bluuebunny/crossref_metadata_2025 huggingface dataset:
Malakoplakia of the Maxillary Sinus
Authors: Nistal Manuel , Regadera Javier , Paniagua Ricardo , Razquin Socorro , Gavilan Javier
Published: January 2017

The first case of malakoplakia in the nasal cavities is reported. The patient, a 21-year-old man, presented a polypoid formation in the left maxillary sinus that was removed and studied by light and electron microscopy. The polypoid formation consisted of pseudostratified epithelium surrounding a central myxoid tissue which contained fibroblasts, histiocytes, and small inflammatory infiltrates. The most relevant features were histiocyte accumulations containing 1 to 5-μm diameter granules which displayed a concentric multilayered configuration. Ultrastructural findings revealed three types of lysosomes within the histiocyte cytoplasm: phagolysosomes, intermediate bodies, and Michaelis-Gutmann bodies. Septate junctions between lysosomes were frequent. The etiopathogenesis of this lesion is discussed.
Damage to the Cochlea following Interrupted Exposure to Low Frequency Noise
Authors: Bohne Barbara A. , Zahn Shirley J. , Bozzay Denyse G.
Published: January 2017

This study determines how the magnitude and pattern of cochlear damage is altered when exposure to noise is interrupted by regularly spaced rest periods. Groups of chinchillas were exposed for six hours per session to an octave band of noise with a center frequency of 0.5 kHz. The rest interval between successive exposures varied from 18 to 162 hours. The total energy in these exposures was equal to that in a nine-day continuous exposure at 95 dB sound pressure level. The ears of all animals were prepared for histological study so that the extent of cochlear damage could be determined. The pattern of damage produced by interrupted exposure to low frequency noise was the same as that found with continuous exposure, while the magnitude of damage was usually reduced. The amount of protection provided by a particular rest period was found to be different for the low and high frequency regions of the cochlea. The significance of these findings with regard to the mechanisms of noise damage is discussed.
Multiple Primary Cancer Risk in Patients with Major Salivary Gland Carcinoma
Authors: Spitz Margaret R. , Newell Guy R. , Byers Robert M. , Gibeau Joanne M. , Batsakis John G.
Published: January 2017

The subsequent primary cancer experience of 498 patients with major salivary gland carcinoma was evaluated using a life-table approach. Expected numbers were generated from two sources. These were population-based tumor registry data and an internal comparison group of randomly selected individually matched patients drawn from the same institution. Compared with either referent group, elevated risk ratios for all cancer sites combined were demonstrated. Risks for subsequent lung cancer were raised but were not statistically significant. For subsequent skin cancer, significantly elevated risks were noted.
Aluminum Oxide Ceramic Ossicular Replacement Prosthesis
Authors: Yamamoto Etsuo
Published: January 2017

Two different prototypes of columella materials made from aluminum oxide ceramics were newly designed by the author for ossicular reconstruction. CORP-P (ceramic ossicular replacement prosthesis-partial) is used as a columella to fit onto the stapes head, and CORP-T (ceramic ossicular replacement prosthesis-total) is used as a columella placed onto the footplate of the stapes. In addition to the general properties of ceramic implants, CORP has these two characteristics: the unique shape of its head, which allows easy and smooth contact with the fascia graft, and the radiopacity, which makes it possible to confirm the position of the implants by x-ray examination after implantation.
Influence of Environmental Temperature on Human Nasal Mucosa
Authors: Olsson Peter , Bende Mats
Published: January 2017

Nasal mucosal blood flow and nasal patency were studied in seven healthy subjects in order to evaluate normal physiological reactions to cold and heat. Blood flow was measured by means of the 133Xe washout method, and nasal patency was determined by measuring maximal nasal expiratory air flow. In comparison with the results at room temperature (23°C), there was a decreased blood flow and a decreased nasal patency after 20 minutes of exposure to cold (6°C). After exposure to heat (40°C), an unaltered blood flow and an increased nasal patency were registered. The results suggest that nasal patency is important for the conditioning of air and support the hypothesis that changes in nasal mucosal blood flow is engaged in body temperature regulation.
Epidermal Cysts of Temporal Fossa: An Unusual Complication of Ear Surgery
Authors: Tovi Ferit , Bartal Nodar , Zirkin Chaim
Published: January 2017

Otologic procedures have been described as etiologic factors in the development of epidermal cysts in the middle ear as well as in the tympanic membrane. We recently treated two cases of large epidermal cysts of the temporal fossa with extension to the infratemporal space; both cases had histories of ear surgery on the same side as the cysts and therefore the cysts are presumed to have originated from implanted epidermal elements at the time of surgery.
The Annular Ligament Attachment to the Normal Human Stapes Footplate
Authors: Graham Malcolm D.
Published: January 2017

Following disarticulation of the stapes from the oval window, the free edge of the adult human stapes was examined with the scanning electron microscope. Regions of the articulating surface of the rim were examined and found to vary considerably. Anterior, posterior, and lateral ligaments are described, each with tympanic, intermediate, and lateral components.
Measurement of Action Potential Thresholds in Experimental Endolymphatic Hydrops
Authors: Morizono Tetsuo , Cohen James , Sikora Michael A.
Published: January 2017

