bluuebunny/crossref_metadata_2025 huggingface dataset:
Therapy of iatrogenic subglottic stenosis: A steroid/antibiotic regimen
Authors: Croft Charles B. , Zub Konrad , Borowiecki Bernard
Published: October 2006

The authors have evaluated the efficacy of a medical regimen, consisting of systemic antibiotics and steroids, in the management of acute iatrogenic subglottic stenosis.

The study consisted of the infliction of a standardized subglottic injury to three groups of five dogs: Group I animals were placed on prednisone 1 mg/kg/24 hours and potassium phenoxymethyl penicillin 50 mg/kg/24 hours from the day of the trauma. Group II were placed on a similar regimen from the eighth day after subglottic trauma. Group III received no medical therapy at all. Therapy was continued in treated Groups I and II for five weeks. At the end of the study the dogs were sacrificed and the final degree of subglottic stenosis evaluated, at which time the laryngotracheal complexes were submitted for pathological evaluation.

A significant difference was found between the degree of stenosis attained in the three groups. The study suggests that the introduction of a steroid/antibiotic regimen has a beneficial effect in developing subglottic stenosis and that the timing of such therapy is of importance.
Sequential combination chemotherapy for advanced squamous cell carcinoma of the head and neck
Authors: Lester Eric P. , Kinnealey Ann , Matz Gregory J.
Published: October 2006

Thirty‐four patients with advanced squamous cell carcinoma of the head and neck have been treated with sequential combination chemotherapy consisting of Cytoxan, methotrexate, oncovin, bleomycin and adriamycin, followed by Leucovorin (COMBAL). All patients had undergone extensive prior radiation and/or surgery. All the patients had recurrent cancer.

Toxicity included two deaths from drug induced pancytophenia and one from sepsis. Treatment was well tolerated and could be given in the outpatient clinic. No bleomycin pulmonary or adriamycin cardiac toxicity was seen. Results include 4 patients who achieved complete remission, objective improvement in measurable lesions in 6 others, stabilization of disease for 1 to 3 mo. in 5, and progression of disease in 13. Survival has ranged from 1 to 19+ months with a median of 10.7 mo. for patients that were evaluated. We conclude that COMBAL produces objective evidence of improvement in approximately 45% of patients with far advanced, previously treated squamous cell carcinoma of the head and neck.
The surgical anatomy of the spinal accessory nerve and the internal branch of the superior laryngeal nerve
Authors: Hill James H. , Olson Nels R.
Published: October 2006

Injury to the spinal accessory nerve may occur during conservation neck dissection. In supraglottic laryngectomy preservation of the internal branch of the superior laryngeal nerve has largely been ignored. Cadaver dissection and diagrams are used to review the surgical anatomy of these two structures. Particularly important are the relationship of the spinal accessory nerve to the sternocleidomastoid muscle, its interaction with the cervical plexus, and its superficial path inferiorly. Landmarks for the identification of the internal branch of the superior laryngeal nerve are indicated, and technique for preservation is described. An intact accessory nerve can be efficiently preserved thereby eliminating the shoulder syndrome. Significant sparing of the internal branch of the superior laryngeal nerve can be routinely accomplished as an aid in minimizing postoperative aspiration.
Anterior table frontal sinus fractures
Authors: Whited Robert E.
Published: October 2006

Frontal sinus fractures cover a spectrum of injury. A series of 52 primarily treated patients from the University of Cincinnati Medical Center is presented. Initial systematic management was applied to these patients and consisted of complete radiographic evaluation supplemented by wound care and cosmetic restoration when needed. All patients were followed on a long‐term basis; both clinically and radiographically. Results to date are that 49 patients have had an uneventful post‐traumatic course with re‐establishment of normal sinus aeration. From the cosmetic standpoint no contour revisions have been needed and only two patients required elective scar revision. Three patients developed chronic suppurative sinus disease within the first post‐traumatic year which was readily diagnosed and managed without complication by osteoplastic frontal sinusotomy and adipose obliteration.
Clinical accuracy of tuning fork tests
Authors: Stankiewicz James A. , Mowry Harris J.
Published: October 2006

A review of the literature reveals a surprisingly sparse amount of true documentation concerning the validity of using tuning forks as an adjunctive measure in the diagnosis of hearing impairment. Most reports are historical or anecdotal. With this in mind, a protocol was set up to identify the value of three standard tuning fork tests ‐ the Rinne, the Weber, the Bing Occlusion ‐ at frequencies of 256, 512 and 1024 Hz. The data were compared to otologic examination, audiometry and acoustic impedance. Results indicate the Rinne, Weber and Bing Occlusion tests do not accurately predict the type of hearing impairment as frequently as the literature suggests.
Rehabilitation of the crippled larynx: Application of the tucker technique for muscle‐nerve reinnervation
Authors: May Mark , Lavorato Alfred S. , Bleyaert A. L.
Published: October 2006

Interruption of laryngeal innervation may partially or totally impair respiration, deglutition and phonation — the three basic laryngeal functions.

Tucker has developed a principle of muscle‐nerve pedicle transfer for laryngeal reinnervation to relieve airway obstruction following bilateral recurrent laryngeal nerve injury. We have applied the principle of reinnervation proposed by Tucker to treat patients not only with airway obstruction, but also with aspiration and impaired phonation due to interruption of laryngeal innervation. There were 23 patients in this study. The functional defects included: Voice alteration in 10 patients, airway obstruction in 8 and aspiration, as well as a voice change, in 5.

