bluuebunny/crossref_metadata_2025 huggingface dataset:
Neoplasms of the vagus nerve
Authors: Green J. Douglas , Olsen Kerry D. , Desanto Lawrence W. , Scheithauer Bernd W.
Published: October 2006

A tumor of the vagus nerve often, is discovered unexpectedly at operation. We report 36 of these rare neoplasms in 35 patients. The majority of the tumors presented as a mass in the upper cervical or parapharyngeal region. Usually the mass was asymptomatic. The following types and frequencies of neoplasms of the vagus nerve were noted: paragangliomas, 50%; neurilemmomas, 31%; neurofibromas, 14%; and neurofibrosarcomas, 6%. Surgical resection, with preservation of the vagus nerve when possible, is the treatment of choice. The clinical features, diagnosis, management, and prognosis of the tumors are presented. Special problems that occur with vagal neoplasms include postoperative dysfunction, catecholamine secretion, and intracranial or skull‐base extension.
Acupuncture for the alleviation of tinnitus
Authors: Thomas M. , Laurell G. , Lundeberg T.
Published: October 2006

The present study describes the effect of acupuncture in 12 patients with tinnitus. The patients were referred from the Department of Audiology, Karolinska Hospital, where their hearing and tinnitus were assessed. None of the patients had benefited from previous treatment for tinnitus.

The selection of acupuncture points depended on the individual and was, to a limited extent, based on traditional Chinese medicine (TCM). Local points such as Si 19, Sj 17, and Sj 21 were fairly standard; distal points took into account associated problems of the patient, but were also points recommended in TCM for tinnitus.

Ten treatments were attempted within a 6‐ to 12‐week period. The treatments were carried out weekly or biweekly, depending on the availability of patient and acupuncturist.

Six patients had transient effects and noise reduction. However, no positive long‐term results were obtained. Similarities between the experience of tinnitus and of pain are discussed in light of these findings.
Dedication
Authors: Carpenter Anna‐Mary
Published: October 2006

This supplement is dedicated to my dear Professor Dr. Anna‐Mary Carpenter who retired on August 1,1987 after 50 years of active teaching. Her scientific career started in 1938 at the University of Pittsburgh where she was a member of the Pathology Department at the Children's Hospital until 1954 when she joined the Anatomy Department at the University of Minnesota. She became Full Professor in 1963 and remained in that position until 1982, becoming then Professor Emerita. She also served as Professor of Pathology at Indiana University, Northwest Center since 1980, and has lived in Indiana since 1982.

In spite of all her degrees, scientific deeds, and international recognition (innovations in diabetes, quantitative morphology, and being first to “section” a pancreas using computer simulation), her greatest achievements have come from her teachings of her discipline. She has trained several generations of graduate students, postdoctoral fellows, and more than 5,000 medical students. Her extraordinary teaching ability and capacity is the result of her profound knowledge and understanding of morphology. Her personal interest and dedication to all of her students gained her the legendary nickname “Ma Carpenter.” Dr. Carpenter represents an exceptional breed of true scholar and scientist. As one of her students and with the conviction of representing all of them, I want to assure her that those true scientific and university values taught for over 50 years are alive and very strong in all of us, that her teachings will persist for generations, and that she will live in our hearts.
Experimental studies on round window structure: Function and permeability
Authors: Goycoolea Marcos V. , Muchow David , Schachern Patricia
Published: October 2006

Current research and an overall review of 12 years of round window membrane studies is presented. The approach, rationale, and concepts that have evolved from the studies are described. An ultrastructural study of the round window membrane of rhesus monkeys disclosed three basic layers: an outer epithelium, a middle core of connective tissue, and an inner epithelium. Morphologic evidence in monkeys, cats, and chinchillas suggests that these layers of the round window participate in absorption and secretion of substances to and from the inner ear, and that the entire membrane could play a role in the defense system of the ear. Cationic ferritin, horseradish peroxidase, 1‐μm latex spheres, and neomycin‐gold spheres placed in the middle ear of these experimental animals were observed to traverse the round window membrane through pinocytotic vesicles. Three‐micron latex spheres and anionic ferritin were not incorporated by the membrane. Cationic ferritin and 1‐μm latex spheres placed in perilymph were incorporated by the inner epithelial cells, suggesting absorptive capabilities of the round window membrane. Cationic ferritin was observed within the mesothelial cells underlying the scala tympani side of the basilar membrane, suggesting a role for these cells in the inner‐ear defense system. A review of the subject and a general perspective from the author's viewpoint are discussed.
Apneic anesthesia for improved endoscopic removal of laryngeal papillomata
Authors: Weisberger Edward C. , Miner James D.
Published: October 2006

During a 2‐year period at Indiana University Medical Center, nine patients underwent 51 endoscopic procedures employing the technique of apneic anesthesia for removal of papillomata involving the larynx.

The apneic anesthesia technique affords improved visualization of the larynx and subglottis because the view is unencumbered by an endotracheal tube. This unencumbered view allows a more thorough removal of diseased tissue, especially in the posterior commissure and subglottis. In addition, the absence of an endotracheal tube reduces the risk of a fire occurring in the upper airway and eliminates the chance of physically disseminating papilloma particles into the lower tracheal‐bronchial tree or toward the physician—a problem that is inherent in the intermittent jet ventilation technique. No significant complications related to the use of this technique have been encountered; however, the safety of apneic anesthesia is greatly enhanced by using a pulse oximeter and transcutaneous oxygen monitor to continuously monitor arterial oxygen saturation.