Unilateral experimental endolymphatic hydrops was created by endolymphatic sac and duct obstruction in guinea pigs. Studies of action potential (AP) threshold were then performed and compared with histologic findings. Action potential thresholds were significantly increased in the hydrops ears. The close relationship between AP changes and hydrops was sufficient to allow the detection of hydrops by AP threshold measurements alone. The AP threshold changes were positively related to the degree of hydrops and postoperative interval in a manner consistent with hearing changes seen in Meniere's disease. Based upon the foregoing, experimental endolymphatic hydrops appears to be a valid and usable model for the study of the cochlear aspects of Meniere's disease.
Nasal Blood Flow and Airway Resistance Canine Study
Authors: Lung Mary A. K. Y. , Wang James C. C.
Published: January 2017

Nasal blood flow was measured in anesthetized dogs by an electromagnetic flow sensor placed around the terminal branch of the internal maxillary artery, the major arterial supply to the nasal mucosa. Nasal airway resistance was monitored simultaneously by recording the transnasal pressure when airflow through the nasal cavity was maintained constant. Phenylephrine decreased nasal blood flow and airway resistance while albuterol (salbutamol) did the opposite. Prostaglandin E, increased nasal blood flow but decreased airway resistance. The present study demonstrates that nasal vascular and airway resistances may change in parallel or opposite directions, implying that nasal airway resistance cannot be used to assess the vascular situation in the nose.
Effect of a Middle Ear Immune Response on Inner Ear Antibody Levels
Authors: Harris Jeffrey P. , Ryan Allen F.
Published: January 2017

The effect of a middle ear immune response upon antibody levels in the perilymphatic compartment of the inner ear was investigated in the guinea pig. Animals were systemically sensitized with keyhole limpet hemocyanin (KLH) and bovine serum albumin (BSA) until high circulating levels were achieved. The middle ear cavity was then challenged with KLH, resulting in a vigorous immune response with effusion and mucosal inflammation. Antibody levels against KLH and BSA were then compared in serum, middle ear effusions, and perilymph. Anti-KLH levels in perilymph were found to increase substantially during middle ear response to challenge, while the anti-BSA levels did not, indicating a local origin for the anti-KLH antibody. The most likely explanations for these findings are 1) inner ear antibody originated in the middle ear and diffused across the round window membrane, or 2) antigen diffused across the round window membrane and evoked local production of antibody within the inner ear.
Histamine-Induced Middle Ear Effusion and Mucosal Histopathology in the Guinea Pig
Authors: Boisvert Pierre , Schiff Maurice , Wasserman Stephen I. , Ryan Allen F.
Published: January 2017

It has been suggested that immune responses and resultant generation or release of inflammatory mediators play a role in otitis media with effusion (OME). To explore the potential of one such mediator to contribute to OME, the effects of histamine injected into the middle ear cavity were examined. Injection of histamine into the guinea pig middle ear was found to produce dilation and endothelial disjunction in capillaries, leading to striking mucosal edema and effusion which persisted for at least several hours. This response could be partially blocked by pretreatment with either H1 or H2 antihistamines. It is suggested that histamine released during immune responses in the middle ear may contribute to the formation of effusion and submucosal edema as observed in OME.
Evaluation of Choanal Atresia
Authors: Benjamin Bruce
Published: January 2017

A series of 65 cases of choanal atresia seen in 19 years is reviewed. We use a wisp of cotton fiber held under the nose and a plastic catheter passed into each nasal cavity to test nasal patency. Horizontal computerized tomography is confirmed as the radiological study of choice, and a standard endoscopic technique used during surgical correction is described.
New Mobilization and Laterofixation Procedure for Cricoarytenoid Joint Ankylosis in Rheumatoid Arthritis
Authors: Bake Björn , Sandberg Nils , Ejnell Hasse , Månsson Ingemar , Geterud Åke , Hallén Olle , Bjelle Anders
Published: January 2017

Ankylosis of the cricoarytenoid joints due to rheumatoid arthritis can cause severe laryngeal obstruction. With a mobilization and laterofixation procedure, five of six patients were successfully operated upon. Documented improvement of breathing was achieved and the voice function was acceptable after decannulation.
Comparisons of Tracheostomy Incisions in a Pediatric Model
Authors: Fry Terry L. , Fischer Newton D. , Jones Raleigh O. , Pillsbury Harold C.
Published: January 2017

Tracheostomy in children causes approximately twice the mortality and morbidity as in the adult. The occurrence of complications correlates closely with the severity of the preoperative tracheal disease, the length of time the tracheostomy is needed, and the age of the patient. Morbidity documented in the postoperative period includes tracheal stenosis and collapsible anterior tracheal wall. The increased incidence of these problems in the pediatric patient may be related to the less rigid nature of the younger cartilage or to partial arrest of the normal tracheal growth rate, and may be aggravated by the style of tracheal incision used. Our study utilized weanling male ferrets in an effort to evaluate the possibly different response of growing, less resilient cartilage to different types of tracheal incision. Animals were randomized into three groups based on the type of incision used: inferiorly based trapdoor, vertical slit, or horizontal H. Endoscopic, radiographic, and airflow studies, as well as cross-sectional areas, were compared on all animals surviving tracheal cannulation for eight days and subsequent decannulation for seven days. Recommendations for pediatric tracheal incision are made on the basis of these studies.
Airway Obstruction and Sleep Apnea in Hurler and Hunter Syndromes
Authors: Shapiro Jo , Strome Marshall , Crocker Allen C.
Published: January 2017

