bluuebunny/crossref_metadata_2025 huggingface dataset:
Arterial Baroreceptor Fibers in the Recurrent Laryngeal Nerve
Authors: Strauss Stanley G. , Fukuda Hiroyuki , Kirchner John A.
Published: October 2014

Stimulation of the larynx, as during intubation, can produce significant cardiac arrhythmias. Investigation of the cause of these arrhythmias has led us to believe that they are in part due to stimulation of a baroreceptor reflex pathway which passes through the larynx rather than to initiation of a simple reflex in the larynx itself. Pressure sensors (baroreceptors) in the aortic arch form part of a system which monitors systemic blood pressure. Stimulation of these baroreceptors produces, via a medullary reflex arc, a slowing of the heart rate, a decrease in sympathetic vascular tone, and as a result a drop in blood pressure. The pathway from the aortic arch baroreceptors has heretofore been thought to run directly through the vagus nerve. We have shown, however, that in the rat a significant number of fibers from aortic arch baroreceptors run in the left recurrent laryngeal nerve (RLN), through the larynx into the left superior laryngeal nerve (SLN), and only then into the vagus. Blocking or cutting the left RLN produces a significant drop in overall baroreceptor reflex activity, and furthermore, nerve fibers have been isolated in the left RLN which show exactly the same patterns of discharge as those from arterial baroreceptors elsewhere. It is our belief that at least some of the arrhythmias produced during laryngeal manipulation can be explained on the basis of mechanical compression producing stimulation of the baroreceptor fibers as they pass along the thyroid cartilage through the ramus communicans between the RLN and SLN. Further work needs to be done to show that compression does in fact stimulate the baroreceptor pathway, but there is now little doubt that, in experimental animals, such a pathway exists.
Distribution and Density of Goblet Cells in the Normal Adult Human Middle Ear
Authors: Bak-Pedersen K. , Tos M.
Published: October 2014

The purpose of this study was to map the distribution and density of goblet cells in the clinically normal middle ear. From 12 temporal bones, derived from 12 adult patients with clinically normal middle ears, the mucosa was prepared and stained by the PAS-alcian blue whole-mount method. In six of the patients the middle ears with meticulous gross and microscopic investigation showed mild sequelae of previous otitis media, called the slightly abnormal series, whereas the other six patients who had entirely normal middle ears were designated the normal series. Each middle ear was investigated in 12 different areas: tympanic orifice, hypotympanum anteriorly and posteriorly, round window niche, oval window niche, promontory anteriorly, in the middle, and posteriorly, epitympanum, antrum, and mastoid process. In each middle ear area the goblet-cell density and distribution were determined on the basis of 30 to 50 counts of 0.01768 mm2 epithelial surface, a total of at least 4800 counts. In six patients goblet cells were found in all 12 areas, in three patients in 11, and in three patients in 10. In both series there was a distinct decrease in goblet-cell density from the tympanic orifice, towards the posterior areas of the middle ear and the mastoid process. However, two patients of the slightly abnormal series exhibited a considerably greater density in the posterior than in the anterior part of the hypotympanum. The mean goblet-cell density in the slightly abnormal series was distinctly greater in all middle ear areas than in the normal series. Correspondingly, goblet cells were demonstrated in the antrum and mastoid process in all patients of the slightly abnormal series, but in only half of the normal series. Therefore, the greater goblet-cell density in the slightly abnormal series presumaby results from a previous past disease condition of the middle ear.
Arterial Collateralization after Common Carotid Ligation
Authors: Robbins Jeffrey P. , Fitz-Hugh G. Slaughter , Craddock William D.
Published: October 2014

The two major indications for common or internal carotid ligation are the resection of neoplasm and the control or prevention of hemorrhage. Sixty percent of those undergoing elective carotid ligation and 12% of those undergoing emergency ligation survive these procedures without evidence of neurological sequelae. This uncompromised survival is based upon the presence or rapid developmnt of collateral circulation to the cerebral vascular bed. Arteriographic studies are utilized to illustrate the development of intra- and extracranial collateralization to the internal carotid artery after interruption of the ipsilateral common carotid. The major collateral circuits demonstrated via a case report are as follows: 1) from the vertebral artery to the external carotid and hence to the internal carotid; 2) from the posterior communicating artery to the internal carotid; and 3) from the ophthalmic artery to the internal carotid.
Secretory Immunoglobulin a (Siga) in Middle Ear Effusions
Authors: Mogi Goro , Maeda Shoichi , Honjo Shoichi , Yoshida Toyoharu
Published: October 2014