The causes of injury were surgery in 9 patients, trauma in 5, tumor in 3, polio in 1 and a birth defect in 1 patient. No cause of nerve injury could be determined in 4 patients.

The technique employed involved selective reinnervation of the laryngeal nerve branches to one or more laryngeal muscle groups; the muscle groups reinnervated were selected so as to overcome the functional defect of each particular patient.

The patients have been followed for 6 mo. or longer. The results have been independently evaluated by a speech pathologist and documented by indirect and direct endoscopic observations, as well as by audio and audio‐video recordings. In some cases, there was further documentation by cine‐fluoro‐audio tape recordings, laryngo‐pharyngography, laryngeal tomography and pulmonary function studes.

The muscle‐pedicle transfer technique described by Tucker was found to be useful to correct laryngeal dysfunction in carefully selected cases.
Carcinoma of the lip
Authors: Baker Shan R. , Krause Charles J.
Published: October 2006

Carcinoma of the lip is a common variety of head and neck malignancy frequently seen in the elderly Caucasian male. Three hundred and fifty consecutive cases of invasive squamous cell carcinoma of the lip are analyzed and the treatment methods and their results are presented. Surgical management is recommended for most patients because of the advantage of tumor margin assessment, avoidance of radiotherapy complications, and rapid rehabilitation.
Cholesteatoma with intact tympanic membrane: A report of 41 cases
Authors: House John W. , Sheehy James L.
Published: October 2006

Aural cholesteatoma may present itself as an unexplained hearing impairment without either perforation or otorrhea and without radiologic evidence of bone destruction. The etiology is probably congenital.

In our cholesteatoma cases, 3.7% occur in individuals with an intact tympanic membrane. Most of these patients have had the disease 5 years or less and 50% are under 20 years of age. Complications of the disease are uncommon in this group.

All but 1 of our 41 cases were managed with the intact canal wall technique. Most were reexplored (planned second‐stage) and residual disease was encountered in 32%.

One should keep the possibility of a congenital cholesteatoma in mind whenever encountering a unilateral serous otitis media or an unexplained unilateral conductive hearing impairment, regardless of the patient's age.
Cervical esophageal strictures ‐ a surgical approach
Authors: Pierce Max K.
Published: October 2006

Seven patients have successfully undergone surgical correction of their cervical esophageal strictures. The strictures are secondary to caustic ingestion or follow the repair for Zenker's diverticulum. In the first stage the stricture is exteriorized with an extended cervical esophagostomy. The second stage follows in four or six weeks, at which time the adjacent skin to the stoma is trap‐doored over the defect and provides a significant amount of skin to augment the esophageal lumen. All of these patients are eating normally.
Caustic ingestion: Controversies in management. A review of 214 cases
Authors: Hawkins Donald B. , Demeter Milan J. , Barnett Thomas E.
Published: October 2006

Two hundred fourteen patients admitted with a history of caustic ingestion are reviewed. Sixty‐five had mucosal penetrating burns. Children five years of age and under accounted for 39% of admissions, but only 8% of burns requiring treatment. Adults accounted for 48% of admissions and 81% of burns requiring treatment. Complications associated with mucosal penetrating burns occurred in 31 patients; all but one were due to lye or acids. A three year prospective study evaluating methylprednisolone in the management of caustic burns is reported. This included 24 patients with mucosal penetrating burns due to lye or acids. The results of this study, and this review as a whole, indicate that methylprednisolone is beneficial in moderately severe burns due to lye, but is not indicated for severe burns from liquid lye, or for acid burns.
Diagnosis of perilymph fistula using eng and impedance
Authors: Daspit C. Phillip , Churchill Diane , Linthicum Fred H.
Published: October 2006

The presence of perilymph fistula has been difficult to determine because of the lack of efficient and reliable testing methods. The condition is suspected on the basis of history alone and confirmed by surgery.

This paper details a quick, reliable procedure called the ENG fistula test, using impedance bridge for pressure change and electronystagmography to aid the establishment of nystagmus and dizziness. To evaluate this procedure, a combination of tests were performed, including Valsalva maneuver, tragal compression, and pneumatic otoscopy, which were previously considered helpful in the diagnosis of fistula. Of them, Valsalva maneuver and tragal compression proved inconclusive; pneumatic otoscopy proved to be helpful. In comparison, however, the ENG fistula test proved most valuable, with results surgically confirmed in 90.8% of cases in this series.

This study involved 74 patients whose primary complaint was dizziness. Only some patients simultaneously experienced hearing loss. Included are 5 patients whose positive ENG fistula test results and 15 whose negative test results were confirmed by surgery. Selected case histories are presented.
Cytomegalovirus and the otolaryngologist
Authors: Strauss Melvin
Published: October 2006

Human cytomegalovirus (CMV) is ubiquitous and has been documented as the etiologic factor in several diseases ranging from respiratory tract infection to congenital deafness. Special clinical manifestations of CMV of interest to the otolaryngologist are presented as related to the temporal bone and audiovestibular system, the facial nerve, the aerodigestive tract, the thyroid, the hematopoietic‐lymphoreticular system, and salivary gland.