Details of the apneic anesthesia technique are described, as are the relevant aspects of pulmonary physiology, which must be clearly understood to safely employ this method.
Orbital decompression for optic neuropathy secondary to thyroid eye disease
Authors: Schaefer Steven D. , Merritt James H. , Close Lanny G.
Published: October 2006

To improve our management of optic neuropathy from thyroid eye disease, we have refined the external ethmoidectomy approach, which permits the removal of the medial orbital wall and adjacent floor. We now report our experience with six patients (11 eyes) selected for this surgical technique. These patients are part of a larger population of patients with thyroid eye disease who have been surgically managed by us over the last 6 years.
Routine identification of the facial nerve using electrical stimulation during otological and neurotological surgery
Authors: Silverstein Herbert , Smouha Eric , Jones Raleigh
Published: October 2006

We routinely identify the facial nerve to avoid facial nerve injury during most otologic surgery. Since 1985, we have used a facial nerve stimulator/monitor as an added safety feature in 383 consecutive otologic and neurotologic cases. In our last 30 middle‐ear, 8 retrolabyrinthine vestibular neurectomy, and 14 acoustic neuroma cases we used the monopolar stimulator probe‐tip to determine threshold currents needed to produce facial twitch. Stimulation thresholds varied according to the amount of soft tissue or bone overlying the facial nerve. The stimulator was useful for predicting dehiscences in the bony facial canal during middle‐ear and mastoid surgery. The exposed facial nerve usually stimulated at a level less than 0.1 mA (mean 0.05 mA), and the horizontal facial nerve covered by bone stimulated at 0.25 mA or greater (mean 0.6 mA). The stimulator was also used to predict the amount of bone overlying the vertical facial nerve at the annulus. An approximate relationship of 1.0 mA of threshold current to 1.0 mm of bony covering was found. After acoustic neuroma surgery, the stimulation threshold of the facial nerve at the brain stem helped predict postoperative facial function. Cases with current thresholds of 0.3 mA or less resulted in normal facial function. During ear surgery, routine identification of the facial nerve with the aid of a facial nerve stimulator will help avoid facial nerve injury.
Atrophy of the stria vascularis as a cause of sensorineural hearing loss
Authors: Pauler Margarethe , Schuknecht Harlod F. , White Judith A.
Published: October 2006

Correlations were made between pure‐tone thresholds and computer‐aided cross‐sectional measurements of the stria vascularis on histological sections of postmortem cochleas from 24 subjects who had reliable audiometric records. The criterion for selection was strial atrophy as the predominant pathological change in 17 experimental ears and normal hearing for seven control ears. Losses in the summed cross‐sectional areas of stria vascularis showed a direct correlation with hearing loss. The cause for the strial atrophy is presumed to be a genetically determined predisposition for early cellular decay. The mechanism by which strial atrophy causes hearing loss is speculative.
Internal maxillary artery ligation for epistaxis: An analysis of failures
Authors: Metson Ralph , Lane Ronald
Published: October 2006

The records of 100 consecutive patients undergoing transantral ligation of the internal maxillary artery (DMA) for epistaxis, including 15 patients who developed postoperative bleeding, were reviewed. Preoperative parameters predictive of surgical failure were advanced age, anemia, and a history of hypertension. The causes of postoperative epistaxis, as determined by surgical reexploration or angiography in 12 cases, included failure to identify the IMA in the pterygomaxillary space (6 cases), blood flow through partially closed clips on the IMA (2 cases), bleeding from posterior ethmoid arteries (2 cases), and revascularization of the nasal blood supply (2 cases). The incidence of surgical failure may be reduced by proper techniques of IMA identification and ligation.
Pyoderma gangrenosum involving the head and neck
Authors: Yco Mario S. , Warnock Gary R. , Cruickshank James C. , Burnett John R.
Published: October 2006

Pyoderma gangrenosum (PG) is a rare pathergy associated with systemic diseases such as ulcerative colitis and polycythemia vera. Its recognition in the differential diagnosis of other ulcerative lesions is important in managing an affected patient. A patient who developed lower extremity, oral, and cervical manifestations of this disease on separate occasions is presented. It is imperative that every clinician be aware of this entity because of the potential untoward effects of delayed or improper treatment including unnecessary surgery. Systemic and intralesional steroids are the treatment of choice.
Adenocaecinomas of major and minor salivary gland origin: A histopathologic review of treatment failure patterns
Authors: Matsuba Howard M. , Mauney Marc , Simpson Joseph R. , Thawley Stanley E. , Pikul Frank J.
Published: October 2006

Fifty‐four cases of adenocarcinoma of major and minor salivary gland origin were seen between 1960 and 1980. Fifty of these were treated definitively. Planned surgery combined with radiation was the initial treatment for 22 patients (44%), surgery alone for 16 (30%), and radiation alone for 13 (26%). Of the patients receiving surgery with curative intent, 82% underwent complete resections (i.e., negative margins). Cervical lymph node involvement was present in 23% of cases, and 73% of these patients died of their disease within 3 years. Distant metastases developed in 37% of patients, with a median time of 1 year; 93% of these patients died within 3 years.