Immunochemical studies of secretory immunoglobulin A (SIgA) in middle ear effusions were attempted for the purpose of investigating the existence of the local immunologic defense mechanism and the local protein synthesis in the middle ear. SIgA was isolated from normal human parotid secretions by means of DEAE-cellulose column chromatography and G-200 Sephadex gel filtration. Antiserum against SIgA was made by immunizing a rabbit with the SIgA isolated from the parotid secretions. Antisecretory piece antiserum was made by absorbing the anti-SIgA antiserum with pooled normal human sera. Immunodiffusion analysis of SIgA was performed on 160 specimens of middle ear effusion from patients with otitis media with effusion. Seventy-five of 160 (46.9%) specimens were found to have SIgA. In the serous category 5 of 41 (12.2%) acute cases were positive while 24 of 59 (40.7%) chronic cases were positive. One of 2 acute cases of the seropurulent effusions showed the positive reaction and 2 of 3 cases of the purulent type were positive. In the mucopurulent type 2 of 4 acute cases were positive and all 3 chronic cases were positive. In the mucoid type 9 of 14 (64%) acute cases gave a positive precipitation line while 29 of 33 (87.9%) chronic cases gave the positive reaction. The appearance of precipitation line developed with effusions varies from very faint to distinct. However, as a rule the line of the mucoid, mucopurulent and purulent effusions was strong. Since SIgA is the predominant immunoglobulin in external secretions but is not present or is at very low concentration in normal sera, findings of this study suggested that the middle ear lining membrane possesses the secretory function similar to the epithelium of other external secretory tissues, and suggested the hypothesis that the middle ear epithelium shares the local immunologic defense system as that of respiratory epithelium.
Carcinoma of the Sphenoid Sinus
Authors: Van Wart Charles A. , Dedo Herbert H. , McCoy E. Gordon
Published: October 2014

Carcinoma of the sphenoid sinus produces deep constant headache, radiological signs of sphenoid sinus destruction and extraocular paralysis, usually without cervical node metastasis. Radiotherapy offers palliation and some limited prospect of cure, especially if there is no bony destruction of the base of the skull.
The Variability of the Galvanic Body-Sway Test
Authors: Coats Alfred C.
Published: October 2014

The variability of galvanic unilateral weakness (UW) and directional preponderance (DP) was studied in 31 normal subjects. Variability of absolute UW and DP increased linearly with increasing response amplitude. Variability of percent UW and DP was very high at low response amplitudes. However, it declined rapidly as response amplitude increased and reached a relatively constant level at a total response amplitude of about 25 mm (though continuing to decline slightly). The percent measurements thus appear best for clinical use, provided the total response amplitude is greater than 25 mm. Increasing stimulus current caused a marked decrease in percent UW and DP variability. Therefore, for clinical testing we use the highest stimulus that does not produce discomfort (1.0 mA). Varying stimulus rise-fall time did not affect test variability. Subjects with greater spontaneous sway tended to have less variable percent UW and DP, thus suggesting that reducing subject stability might improve the galvanic test. Test-retest variability differed significantly from subject to subject. Standard deviations from subjects with the most variable responses did not differ significantly from standard deviations across all subjects. This result suggested that the primary determinant of limit of normal is the inherent variability of the test rather than differences among subjects.
Narrow and Atretic Transverse Dural Sinuses: Clinical Significance
Authors: Kaplan Harry A. , Browder Ann , Browder Jefferson
Published: October 2014

In 422 specimens of cerebral dural sinuses obtained at autopsy, there were 13 with marked narrowing of a segment of one or the other transverse sinuses, and 11 with absence of a part or all of a transverse sinus. In both groups a variety of compensatory venous channels had formed during embryonal development, apparently serving as bypasses for the partially or completely occluded transverse sinus. A knowledge of the anatomical variances at the confluence of sinuses is important to surgeons who manage patients with inflammatory problems implicating a transverse sinus and those performing radical dissection of the neck for cancer.
Electronystagmography after Stapedectomy
Authors: Spector Martin
Published: October 2014

The aim of this study was to assess the persistent vestibular changes after stapedectomy as shown by electronystagmography. Sixty-two otosclerotic ears were studied before and after stapedectomy for vertigo, spontaneous and positional nystagmus with closed eyes and intensity of caloric responses. In this sense, preoperative vertigo, spontaneous or positional nystagmus, poor bone conduction or caloric hypoactivity did not routinely correlate with postoperative vestibular troubles. In most cases vertigo was ameliorated after operation. In six cases drilling of the footplate induced a 66% rate of vestibular dysfunction. A poor hearing result was usually associated with vestibular dysfunction. The vestibular apparatus was more commonly adversely affected by stapedectomy than the cochlear apparatus.
Long Term Results of Electrode Implantation and Electronic Stimulation of the Cochlea in Man
Authors: House William F. , Urban Jack
Published: October 2014

Electronic stimulation of hearing sensation has been achieved and tested in one patient over a period of three years. The results are encouraging and warrant more widespread testing and development of this method of rehabilitation of totally deaf patients.
Tympanoplasty: Long-Term Results
Authors: Cody D. Thane R. , Taylor William F.
Published: October 2014

Long-term results after 878 tympanoplasties using five different methods of repair were analyzed. The five groups were as follows: canal skin and fascia, single fascia, double fascia, canal skin, and canal skin and homograft tympanic membrane. Ten percent of the graft failures occurred 18 months or longer after operation. The highest percentage of graft takes (88%) and satisfactory hearing improvement (socially adequate level 87%, air-bone gap closure to within 15 dB 76%) and the lowest incidence of depression in cochlear reserve (0.7%) was in the double fascia group. Overall hearing results achieved in the 878 tympanoplasties were poorer than anticipated. Differences in results in the five groups, although occasionally large, were not statistically significant. Differences in the percentage of successful graft takes in ears that had no active disease as compared with ears that had active disease and in primary operations as compared with revision operations were not statistically significant. Complications encountered were common and varied.
Laryngeal Papilloma: Etiologic and Therapeutic Considerations
Authors: Cook Ted A. , Cohn Arnold M. , Brunschwig J. Pierre , Goepfert Helmuth , Butel Janet S. , Rawls William E.
Published: October 2014