The Hurler and Hunter syndromes are two forms of mucopolysaccharidosis. Although the diseases are rare, those afflicted commonly require otolaryngologic consultation. Upper airway obstruction is often severe, progressive, and not infrequently the suspected cause of death in these patients. Four patients with these problems are presented. In all of the children, obstructive sleep apnea was a major management problem. This and other upper airway difficulties are detailed with clinical and pathological correlates.
Bronchomalacia in the Neonate
Authors: Denneny James C.
Published: January 2017

Congenital bronchomalacia is a disease typically associated with infants between 1 and 12 months of age; cases in children less than 1 month of age are rare. Bronchomalacia is commonly associated with tracheomalacia and rarely warrants operative intervention. Three cases of bronchomalacia are presented, including two unusual cases of bronchomalacia associated with neuromuscular disorder, one complicated by hypotonia. These patients required ventilatory support in the form of continuous positive airway pressure to prevent lobar collapse. Following tracheobronchial and neuromuscular maturation, these infants were able to be weaned from respiratory assistance without further sequelae. Bronchomalacia is discussed, the literature reviewed, and the standard therapies presented. The results indicate a possible relationship between neuromuscular disorders and respiratory collapse.
Supraglottitis and Concurrent Hemophilus Meningitis
Authors: Friedman Ellen M. , Healy Gerald B. , Damion Jules , McGill Trevor J. I.
Published: January 2017

Acute epiglottitis is a true pediatric emergency. The intense inflammation of the supraglottic larynx may completely obstruct the larynx within several hours. This infection is secondary to infiltration of Hemophilus influenzae type b (HIB), and 90% to 95% of patients have positive blood cultures. During this period of generalized septicemia HIB involvement of other soft tissue sites may occur. The goal of this article is to alert otolaryngologists to the possibility of extraepiglottitic HIB involvement. In particular, HIB meningitis, concurrent with supraglottitis, will be discussed. Although the overall incidence of multiple site involvement is relatively low, it is important to be aware of the possibility, since the outcome may be significantly altered.
Airway-Obstructing Epiglottic Cyst
Authors: Henderson Lorre T. , Denneny James C. , Teichgraeber John
Published: January 2017

Laryngeal cysts, particularly epiglottic cysts, are generally benign lesions which cause mild dysphagia or hoarseness. We report a case of an epiglottic cyst that caused almost complete airway obstruction. A 43-year-old man presented with progressive dysphagia, hoarseness, and airway obstruction secondary to a large cystic mass involving the entire epiglottis and filling the hypopharynx. He required emergency tracheotomy to secure the airway, and the cyst was incised and drained. Following a subsequent recurrence, laser excision of the cyst was performed and the problem resolved. The cystic mass was found to fill the valleculae, and involved the lingual and laryngeal surfaces of the epiglottis and the left false vocal cord. A review of laryngeal cysts is presented with emphasis on anatomic and embryologic considerations. The potential lethal nature of these lesions is emphasized.
Laryngeal Stenosis following Carbon Dioxide Laser in Subglottic Hemangioma; Report of Three Cases
Authors: Cotton Robin T. , Tewfik Tewfik L.
Published: January 2017

Recent reports recommend carbon dioxide laser as the safest and the most effective treatment for subglottic hemangioma in infants. Though one report mentions the development of a small amount of subglottic scarring in an 8-month-old girl after resection of a subglottic hemangioma, there is insufficient emphasis in the literature with respect to stenosis as a complication of CO2 laser therapy. The authors present three cases of severe laryngotracheal stenosis developing in infants treated with the CO2 laser for subglottic hemangioma. The presentation of these three cases should be a warning to the otolaryngologist that the use of the CO2 laser is not without significant risk of scar tissue formation.
Limitations of Bronchoscopic Carbon Dioxide Laser Surgery
Authors: Ossoff Robert H. , Toohill Robert J. , Duncavage James A. , Tucker Gabriel F.
Published: January 2017

Laser technology has provided new options in the endoscopic management of patients with selected diseases of the tracheobronchial tree. At present, bronchoscopic laser surgery is performed using either the carbon dioxide laser or the neodymium:yttrium aluminum garnet (Nd:YAG) laser. Strong and his colleagues first performed bronchoscopic laser surgery over 10 years ago when they successfully coupled the CO2 laser to a rigid ventilating bronchoscope. Since that time, the indications for bronchoscopic laser surgery have expanded and the instruments used have become both safer and more “user friendly.” Despite these advances in CO2 laser technology, certain limitations are associated with its use for the endoscopic management of patients with tracheobronchial lesions. This paper discusses these limitations, places this technology in perspective, and reviews recent publications which have suggested that the Nd:YAG laser may be more efficacious than the CO2 laser for the treatment of the same group of patients.
Transtracheal Catheter Technique for Pulmonary Rehabilitation
Authors: Heimlich Henry J. , Carr Gerson C.
Published: January 2017