Histologic grading was performed using objective criteria. Thirty‐four percent of tumors were well‐differentiated, 27% moderately differentiated, and 39% poorly differentiated. Patients with well‐differentiated adenocarcinomas tended to survive disease‐free longer and developed fewer distant metastases than those patients with moderately or poorly differentiated tumors.
Superselective embolization of laryngeal hemangioma
Authors: Konior Raymond J. , Holinger Lauren D. , Russell Eric J.
Published: October 2006

Diffuse upper respiratory hemangiomas are extremely rare lesions. Unlike the much more common congenital subglottic hemangiomas, diffuse upper respiratory hemangiomas do not resolve spontaneously and may prove quite recalcitrant to conventional forms of therapy.

Superselective embolization, a highly successful technique for the management of head and neck vascular lesions, was used to effectively control an obstinate laryngotracheal hemangioma. Superselective embolization appears to provide yet another viable therapeutic option in the management of laryngeal hemangiomas.
Use of stents in laryngotracheal reconstruction in children: Indications, technical considerations, and complications
Authors: Zalzal George H.
Published: October 2006

The keys to successful outcome in surgical repair of laryngotracheal stenosis in children are choice of surgical procedure, including possible need for stenting; choice of type and length of stent; and duration of stenting. Choosing the appropriate method for stenting requires considering consistency of stenosis, altered anatomy, size, location, and stability of grafts when used for surgical repair and host tissue healing factors.

Possible stents that can be used include endotracheal tubes, Silastic® sheet rolls, Montgomery T‐tubes, and laryngeal stents. This study investigates the effectiveness of the Aboulker stent, an increasingly popular stent for use in children. Indications and associated technical considerations for using the stent in 18 cases are reviewed. Postoperative care and follow‐up, directed against infection and towards securing the stent in its original location, and management of complications are discussed.
A statistical study of ENoG test error
Authors: Raslan Wasim F. , Wiet Richard , Zealear David L.
Published: October 2006

Electroneurography (ENoG) is currently the most sophisticated and objective test available for assessing nerve degeneration in patients suffering from facial nerve paralysis. However, the test requires considerable experience before error due to intertest variability can be brought within reasonable limits. In a statistical study on normal participants, the error associated with two conventional recording techniques—optimized lead placement (OLP) and standardized lead placement (SLP)—was determined to be 17.8% and 20.7%, respectively. A significant increase in error was observed with the OLP approach (22.9%) if responses could not be monitored oscilloscopically, a common situation in patients with severe degeneration. In a final study, however, a previously unreported factor was found to significantly reduce test error: recording electrode size. In particular, unconventionally small recording electrodes (3 to 7 mm) produced as much as 4% less error when administering the technique.
Embolization: An adjunctive measure for removal of carotid body tumors
Authors: Ward Paul H. , Liu Chen , Vinuela Fernando , Bentson John R.
Published: October 2006

Small carotid body tumors that do not encircle the internal carotid artery are excised with relative ease and minimal risk by the conventional subadventicial approach. Large carotid body tumors frequently encircle the internal and external cartoid arteries, and extensive bleeding often complicates the resection, increasing the risk of carotid artery rupture and damage to major cranial nerves. Recent improvements in surgical techniques and selective embolization have lessened the risks of surgical excision, decreased the blood loss, and diminished the time required for resection. Experiences in the resection of carotid tumors with and without embolization are compared. Early resection of carotid body tumors, before involvement of the internal carotid artery and carotid bulb, is advocated.
The caldwell‐luc procedure: Institutional review of 670 cases: 1975–1985
Authors: Defreitas Junior , Lucente Frank E.
Published: October 2006

The Caldwell‐Luc procedure, which has long been fundamental in the treatment of perisinus disease, has undergone increasing scrutiny when used for inflammatory antritis. Individual morbidity rates of less than 10% to greater than 40% have been reported. To assess the data from our own institution, a retrospective study of 670 Caldwell‐Luc procedures was undertaken.

Patients ranged in age from 10 to 82, with a mean age of 42.9 years. There were 271 males and 325 females. Parameters studied included symptoms, physical findings, operative techniques, surgical findings, length of hospitalization, and postoperative complications.

Immediate postoperative complications included facial swelling in 89% of patients, cheek discomfort in 33%, significant hemorrhage in 2.9%, and temperature elevation in 12.1%. Long‐term follow‐up ranged from 2 years to 10 years. Overall complication rates in 464 patients included facial asymmetry (3), facial numbness or paresthesia (42), oroantral fistulas (5), gingivolabial wound dehiscences (7), dacryocystitis (12), devitalized tooth (2), recurrent sinusitis (56), and recurrent polyposis (25). A revision antrostomy was required in 37 patients, a revision Caldwell‐Luc in 22 patients, an intranasal sphenoethmoidectomy in 17, and root canal therapy in 2 patients. The most frequent complication was recurrent nasal obstruction, occurring in 28% of patients. Overall complication rates tended to increase with a longer follow‐up period.
Neurotization of pectoralis major myocutaneous flap by the hypoglossal nerve in tongue reconstruction: Clinical and experimental observations
Authors: Katsantonis George P.
Published: October 2006

Recently, neurotization has been proposed for providing mobility to the pectoralis major, or other myocutaneous flap in lingual reconstruction following total glossectomy. The development of an active tongue‐like structure may offer the patient higher potential for rehabilitation of speech and deglutition. The purpose of this thesis is to report experimental and clinical observations on neurotization of the pectoralis major myocutaneous flap.

