic classification and staging by the Carnegie System, and the correlation of the time sequence of development of the epiglottis is presented. No correlation is made as to the mechanism of the origin of this laryngeal anomaly, as adequate embryologic knowledge of the development of the pharynx is not available at this time.
Patterns of anomalies in children with malformed ears
Authors: Rapin Isabellb , Ruben R. J.
Published: September 2006

Sixteen children with anomalies of the auricle and/or middle ear who presented malformations of the face, mouth, upper airway, spine, limbs, heart, gastrointestinal (GI), and/or genitourinary (GU) systems, were described. While clusters of anomalies suggested syndromes such as the oculo‐auriculo‐vertebral syndrome of Goldenhar, hemifacial microsomia, mandibulo‐facial dysostosis (Treacher Collins syndrome), Pierre Robin, Klippel‐Feil, Moebius, Duane, and/or VATER syndromes, many children did not fit what are usually considered even minimal criteria for these syndromes. Several children had malformations which fit the description of more than one syndrome.

The importance of investigating the children for unsuspected anomalies, especially of the GU system, was emphasized. Life threatening problems in this group consisted of airway problems, congenital heart disease, and major anomalies of the GI and GU systems. Better management of sucking, swallowing and airway problems might have decreased the early morbidity and mortality (3/16) in this group.

Children with multiple defacing anomalies may not be mentally retarded so that aggressive management of their visceral anomalies and hearing problems, and early educational intervention are mandatory. Delay in development may be due to hearing loss, vestibular impairment, ataxia, the consequences of early malnutrition, and multiple hospitalizations rather than to mental retardation. A pessimistic attitude in infancy is unwarranted since it is impossible to predict which children will end up competitive individuals.
Recurrent meningitis secondary to idiopathic oval window csf leak
Authors: Parisier Simon C. , Birken Eric A.
Published: September 2006

Bacterial meningitis remains a life‐threatening infection even in the present antibiotic era; thus, any abnormality which predisposes a patient to a recurrence of this serious disease, must be identified and corrected. This report describes the history of a 12‐year‐old boy with a profound neurosensory hearing loss, a related absence of vestibular function and a Monclini‐type of temporal bone dysplasia who developed recurrent episodes of meningitis which were due to an idiopathic cerebrospinal fluid otorrhea. Even though the meningitis was labyrinthogenic in origin, the patient did not experience the associated symptoms of hearing loss and/or vertigo since the affected inner ear was clinically unreactive. By surgically exploring the middle ear, the presence of a cerebrospinal fluid otorrhea was confirmed. The leak was observed to be coming from a defect in the stapes footplate, and it was controlled by firmly packing the inner ear vestibule with muscle.

A remarkable similarity exists between the patient described above and the 15 previously reported cases of meningitis due to a spontaneous cerebrospinal fluid otorrhea. Generally, the problem occurred in young children, the average age being 6.4 years; male and female were equally afflicted. All 15 previously reported cases had a severe neurosensory hearing loss which was unilateral in 10 individuals and bilateral in the other five. In 11 of the case reports, the vestibular function was evaluated, and the labyrinth was noted to be unreactive in the affected ear. An associated congenital abnormality of the inner ear was described in 11 of the patients reviewed.

Anatomically, in 13 cases, the leak was observed to be coming from the oval window area. Other affected sites included one report of a fissure of the promontory and one report of a defect in the roof of the eustachian tube.

Multiple surgical procedures were required in 11 of the 15 patients in order to identify the exact source of the otorrhea and to seal it permanently. In three cases, the successful procedure was a middle ear exploration with stapedectomy and packing of the inner ear vestibule. Overall, a total of 36 operations was performed in the 15 patients reviewed.

In conclusion, when the physician is confronted by a case of meningitis in a patient with a unilateral or bilateral total loss of hearing and vestibular function, the possible presence of an idiopathic cerebrospinal fluid leak should be considered, especially if radiographic studies demonstrate a temporal bone dysplasia. In these selected cases, if the etiology of the meningitis is obscure, a middle ear exploration should be performed both for diagnostic purposes as a means to ascertain definitely the presence of a leak and for therapeutic purposes to seal it effectively.
Office otology follow‐up
Authors: Caparosa Ralph J. , Shamblin Jerry D.
Published: September 2006

The validation of otological care in the previous quarter century has been based, by and large, on short‐term follow‐up information. The rapid variation in procedures introduced during this period indicates that there may be need for further consideration. Analyses based on relatively short duration have led to the “acceptance” of a variety of diagnostic and treatment methods which have proven disappointing in some cases. To help avoid this invalid “acceptance,” a review of patients with significant follow‐up may result in a more critical evaluation of future procedural changes.