In over 100 chronic obstructive pulmonary disease patients, continuous oxygen therapy has been provided for up to 4 years using Micro-Trach percutaneous transtracheal catheters less than 2.0 mm in diameter. Successful rehabilitation has been achieved. Advances in materials, insertion technique, and protocols have simplified patient management. Complications occasionally encountered are bleeding, infection, subcutaneous emphysema, increased mucus production, and catheter failure or displacement. Long-term delivery of supplemental oxygen directly into the tracheobronchial tree eliminates the oxygen loss through the oral and nasal orifices that occurs when a nasal cannula is used. This closed system permits maintenance of therapeutic arterial blood levels with improved efficiency, greater comfort, and increased activity. The elimination of nasal irritation and cosmetic objections caused by nasal cannulas increases patient compliance, resulting in uninterrupted 24-hour-a-day oxygen use as indicated. The technique of inserting a transtracheal catheter and postinsertion management are discussed in detail.
Differentiating Upper from Lower Airway Compromise in Neonates
Authors: Pransky Seth M. , Grundfast Kenneth M.
Published: January 2017

Technologic advancements and improvements in supportive care have resulted in increased survival of very low birth weight and premature infants. With salvage of these high risk newborns, many difficult management problems arise. Respiratory distress of the newborn is the most common airway problem that affects these patients and subglottic edema or stenosis may frequently complicate management of the airway. Decision-making in airway maintenance and respiratory care can be problematic due to multiple factors that must be considered. The otolaryngologist is often consulted when upper airway obstruction is suspected. Relevant respiratory physiology is reviewed in order to help direct therapeutic decision-making. Parameters of assessment are enumerated and methods for choosing among therapeutic alternatives are presented. A paradigm to aid in differential diagnosis is described.
Myoepithelioma
Authors: Batsakis John G.
Published: January 2017

Myoepithelial cells are integral components of normal salivary glands. Their active or passive participation in the histogenesis of several salivary gland tumors is a debated issue. This debate notwithstanding, a rare form of salivary tumor composed entirely of myoepithelial cells exists and probably represents a monomorphic form of mixed tumor. This tumor, the myoepithelioma occurs in most major and minor salivary tissues and is generally a biologically benign lesion.
Carbon Dioxide Laser Management of Laryngeal Stenosis
Authors: Duncavage James A. , Ossoff Robert H. , Toohill Robert J.
Published: January 2017

A retrospective review of 20 cases of laryngeal stenosis treated with the carbon dioxide laser was conducted at the Medical College of Wisconsin and Northwestern University. The stenoses were grouped into four categories: supraglottic, glottic, subglottic, and combined glottic-subglottic. Twenty patients had 21 lesions excised by 40 laser procedures. Eleven of 21 stenoses were successfully managed by carbon dioxide laser endoscopy: 3 of 3 supraglottic, 6 of 10 glottic, 2 of 4 subglottic, and 0 of 4 combined laryngeal/tracheal stenoses. Eleven of the 20 patients had significant airway improvement or decannulation. Soft tissue stenoses of the supraglottic area respond favorably to carbon dioxide laser excision. In other regions of the larynx, the use of supplemental stents, steroid injections, dilatations, and the microtrapdoor surgical flap technique in scar stenosis may increase the rate of success. The lower success rate in the posterior commissure, subglottic, and combined laryngotracheal stenoses is due to the circumferential, thick stenosis with a vertical depth of more than 1 cm and the fibrotic fixation of the arytenoid cartilages. Small cicatrices appear to respond better to laser vaporization than the large ones which frequently recur.
Diagnosis and Treatment of Verrucous Squamous Cell Carcinoma of the Larynx: A Critical Review
Authors: Ferlito Alfio
Published: January 2017

Verrucous squamous cell carcinoma of the larynx is a clinical and pathological entity which was recognized only in recent years. It is a highly differentiated variant of squamous carcinoma whose incidence is difficult to assess (3.82% of all laryngeal malignant lesions in our series of 3,012 patients seen from 1966 through 1983). The laryngologist and the pathologist must cooperate closely to formulate a correct diagnosis, because the microscopic findings may not show cytological criteria for malignancy, while the clinical appearance of the exophytic, broadly implanted, and fungating lesion is suggestive of malignancy. A large enough specimen is required to carry out adequate investigations in order to differentiate the lesion from keratosis, verruca vulgaris, or squamous cell carcinoma with a verrucous appearance. The most effective form of treatment is surgery, because radiotherapy has shown a high rate of recurrence or persistence of tumor and because there is the risk of occasional anaplastic or sarcomatoid transformation as seen in this and other sites. Neck dissection is not indicated because the tumor has not shown an ability to spread to regional lymph nodes or to distant organs.
Videophotolaryngography Using a New Low Cost Video Printer Instant Electronic Filmless Photography
Authors: Yanagisawa Eiji , Carlson Roy D.
Published: January 2017