The pectoralis major myoflap of 16 rats was reinnervated by either a hypoglossal nerve pedicle of hypoglossal‐genioglossus muscle neuromuscular pedicle. Functional flap reinnervation was confirmed in eight of the 16 animals. The author's clinical experience with reconstruction of the tongue utilizing neurotized pectoralis major myocutaneous flap is presented.
Management of neurovascular complications in extended skull base surgery
Authors: Leonetti John P. , Smith Peter G. , Grubb Robert L.
Published: October 2006

Combined oncologic approaches to the skull base now permit resection of extensive basicranial neoplasms. Despite advances in microsurgical techniques, disabling or life‐threatening complications are still encountered in such surgery. Successful management of these sequelae is dependent upon meticulous intraoperative care and compulsive postoperative clinical assessment.

Perioperative neurovascular complications were recorded in 164 consecutive skull base procedures. The most frequent severe complication was cerebral edema, which occasionally required surgical intervention. Dysphagia was the most common complication noted in the late postoperative period.

Based upon this review, the management and methods found to minimize the incidence of various perioperative neurovascular complications related to extended skull base surgery are described.
Phonatory characteristics following surgical treatment of severe polypoid degeneration
Authors: Bennett Suzanne , Bishop Sandra G. , M. Lumpkin Samuel M.
Published: October 2006

This paper summarizes the results of our research into the efficacy of phonosurgery. Our study group consisted of 25 women whose severe, bilateral polypoid degeneration was managed surgically by one of the following methods: Hirano's technique, mechanical stripping, or CO2 laser enucleation. We found that all three procedures improved the voice. Surgery increased the average speaking fundamental frequency level substantially and improved the phonationnl range. Listeners' judgments about the appropriateness of vocal pitch and severity of hoarseness also changed positively following surgery. No one method was clearly better than another in improving the voice. However, patients treated using Hirano's method experienced the most rapid return of functional voice use, probably because the procedure is less traumatic and promotes more rapid healing than mechanical stripping or laser removal.
Human endothelial cell growth factors derived from thyroid anaplastic cell carcinoma
Authors: Itoh Kazunori , Fukuda Katsunori , Matsuzaki Tsutomu , Takao Sonshin , Ohyama Masaru
Published: October 2006

Human endothelial cell growth factors were partially isolated from transplanted thyroid anaplastic cell carcinoma propagated in nude mice. Purification was monitored in human umbilical cord vein endothelial cell cultures by (3H)‐thymidine incorporation into DNA. Crude tumor extracts with 0.1 M Tris‐HCl, pH 7.2 were fractionated by ammonium sulfate precipitation. The active materials precipitated by 35% to 50% ammonium sulfate were further purified by Bio‐Rex 70 (Bio‐Rod, Richmond, Calif.) cation exchange chromatography. Active fractions eluted by 0.5 M to 0.7 M NaCl were further analyzed via heparin‐sepharose affinity chromatography. This resulted in separation of one major peak eluted by 0.9 M to 1.2 M NaCl and confirmed to promote human umbilical cord vein endothelial cell proliferations, and three other peaks. The molecular weight determination of the most active fraction performed by high‐pressure liquid chromatography utilizing TSK 2000 gel column indicates 41,000 and 19,000 daltons for the active materials, respectively. Our results demonstrate that the angiogenesis properties of a solid tumor (thyroid anaplastic cell carcinoma), are not composed of a simple mechanism in vivo.
Survival following recurrent malignant melanoma of the head and neck
Authors: Hoyt David J. , Fisher Samuel R.
Published: October 2006

A retrospective analysis of 877 patients who had malignant melanoma of the head and neck identified 366 patients who developed recurrent disease. Sex, race, age, histology, Clark level, thickness, ulceration, lymph node status, lymph node dissection, site of recurrence, and time to recurrence were analyzed to determine their effect on survival following the development of recurrent disease. Survival following the development of recurrence was found to be influenced by the site of first recurrence and the age of the patient at the time of recurrence. For a given age, patients who had initial recurrences at distant sites were three times as likely to die following recurrence than patients with local recurrence. Patients who had initial recurrences at distant sites were twice as likely to die following recurrence than patients with regional sites of recurrence (p<0.001).
Bilateral parotid enlargement in HIV‐Seropositive patients
Authors: Tunkel David E. , Loury Mark C. , Goins Martin A. , Johns Michael E. , Fox Cecil H.
Published: October 2006

