bluuebunny/crossref_metadata_2025 huggingface dataset:
Atypical mycobacterial cervical adenitis: Clinical presentation
Authors: Thompson James N. , Watanabe Michael J. , Greene Gerald R. , Morozumi Pius A. , Kohut Robert I.
Published: October 2006

A typical mycobacterial cervical adenitis (AMCA) is a disease primarily of childhood and usually presents as a unilateral mass or draining sinus. The pathogens are mycobacteria which are distinct from Mycobacteria tuberculosis, leprae and bovis (the typical mycobacteria).

The atypical mycobacteria are readily recovered from the environment and are generally of low virulence. They are increasingly being recognized as pathogens for man though they are probably not transmissible from human contact. Most commonly these organisms are implicated in either pulmonary disease or lymphadenopathy.

Fourteen cases of AMCA occurring in childhood are presented. A review of the bacteriology of the atypical mycobacteria is included. The clinical presentation, differential diagnosis, chemotherapeutic management and role of surgical intervention are discussed.
Laryngeal rheumatoid arthritis
Authors: Bridger Michael W. M. , Jahn Anthony F. , Van Nostrand A. W. Peter
Published: October 2006

The classic sequence of pathologic changes associated with rheumatoid arthritis as they affect the cricothyroid and cricoarytenoid joints of five larynges is described.

Although several previous reports have drawn attention to the presence of rheumatoid arthritis in the larynx, the current study emphasizes that the small joints of the larynx may be involved by the full spectrum of pathologic changes and that both cricothyroid and cricoarytenoid joints are equally prone to the various stages of inflammation, joint destruction and ankylosis that characterize the disease elsewhere. Rheumatoid nodules were seen in two cases and granulomatous areas surrounding cricothyroid joints were noted in two others.
Perforation of the nasal septum in patients with renal failure
Authors: Adler Detlev , Ritz Eberhard
Published: October 2006

Spontaneous perforation of the nasal septum was observed in 8 out of 104 patients (74 on maintenance hemodialysis; 30 after cadaveric renal transplantation). All patients showed a round or oval defect of the non‐osseous septum, which was accompanied by marked atrophic rhinitis. Epistaxis was common in uremic patients in general and was also present in 5 patients with septal perforation, but otherwise the defect was hardly associated with any symptoms. Various factors may play a role in the pathogenesis of this lesion; local trauma from nasal catheters postoperatively; impaired mucosa cell proliferation; disturbed innervation of the vessels in the nasal septum due to polyneuropathy of the autonomous nervous system; ischemia secondary to arteriolar narrowing.
Amyloidosis of the maxillary antrum
Authors: Greenway R. E. , Fetterly A. C. , Shuren A.
Published: October 2006

A rare case of primary amyloidosis which presented as a destructive lesion of the maxillary antrum is discussed. Current methods of diagnosis and treatment of amyloidosis are outlined.
The round window membrane following application of staphylococcal exotoxin: An electron microscopic study
Authors: Schachern Patricia A. , Paparella Michael M. , Goycoolea Marcos , Goldberg Burt , Schlievert Patrick
Published: October 2006

The round window membrane has been considered as a pathway for the passage of toxic substances from the middle ear cavity to the vestibular labyrinth in cases of otitis media. To determine the role of the round window membrane in this passage, chinchillas were given intrabullar inoculations with staphylococcal exotoxin and the round window membranes were examined electron microscopically. We observed cytoplasmic vacuolization, intercellular edema, cellular and nuclear swelling of the surface epithelia and polymorphonuclear leukocyte (PMN) infiltration of the fibrous layer. Light microscopic observation of the labyrinth revealed PMN infiltration of the most basal portion of the scala tympani. These findings demonstrate a chemotactic effect of the toxin for PMNs and support the concept of the round window membrane as an important avenue of entry.
A study of the effects of cardiopulmonary bypass surgery on auditory function
Authors: Shapiro Myron J. , Purn Janet M. , Raskin Cindy
Published: October 2006

Cardiopulmonary bypass surgery is commonplace in many medical centers and rare instances of unilateral hearing loss in these patients have been reported and have been attributed to embolism. Two more patients are reported and their discovery prompted a study of pre and postoperative hearing in 68 patients at Newark Beth Israel Medical Center, where a single team performs the cardiopulmonary bypass surgery. Previous similar studies showed no changes following CPB surgery. Almost all patients have been male and prolonged pump times (over 150 min.) were noted in 7 of 11 reports.

Based on changes in hearing found on pre and postoperative testing in the 6 patients, 3 groups were developed: those with no change and those with slight changes were compared with those having average deficits of more than 10 db. Prolonged pump times occurred only twice in the series and were not associated with loss. A second milder form of hearing loss, which was bilateral and affected the high tones, was noted in significant numbers. Two of these patients had persistent tinnitus after surgery. Although the series is small, there appears to be an increased susceptibility in males to the development of high tone loss as well.