In addition, current concepts of CMV oncogenic potential are discussed as they relate to head and neck neoplasms. The results of a study performed on surgical pathology specimens obtained from 26 patients, in an attempt to isolate CMV in tissue culture from salivary gland and/or neoplasms of the head and neck, detected no evidence of viral presence. The significance of these findings and the role of future research is discussed.
Epidemiology of head and neck cancer
Authors: Keane William M. , Atkins Joseph P. , Wetmore Ralph , Vidas Michael
Published: October 2006

Epidemiologic considerations which are pertinent to cancer of the head and neck are broad and varied. Cigarette smoking continues to be the major cause of head and neck neoplasms. Occupational and environmental exposures to carcinogens have been well identified. Tumors may develop as a result of medical therapies. Susceptibility on a genetic basis has been shown, and the role of viruses in carcinogenesis has been further documented.
Differences in the ability of cells to fuse are mediated by strains of epstein‐barr virus
Authors: Takimoto Torn , Sato Hiroshi , Ogura Hisashi , Tanaka Saichiroh , Masuda Koh , Ishikawa Shigeru , Umeda Ryozo
Published: October 2006

Epstein‐Barr virus (EBV) preparations from both NPC‐KT cells (NPC‐EBV) and P3HR‐1 cells (HR‐l‐EBV) can induce cell fusion between EBV receptor (EBVR)‐positive Raji cells and EBVR‐negative cells, but other strains of EBV cannot induce cell fusion. The effect of these two EBV isolates on ability of cells to fuse has been studied to determine if there are differences in the biological properties of the different EBV isolates, particularly the isolates obtained from nasopharyngeal carcinoma such as NPC‐EBV. The frequency of cell fusion between NPC‐EBV‐superinfected Raji cells and EBVR‐negative epithelial cells (Ad‐AH) was increased more than 30‐fold in the presence of medium containing 1% dimethylsulfoxide (DMSO). However, the frequency of cell fusion between HR‐1‐EBV‐superin‐fected Raji cells and Ad‐AH cells was unaffected under the same conditions. The data show that differences in the ability of cells to fuse ore induced by variants of EBV in response to DMSO. These differences may be important in elucidating the different biological properties of EBV isolates and might have implications for the pathophysiology of EBV‐associated illness.
Comparison of electrode sites in electrical stimulation of the cochlea
Authors: Lusted Hugh S. , Shelton Clough , Blair Simmons F.
Published: October 2006

There is considerable controversy about the “best” location for single channel cochlear implant electrodes. We measured the electrically induced auditory brain stem response (EABR) in a series of normal to totally denervated cat ears in response to promontory (P), round window (RW) and scala tympani (ST) stimulation. The status of the ganglion cell population was then assessed by light microscopy. In ears with light to medium ganglion cell loss the ST EABR yielded the most definitive input‐output functions. RW responses were present at increased thresholds and smaller peak amplitudes. P responses were worse or even missing completely. In severely damaged ears, including some with no detectable ganglion cells, ST and RW EABRs were both markedly reduced with considerable overlap between the two sites. P responses, when present, were almost buried in the electrical noise near threshold. Extrapolating these results to humans suggests that when ganglion cell loss is very severe the RW or ST is an acceptable stimulation site. When ganglion cell loss is moderate or better, ST electrodes are superior.
Documentation of upper airway obstruction in unilateral vocal cord paralysis: Flow‐volume loop studies in 43 subjects
Authors: Kashima Haskins K.
Published: October 2006

Upper airway impairment of variable severity occurs in unilateral vocal cord paralysis (UVCP). Among 43 subjects with UVCP all had voice disturbance, 22 had symptoms of airway impairment, and 27 had some disturbance of swallowing. The severity of the airway impairment was evaluated by flow‐volume loop spirogram which demonstrated reduced inspiratory flow rates (maximal and midvital capacity). Clinical recovery from paralysis or intracordal Teflonr̀ injection was accompanied by improvement in inspiratory flow rates.

Airway impairment is most severe in subjects having UVCP due to intrathoracic disorder or intraoperative nerve interruption. Vocal cord position did not correlate with the severity of airway disturbance.

The FVC and FEV1 determinations were normal in 33 and 29 cases, respectively, whereas the I‐50 and E‐50/I‐50 were normal in only 11 and 7 instances. This selective restriction of inspiratory flow rates and the abnormally low E‐50/I‐50 ratio was observed regularly. The sensitivity and reproducibility of the flow‐volume loop examination support the utilization of this test to evaluate the nature and severity of upper airway impairment; consecutive examinations can be utilized to monitor the clinical course or outcome from treatment.
Composite nasal septal cartilage graft for reconstruction after extended frontolateral hemilaryngectomy
Authors: Butcher R. Brent , Dunham Michael
Published: October 2006

With the advent of extended partial laryngectomy for T2 and selected T3 true vocal cord carcinomas, the head and neck surgeon has had to deal not only with the rehabilitation of voice, but with the problem of laryngeal stenosis with obstruction of laryngeal airflow. To manage this difficult problem, it is necessary to restore the cartilagenous superstructure to prevent collapse of the laryngeal soft tissues. This is best done at the time of initial cancer resection. At the time of extended frontal lateral hemilaryngectomy, an exact template of the resected cartilage is made. From this, a composite nasal septal cartilage graft is utilized to restore the laryngeal superstructure. The anterior commissure is reconstructed by scoring the septal cartilage. It has been our experience with this procedure that the neoglottis remains both competent and functional.
Changes in the bacterial flora of the external ear canal from the wearing of occlusive equipment
Authors: Brook Itzhak , Coolbaugh James C.
Published: October 2006

External otitis has been associated with wearing obstructive gear covering the earlobe and external ear canal. In this study we investigated the changes in the bacterial flora of the external ear canal after wearing rubber hoods.