Bilateral enlargement of the parotid glands has been noted in five patients who are seropositive for antibody to the human immunodeficiency virus. A characteristic cystic appearance has been noted in these lesions on clinical and radiographic examination. A benign lymphoepithelial infiltrate with cystic degeneration is found in parotid specimens from these patients. The presence of human immunodeficiency virus ribonucleic acid in inflammatory cells infiltrating the parotid specimen was confirmed by an in situ hybridization technique. The clinical manifestations of sicca syndrome were not present nor were opportunistic infections diagnostic for the acquired immunodeficiency syndrome.
Hypopharyngeal reconstruction: A comparison of two alternatives
Authors: De Vries Egbert J. , Johnson Jonas T. , Wagner Robin L. , Myers Eugene N. , Stein David W. , Schusterman Mark A. , Shestak Kenneth , Jones Neil F. , Williams Scott
Published: October 2006

Gastric pull‐up or free jejunal interposition was used for reconstruction after total laryngopharyngectomy in 31 patients. Complications and functional outcomes of the two methods are compared. Primary swallowing was achieved in 86% of patients after gastric pull‐up and in 82% of patients after jejunal interposition. Patients who underwent jejunal interposition were able to swallow sooner and had a shorter hospital stay than patients who underwent gastric pull‐up. Esophageal tumor recurrence after jejunal interposition was not observed. Hepatic failure occurred in two gastric pull‐up patients, leading to perioperative death in one. Flap necrosis occurred in two jejunal interposition patients and one gastric pull‐up patient. Two additional fistulas occurred in jejunal interposition patients as a result of microvascular complications. Stricture developed in four jejunal interposition patients, requiring revision surgery in two. Minor complications were more common in the gastric pull‐up group. Long‐term speech and swallowing function are compared. Our current choice of jejunal interposition or gastric pull‐up for reconstruction after total laryngopharyngectomy primarily depends on the location of the tumor.
Congenital torticollis: Evaluation by fine‐needle aspiration biopsy
Authors: Gonzales John , Ljung Britt‐Marie , Guerry Tom , Schoenrock Larry D.
Published: October 2006

Fine‐needle aspiration biopsy, used extensively for evaluating head and neck masses in adults, also provides an excellent minimally invasive means of evaluating infants with neck masses and torticollis. Three cases of torticollis involving infants are presented. In each case, fine‐needle aspiration revealed a benign fibrous lesion, ruling out malignancy. The remaining cytologic differential diagnosis between infantile fibromatosis, fibromatosis colli, and calcifying aponeurotic fibrosis is discussed, with mention of the possible causes of and treatment for congenital torticollis. We conclude that fine‐needle aspiration provides a fast and accurate diagnosis of neck masses in infants who have congenital torticollis, thereby avoiding surgical procedures in this very young age group.
Atypical osteomyelitis of the skull base
Authors: Grobman Lawrence R. , Casiano Roy , Goldberg Scott , Ganz William
Published: October 2006

Most cases of osteomyelitis of the skull base occur as a result of inadequately treated localized malignant otitis externa. We present four patients with osteomyelitis of the skull base who did not present initially as malignant otitis externa. Increased morbidity may occur when these atypical cases are not promptly recognized and treated.
The predictive efficacy of the müller maneuver in uvulopalatopharyngoplasty
Authors: Katsantonis George P. , Maas Corey S. , Walsh James K.
Published: October 2006

Flexible pharyngoscopy with the Müller maneuver has been proposed as a method for selection of uvulopalatopharyngoplasty candidates. In this prospective study, its predictive efficacy has been evaluated in 24 consecutive obstructive sleep apnea patients undergoing uvulopalatopharyngoplasty. FPMM enabled us to accurately predict the uvulopalatopharyngoplasty outcome in 12 of the 24 patients (50%).

Although flexible pharyngoscopy with the Müller maneuver appears to be helpful in the selection of candidates for UPP, its distinct predictive efficacy is low.
Repair of orbital floor fractures with marlex® mesh
Authors: Scapini David A. , Mathog Robert H.
Published: October 2006

The best method for reconstructing the acutely fractured orbital floor is controversial. In this review, the outcome of 81 patients with an operatively confirmed pure orbital blow‐out fracture is evaluated with respect to postoperative enophthalmos, diplopia, infection, and extrusion. A Marlex® mesh implant was used to repair 58 of the fractures, with minimal resultant complications. We believe that Marlex® mesh is an ideal implant for use in repairing the early blow‐out fracture.
Neuroaudiologic abnormalities in patients with type 1 neurofibromatosis
Authors: Pensak Myles L. , Keith Robert W. , Dignan Peter St. John , Stowens Daniel W. , Towbin Richard B. , Katbamna Bharti
Published: October 2006

Although the protean manifestations of neurofibromatosis have been studied for many years, much is yet to be learned about this disease in young children. Specifically, little is known about the prevalence and significance of early neurotologic abnormalities in this population. Our review of the recent literature, however, failed to identify any publication on the use of ABR and acoustic reflex testing in the pediatric neurofibromatosis population.

This study reports on a standardized differential diagnostic battery conducted on 44 children diagnosed as having neurofibromatosis. Results of the neuroaudiologic battery indicated that 32% of the children had significant abnormalities on ABR and acoustic reflex dynamic tests. This is a substantially higher prevalence of abnormalities than reported by another group at a recent NIH concensus meeting on neurofibromatosis.