A study of 13 patients with laryngeal papillomas is presented, with an analysis of epidemiologic factors, electron microscopic study of the lesion, and therapeutic trial of frequent microlaryngoscopic surgery and application of idoxuridine. Five of the nine children in this group were delivered by mothers who had condyloma accuminatum at time of delivery. These five children developed symptoms and required surgery much earlier than the other four. This correlation is shown to be statistically significant. The electron microscopic study of tissue specimens from all our patients failed to find any actual virus particles. The comparison study with skin and genital warts, however, showed ultrastructural details linking the three lesions. Results of the therapeutic program showed an overall improvement in frequency of recurrence, but no complete cures. This improvement is felt to be related to frequent complete surgical excision, and not to application of idoxuridine.
Flow Resistance in Tracheotomy Tubes
Authors: Cavo John , Ogura Joseph H. , Sessions Donald G. , Nelson J. Roger
Published: October 2014

The role of the upper airway (the breathing passage above the trachea) in maintaining the normal junction of the respiratory system has been suggested by previous investigators. During a tracheotomy the upper airway is by-passed by a prosthetic metal or plastic tube which is placed into the trachea through the neck. In order to determine which, among the most commonly used tracheotomy tubes, most closely simulate the flow resistance of the adult human upper airway, a series of varying flow rates were passed through different sized tubes. Pressure drops were recorded and resistance values were thereby determined. Our data was compared with previously determined values for flow resistance of the adult human upper airway. Resistance related to turbulent and laminar flow was considered. On the basis of our data we have suggested that large caliber tracheotomy tubes be used in adult patients in whom the prolonged need for a tracheotomy is anticipated.
Scala Vestibuli Partition with Deafness and Renal Disease
Authors: Gussen Ruth
Published: October 2014

Spiral ligament projections, partitioning the beginning of the scala vestibuli, bilaterally, were demonstrated in a patient with chronic renal disease, who had a bilateral midfrequency cochlear hearing loss. There were also spongy spiral ligament changes, strial atrophy and decreased spiral ganglion cells in the basal and middle cochlear turns. The patient was maintained on immunosuppressive therapy for four years after receiving a renal transplant. He died of a primary malignant lymphoma of the brain and cryptococcal meningitis, both probably related to immunosuppressive therapy.
Acute Histopathologic Inner Ear Changes in Deafness Due to Neomycin: A Case Report
Authors: Lowry Louis D. , May Mark , Pastore Peter
Published: October 2014

A case presentation of a patient receiving 8 gm of neomycin intramuscularly in preparation for surgery is presented. Acute renal failure and total deafness followed this injection and the temporal bones were removed on the seventeenth day postinjection. Histological findings showed inner and outer hair cell degeneration and a normal spiral ganglion count. There were some changes in the stria vascularis which were noted in the basal turn.
Senile Changes in the Middle Ear Joints
Authors: Etholm B. , Belal A.
Published: October 2014

Histological study of the IM and IS joints in 125 ears from 86 individuals varying in age from infancy to 96 years showed arthritic changes which increased in severity with advancing age. The earliest changes in the articular cartilage consisted of fraying and fibrillation, followed by thinning and calcification. The joint capsule showed atrophy and hyalinization and the articular disc showed hyaline deposits in early cases and calcium deposits in severe cases. Audiograms which were available on 55 ears showed that arthritic changes in these joints did not impair sound transmission through the middle ear.
Sympathetic Stimulation and Otic Blood Flow
Authors: Todd N. W. , Dennard J. E. , Clairmont A. A. , Jackson R. T.
Published: October 2014

The radioactive microsphere technique was used in dogs to assess the effect of sympathetic stimulation on temporal bone blood flow. The stellate, caudal cervical and superior cervical ganglia, and the vertebral and cervical sympathetic nerves were stimulated. In a large majority of the animals, stimulation had no effect on temporal bone blood flow although nasal tissue was greatly affected. In a minority of animals, a small effect was seen in temporal bone tissue. Similarly, norepinephrine infusion usually did not produce evidence of reduced blood flow in the temporal bone. It was concluded that the sympathetic innervation of otic blood vessels was not capable of controlling otic blood flow, only modulating it. A sympathetic vasospasm does not seem possible. Mention is made of the dual sympathetic innervation of the cochlea described by Spoendlin and Ross. The possible mediation of sympathetic effects in the cochlea by cyclic AMP is suggested.
Scleroma Affecting the Middle Ear Cavity with Report of Three Cases
Authors: Barbary A. , Fouad H. , Fatt-Hi A.
Published: October 2014

Scleroma has especial predilection to the mucous membranes particularly of the nose and larynx. Other sites are rarely affected such as the pharynx, lacrimal sac, sinuses, bone and skin. However, no case of middle ear involvement is mentioned. Among 300 patients examined during the last few years, only three cases showed scleromatous involvement of the middle ear cavity. 1) A patient developed right facial nerve paralysis two days after an operation of tympanoplasty. Exploration showed granulomatous tissue present surrounding the bony facial canal and filling the middle ear, mastoid and attic regions. Biopsy proved to be scleroma. 2) During one tympanoplasty, excessive vascular granulations were observed and biopsy revealed scleroma. 3) A 24-year-old patient had advanced rhinopharyngoscleroma and bilateral chronic suppurative otitis media with granulations. An exploratory operation of the right ear was done and vascular granulations were found infiltrating the middle ear, attic, antrum and mastoid air cells. Biopsy was scleroma. As one of the three cases had rhinopharyngoscleroma, this raises the possibility of direct spread through the submucosa. However the other two cases show no nasal or pharyngeal affections. Scleroma can invade the facial bony canal and cause nerve paralysis as demonstrated in one patient.
Oat Cell Carcinoma of the Larynx
Authors: Ferlito Alfio
Published: October 2014