The bacterial flora of external ear canals surfaces was investigated in a group of 19 volunteers who wore rubber hoods for n period of 25 to 30 minutes while doing manual work. The protective effect of 2% acetic acid was tested by intilling it in the left ear of all participants. Staphylococcus epidermidis, Propionibacterium acnes, and alpha‐hemolytic streptococci were the predominant isolates from the ear samples. After hoods were worn, there was a substantial increase in the number of these organisms in 7 (36.8%) of the external ears. However, an increase in the bacterial counts in the external ear canals occurred in only 2 (10.5%) of the individuals treated prophylactically with acetic acid drops (P<0.02).
Laryngotracheal stenosis in spondyloepiphyseal dysplasia
Authors: Myer Charles M. , Cotton Robin T.
Published: October 2006

Laryngotracheal stenosis has not been reported previously as a manifestation of spondylocpiphyseal dysplasiu. Two recent cases are reported detailing the upper airway pathology encountered. The clinical features of spondyloepiphyseal dysplasiu are reviewed in an attempt to develop a treatment protocol for such patients with laryngotracheal stenosis. The ultrastructural abnormalities found in these patients' cartilages are emphasized. Caution is advised before attempting laryngotracheoplasty.
Sinusitis in immunodeficient and immunosuppressed patients
Authors: Berlinger Norman T.
Published: October 2006

Sinusitis tends to occur in immunodeficient and immunosuppressed patients during periods of severe leukopenia. This group of patients includes those with primary immunodeficiency diseases, patients with leukemia receiving chemotherapy, and those undergoing bone marrow transplantation or kidney transplantation. The clinical and radiographic signs may be minimal or initially unimpressive. Sinusitis clue to Aspergillus, Phycomycetes, or Psendomonas may be fulminant and even fatal, requiring extensive surgical procedures for control.
Evaluation of the effectiveness of uvulopalatopharyngoplasty
Authors: Conway William A. , Slcklesteel Jeanne M. , Wittig Robert M. , Fujita Shiro , Zorick Frank J. , Roehrs Timothy A. , Roth Thomas
Published: October 2006

A new surgical procedure to treat obstructive sleep apncn by uvulopalatopharyngoplasty (UPPP) was evaluated in 66 patients, 63 men and 3 women, with objectively documented sleep apnea syndrome. Removal of redundant tissue in the oropharynx (UPPP) significantly improved excessive daytime sleepiness, reduced by half the frequency of apneas and hypoxia occurring during sleep, and improved the quality of sleep. Closer analysis indicated that all 66 patients did not benefit to the same degree. Among patients classified as responders, the frequency of apnea was reduced to a level seen in healthy adults of the same age, measures of sleep approached normal, and excessive daytime sleepiness was eliminated. In nonresponders, frequency of apnea and consequent disruption of sleep was not reduced, but nocturnal hypoxia was improved.
The versatile cartilage autograft in reconstruction of the nose and face
Authors: Tardy M. Eugene , Denneny James , Fritsch Michael H.
Published: October 2006

This paper deals with the long‐term follow‐up of cartilage autografts taken from various parts of the body to reconstruct areas of the nose, ear, trachea, eyelid, and other areas of the body which require augmentation, effacement, and long‐term support. Our thesis will be that the cartilage autograft is the implant of choice in many of these areas, and that fate of autogenous cartilage is well known and should be given strong priority in facial grafting.
Three‐dimensional computer reconstruction of the neuromuscular junction distribution in the human posterior cricoarytenoid muscle
Authors: Gambino Dean R. , Malmgren Leslie T. , Gacek Richard R.
Published: October 2006

Recent studies have indicated that in a denervated muscle highly specific interactions occur between regenerating axons and the basal lamina of the myofiber precisely at the original synaptic sites. Since these findings suggest that synapse regeneration is facilitated at the original synaptic sites, a knowledge of the distribution of neuromuscular junctions in the human posterior cricoarytenoid (PCA) muscle may guide reinnervation procedures in this muscle. We, therefore, have used histochemical and computer graphics techniques to reconstruct the three‐dimensional distribution of neuromuscular junctions in the human PCA taken fresh at autopsy. The results indicated a more localized pattern of neuromuscular junctions as compared to the human thyroarytenoid muscle. The results will be discussed with respect to their implications for procedures for reinnervation of the posterior cricoarytenoid muscle.
The petrified auricle: Comments on ossification, calcification and exostoses of the external ear
Authors: Dibartolomeo Joseph R.
Published: October 2006

The petrified auricle is a clinical entity in which the auricle, in part or total, has become stone‐hard and moves as a rigid unit. This uncommon condition is most often due to ectopic calcification of the auricular cartilage. It may occur as a result of local trauma, in association with various systemic diseases such as Addison's disease, hypopituitarism, thyroid or parathyroid disorders, or following radiation therapy. Auricular ossificans (ectopic ossification) is a rare phenomenon in which the rigidity of the petrified ear is due to replacement of the elastic cartilage by bone. In the literature there are presently nine cases documented histologically. Two more cases are reported here.