Based on the preponderance of males, with their high incidence of basilar artery atherosclerosis, and the frequent prolonged pump times, perfusion failure seems to be the most likely etiology for the rare cases of hearing loss accompanying cardiopulmonary bypass surgery.
Laryngeal lymphoscintigraphy
Authors: Jackson B. Stanley , Rosenthall Leonard , Attia Elhamy
Published: October 2006

A method of studying lymphatic drainage of the larynx was undertaken using radioactive colloids. Sites of injection were the true and false cords, aryepiglottic folds, anterior and posterior commissure, epiglottis and arytenoid. The patient was then scanned with the gamma camera 3 to 5 hours and again 24 hours post injection. Thirty‐six patients were injected and results were recorded as to previous X‐ray therapy, nodal activity post scanning, ipsilateral or contralateral and distant spread, and the type of radioactive particle —99mTc labeled sulfur collond, 99mTc microalbumin (200‐800 nm diameter), and 99mTc mini‐microalbumin (less than 50 nm diameter).

The three radiopharmaceuticals gave similar results. Previous X‐ray therapy did not alter lymphatic drainage. Of 36 patients, 23 showed nodal activity on scintiscanning: none showed any axillary nor mediastinal activity.
Use of the williams microclip in various aspects of tympanoplastic surgery
Authors: Weider Dudley J.
Published: October 2006

The microclip was invented by J. David Williams, M.D. in 1971 in an attempt to devise a technique to reliably secure a medially placed fascia graft to a tympanic membrane remnant. This method immediately improved the graft take rate to better than 90% in the Alaska native population with whom he was working. Included in this 90% and above category were many ears that demonstrated some degree of mucosal edema, granulation tissue, or mucopurulent discharge — referred to in this paper as the “wet ear.”

Anatomic and audiologic results of 286 consecutive otologic procedures requiring a tympanic membrane graft will be presented in which the Williams microclip has been employed to secure a medially placed graft. Attention will be devoted to both success and failure of the methods employed. Special attention will be given to the description of surgically challenging situations in tympanoplasty surgery such as “the narrow to nonexistent remnant segment” where the microclip demonstrates its exceptional usefulness.

Last, additional uses of the microclip (other than in tympanic membrane grafting) will be discussed including its application in a new technique of ossicular chain reconstruction. Case reports and statistical data will augment material presented.
Clinical aspects of osseous hemangiomas of the skull base
Authors: Glasscock Michael E. , Smith Peter G. , Schwaber Mitchell K. , Nissen Alan J.
Published: October 2006

Osseous hemangiomas are distinctly unusual tumors of the skull base. They clinically mimic other, more common lesions in this region, and their diagnosis is rarely made preoperatively with currently available techniques.

Three cases of osseous hemangiomata, 2 involving the geniculate region and 1 arising from the jugular bulb, are described in relation to the perioperative assessment and management of these lesions. A review of 21 previously reported skull base hemangiomas is included.
Diagnostic accuracy of rotation testing vs. standard vestibular test battery — A long‐term study
Authors: Leliever William C. , Calhoun Karen H. , Correia Manning J.
Published: October 2006

Interpretation of vestibular test results derived from rotational and other electronystagmography studies often give confusing diagnostic and progonstic information. We have reviewed 90 consecutive patients seen in the Vestibular Clinic at the University of Texas Medical Branch comparing the accuracy of the damped torsion swing test (DTS) with a conventional vestibular test battery (VTB) to predict vestibular function abnormality (peripheral or central). These predictions were compared with vestibular diagnoses obtained by long‐term follow‐up (24‐36 months). VTB and DTS results were evaluated in a double‐blind study by two of the authors (W.C.L. and M.J.C.). Agreement of both VTB and DTS interpretation was uncommon (23/77) (30%); however, when present, it resulted in a 91% accuracy in predicting correct final diagnosis. Where VTB and DTS diagnoses differed, the DTS was more accurate in determining final vestibular system abnormality. In fact, while DTS testing correctly detected abnormality in 17 patients, the VTB was normal in 11. Rotation testing alone may provide a useful and accurate screening test prior to initiating further vestibular testing, particularly when central pathology is suspected.
Changing concepts in the management of otitic intracranial infection: Use of computerized axial tomography in early detection and monitoring of cerebritis
Authors: Freeman Joseph
Published: October 2006

The pathogenesis and course of intracranial inflammatory disorders of otitic origin have been studied extensively in the past by clinical, surgical, and morbid means. The recent contribution by CT scanning cannot be overestimated as a modality for identification of the pathologic process. Its use for early detection and monitoring of a clinically suspected intracranial complication of otitic suppurative disease is documented for the first time in this report. Cerebritis or encephalitis as the early manifestation of impending brain dissolution can be identified and followed during specific antibiotic therapy. The proper timing for surgery to remove the otitic focus is enhanced. A review of the literature and a case report illustrate this contribution.
Partial vs. total footplate removal in stapedectomy: A comparative study
Authors: Moon Cary N. , Hahn Milege J.
Published: October 2006