We introduce a new concept of electronic videophotography of the larynx on the television screen using a new Mitsubishi video printer. With this method no standard film or chemical processing are used. Black and white prints of the television image can be electronically reproduced in less than 15 seconds by pressing a button on the video printer. This method is of great value for documentation of the progression of disease and comparison of the preoperative and postoperative appearances of the larynx. The printout of the black and white television image of the larynx can be attached to the patient's chart as a permanent pictorial record. Such prints can also be given to the patient or can be sent to the referring physician, the radiotherapist, and others involved in managment of the patient. This method is also useful for demonstration of a pathological condition and for teaching at head and neck tumor conferences.
Laryngeal Dysgenesis
Authors: Belmont Judson R. , Heffner Dennis , Grundfast Kenneth M. , Hyams Vincent J.
Published: January 2017

A case of a previously undescribed anomaly of the larynx is presented and offers insight and support of current concepts of fetal laryngeal development. The patient possessed unilateral absence of true and false vocal cords, laryngeal ventricle, and saccule. Current concepts of embryological development would place the development of this anomaly and most of the patient's other multiple anomalies in the period of the 6th to 9th weeks of fetal life. This report lends substantiation to the stages of laryngeal development by demonstrating an aberration in the normal sequential development. Additionally, the time period of this maldevelopment is suggested by the concurrence of multiple other anomalies. Aspects of laryngeal embryology relevant to laryngeal maldevelopment are reviewed.
Drugs Affecting Clearance of Middle Ear Secretions: A Perspective for the Management of Otitis Media with Effusion
Authors: Brown David T. , Marsh Roger R. , Potsic William P. , Litt Mitchell
Published: January 2017

Otitis media with effusion (OME) is characterized by the production and accumulation in the middle ear of mucus secretions, whose physicochemical properties are an important feature in the etiology and treatment of the disease. Many types of pharmaceutical agents, including anti-inflammatory agents, antihistamines, antibiotics, and mucolytics, have been used in attempts to improve the clinical status of patients with OME. This study critically reviews the literature from the point of view of possible changes induced by these agents in the physicochemical properties of the secretions and hence their clearance from the middle ear. In vitro studies on mucociliary clearance of respiratory (tracheobronchial) secretions and middle ear effusions are cited as the basis for analyzing the important parameters expected to govern middle ear clearance and to determine the rationale for use (or nonuse) of various classes of drugs. It is expected that this analysis will prove useful in the design of properly controlled trials of such agents.
Pneumatization and Thickness of the Petrous Bone in Patients with Meniere's Disease
Authors: Sando Isamu , Ikeda Minoru
Published: January 2017

Histological evaluations were made of the degree of pneumatization and thickness of the petrous bone surrounding the vestibular aqueduct, and of the relationships of these parameters to the condition of the vestibular aqueduct in 27 temporal bones with idiopathic endolymphatic hydrops from individuals with Meniere's disease. The results were compared with those from the same parameters in 79 control temporal bones without endolymphatic hydrops from individuals who had no premortem history of otologic disease. Pneumatization of the temporal bones of patients with Meniere's disease was in most cases less than that of control temporal bones; this difference was statistically significant. Poor pneumatization of the temporal bones of individuals with Meniere's disease appeared to be closely associated with hypoplasia of the vestibular aqueduct, an anatomical feature of many individuals with Meniere's disease. However, no statistically significant difference could be found between the thickness of the petrous bone in the periaqueductal region in bones of patients with Meniere's disease and this parameter in control bones.
Vascularity of Endolymphatic Sac in Meniere's Disease
Authors: Ikeda Minoru , Sando Isamu
Published: January 2017

The vascularity of the endolymphatic sac (ES) in the vestibular aqueduct (VA) and of periaqueductal bony channels was studied in 18 temporal bones from patients with Meniere's disease and in the same number of control bones with no endolymphatic hydrops and no premortem history of otologic disease. The control bones were selected on the basis of having VAs of the same sizes as the hydropic bones. This was important in order to eliminate any possibility that differences in degree of vascularity of the ES could have been due simply to differences in the degree of development of the VA. All specimens were sectioned and stained with hematoxylin and eosin. The ES of each bone was reconstructed two-dimensionally by the medial view graphic reconstruction method, and its vascularity was studied histologically under a light microscope. There were fewer and smaller blood vessels in the ESs of bones from individuals with Meniere's disease than in the ESs of control bones. This was particularly true in the richly rugose and the cranial orifice portions of the sac. However, no significant differences were recognized in the degree of vascularity of the periaqueductal bony channels between control and Meniere's disease bones.
Endoscopic Surgery for Mycotic and Chronic Recurring Sinusitis
Authors: Stammberger Heinz
Published: January 2017