A case of oat cell carcinoma of larynx occurring in a 67-year-old male is reported. This neoplasm is extremely rare in the larynx and the case described is the second so far reported in world literature. The tumor is morphologically identical to those arising in the lung.
Audiological Comparison of Cochlear & Eighth Nerve Disorders
Authors: Jerger James , Jerger Susan
Published: October 2014

Four new approaches to the diagnostic problem of differentiating cochlear and retrocochlear disorders are described. The four procedures are: 1) the forward-backward discrepancy in the Békésy audiogram; 2) the Békésy Comfortable Loudness (BCL) test; 3) the rollover of the performance-intensity function for PB words; and 4) the acoustic reflex. Findings on these new auditory test procedures were contrasted in three groups of patients having either confirmed cochlear, VIII nerve or brain stem disorders. Results suggest that suprathreshold levels are a more fruitful area in which to explore VIII nerve symptomatology than threshold levels.
Radiologic Aspects in Differential Diagnosis of Neural and Sensory Deafness
Authors: Britton B. Hill
Published: October 2014

The use of radiologic techniques as part of the physical examination of patients with sensory and neural deafness is reviewed. Polytomes, line drawings, and a clinical discussion of the following conditions are presented: osseous displasia, congenital deformities of the internal auditory canal and/or the labyrinth, purulent labyrinthitis, temporal bone fractures and tumors of the temporal bone and cerebellopontine angle. It is felt that current diagnostic radiologic techniques should be utilized to their fullest extent in the diagnosis and management of temporal bone problems.
Cochlear and Neural Diseases: Classification and Oto-Audiologic Correlations
Authors: Marcus Richard E.
Published: October 2014

An extended clinical classification of cochlear and neural disease is presented along with an anatomical definition of corresponding cochlear and neural compartments. The clinical classification has three categories: prenatal, neonatal, and delayed, with each subdivided into genetic and acquired groups. The cochlear and neural compartments are arbitrarily divided at the habenula perforata with the unmyelinated dendrites considered part of the cochlear compartment. This allows a clinical reconciliation of cochlear and neural disease with oto-audiologic and pathologic findings. Patients are presented with Alport's syndrome, meningitis and obliterative labyrinthitis, mumps, diabetes and sickle cell disease to illustrate the clinical classification. Pathologic correlations are postulated in each of the patients.
Connective Tissue Disorders in Otolaryngology
Authors: Lucente Frank E.
Published: October 2014

Connective tissue disorders may present with various otolaryngologic symptoms. The manifestations may represent vasculopathy, arthopathy, neuropathy or a combination of pathological processes. Rheumatoid arthritis may involve the middle ear, temporomandibular joints and larynx with mild symptoms or may be life-threatening in instances of cricoarytenoid arthritis. Dermatomyositis with its cutaneous and muscular symptoms prevalent in the head and neck is frequently associated with malignancy in patients over 40. Scleroderma not only affects the gastrointestinal tract but can also produce significant limitations of respiratory function. Systemic lupus erythematosus, polyarteritis modosa, Wegener's granulomatosis and giant cell arteritis produce numerous vascular changes in structures of otolaryngologic significance. In this puzzling group of disorders, protean symptoms may precede the development of a fulminant, widespread and fatal disease.
Inherited Bell's Palsy
Authors: Willbrand Jeffrey W. , Blumhagen Joel D. , May Mark
Published: October 2014

Twenty-nine cases of Bell's palsy in a single family appear to suggest an autosomal dominant inheritance. In addition, a review of 230 consecutive patients with Bell's palsy revealed a 6% incidence of a positive family history of facial paralysis. These findings implicate inheritance in the etiology of Bell's palsy.
A New Silicone Elastomer Tube for Use during Microsurgery on the Larynx
Authors: Carden Edward , Ferguson George B. , Crutchfield William M.
Published: October 2014

A new special endotracheal tube for ventilating patients during microlaryngeal surgery is described. It is 6.25 cm long, made of silicone elastomer and has a “soft” cuff built onto it. It is placed below the patient's cords and the cuff blown up while the patient is paralyzed, and under anesthesia. The patient's lungs can be ventilated by jetting oxygen from the jet tube which is built into it. While the oxygen is not flowing the patient can passively exhale through the tube and cords. Obstruction to the surgical field is minimal and consists of the cuff inflating tube .08 cm in diameter and the jet tube .25 cm in diameter which will be in the posterior commissure out of the way. The tube is designed in such a way that both during inflation and exhalation gas is blown out through the cords to help to blow blood and debris away from the operating field.
Origins of the Crossed Olivocochlear Bundle Shown by an Acid Phosphatase Method in the Cat
Authors: Luk Gordon D. , Morest D. Kent , McKenna Nancy M.
Published: October 2014