Discussion of the implications of these findings regarding evaluation protocols, as well as management for this select patient population, will follow.
Airway complications in the head injured
Authors: Woo Peak , Kelly Glen , Kirshner Patricia
Published: October 2006

Fifty head‐injured patients who had tracheostomy were followed during rehabilitation by video fiberoptic laryngoscopy examination. Complications of aspiration (23/50), airway stenosis (13/50), and phonation dysfunction (16/24) were followed. Spontaneous resolution of aspiration may require a prolonged course. A majority of patients (37/50) had improvement and could be decannulated. Prognostic factors correlated to eventual decannulation included age, level on the Glasgow Coma Outcome Scale, and type of head injury. Those with poor neurologic improvement and glottic incompetence (13/50) are poor candidates for decannulation. Significant airway stenosis can involve both laryngeal and tracheal sites. Neurologic dysfunction may complicate the decannulation process after airway anatomy has been restored by surgery. Dysphonia resulting from intubation, peripheral laryngeal and nerve injury, or central laryngeal movement dysfunction are common. Preventive maintenance with ongoing evaluation can avoid airway crises such as aspiration pneumonia, hemoptysis, and innominate artery.
Voice intensity of patients using a communi‐trach I® cuffed speaking tracheostomy tube
Authors: Leder Steven B. , Traquina Diana N.
Published: October 2006

Voice intensity levels produced by 20 patients with cuffed speaking tracheostomy tubes (Communi‐Trach I®) at three different airflow rates were investigated. Results indicated that audible and intelligible speech was produced with significantly greater intensity over ambient room noise at 5 l/minute, 10 l/minute, and 15 l/minute of airflow. Criteria for use, common causes of malfunctioning, and rehabilitation techniques necessary for the successful use of cuffed speaking tracheostomy tubes are discussed.
Spontaneous otoacoustic emissions: Clinical interest
Authors: Bonfils Pierre
Published: October 2006

Spontaneous otoacoustic emissions (SOEs) were recorded in a group of normally hearing participants (n=148 ears) and a group of patients demonstrating several common types of sensorineural hearing loss (n=136 ears) in order to study the clinical interest of spontaneous otoacoustic emissions. In the normal population, the incidence of SOEs decreased from 68% in the group of infants less than 18 months old to 0% after the age of 70 years old. On the other hand, the SOE incidence and the spectrum content did not change with sex. In the group of participants with sensorineural hearing loss, the incidence of SOEs decreased linearly with increasing click threshold or the detection‐threshold of evoked otoacoustic emission. No statistical difference in SOE incidence was found between participants with or without tinnitus. These results have several important applications concerning the possible clinical application of SOEs.
Bronchoscopic brachytherapy
Authors: Marsh Bernard R.
Published: October 2006

Increasing lung cancer mortality has created renewed interest in the bronchoscopic use of isotopes for palliation of recurrent airway carcinomas. In the first part of this paper we report our clinical experience with iodine‐125 implantation for treatment of endobronchial carcinomas in 18 patients followed until death. Symptoms of cough, hemoptysis, and dyspnea were most effectively relieved with tumors limited to the bronchial lumen. Contraindications to this procedure include extensive extrabronchial tumors causing airway compression and severe debility.

In the second part of this paper the development of a new isotope delivery system designed to overcome technical difficulties experienced in the treatment of some patients with interstitial iodine 125 is described. An isotope capsule was constructed to permit insertion and removal by means of a fiberoptic bronchoscope. This device was successfully tested in animals and is now approved for clinical trials. It represents a unique, new modality for treatment of superficial, multifocal, and less‐advanced recurrent bronchogenic carcinomas.
An immunohistochemical study of the endolymphatic sac in patients with acoustic tumors
Authors: Bui Hang T. , Linthicum Fred H. , Hofman Florence M. , Bowman Carol A. , House William F.
Published: October 2006

Intraosseous endolymphatic sacs obtained from patients with acoustic neuromas who had undergone total labyrinthectomy during tumor removal were examined for the presence of T helper/inducer and T suppressor/cytotoxic lymphocytes, B lymphocytes, plasma cells, and macrophages. Immunoperoxidase staining of cryostat sections revealed the presence of T helper/inducer lymphocytes, T suppressor/cytotoxic lymphocytes, and macrophages. The number of B lymphocytes and plasma cells was much smaller than the number of T lymphocytes. The number of T suppressor/cytotoxic lymphocytes was higher than the number of T helper/inducer lymphocytes. This study supports the notion of local immune responsiveness in the human inner ear. This is the first immunohistochemical study to analyze lymphocyte subpopulations; specifically, to provide insight into T‐cell function in the endolymphatic sac.
Post‐traumatic cholesteatoma
Authors: McKennan Kevin X. , Chole Richard A.
Published: October 2006

Cholesteatoma can develop as a late complication of fracture of the temporal bone. The otologist must be wary of it since the growth of the cholesteatoma resulting from a temporal bone fracture can be undetected for years allowing for invasive and extensive growth. Three illustrative cases are presented.
Adaptation to surgery for head and neck cancer
Authors: Krouse John H. , Krouse Helene J. , Fabian Richard L.
Published: October 2006