Chronic sinusitis and its complications are often caused or perpetuated by fungi. In Europe and North America Aspergillus species are the most common contaminants of the sinuses, with relatively few cases of mycoses caused by Mucor, Candida, Penicillium, Cladosporium and Fusarium reported in the literature. Although Aspergillus and Mucor are mainly saprophytic, they may cause severe potentially lethal complications. Consequently, therapy should include complete removal of the mycotic masses and prevention of reinfection In nearly all cases in our experience, fungal diseases of the maxillary sinuses are secondary diseases, the pathologic conditions for which are created by chronic recurring sinusitis. Nasal endoscopy has shown that in most cases of recurring sinusitis, infection spreads from the nose into the larger sinuses, mostly from an infected anterior ethmoid. Maxillary and frontal sinuses are fully dependent on the pathophysiologic conditions in the anterior ethmoid because their ventilation and drainage pass through its complicated system of fissures and clefts into the middle nasal meatus. Endoscopic endonasal surgery of the diseased ethmoid is therefore an important element in our treatment schedule. Stenotic and/or chronically infected areas of the anterior ethmoid are identified by conventional or computed tomography. These areas then undergo endonasal operation under the guidance of rigid endoscopes. Diseased mucosa is removed, narrow or stenotic areas are widened, and the natural maxillary sinus ostium is enlarged. In many cases it is possible to remove all mycotic masses through this new window. Fenestration into the inferior nasal meatus is unnecessary with this method, and the sinus mucosa is usually left untouched. For follow-up treatment, instillations of antimycotic or antibiotic ointments are used. Even in cases of massive mucosal changes, the dependent sinuses, such as the frontal or maxillary sinuses, usually heal spontaneously after this procedure without having been treated directly. More than 140 patients with mycotic sinusitis, 48 of whom were studied and followed up for this paper, were treated by us during the last 8 years. The endoscopic surgical technique we have developed is described in detail.
Congenital Glottic Webs in Children
Authors: Cohen Seymour R.
Published: January 2017

This study is a retrospective review of congenital glottic webs in children. Its purpose is to clarify the controversial aspects of this lesion and to offer a more definitive approach to its treatment. The study includes discussions of embryology and anatomy, a thorough literature review, and a detailed statistical analysis of patient data. Fifty-one pediatric cases are reported, with symptoms and endoscopic findings described in detail. Treatment with dilatations, incisions (knife, scissors, laser), stenting, and external laryngeal surgery with keel insertion are evaluated, and results of therapy, both before and after the development of laser surgery, are reported. Of the 51 patients, 22 required tracheotomy and all who completed therapy were ultimately decannulated. Vocal dysfunction was the most difficult symptom to treat, and perfection of the voice was attained only infrequently. However, the ultimate results of therapy, as noted in this series of patients, should counter the pessimistic viewpoints expressed in the literature.
Significance of Kallikrein-Kinin System in Otitis Media with Effusion
Authors: Hamaguchi Yukiyoshi , Majima Yuichi , Ukai Kotaro , Sakakura Yasuo , Miyoshi Yasuro
Published: January 2017

Significance of the kallikrein-kinin system in the pathogenesis of otitis media with effusion (OME) was evaluated by prekallikrein level, kallikrein activity, and concentration of high molecular weight (HMW) kininogen in 45 middle ear effusions (MEEs, 38 serous and seven mucoid). All MEEs had varying prekallikrein levels (73.1 ± 127.5 relative fluoro units [RFU]), and the mean value in serous effusions (82.2 RFU) was much higher than that in mucoid effusions (23.0 RFU). Hydrolytic activity of kallikrein in serous effusions was 18.0 ± 27.9 RFU, and was significantly higher than that in mucoid effusions (8.0 ± 4.2 RFU, p<0.05). Concentration of HMW kininogen in serous effusions was 51.2 ± 72.77% of plasma value, but it could not be detected in any mucoid effusions. Analysis of protein composition by polyacrylamide gel electrophoresis indicates that plasma protein that has leaked into the middle ear is a major component of MEEs. The kallikrein-kinin system would be active in serous effusions, and liberated bradykinin enhances vascular permeability in the middle ear mucosa, leading to profuse plasma leakage, which characterizes the component of serous effusions. On the other hand, this system would almost be consumed in mucoid effusions.
Lysosomal Thiol Proteases in Middle Ear Effusions
Authors: Hamaguchi Yukiyoshi , Majima Yuichi , Sakakura Kenji , Sakakura Yasuo
Published: January 2017

Hydrolytic activity of lysosomal cathepsins B and H, and trypsin-like proteases in 115 middle ear effusions (MEEs, 40 serous and 75 mucoid) from chronic otitis media with effusion (OME) patients was measured and compared to that in plasma. The activity of both cathepsins in MEEs was significantly higher than that in plasma (p<0.01), and cathepsin B activity in mucoid MEEs was also significantly higher than that in serous MEEs (p<0.01). The activity of trypsin-like proteases was very weak in both MEEs and plasma. Profiles of various inhibitors indicated the qualitative difference of proteolytic enzymes between MEEs and plasma. Mucoid MEEs had significantly higher activity of thiol proteases than serous ones (p<0.01). Cathepsin B-like lysosomal thiol proteases, derived mainly from macrophages, could become a major proteolytic factor to perpetuate and amplify the inflammatory reaction of chronic OME.
Problems and Complications of Cochlear Implant Surgery
Authors: Cohen N. L. , Rosenberg R. , Goldstein S.
Published: January 2017

As with any operation, problems and complications may arise with cochlear implant surgery. These may be associated with the scalp flap, mastoid, facial recess, middle ear, or scala tympani. We describe a number of these potential problems and suggest means of avoiding or dealing with them. With careful planning and meticulous attention to detail, complications associated with cochlear implant surgery can be minimized.
Responses of Cat Auditory Nerve Fibers to Biphasic Electrical Current Pulses
Authors: Javel E. , Tong Y. C. , Shepherd R. K. , Clark G. M.
Published: January 2017