This presentation will be in four parts:

History of the office structure.

Discussion of five long‐term patients that illustrates and supports certain otological concepts.

A review of surgical care for chronic suppurative otitis media in 1968.

A review of patients treated for serous otitis media with myringotomy and tubal insertion in 1968.
Globus hystericus — office evaluation by psychological testing with the mmpi
Authors: Pratt Loring W. , Tobin Wayne H. , Gallagher Ruth A.
Published: September 2006

Ninety‐nine patients, twenty‐three men and seventy‐six women, who complained of a lump in the throat were evaluated with the Minnesota Multiphasic Personality Inventory, which revealed that these patients had a higher than average score on the depression and the hypochondriasis scales. The intensity of this finding was greater in males. One must never overlook the possibility of a neurotic patient also having serious organic disease.
Rhinosporidiosis
Authors: Kutnick Steven L. , Kerth Jack D.
Published: September 2006

A case of rhinosporidiosis occurring in an immigrant from India is presented along with a review of the disease. Rhinosporidiosis most commonly involves the nose, and presents as a friable papillomatous mass causing nasal obstruction, epistaxis, purulent discharge, and headache may also occur. The treatment of choice is surgical excision with cauterization of the base.
Medullary carcinoma of the thyroid
Authors: Fierstein Jeffrey , Sessions Donald G. , Thawley Stanley E. , Ogura Joseph H.
Published: September 2006

Medullary carcinoma is an unusual malignant neoplasm. The cell of origin is considered to be the C‐cell which is derived from the ultimo‐branchial body and neural crest. The tumor is solid and has characteristic amyloid in the stroma. The lesion usually presents as a neck mass, and multicentricity is not unusual. In some patients diarrhea may be an important presenting symptom. Serum calcitonin is typically elevated and is important in the diagnostic confirmation. About 10 percent of the cases are part of a familial endocrine syndrome which includes pheochromo‐cytomas, mucosal neuromas, and other endocrine gland adenomas. Frequent multicentricity and early cervical lymphatic and systemic metastases necessitate total thyroidectomy and radical neck dissection. Prognosis varies from a rapid demise to long term survival.
Beyond Dressing and Driving: Using Occupation to Facilitate Community Integration in Neurorehabilitation
Authors: Fleming Jennifer M. , Doig Emmah , Katz Noomi
Published: September 2006

During the process of community integration, individuals with acquired brain injury may experience difficulties in all areas of occupational performance including self-care, home management, community access, leisure, social activities and vocational pursuits. Community based rehabilitation services provide opportunities to minimise such difficulties by working with clients as they engage in meaningful real-life context-based occupations. The therapeutic use of occupation is at the core of occupational therapy practice. We reflect on the nature and principles of occupation and highlight particular benefits for facilitating community integration after brain injury. This is illustrated using the example of executive dysfunction. Several challenges for the occupational therapy profession arise from the shift in focus from hospital to community based rehabilitation, and the need for further research on community integration after brain injury from an occupational perspective is recognised.
Understanding Social Support and Friendship: Implications for Intervention After Acquired Brain Injury
Authors: Rowlands Allison
Published: September 2006

This article reviews current literature on social support and friendship, loneliness and social isolation, and discusses these in the context of disability and specifically acquired brain injury. The examination provides a backdrop for considering interventions which aim to promote or regenerate friendships in the lives of people with this injury. The social consequences for individuals who have sustained an acquired brain injury have been well documented and are briefly reviewed. An understanding of the social support and friendship literature, reviewed in this article, is helpful for practitioners in designing interventions in the lives of this group of people, whose limited friendship and social support systems compromise quality of life and inclusion in the community. The article describes interventions that have been attempted to facilitate network building and friendship development for vulnerable or disadvantaged people in a wide range of contexts. The role of informal support systems is also discussed. A critique of these interventions is also presented and the conclusion reached is that while such models are not perfect and are often not rigorously evaluated, it is critical to provide assistance in order to achieve genuine social inclusion of people with acquired brain injury. It is their human right.
Monitoring Recovery of Cognitive Function Following Severe Traumatic Brain Injury
Authors: Wilson Barbara A. , Shiel Agnes , McLellan Lindsay , Horn Sandra , Watson Martin A.
Published: September 2006