This study uses acid phosphatase to show that more than one cell type in the superior olive contributes to the crossed olivocochlear bundle. Rasmussen's anterograde degeneration findings point to the dorsomedial periolivary nucleus as a site of origin, but retrograde chromatolysis is not recognized there after cochlear ablations in cats. In other regions of the nervous system large increases of lysosomal enzyme levels have been demonstrated in the parent perikarya a few days after peripheral nerve section. Such changes occurred in the hindbrains of adult cats 4, 9, and 19 days after unilateral labyrinthectomy. Enzyme in the dorsomedial periolivary nucleus was related to a distinct red precipitate in the perikarya of the small elongate and large radiate neurons. In an unoperated control, precipitate appeared in 30% of both kinds of cells on each side. In the operated cats, precipitate also occurred in 30% of the cells (n=1000+) on each of the control sides, compared to 60–70% (n=1000+) on the opposite side. This result corresponds to 200% and 250% increases for elongate and radiate cells. The results did not vary from cat to cat or with the survival times used or the rostro-caudal level of the nucleus sampled. Other origins of the crossed olivocochlear bundle appear to be stellate cells in the ventral and medial trapezoid nuclei. Inasmuch as two distinct types of neurons contribute to the crossed olivocochlear bundle, their respective endings in the cochlea might express physiological differences. In the dorsomedial periolivary nucleus there are more olivocochlear neurons with small axons than with large axons. The small axons may have been overlooked in previous light microscopic observations of the olivocochlear bundles in the cochlea. Moreover, these two populations of olivocochlear neurons might have different innervation patterns in the organ of Corti.
Influence of Manganese on Genetically Defective Otolith
Authors: Lim David J. , Erway Lawrence C.
Published: October 2014

The genetically mutant pallid mouse (which possesses specific otolith defects) and the manganese-supplemented (Mn) pallid mouse (in which otolith defects were prevented) were studied using light and transmission and scanning electronmicroscopy. Untreated pallid mice which showed head-tilting, circling and ataxia also had swimming difficulty. In these animals, the otolith defects were the only consistent findings. With one exception, no pronounced anomalies were found in the sensory epithelium, nerve fibers and ganglion cells. Only a few vestibular melanocytes, in which the melanin granules failed to fully mature, were observed in the pallid mouse. Melanization in vestibular melanocytes appeared to be improved by Mn-supplementation. The genetic basis for involvement of Mn in otolith development was discussed. This animal model provides opportunities for basic research concerning the possible prevention of genetic disorders involving the inner ear.
Corrosive Injury of the Oral Cavity and Esophagus Caused by Some Denture Cleanser Powders
Authors: Abramson Allan L. , Pryor William H. , Eason Robert L. , Messer Eugene J.
Published: October 2014

Denture cleansers are frequently found in the American household since there are in excess of 16 million people wearing dentures. These unbiquitous products were thought to be without serious complications, but this belief was recently changed when a denture cleanser powder was found to cause severe oral cavity burns in a young child. This prompted us to investigate experimentally the chemical, caustic and histopathological properties of D.O.C.®, K.I.K.®, Kleenite®, Iodenture®, Extar D.C.® and Polident® denture cleanser powders. All but the latter two were found to be highly alkaline, capable of producing severe focal to diffuse caustic burns of the upper digestive tract.
Questionable Methods of Foreign Body Treatment
Authors: Ritter Frank N.
Published: October 2014

Foreign bodies of the air and food passages have been removed safely for years by endoscopic means. Recently new nonendoscopic techniques have been introduced to remove these foreign bodies and some have resulted in severe complications. One example is papain which has been advocated for dissolving esophageal meat impaction; and, while successful in some patients, this method has led to two deaths. Coins have been successfully extracted from the esophagus by using a distended Foley catheter, but such a technique could result in aspiration. Bronchial foreign bodies have been expelled by placing the patient in a head down position and taping the chest to dislodge them. This produced a cardiorespiratory arrest in one patient and after resuscitation, temporary blindness. It would appear that these newer techniques are more dangerous statistically than time honored and proven endoscopy.
Advances in Endoscopic Examination of the Respiratory System
Authors: Ward Paul H. , Berci George , Calcaterra T. C.
Published: October 2014

The development of fiberoptic endoscopes and the discovery of a new system of telescope optics have dramatically revolutionized endoscopy. These advances are discussed, and the superior photographic documentation that is now possible through these instruments is presented.
Bronchoscopic Carbon Dioxide Laser Surgery
Authors: Strong M. Stuart , Vaughan Charles W. , Polanyi Thomas , Wallace Robert
Published: October 2014

Endotracheal and endobronchial carbon dioxide laser surgery can be carried out using standard ventilating bronchoscopes, a recently developed laser endoscope attachment and a 50W CO2 surgical laser unit. General anesthesia, using nonflammable anesthetics, is delivered through the side arm of the ventilating bronchoscope; the tidal flow of gases keeps the trachea and bronchi free of steam and smoke. The technique has been particularly helpful in the bloodless removal of recurrent papillomas from the trachea and main stem bronchi of ten children with tracheostomies. While three of the patients have gone into remission following laser excision, the method cannot be curative of itself. There were no complications attributable to the carbon dioxide laser surgery, per se, but constant vigilance must be exercised as with all laser surgery. As instrumentation becomes refined the technique will have wider application in the management of tracheobronchial disease.
Recent Improvements in Anesthetic Techniques for Use during Bronchoscopy
Authors: Carden Edward
Published: October 2014