Discharge patterns of single auditory nerve fibers were recorded from normal-hearing cats implanted with a 12-band intracochlear electrode array. Stimuli were biphasic current pulses of specifiable width, amplitude, and rate. Acoustic tuning curves were obtained to determine the cochlear positions of the fibers. Response latencies to electrical stimuli formed two groups. Short latency (0.3 to 0.7 ms) responses were attributed to direct activation of spiral ganglion neurons. At high stimulus intensities, these often exhibited abrupt shifts toward even shorter latencies. Long latency (> 1.5 ms) responses were probably caused by electrophonic activation of functional hair cells. Response thresholds to electrical stimuli depended on a fiber's proximity to the stimulating electrodes, and they did not depend on a fiber's acoustic response threshold or spontaneous discharge rate. High intensity (> 1.5 mA) stimuli could excite fibers over a wide range of characteristic frequencies, even for the narrowest (0.45 mm) electrode separations. Response threshold was an exponentially decreasing function of pulse width for widths up to 300 μs/phase. Fiber discharges were highly phase-locked at all suprathreshold intensities, and saturation discharge rates usually equaled stimulus pulse rates for rates up to at least 800 pulses/s. Dynamic ranges were small (1 to 6 dB), increased with pulse rate, and were uncorrelated with electrical response threshold. Within the dynamic range, shapes of poststimulus time and interspike interval histograms resembled those obtained in response to acoustic stimuli. Depolarization block caused fiber activity to cease in 2 to 5 seconds for sustained stimuli presented at high (> 600 pulses/s) pulse rates and intensities.
Selective Cochlear Stimulation Using Frequency-Shifted Tones: Comparative Study of Sound-Generated and Electrically Elicited Responses
Authors: Funasaka S.
Published: January 2017

Whole nerve action potentials (AP) and auditory brain stem responses (ABR) were studied when produced by varying intensities of sound or electrical stimuli, respectively. The sound stimulus used was a frequency-shifted tone with amplitude modulation. The sharp tuning curve of the AP obtained in response to the frequency-shifted tone, and the 1.7:1 ratio of the latency differences between 515 and 1,150 Hz and between 1,150 and 2,230 Hz indicated that the AP is “place specific.” The latency of the AP decreased with increasing sound intensity levels. The amplitude of the AP increased with increasing intensity up to 75 dB, beyond which it showed a flat or a twin peak with decreased amplitude. These waveform changes were observed in both normal and abnormal cochleae. The amplitude of each wave of electrically elicited ABR increased with increasing current levels, but the latency remained constant. This indicates that an electrically elicited response consists of well-synchronized firings and may cause a different sensation from natural stimuli. Hence patients with cochlear implants are likely to need special training to gain full benefit from their implants.
Discrimination of Complex Speech-Related Signals with a Multichannel Electronic Cochlear Implant as Measured by Adaptive Procedures
Authors: Hood L. J. , Svirsky M. A. , Cullen J. K.
Published: January 2017

Major emphasis has been placed on identifying speech, with and without lipreading, after cochlear implantation. Although this is pragmatically important, identification measures provide limited information as to device and patient performance along acoustic dimensional continua known to underlie the phonetic features that differentiate one phoneme from another. We have undertaken a series of discrimination studies for a patient implanted with the Nucleus multichannel prosthesis, using synthetic, speechlike stimuli and other complex signals that incorporate acoustic changes important to speech perception. Measures of temporal resolution, transition discrimination, and second formant difference limens were made using adaptive procedures with feedback. All signals were presented free field to assess the complete prosthesis in relation to patient performance. Similar measures were also obtained for a group of normal-hearing subjects for comparative purposes.
Pneumococcal Middle Ear Infection and Cochlear Implantation
Authors: Berkowitz R. G. , Franz B. K-H. , Shepherd R. K. , Clark G. M. , Bloom D. M.
Published: January 2017

A limited study for the experimental induction of pneumococcal otitis media is presented. It is a useful model to study the effects of otitis media in the implanted and nonimplanted cochlea of the cat. Pneumococcal otitis media caused minor pathological changes in two nonimplanted cochleas and more widespread changes together with significant loss of neural elements in two implanted cochleas. However, the small number of animals used in this study did not allow us to distinguish between the effects of electrode insertion trauma, infection, or the combination of both.
Cochlear Implant for Simultaneous Multichannel Stimulation
Authors: McDermott H.
Published: January 2017

A new cochlear implant is described that can stimulate up to three bipolar electrode pairs simultaneously. It uses a scala tympani electrode array comprising 20 separate platinum ring electrodes. The bipolar mode of stimulation is used to minimize the spread of current in the cochlea. Nearly all of the electronics of the device are integrated into a single custom-designed large-scale integrated circuit. A prototype of the chip has been fabricated using an advanced complementary metal oxide semiconductor technology. Preliminary test results indicate that the device functions according to its specifications. The implant, which is still under development, will use a single transcutaneous inductive link to receive both controlling data and electric power from an external speech processor.
Speech-Processing Strategies and Their Implementation
Authors: Seligman P.
Published: January 2017