We examined the postoperative adjustment of 45 patients who underwent surgery for cancers of the head and neck: 23 who had laryngeal cancer, 18 who had oral cavity/oropharyngeal cancers, and 4 who had cancers of other sites. Patients were assessed preoperatively, and at 3 months and 9 to 12 months postsurgery. Interviews and questionnaires were used to assess depression, body image, limitations, pain, financial problems, need for help at home, and social interaction. Results revealed that pain, fatigue, weakness, and loss of speech were major concerns. Pain and financial concerns were worst at 3 months and then improved. Physical limitations increased steadily with time. Depression was a major factor in patients with oral cavity and oropharyngeal cancers. Of note, patients who underwent postoperative radiation therapy had the most difficulty adapting to their illness and treatment, with persistent limitations in function and social isolation. The implications of these findings are discussed.
Growth of the lateral surface of the temporal bone in children
Authors: Simms David L. , Neely J. Gail
Published: October 2006

The adaptation of implantable auditory prostheses for use in children has raised questions concerning both what effect growth may have on the implant and what effect the implant may have on growth. The purpose of this study is to describe temporal bone lateral surface dimensions in children of different ages to draw inferences about growth rates.

Using a surface projected grid and point calipers, 158 intact temporal bones from 103 individuals of known ages between birth and 20 years were measured at six points from a fixed reference. These specimens were located in the skeletal collections of the Smithsonian Institute's Museum of Natural History, the Medical Museum of Walter Reed Hospital at the Armed Forces Institute of Pathology, and the Cleveland Museum of Natural History.

Linear regression analysis helped clarify a bimodal pattern of growth in which marked increases in dimension occur from birth to 4 years of age and much less change is seen from age 4 to 20 years.

These data suggest that implantation in children under 4 years of age is subject to maximal growth effects.
Replacement of upper esophagus: Results with myocutaneous flap and with gastric transposition
Authors: Silver Carl E. , Cusumano Robert J. , Fell Stanley C. , Strauch Berish
Published: October 2006

The authors reviewed 25 cases of pharyngoesophageal replacement. A tubed pectoralis major myocutaneous flap was employed in ten cases where an adequate distal resection margin could be obtained above the thoracic inlet. Total gastric transposition was used in 15 cases where resection extended into the mediastinum.

The overall rates of complications (52%), postoperative mortality (20%), and satisfactory deglutition (80%) were similar for both operations and were superior to those achieved with reconstructive procedures previously used by the authors. The choice of method is influenced by the length of the pharyngoesophagus to be replaced and the general condition of the patient. Gastric transposition is a more versatile operation and is adaptable to replacement of the entire esophagus if necessary, while the tubed pectoralis major myocutaneous flap has proven particularly effective for the rehabilitation of elderly and severely debilitated patients.
Radiographic diagnosis, surgical treatment, and long‐term follow‐up of cholesterol granulomas of the petrous apex
Authors: Thedinger Britt A. , Montgomery William W. , Nadol Joseph B. , Thedinger Bradley S. , Greenberg Jeffrey J.
Published: October 2006

Cholesterol granuloma is an unusual lesion of the petrous apex. Accurate preoperative differentiation of the various lesions of the petrous apex by computed tomography scanning only has been difficult. We reviewed the clinical findings, computed tomography and magnetic resonance imaging scans, surgical approaches, and long‐term follow‐up in 10 patients with cholesterol granuloma of the petrous apex who were seen between 1971 and 1988. Headache and deficits of the 5th, 6th, 7th, and 8th cranial nerves were common presenting symptoms. Magnetic resonance imaging with special imaging techniques was accurate in diagnosing cholesterol granuloma in four patients preoperatively and three patients prior to revision surgery. The optimal surgical approach was chosen on the basis of clinical and radiographic findings and included the transsphe‐noidal, infralabyrinthine, transcochlear, and suboccipital routes. Our review reveals that magnetic resonance imaging is more specific than computed tomography in establishing a preoperative diagnosis and is also the technique of choice in follow‐up. The long‐term results are discussed.
Congenital aural atresia
Authors: Schuknecht Harold F.
Published: October 2006

This report is based on 25 years' experience in the surgical management of 69 ears with congenital aural atresia. There were 7 ears with meatal atresia, 11 with partial atresia, 50 with total atresia, and 1 with hypopneumatic total atresia. Meatoplasty was performed in 7 ears, canaloplasty was performed in 22 ears, canaloplasties with struts in 8 ears, and mastoidectomy with stapediopexy was performed in 26 ears. Of the 62 ears that had partial or total atresia, five (8%) had hidden cholesteatomas that were destined to create future complications by expansion and erosion had they not been removed. In five of the 62 ears, temporary facial palsy resulted from exposing the facial nerve in the atresia plate, and in another five ears, attempts to improve hearing were abandoned intraoperatively because of surgically insurmountable anomalies. A reasonable criterion for success in an operation for bilateral atresia is that the need for a hearing aid is obviated; whereas, for unilateral atresia, a successful procedure should largely eliminate the disadvantages of unilateral hearing loss. These criteria seem to be satisfied if the threshold of hearing can be brought to a level of 20 dB or better. This criterion was met in 30% of the group that underwent canaloplasty and in 8% of the group that underwent mastoidectomy with stapediopexy.
Osteocartilaginous necrosis of the sinonasal tract following cocaine abuse
Authors: Kuriloff Daniel B. , Kimmelman Charles P.
Published: October 2006