Bronchoscopy usually necessitates anesthesia in order for it to be performed without excessive patient discomfort. Bronchoscopy with the rigid bronchoscope under local anesthesia is the more unpleasant but causes normal or lower than normal arterial CO2 levels with normal or increased arterial O2 levels. General anesthetic techniques for use with the rigid bronchoscope have improved markedly in recent years. At present three ventilation techniques seem safe: the Sanders' venturi, Carden sidearm injector and Komessaroff bronchoflator systems. These techniques can be expected to deliver adequate ventilation and oxygenation (Sanders system) to very good ventilation with much higher arterial oxygen levels (the Carden and Komessaroff systems). These techniques involve thiopental and succinylcholine for anesthesia; an oxygen/nitrous oxide blender added to the Carden sidearm system enables balanced anesthesia to be used, which is a decided advantage. Bronchofibroscopy is a new art which can be performed with relatively little patient discomfort under local anesthesia but at the risk of lowering the arterial oxygen tension. Added oxygen should be used but preferably not down the instrument itself. Under general anesthesia bronchofibroscopy has been performed, but ventilation of the patient is often impaired unless a large endotracheal tube is used for passage of the instrument.
Hearing Dysfunction Associated with Congenital Sporadic Hypothyroidism
Authors: Rubenstein M. , Rubenstein C. , Theodor R.
Published: October 2014

A study of the effect of congenital sporadic hypothyroidism (CSH) on hearing dysfunction was undertaken. Fifteen female and six male CSH patients were evaluated audiometrically. All of these patients had a protein bound iodine quotient (PBI) of less than 4 mg% at the time of diagnosis and were currently under treatment. The patients ranged in age from four and one-half years to 40 years old; eight had sensorineural hearing loss; three had mixed hearing loss; only two had conductive loss and eight had essentially normal hearing. Special audiometric studies were performed including SISI, Rosenberg threshold tone decay, Békésy tracings, and evoked response audiometry (ERA). The SISI and tone decay test results were equivocal. However, statistically abnormal Békésy tracings, with unusually wide excursions were noted. This may be explained by a prolonged nerve conduction time. Evoked response audiometry, which is objective and is independent of cortical neuromuscular function, demonstrated that the unusually wide Békésy excursions were not the result of sluggish motor responses alone. A statistically significant prolonged latency period measured by ERA (without sedation) was found in four patients who were under compensatory hormonal treatment. A parallel preliminary animal experiment was performed in an attempt to confirm these clinical ERA findings. Guinea pigs were induced to hypothyroidism by propylthiouracil. After two months of continuous treatment the ERA was measured. All six guinea pigs had prolonged nerve conduction times at two frequencies. The latency periods were generally 2.5 to 3 times greater than control guinea pigs. A case report is presented of a patient who developed increased hearing loss when replacement therapy was stopped. The hearing levels improved when a euthyroid state was medically reestablished. The results of ERA and Békésy tracings suggest that abnormally prolonged nerve conduction time can play an important role in the hearing dysfunction of CSH patients.
Asymptotic Threshold Shift (ATS) in Man from 24 Hour Exposure to Continuous Noise
Authors: Melnick William , Maves Michael
Published: October 2014

Ten men were exposed to a 300–600 Hz band of noise at an octave-band-level of 90 dB in a sound field for a period of 24 hours. Hearing thresholds were measured in one ear at 11 test frequencies ranging from 125 to 8000 Hz prior to exposure and at selected time intervals during and after exposure. Temporary threshold shift (TTS) appeared to reach asymptotic levels by 12 hours of exposure. Maximum TTS was approximately 11 dB and occurred at 500, 750 and 1000 Hz. TTS was appreciable at 1500 Hz amounting to 7 dB and was less than 5 dB at other frequencies. The growth pattern of TTS was triphasic; slow development during the first two hours of exposure, a rapid increase from 2 to 8 hours, and then apparently reaching an asymptote by the twelfth hour. Recovery was prolonged for the relatively small magnitude of TTS, requiring 24 hours before most of the subjects returned to preexposure threshold levels. Asymptotic TTS (ATS) showed dependence on preexposure threshold hearing levels.
Labyrinthitis Ossificans Due to Chronic Otitis Media
Authors: Suga Fumiro , Lindsay John R.
Published: October 2014

Histopathology of two cases of unilateral labyrinthitis ossificans in the presence of bilateral chronic suppurative otitis media is presented. In both cases, ossification and fibrosis were limited to the scala tympani of the lower basal turn, apparently due to inflammation entering through the round window membrane. The round window was occluded by new bone and fibrous tissue presumably resulting in a conductive hearing loss in addition to the conductive loss due to middle ear lesions. Degeneration of the hair cells of the organ of Corti was limited to the lower basal turn where ossification and fibrosis occurred.
Local Anesthesia in Otolaryngology
Authors: Schenck Nicholas L.
Published: October 2014