In most cases, the auricular changes are preceded by acute, severe hypothermia (frostbite). Exostoses of the external auditory canal is another disease of the external ear in which the proliferation of bone follows chronic mild hypothermia of the external auditory canal caused by exposure to cold water while surfing. It is postulated that if surfers who have developed exostoses of the external auditory canal from the cold water continue to enjoy such littoral activities, ossification of the auricle may also occur.
Group psychotherapy for head and neck cancer patients
Authors: Harris Lenore L. , Vogtsberger Kenneth N. , Mattox Douglas E.
Published: October 2006

The diagnosis of cancer has n profound emotional effect on the patient. We report the two‐year experience of a weekly support group attended by 142 hospitalized head and neck cancer patients and 33 family members.

The major goal for the group was to provide an open forum for discussion of any problems that faced the patient. Group size was usually four to eight patients and two to four therapists. Weekly data sheets documented attendance and major themes for the group. The most common theme was anticipation of and reaction to treatment.

Initial difficulties with the group included ambivalence by the professional staff, Iow attendance, and logistical problems. Subjective impressions of the staff were that the group improved patients morale, patient to patient support, compliance, and decreased the rate of discharge against medical advice.
Head and neck complications of epidermolysis bullosa
Authors: Kaluza Charles , Kennedy Bobby Joe , Harman Lee
Published: October 2006

Epidermolysis bullosa is a rare congenital skin disease which is characterized by easy formation of traumatic skin bullae. The disease is usually detected in early infancy due to the recurrent bullae. Prognosis is dependent on the histological variant which is present. A case of autosomal recessive epidermolysis bullosa is presented, which demonstrates many of the head and neck complications of the disease. Traditional skin care modalities as well as multiple surgical procedures such as skin grafts and the use of amniotic membrane were used without success. Limited natural healing, which was possibly promoted by oral phenytoin, has occurred.
Benign parotid diseases of childhood
Authors: Wright Geoffrey L. , Smith Richard J. H. , Katz Charles D. , Atkins James H.
Published: October 2006

A 25‐year retrospective study of 63 pediatric surgical cases of benign parotid disease was done. Inflammatory disorders accounted for 34 of the cases. The remaining 29 non‐inflammatory conditions included vasoformative, solid, and cystic lesions and were nearly always asymptomatic.
Microscopic analysis of the mastoid bone in chronic serous otitis media
Authors: Newberg Lewis B. , Ling Virginia , Shamsuddin Abulkalam M.
Published: October 2006

The puthologic changes of the middle ear and mastoid bone mucosa in two pediatric patients with long standing chronic serous otitis media were studied by electron and light microscopy. The embryological development of the eustachian tube, middle ear cleft, and mastoid bone suggests a common physiological and anatomical continuity. The histological changes by light and electron microscopy in these patients demonstrates the metaplastic changes of the basal cell of the mucosa differentiating into mucous and keratin cells. These metaplastic changes are associated with the exudative process known as chronic serous otitis media.
Surgical section of the posterior ampullary nerve
Authors: Meyerhoff William L.
Published: October 2006

Surgical section of the posterior ampullary nerve (PAN) has been used as a form of therapy for persistent benign paroxysmal positional vertigo (BPPV). Eighteen patients were reviewed. The PAN was identified in 16 patients, 15 of whom were completely cured and one of whom had improvement of symptoms. Severe sensorineural hearing loss (SNHL) occurred in three patients. This study suggests that surgical section of the PAN is effective. The procedure is facilitated by a postauricular incision and canalplasty.
Sinusitis in intensive care unit patients
Authors: Kronbiorg Frank G. , Goodwin W. Jarrard
Published: October 2006

The ultimate source of sepsis may be difficult to pinpoint in critically ill patients with multiple possible sources of iatrogenic infection. In the last year, we have been consulted with regard to several febrile intensive care unit patients in whom sinusitis was initially identified by computerized axial tomography done for other reasons. The questions are: 1. are the x‐ray findings significant; 2. is this the cause of fever and sepsis; 3. how should the patient be treated for this problem; and 4. can this be prevented.

In five patients, sepsis was clearly related to sinusitis. Treatment had included nasal tubes in all six patients, and in addition, five patients had received high doses of corticosteroids while intubated. The sixth patient was a diabetic.

Etiology, diagnosis, and management are discussed in detail. We believe that prolonged nasal intubation should be avoided, particularly in patients with decreased resistance to infection. Initial treatment consists of removing intranasal tubes and the administration of broad spectrum or culture specific antibiotics. Surgery is indicnted in the event of persistent sepsis or secondary complications. Computerized tomography is an excellent tool for diagnosis and following response to therapy.
Tracheostomy tube fracture: An unusual etiology of upper respiratory airway obstruction
Authors: Otto Randal A. , Davis William
Published: October 2006

Tracheostomy tube fracture with subsequent migration of the proximal fragment down the tracheobronchial tree is an almost unheard of cause of tracheal foreign bodies. Most such occurrences have been reported outside the United States, and only six previous reports have been filed. We report an additional case of fractured tracheostomy tube and review the literature.
Newer technique of tracheoesophageal fistula for vocal rehabilitation after total laryngectomy
Authors: Maniglia Anthony J.
Published: October 2006