As cocaine abuse has become increasingly widespread, there has been a concomitant rise in associated medical complications. Nasal inhalation (“snorting”) causes profound effects on the upper respiratory tract in addition to the well known nasal septal perforation. Septal necrosis can be accompanied by bleeding, granulation tissue, ulceration, and sinusitis. There are few reports of extensive sinonasal tract osteocartilaginous necrosis from cocaine abuse. We present five patients with this complication, which must be distinguished from other destructive mid‐face lesions such as Wegener's granulomatosis and polymorphic reticulosis.
An experimental model for the endoscopic correction of subglottic stenosis with clinical applications
Authors: Healy Gerald B.
Published: October 2006

The use of long‐term endotracheal intubation in the treatment of respiratory distress syndrome in the newborn has seen an increase in the number of cases of acquired subglottic stenosis. Multiple methods of correction have been advocated in conjunction with the use of antibiotics, corticosteroids, and indwelling stents.

An animal experiment utilizing 64 dogs was undertaken in an effort to devise an endoscopic procedure using the CO2 laser which might be successfully employed in the human patient. An attempt was also made to study the efficacy of antibiotics, corticosteroids, soft stents and rigid stents. Animals were divided into multiple groups, and their larynges were studied grossly and histologically some weeks after therapy was completed. Analysis of the results was undertaken, and the method with the best outcome was then employed in the human portion of the study.

Twenty‐four human patients, 12 with severe stenosis and 12 with partial stenosis were evaluated, and their outcome is reported.
Severe soft tissue infection of the face and neck: A classification
Authors: Klabacha Martin E. , Stankiewicz James A. , Clift Susan E.
Published: October 2006

Successful treatment of severe soft tissue infections of the face and neck necessitates early recognition followed by aggressive medical and surgical therapy. These infections often spread via tissue planes, and it is essential that all areas of necrosis be exposed, debrided, or excised according to tissue planes. A classification of soft tissue infection based upon tissue plane involvement is proposed as an aid to diagnosis and treatment. In addition, a protocol for management of these infections is presented.
Rhinocerebral mucormycosis: Predisposing factors
Authors: Mcnulty John S.
Published: October 2006

Rhinocerebral mucormycosis is, with few exceptions, only reported in patients with severe metabolic or immunologic imbalances. Factors which may predispose to the development of mucormycosis are reviewed. These factors include ketoacidosis and immunologic deficiency states due either to the primary disease or to the treatment for other diseases. An appreciation for these predisposing factors is very important in order that aggressive diagnosis and therapy be undertaken without delay.
Laryngeal papillomatosis: Recurrence after 33‐year remission
Authors: Bergstrom Lavonne
Published: October 2006

After repeated laryngeal papilloma excisions, a 4‐year‐old Caucasian male became symptom‐free. Benign squamous papilloma recurred in the larynx and trachea at age 37 after a gunshot wound, prolonged nasogastric intubation, several laparotomies, endotracheal anesthesias, and massive weight loss. This case and others in the literature suggest that current therapy produces prolonged remission, not “cure.” Its course reinforces accumulating evidence for the existence of human papilloma viruses (HPV) whose DNA apparently becomes incorporated into host laryngeal cell DNA, supporting an hypothesis that HPV remains in normal‐appearing epithelium adjacent to papilloma. Like herpes zoster varicella virus, HPV may lie dormant until reactivated by host immunosuppression, trauma, malnutrition or sepsis, features also present in the patient described. Repeated intubation probably injured and destroyed cells, releasing viral material.

Papilloma patients in remission probably should be warned of factors, including intubation for elective surgery, which could induce recurrence.
Argon laser use in papillomas of the larynx
Authors: Brophy John W. , Scully Peter A. , Stratton Clifford J.
Published: October 2006

Papillomas of the larynx are discussed, including the use of lasers. Argon lasers' differences from CO2 lasers and techniques are outlined. Case reports are given in which laryngeal papillomas were removed from two patients with the argon laser and examined by transmission electron microscopy (TEM), scanning electron microscopy (SEM), and stereoscanning electron microscopy (SSEM). The depth and width of morphological changes are noted. Peripheral to the laser impact site, four zones were observed: 1. coagulation necrosis, 2. contracted epithelial cells, 3. minimally damaged epithelial cells, and 4. morphologically undamaged epithelial cells. In Zone 2, cells were violently popped‐off as heat was conducted through the epithelium. The potential for spread of papillomas was discussed and suction of the vapor plume recommended when removing laryngeal papillomas with the argon laser.
Bilateral palatal myoclonus
Authors: Litman Richard S. , Hausman Sanford A.
Published: October 2006

Palatal myoclonus, which is a rare form of tinnitus, is described in this paper in a young child. Multiple etiologies and, therefore, multiple therapies have been described in many papers. In this case, the tinnitus stopped spontaneously after 4 months without therapy, causing one to question further the efficacy of the many recommended modalities of treatment.