Since 1979, the Australian speech-processing strategy has been based on the presentation of an estimate of F2 coded by electrode position and F0 coded by pulse rate. Although providing limited information, this strategy has produced good results with significant hearing-alone performance. This paper describes a number of strategies that provide further speech information in an attempt to increase hearing-alone performance to a level where the cochlear implant is able to operate in its own right rather than as an adjunct to lipreading. The strategies are all based on the addition of F1 to the existing strategy. Both electrode and temporal coding of F1 is described, and the performance and percepts produced are discussed. Amplitudes of the two formants must be carefully controlled to avoid masking. The implications of the strategies on the design of hardware are described.
Experimental Basis and Design of a New Cochlear Prosthesis System
Authors: Génin J. , Charachon R.
Published: January 2017

In a multichannel cochlear prosthesis, electrical interactions between electrodes impose severe limitations on dynamic range and selectivity. We present a theoretical model to cope with these limitations. Building a successful cochlear implant requires full custom-integrated circuits. We present the design of such a device, implemented in complementary metal oxide semiconductor technology. The area of the chip is 9 mm2 and it can stimulate 15 cochlear electrodes with current impulses.
Educational Assessment and Management of Children with Multichannel Cochlear Implants
Authors: Nienhuys T. G. , Musgrave G. N. , Busby P. A. , Blamey P. J. , Nott P. , Tong Y. C. , Dowell R. C. , Brown L. F. , Clark G. M.
Published: January 2017

This paper describes the assessment and training program to evaluate speech, language, and communication skills of profoundly deaf children during and after training. Two sensory aids/prostheses are used: hearing aids and the Nucleus multichannel cochlear implant. Using a single-subject time-series experimental design, children's speech, language, and communication skills are assessed. For speech skills, assessment includes formal tests of articulation and intelligibility, syllable stress and process analyses, analyses of suprasegmental features, and voice quality. For general communication abilities, conversational skills with different speakers, story production skills, comprehension and expression of procedural information, discourse skills, and a measure of conversational interaction skills (pragmatics) are analyzed at regular intervals. Regular observations also sample the subjects' mode and frequency of interactions with individuals and groups in the school and home setting. Normative tests and formal analyses of language samples are also used to assess the overall language age of the child, vocabulary size, and kinds of expressive and receptive, syntactic, and semantic ability.
Psychophysical and Speech Studies with an Electrotactile Speech Processor
Authors: Blamey P. J.
Published: January 2017

A multiple-channel electrotactile speech processor worn on the fingers of one hand has been constructed. This processor implements a speech-coding strategy that presents the second formant frequency by electrode position, fundamental frequency by electrical pulse rate, and amplitude envelope by pulse width. This strategy is similar to the one used by the Nucleus cochlear implant. Psychophysical tests with normally hearing and profoundly deaf subjects have measured the discrimination of stimuli differing in pulse rate, electrode, or pulse width. The levels of performance were comparable to those for cochlear implant patients except for pulse rate discrimination. Three untrained normally hearing adults using electrotactile stimulation without hearing or lipreading scored significantly better than chance for a range of two alternative forced-choice speech discrimination tasks. Provided that subjects can learn to associate linguistically meaningful concepts with tactile sensations, an improved level of speech comprehension may be achieved when the electrotactile speech processor is used together with lipreading.
Transtympanic Electrically Evoked Auditory Sensations
Authors: Gibson W. P. R. , Game C. J. A. , Pauka C. K.
Published: January 2017

A transtympanic needle was used to inject electric current near the round window niches of totally deaf ears. Bursts of 50- or 100-Hz square waves evoked hearing from most of the tested ears. Various stimulus waveforms were used to show the usual phenomena of nerve excitation (eg, anode break excitation, anodal current inhibition, and cathodal current excitation).
Surgical Evaluation of Candidates for Cochlear Implants
Authors: Black F. O. , Lilly D. J. , Fowler L. P. , Stypulkowski P. H.
Published: January 2017

The customary presentation of surgical procedures to patients in the United States consists of discussions on alternative treatment methods, risks of the procedure(s) under consideration, and potential benefits for the patient. Because the contents of the normal speech signal have not been defined in a way that permits a surgeon systematically to provide alternative auditory signals to a deaf patient, the burden is placed on the surgeon to make an arbitrary selection of candidates and available devices for cochlear prosthetic implantation. In an attempt to obtain some information regarding the ability of a deaf patient to use electrical signals to detect and understand speech, the Good Samaritan Hospital and Neurological Sciences Institute cochlear implant team has routinely performed tympanotomies using local anesthesia and has positioned temporary electrodes onto the round windows of implant candidates. The purpose of this paper is to review our experience with this procedure and to provide some observations that may be useful in a comprehensive preoperative evaluation for totally deaf patients who are being considered for cochlear implantation.
Extracochlear Implantation: Technique and Results
Authors: Fraysse B. , Soulier M. J. , Urgell H. , Levy P. , Furia F. , Defrennes V.
Published: January 2017

The authors present an overview of the technique and results in the rehabilitation of totally deaf adults by an extracochlear single-channel electrode. Eight patients were implanted with a follow-up of at least 6 months. Sound signal processing, the receiver, and the electrode are described. The access to the round window is through the facial recess. The internal coil is placed over the pectoral muscle. The rehabilitation program consists of training patients to recognize background sounds up to more discriminating exercises. The results are discussed.