We report on the development of a new assessment tool to monitor recovery after severe traumatic brain injury (TBI). Although a number of scales exist to identify such recovery, most are limited if one is interested in monitoring small changes or in setting goals for rehabilitation. This is due to the fact that items are too broad, they may cross more than one dimension (e.g. cognition and motor functioning) and there is a danger that recording of responses may be too subjective. The Wessex Head Injury Matrix (WHIM) was developed to avoid these problems. We observed 88 people with severe TBI. These were consecutive admissions to two hospitals. Mean coma duration was 14 days and mean duration of post traumatic amnesia (PTA) was 56 days. Of 145 behaviours observed, we selected 62 and each behaviour was compared to every other behaviour to determine a likely order of recovery. The resulting WHIM is an observational tool to assess and monitor cognitive recovery after severe head injury. It can be used with patients who are in coma, just out of coma or who are minimally conscious. Two case examples are provided.
Mode of Functional Connectivity in Amygdala Pathways Dissociates Level of Awareness for Signals of Fear
Authors: Williams Leanne M. , Das Pritha , Liddell Belinda J. , Kemp Andrew H. , Rennie Christopher J. , Gordon Evian
Published: September 2006

Many of the same regions of the human brain are activated during conscious attention to signals of fear and in the absence of awareness for these signals. The neural mechanisms that dissociate level of awareness from activation in these regions remain unknown. Using functional magnetic resonance imaging with connectivity analysis in healthy human subjects, we demonstrate that level of awareness for signals of fear depends on mode of functional connectivity in amygdala pathways rather than discrete patterns of activation in these pathways. Awareness for fear relied on negative connectivity within both cortical and subcortical pathways to the amygdala, suggesting that reentrant feedback may be necessary to afford such awareness. In contrast, responses to fear in the absence of awareness were supported by positive connections in a direct subcortical pathway to the amygdala, consistent with the view that excitatory feedforward connections along this pathway may be sufficient for automatic responses to “unseen” fear.
Orientation-Specific Computation in Stereoscopic Vision
Authors: Farell Bart
Published: September 2006

The left and right eyes receive subtly different images from a visual scene. Binocular disparities of retinal image locations are correlated with variation in the depth of objects in the scene and make stereoscopic depth perception possible. Disparity stereoscopically specifies a stimulus; changing the stimulus in a way that conserves its disparity leaves the stimulus stereoscopically unchanged. Therefore, a person’s ability to use stereo to see the depth separating any two objects should depend only on the disparities of the objects, which in turn depend on where the objects are, not what they are. However, I find that the disparity difference between two stimuli by itself predicts neither stereoacuity nor perceived depth. Human stereo vision is shown here to be most sensitive at detecting the relative depth of two gratings when they are parallel. Rotating one grating by as little as 10° lowers sensitivity. The rotation can make a perceptible depth separation invisible, although it changes neither the relative nor absolute disparities of the gratings, only their relative orientations. The effect of relative orientation is not confined to stimuli that, like gratings, vary along one dimension or to stimuli perceived to have a dominant orientation. Rather, it is the relative orientation of the one-dimensional components of stimuli, even broadband stimuli, that matters. This limit on stereoscopic depth perception appears to be intrinsic to the visual system’s computation of disparity; by taking place within orientation bands, the computation renders the coding of disparity inseparable from the coding of orientation.
The Role of Feedback in Shaping the Extra-Classical Receptive Field of Cortical Neurons: A Recurrent Network Model
Authors: Schwabe Lars , Obermayer Klaus , Angelucci Alessandra , Bressloff Paul C.
Published: September 2006

The responses of neurons in sensory cortices are affected by the spatial context within which stimuli are embedded. In the primary visual cortex (V1), orientation-selective responses to stimuli in the receptive field (RF) center are suppressed by similarly oriented stimuli in the RF surround. Surround suppression, a likely neural correlate of perceptual figure–ground segregation, is traditionally thought to be generated within V1 by long-range horizontal connections. Recently however, it has been shown that these connections are too short and too slow to mediate fast suppression from distant regions of the RF surround. We use an anatomically and physiologically constrained recurrent network model of macaque V1 to show how interareal feedback connections, which are faster and longer-range than horizontal connections, can generate “far” surround suppression. We provide a novel solution to the puzzle of how surround suppression can arise from excitatory feedback axons contacting predominantly excitatory neurons in V1. The basic mechanism involves divergent feedback connections from the far surround targeting pyramidal neurons sending monosynaptic horizontal connections to excitatory and inhibitory neurons in the RF center. One of several predictions of our model is that the “suppressive far surround” is not always suppressive, but can facilitate the response of the RF center, depending on the amount of excitatory drive to the local inhibitors. Our model provides a general mechanism of how top-down feedback signals directly contribute to generating cortical neuron responses to simple sensory stimuli.