Almost a half century following attempts to ban its use, cocaine remains at the pinnacle of topical anesthesia in otolaryngology. To understand how nonaddicting synthetic substitutes such as procaine, dibucaine, tetracaine and lidocaine have not totally supplanted cocaine, requires an in-depth analysis of its unique pharmacological properties, untoward effects and potential substitutes. Almost all of the reported cocaine deaths occurred after subcutaneous injection; when used topically, cocaine's toxicity has been confined to an occasional reaction. Certain variables under physician control may be manipulated to reduce the chance of reaction to a minimum. For example, intermittent application of a particular dosage results in lower blood levels, and allowing sufficient time between doses reduces the amount necessary to obtain the desired anesthesia. If total dosage is kept below 200 mg there are few reactions. A singular advantage of cocaine over other topical anesthetics is its inherent ability to cause vasoconstriction, thus retarding its own absorption. The addition of a topical vasoconstrictor such as epinephrine is thus redundant, and may actually be harmful as cocaine sensitizes the patient to exogenous epinephrine. Finally, the usual preoperative dosages of barbiturates are entirely inadequate to prevent or treat cocaine reactions. Why, then, have synthetic local anesthetics not replaced cocaine? Inherent differences in topical effectiveness, duration of anesthesia and toxicity provide the answer. Of other local anesthetics possessing topical effectiveness tetracaine is about six times more toxic than cocaine. Dibucaine is as toxic as tetracaine, and lidocaine, while relatively nontoxic, provides only a 15 minute duration of topical anesthesia. A review of cocaine and its potential substitutes thus leads to the conclusion that cocaine is still a vital and necessary instrument in the otolaryngologist's armamentarium, singularly providing excellent topical anesthesia of usable duration, vasoconstriction, and shrinkage of mucous membranes, all with a quite acceptable margin of safety.
Glomus Tumors in the Head and Neck: III. Analysis of Clinical Manifestations
Authors: Spector Gershon J. , Ciralsky Robert H. , Ogura Joseph H.
Published: October 2014

Seventy-five patients with glomus tumors in the head and neck had a 37% incidence of cranial nerve paralysis and a 14.6% incidence of intracranial extension. Jugular foramen syndrome is associated with 50% and hypoglossal nerve involvement with 75% posterior fossa tumor invasion. Horner's syndrome is associated with 50% middle cranial fossa tumor invasion. The incidence of central nervous system (CNS) involvement with cranial nerve paralysis (not including VII nerve) is 52%. Otologic findings and VII nerve paralysis did not correlate with tumor resectability, CNS extension, and prognosis.
Remote Extracochlear versus Intracochlear Recordings in the Guinea Pig
Authors: Durrant John D. , Ronis Max L.
Published: October 2014

A comparison was made of the whole-nerve action potential recorded from a wire electrode placed on the tympanic membrane (TM) (remote extracochlear recording) and that recorded from intracochlear electrodes in the first and third turn scala tympani of the guinea pig. Cochlear microphonics and summating potentials were also studied. The expected decreased sensitivity at the TM site was observed in all responses, although the microphonic (CM) was diminished more than the action potential (AP) as compared to the responses monitored via the ST1 electrode. Nevertheless, the TM-recorded cochlear potentials largely mimicked the ST1-recorded potentials in a qualitative manner, i.e., similar configurations of the CM pseudo-threshold functions. It was consistently observed that the N2 of the AP is proportionally larger (relative to N1) in the TM recording than in the ST1 recording, These phenomena were attributed to the complex spread of the bioelectrical potentials in the nonhomogeneous volume conductor formed by the tissues of the temporal bone. It was suggested that the observed change in the N1/N2 ratio at the different sites of recording is due to the different contributions of second-order neuronal discharges to the compound AP. In effect, the TM electrode “sees” proportionally more activity from second-order fibers than does the ST1 electrode, and the ST3 electrode, less.
Desmoplastic Fibroma of the Mandible
Authors: Cunningham Calhoun D. , Smith Raymond O. , Enriquez Pablo , Singleton George T.
Published: October 2014

Case of a 4-year-old boy with a desmoplastic fibroma of the mandible. Desmoplastic fibromas are benign fibrous neoplasms which are easily confused with other fibrous tumors. Although benign, they usually display aggressive local tissue extension and frequently recur when treated conservatively. At the present time, wide, local excision appears to be the treatment of choice.
Transvestibular Approach to the Internal Auditory Canal
Authors: Antoli-Candela F. , de Cozar F. Alvarez , Antoli-Candela F.
Published: October 2014

A surgical approach to the internal auditory canal is presented which has proved useful in the following circumstances: 1) as a destructive procedure in Ménière's disease, 2) as a diagnostic procedure in patients in whom an acoustic neurinoma is suspected and a labyrinthectomy is indicated. In this situation the tumor may be removed during the same operative procedure, 3) for the removal of small, mobile, intracanalicular neurinomas, and 4) for complete facial nerve decompression in patients with no vestibular response and no serviceable hearing.
The Fate of Cartilage Grafts for Ossicular Reconstruction in Tympanoplasty
Authors: Don Andrew , Linthicum Fred H.
Published: October 2014

Six autograft tragal cartilages and two preserved homograft nasal septal cartilages removed from revision tympanoplasty were examined with histologic and histochemical stains. The implanted cartilage remained in the middle ear from six months to eighteen months without significant inflammatory reaction or evidence of resorption. It appears that the implanted cartilages removed from tympanoplasty have been well tolerated in the middle ear space.
Gas Tension and pH in Middle Ear Effusion
Authors: Ingelstedt Sven , Jonson Björn , Rundcrantz Hans
Published: October 2014