In 1982, we published a new technique to create a tracheoesophageal (TE) fistula, using the combination of an endotracheal tube and a flexible fiberoptic nasophoryngolaryngoscope. An even more simple technique using a fenestrated metal Yankauer Tonsillar saction is now introduced. This technique allows for the TE fistula to be made by any level of the tracheo‐esophageal junction. It is easily done with topical and local anesthesia with the patient sitting on the otolaryngology examination chair. The method described has been used in 25 consecutive cases with no complications.
Epidermoid cysts, sulci, and mucosal bridges of the true vocal cord: A report of 157 cases
Authors: Bouchayer Marc , Cornut Guy , Loire Robert , Roch J. Blaise , Witzig Edouard , Bastian Robert W.
Published: October 2006

Presented is a summary of our experience with 157 patients having a diagnosis of epidermoid cyst, glottic sulcus, or mucosal bridge of the true vocal cord. Each patient in this group was diagnosed and treated jointly by a phoniatrist and microlaryngoscopist and then evaluated for results of surgical and phoniatric therapy.

Included in the discussion are methods of examination and diagnosis, microanatomy and histopathology of the lesions, methods of treatment, and results of treatment. An argument for a common etiology for these lesions is advanced.
The bifid UVULA: Is it a marker for an otitis prone child?
Authors: Schwartz Richard H. , Rodriquez William J. , Hayden Gregory F. , Shprintzen Robert J. , Cassidy J. William
Published: October 2006

All children seen by a pediatrician in a suburban practice during an 18‐month interval were examined carefully for the presence of an abnormal uvula. Isolated bifid uvula, without overt cleft palate, was detected among 44 children who had been followed in the practice during the first three years of life. A chart review was performed to determine the frequency of acute otitis media (AOM) and of insertion of tympanostomy tubes among these study patients and among age‐matched controls with normal uvulas. Compared to control children, a slightly higher proportion of children with bifid uvulas had experienced more than one episode of AOM (64% vs. 49%) and more than three episodes of AOM (16% vs. 8%) during the first year of life, but these differences were not statistically significant. By age 3 years, the incidences of AOM in the compared groups were more nearly equal. Insertion of tympanostomy tubes during the first three years of life for persistent middle ear effusion was slightly more common among the bifid uvula group than among the controls (14% vs. 10%), but this difference again was not statistically significant. Children with bifid uvula may be at slightly increased risk of middle ear problems during the first years of life, but the magnitude of this increase, if any, appears small.
Value of ct scan in the diagnosis of temporal bone diseases in children
Authors: Zalzal George H. , Shott Sally R. , Towbin Richard , Cotton Robin T.
Published: October 2006

CT scan of the temporal bone has become a frequently ordered test for diagnosis of temporal bone pathology. We retrospectively examined our experience with CT scans of the temporal bones in 124 consecutive children from January 1983 to September 1984 in an attempt to assess its usefulness in diagnosis and treatment of ear disease in children. Patients were divided into six categories according to their pre‐scan diagnosis, (trauma, congenital aural atresia, dizziness, facial nerve paralysis, middle ear disease, congenital sensorineural hearing loss) and CT findings were compared to data found by physical examination, by otologic studies such as audiogram and BSER, by other x‐ray studies and ultimately compared to findings at surgery when applicable.

CT was found to be instrumental in diagnosing middle ear disease; gave necessary preoperative information in children with aural atresia; delineated most temporal bone fractures; ruled out gross inflammatory, neoplastic, or traumatic etiologies in dizzy patients and in facial nerve abnormalities; and provided anatomic information about the inner ear in patients with sensorineural hearing loss. In our group of patients with sensorineural hearing loss, a 6.8% incidence of anatomic malformations was found by CT. However, CT had major limitations in stapes and oval window areas, especially in cases of perilymph fistulas. CT use was also limited in children because of the difficulty in achieving projections that require active patient cooperation.
Partial laryngectomy for vocal cord cancer with marked limitation or fixation of the vocal cord
Authors: Biller Hugh F. , Lawson William
Published: October 2006

Partial laryngectomy was the procedure utilized to treat 26 patients with either marked limitation of vocal cord motion or fixation. The absolute 24‐month tumor free control rate was 73% (19 of 26). Extended hemilaryngectomy with cricoid resection should be performed if subglottic extension of 5 mm or greater is present. Extended hemilaryngectomy has a greater complication rate than the classical hemilaryngectomy.
Epiglotto‐Aryepiglottopexy: A surgical procedure for severe aspiration
Authors: Laurian N. , Shvili Y. , Zohar Y.
Published: October 2006

The loss of the protective function of the larynx is a severe complication of major ablative procedures in the upper aerodigestive tract and of certain severe neurological disorders. This may result in chronic life‐threatening aspiration. Anterior pharyngotomy was used to perform epiglotto‐aryepiglottopexy in four patients. The aim of this procedure is to close the laryngeal inlet and thus prevent aspiration without permanent loss of speech. In two of the patients, it was necessary to reoperate because of partial detachment of the epiglottis. This was performed successfully using the endoscopic approach. As a result, three patients have no aspiration and one has mild aspiration following epiglotto‐aryepiglottopexy.
Autoimmune thyroiditis: Pathophysiology and relationship to thyroid cancer
Authors: Maceri Dennis R. , Sullivan Michael J. , Mcclatchney Kenneth D.
Published: October 2006

Autoimmune thyroiditis (Hashimoto's disease) is one of a myriad of clinical entities associated with the endocrine system. The disease is thought to be a defect in the immune regulatory system. The following report is a study of 112 cases of Hashimoto's thyroiditis treated over a 10‐year period. The incidence of malignancy associated with autoimmune thyroiditis in this study was 6.3%, which correlates well with the incidence of thyroid cancer seen in the general population at autopsy. We have concluded from this study that patients with autoimmune thyroid endocrinopathy are at no greater risk for the development of thyroid malignancy than the general population.

A review of the pathophysiology of autoimmune disorders is discussed and recommendations for treatment of patients with Hashimoto's disease is provided.
Nonrecurrent laryngeal nerves and their clinical significance
Authors: Friedman Michael , Toriumi Dean M. , Grybauskas Vytenis , Katz Arthur
Published: October 2006

The anomalous position of a nonrecurrent laryngeal nerve predisposes the nerve to injury during thyroidectomy and to compression by a thyroid mass. We present three cases in which a seemingly benign thyroid mass traumatized a nonrecurrent laryngeal nerve resulting in either vocal cord paralysis or a vague pressure sensation over the larynx. Some of these patients feel as if they need to clear a foreign body and present with a chronic cough. Normally the nerve is protected from thyroid masses as it passes through the tracheoesophageal groove. In all three patients, surgical excision of the thyroid mass and release of the nerve resulted in recovery of the nerve and resolution of the symptoms. We have found that small, benign, or otherwise asymptomatic lesions of the thyroid gland have a greater tendency to cause vocal cord paralysis in patients with nonrecurrent laryngeal nerves. The surgeon must always be aware of the possibility of the presence of a nonrecurrent laryngeal nerve.
Osteomyelitis of the base of the skull
Authors: Chandler James R. , Grobman Lawrence , Quencer Robert , Serafini Aldo
Published: October 2006

Infection in the marrow of the temporal, occipital, and sphenoid bones is an uncommon, but increasing occurrence. It is usually secondary to infections beginning in the external auditory canal and is caused almost uniformly by the gram negative Pseudomonas aeruginosa bacteria. Technetium and gallium scintigraphy help in the early detection of such infections while CT scans demonstrate dissolution of bone in well‐developed cases. Headache is the predominant symptom. Dysphagia, hoarseness, and aspiration herald the inevitable march of cranial nerves. We have diagnosed and treated 17 cases of osteomyelitis of the skull base. Although the total mortality rate is 53%, it is now a curable disease. Six of our last 8 patients remain alive, although 1 is still under treatment. Treatment is medical and requires the long‐term concomitant intravenous administration of an aminoglycoside and a broad spectrum semisynthetic penicillin effective against the causative organism.
Intracranial otogenic complications: a persisting problem
Authors: Samuel Julian , Fernandes Carlos M. C. , Steinberg Johannes L.
Published: October 2006

Three hundred thirty‐five cases of acute mastoiditis with complications due to extension of infection beyond the mastoid are reported. Two hundred twenty‐four of those presented with intracranial sepsis. Meningitis occurred in 83 cases, brain abscess in 53, extradural abscess in 49 cases, and lateral sinus thrombosis in 39 cases.

Intracranial complications are frequently seen in this group of patients with neglected otitis media. The complications occurred frequently in children and young adults (74%) with an overall mortality rate of 14%.

Meningitis was the most common complication (37%); brain abscess had the highest mortality rate (36%). The overall mortality rate from intracranial complications was reduced in comparison with previous reported series. This is attributed to antibiotic treatment, the use of CT scan in excluding other intracranial complications, and close cooperation between the otologist and neurosurgeon.
Pathology of surgery after induction chemotherapy: an analysis of resectability and locoregional control
Authors: Norris Charles M. , Fabian Richard L. , Miller Daniel , Clark John R. , Ervin Thomas J. , Fallon Barbara , Tuttle Stephanie A. , Frei Emil
Published: October 2006

At the Dann‐Farber Cancer Institute Head and Neck Cancer Clinic, 114 previously untreated patients with advanced squamous cell carcinoma of the head and neck (17% stage III; 83% stage IV) were managed with induction chemotherapy using cis‐platinum, bleomycin, and methotrexate, followed by definitive extirpative surgery and/or radiation therapy. The present report evaluates this group from a surgical and surgical pathology standpoint. The following aspects are evaluated: 1. predictability of, and conversion to, resectability during induction chemotherapy; 2. ease of surgical technique and intraoperative assessment; 3. patterns of pre‐op and postop risks and complications; 4. gross and histopathologic observations of the extent and character of residual primary and nodal disease, particularly after a response to chemotherapy; 5. patterns of locoregional control or failure related to treatment variables.