The composition of gases and the gas tension in middle ear effusion in patients with serous otitis media have been investigated. By using a specially designed micro-method, very small amounts of middle ear fluid could be analyzed. The effusion was obtained by puncturing the air cells of the mastoid process. The average value of Po2 was 41 mm Hg; Pco2 was 58 mm Hg, pH 7.24. The possible mechanism for the impaired perfusion of the mucous membranes is discussed as well as some clinical consequences.
Scanning Evaluation of Parotid Gland after Tympanic Neurectomy
Authors: Rosen G. , Konak S.
Published: October 2014

Nine patients suffering from chronic parotitis, gustato sweating syndrome, and gustato lacrymation syndrome underwent tympanic neurectomy. Follow-up showed discrepancies between the good clinical results and the unchanged parotid scans in eight out of nine patients. Parasympathetic bypasses to the parotid gland are discussed.
Use of the Doppler Ultrasonic Flowmeter for Pedicle Flaps
Authors: Davis William E. , Lichti Edgar L. , Joseph Donald J.
Published: October 2014

The Doppler ultrasonic flowmeter is presented as a method to help in flap outlining, transfer and return. When a directional flowmeter is added, this machine is extremely valuable for returning a flap at the earliest possible time. The Doppler is a safe, inexpensive, atraumatic, reliable instrument that can be learned in a very short time. We have found the Doppler to be very helpful in head and neck flaps.
Benign Paroxysmal Positional Vertigo: A Clinical Study
Authors: Herndon J. W. , Haug O. , Horowitz M. J. , Lynes T. E.
Published: October 2014

Ru-Vert®, a combination product, containing in each tablet, 25 mg of pentylenetetrazol, 12.5 mg of pheniramine maleate, and 50 mg of nicotinic acid, was evaluated in the treatment of seventeen patients with benign paroxysmal positional vertigo. The study was double-blind with crossover. Ru-Vert® at a dosage of two tablets t.i.d. was found to reduce significantly the nystagmus and the vertigo induced by Hallpike maneuvers in these patients.
A Contribution to the Physiology of the Perilymph Part IV: Effect of Histamine on the Cochlear Microcirculation
Authors: Schnieder Ernst-August
Published: October 2014

Because of the topography of the perilymphatic vascular network, the cochlear microcirculation is especially sensitive to the effect of vasoactive substances reaching the perilymphatic space. The cochlear microcirculation is mainly controlled humorally, via the activity of the metarterioles and changes in the flow properties of the blood. Intracochlear histamine reduces the cochlear circulation even more markedly than after intracarotid administration. No systematic effects of parenteral administration of vasoactive substances can be expected on the cochlear circulation. Reversible auditory disorders after stapedectomy may be explicable by the intracochlear release of histamine. The internal release of histamine after sunstroke and cold stress may play a part in sudden disturbances of hearing.
Surgical Anatomy of the Guinea Pig Ear
Authors: Asarch Richard , Abramson Maxwell , Litton Ward B.
Published: October 2014

The basic anatomy of the guinea pig ear is outlined as background for a description of two surgical approaches to the guinea pig temporal bone. These approaches provide access to the external, middle, and inner ear without significant blood loss or mortality. The superior approach, made by incision at the superior anterior attachment of the auricle and removing the lateral wall of the epitympanic space, exposes the round window, epitympanum, lateral canal, and external auditory canal, leaving the tympanic membrane intact. The inferior approach through the neck exposes the cochlea, Eustachian canal, horizontal and posterior semicircular canals, tympanic membrane, and ossicles.
Chordomas: Nasopharyngeal Presentation and Atypical Long Survival
Authors: Richter Harry J. , Batsakis John G. , Boles Roger
Published: October 2014

Atypical clinical and pathological features of cranio-cervical chordomas have prompted a review of these neoplasms at the University of Michigan Medical Center. Contrary to prior investigations, 92% of the spheno-occipital chordomas reported in this study clinically presented with a nasopharyngeal or intranasal mass. This high incidence indicates the requirement for an otorhinologic examination on all patients presenting with the neuro-ophthalmologic syndrome and roentgenologic findings characteristic of chordomas in this anatomical region. Special attention is called to a histologically distinctive variant of chordoma — the “chondroid chordoma.” Apparently restricted to the cranio-cervical region, this variant has been associated with long survival.
A Tympanometric Pressure Swallow Test for Assessment of Eustachian Tube Function
Authors: Williams Peggy S.
Published: October 2014

Normal Eustachian tube function is necessary for maintaining healthy middle ear conditions. A tympanometric pressure swallow test is proposed which can be used to assess Eustachian tube function behind an intact tympanic membrane. In general, after recording a baseline tympanogram, mechanically created positive and negative air pressures are created in a hermetically sealed ear canal causing increased pressure on the middle ear air cushion. The patient is then asked to swallow. Preliminary clinical findings in ears with apparent normal Eustachian tube function show that a shift in the peak pressure point of the tympanogram occurs when the tympanogram is recorded again, implying that the Eustachian tube opens and equalizes middle ear air pressure. Positive canal pressure swallow maneuvers show a peak pressure shift to a negative value, whereas negative pressure swallow maneuvers show a peak pressure shift to a positive value.