The issues subsequently addressed include: how does chemotherapy affect the operative candidacy and resectability of proposed surgical patients? Could, or should surgery be eliminated in the management of some patients treated with induction chemotherapy? Can less radical surgery be contemplated in patients significantly “downstaged” by prior chemotherapy treatment? Is increased locoregional or distant metastatic control observed in these patients? What is the role of surgery in the responder to chemotherapy?
Tonsillectomy: A clinical study comparing the effects of local versus general anesthesia
Authors: Mcclairen Willie C. , Strauss Melvin
Published: October 2006

The purpose of tonsillectomy is the complete removal of the palatine tonsils with minimal blood loss while avoiding unnecessary trauma to adjacent tissue. Despite the fact that advances in modern general anesthetic techniques have lessened risks, it has not been clear what specific differences there are when using local versus general anesthesia for tonsillectomy. In order to provide some objective information as to the advantages or disadvantages of performing tonsillectomy using local or general anesthesia, a retrospective analysis was performed on 73 fully evaluable cases of adult tonsillectomy performed in an 8 1/2‐year period. Approximately one half of these were performed using local and one half general anesthesia. Analyses of the data indicated statistically significant differences in the methods. With local anesthesia the operation required less time, produced less intraoperative hemorrhage, and was less costly. However, there was no significant difference in the incidence of postoperative complications or morbidity.
Surgical complications following twice‐a‐day versus once‐a‐day radiation therapy
Authors: Metson Ralph , Freehling Deborah J. , Wang C. C.
Published: October 2006

With increasing numbers of radiotherapists using twice‐a‐day (BID) rather than conventional once‐a‐day (QD) radiation therapy to treat carcinomas of the head and neck, we attempted to determine whether the increased tissue reaction seen with a BID program results in greater morbidity for subsequent surgery. Postoperative complications in 24 patients receiving prior BID irradiation were compared with 37 controls receiving QD treatments. The incidence of major surgical complications for BID and QD groups was equivalent (20.8% and 18.9%, respectively). The incidence of minor complications was almost three times greater for the BID group (37.5% vs. 13.5%). Patients receiving BID radiation therapy required twice as many intraoperative transfusions (2.13 us. 1.11) and five additional days of postoperative hospitalization (23.7 vs. 18.2). These differences are statistically significant with p‐values of <0.5 and <0.1, respectively. We consider this increase in surgical morbidity to be acceptable if BID radiation therapy leads to improved tumor control.
The second Joseph H. Ogura memorial lecture complications of laryngeal surgery: Etiology and prevention
Authors: Waed Paul H.
Published: October 2006

Conservation, surgery has developed into the fine‐tuned, state‐of‐the‐art procedure during the past century. With success have come the complications of stenosis, edema, infection, granulation tissue, scarring, paralysis of the laryngeal nerves, slough, aspiration, and recurrence of tumor. Some of these problems can be prevented by solid anatomical knowledge and meticulous surgery.
Evaluation of olfactory dysfunction in the connecticut chemosensory clinical research center
Authors: Cain William S. , Goodspeed Ronald B. , Gent Janneane F. , Leonard Gerald
Published: October 2006

The olfactory test administered to patients at the Connecticut Chemosensory Clinical Research Center combines stability of outcome with sensitivity to variables known to affect olfaction (age, sex). The test, which pairs an odor threshold component with an odor identification component, readily resolves differences in function between patients and controls. It reveals differences in the distribution of functioning for various probable causes (nasal/sinus disease, postupper respiratory infection, and head trauma), proves sensitive to improvements in function caused by therapeutic intervention (ethmoidectomy, steroid administration for nasal/sinus disease), and correlates with objective signs of nasal/sinus disease (visual exam, x‐ray). The two components of the test agree well, though the odor identification component seems somewhat more sensitive than the threshold component as currently designed.
The superior laryngeal nerve: Its projection to the dorsal motor nucleus of the vagus in the guinea pig
Authors: Basterra J. , Chumbley C. C. , Dilly P. N.
Published: October 2006

The distribution of neurons in the dorsal motor nucleus of the vagus nerve (DMNV) that innervate the supraglottic and glottic areas of the larynx of the guinea pig have been studied using the horseradish peroxidase (HRP) technique. Following soaking of the superior laryngeal nerve in a solution of HRP, labeled neurons were always located ipsilaterally, at levels between the estria acustica and the caudal end of the inferior olivary nucleus. Characteristically, the neurons were small or medium in size.
Laryngotracheal injury following cricothyroidotomy
Authors: Kuriloff Daniel B. , Setzen Michael , Portnoy William , Gadaleta Dominick
Published: October 2006

Airway complications following elective cricothyroidotomy were reviewed in 48 adult cardiothoracic surgery patients. A 52% incidence of airway complications was found and manifested by failed or delayed decannulation, extensive subglottic granulation tissue, stenosis, vocal cord paralysis, and aspiration pneumonia. The most common cause for decannulation difficulty was subglottic stenosis (50%).

Several risk factors were specifically identified, including a period of cricothyroid cannulation exceeding 30 days, the presence of diabetes, and advanced age.

These findings suggest that airway sequelae following cricothyroidotomy in cardiothoracic surgery patients is higher than previously reported. Indications and risk factors for cricothyroidotomy are discussed.
High‐activity iodine‐125 endocurietherapy for head and neck tumors
Authors: Pradeep Kumar P. , Good Roger R. , Yonkers Anthony J. , Ogren Frederic P.
Published: October 2006

Inoperable solid tumor recurrence within a surgical bed or within a previously irradiated field usually responds poorly to re‐treatment with conventional external beam irradiation (EXRT) and/or chemotherapy. We present a new, alternative method of re‐treatment used in two patients with recurrent head and neck cancer involving the parotid (adenocarcinoma) and neck nodes (squamous cell carcinoma). These patients were successfully re‐treated with high‐activity 125iodine (I‐125) permanent implantation.