A comparative study of the postoperative stapedectomy results for 264 ears with partial footplate removal (PFR) and for 106 ears with total footplate removal (TFR) was performed with reference to decibel gain in three specific frequency ranges, air‐bone gap closure, speech threshold and speech discrimination and incidence of postoperative complications. The data confirm a small but consistently greater decibel gain for PFR cases in the 2000‐8000 Hz range; the decibel gain in the 250‐1000 Hz range is virtually identical for PFR and TFR cases. Air‐bone gap closure and speech results also indicate a somewhat better average result in PFR as compared TFR cases. The permanency of speech discrimination results is examined.
Type I tympanoplasty: Influencing factors
Authors: Adkins Warren Y. , White Benjamin
Published: October 2006

Type I tympanoplasties utilizing an underlay technique with temporalis fascia performed at the Medical University associated hospitals over a 5‐year period were reviewed. Cases were excluded if follow‐up was less than 18 months or if a previous tympanoplasty had been performed. The remaining 71 cases, 40 adults and 25 children, were analyzed for influencing factors. The overall success rate was 89%. The age of the patient, the length of time the ear had been dry, and the presence of infection at the time of surgery had no in fluence on the success rate. The two factors which adversely influenced the success rate were the presence of a near total or total perforation and the presence of bilateral perforations.
Facial nerve neurinoma: Two cases located in the horizontal portion
Authors: Iwanaga Michitaka , Yamamoto Etsuo , Yamauchi Morio , Fukumoto Manabu , Uchino Ryojin , Sawada Shinji
Published: October 2006

Two small facial neurinomas located in the horizontal portion were presented to demonstrate the clinical features, diagnostic evaluation, and surgical treatment. These two cases show the early state of facial neurinoma and suggest the mechanism of facial paralysis by facial neurinoma. Facial nerve decompression is recommended for Bell's palsy unresponsive to the conservative therapy and recurrent facial palsy.
Functional neck dissection: An evaluation and review of 843 cases
Authors: Bocca E. , Pignataro O. , Oldini C. , Cappa C.
Published: October 2006

After briefly reviewing the principles, indications, and merits of functional neck dissection, the results of 1200 neck dissections performed on 843 patients in the period 1961‐1979 are presented. They compare very favorably with those reported for classic (radical) neck dissection by other leading authors; however, a retrospective analysis of data derived from material of different origin is hardly possible and has a disputable value. Therefore, we decided to compare our data on functional neck dissections (FND) with those of classic neck dissections (CND) performed by the same surgical team at the same clinic in the period 1948‐1960.

The clinical material was largely the same in both cases, and the data were collected and analyzed using the same criteria. In both series, neck dissections were divided into elective and curative. It could be demonstrated that the number of neck recurrences observed in the dissected necks is the same for FND and CND in curative dissections, while it is considerably lower for FND in elective neck dissections. This of course does not prove improved radicality in FND, but only proves that a systematic bilateral elective neck dissection in No cases affords improved cancerological safety.

This radical bilateral approach to regional lymph nodes is made possible routinely by FND which avoids the problems of unnecessary mutilation.

The figures produced speak in favor of a wider adoption of FND especially for expanding the indications to elective treatment of regional lymph nodes in cancer of the head and neck. Elective neck dissection is made practically harmless by this newer technique and averts the dreadful appearance of late metastases in No cases.
Surgical repair of extratemporal facial nerve: A comparison of suture repair and microfibrillar collagen repair
Authors: Parker Gregg , White Thomas , Jenkins Rosemary
Published: October 2006

The extratemporal portion of the facial nerve is often severed by various forms of surgical and non‐surgical trauma. A commonly accepted method of repair is with monofilament nylon suture, using microsurgical techniques to approximate the epineurium. A study was designed to compare the clinical and histologic success of repair using microfibrillar collagen hemostat (Avitener̀) with that of suture repair of the epineurium. Although the success rates of these two methods of repair of peripheral facial nerves in rabbits appear to be functionally equivalent, the histologic results show the suture repair to be superior.
A simple operation for bilateral vocal cord paralysis
Authors: Ejnell Hasse , Mansson Ingemar , Bake Bjourn , Hallén Olle , Stenborg Rune , Lindstroum Jourgen
Published: October 2006

To reduce the laryngeal obstruction in bilateral vocal cord paralysis, a new method of laterofixation was developed. The method is technically simple and less traumatic than previously published methods. No peroperative tracheostomy is needed. During surgery two needles are inserted through the thyroid cartilage. A nylon thread is passed through the needles and the needles are then withdrawn. The thread thus forms a permanent loop around the vocal cord. The effects of the laterofixation on breathing and on the voice are documented by assessment of upper airway resistance and by two listening panels respectively. Thirteen patients have been operated upon so far. In most cases the breathing was improved and the influence on the voice was moderate and adjustable. If needed the possibility to perform a more extensive surgical procedure still remains. We suggest our method of laterofixation to be the first treatment of choice in patients suffering from bilateral vocal cord paralysis.
Superior based trapezius flap
Authors: Donald Paul J. , Chole Richard A.
Published: October 2006

The most revolutionary innovation in reconstructive surgery of the past decade is the development of the musculocutaneous flaps. These flaps permit the reconstruction of large head and neck defects in one stage. They carry on excellent reliable blood supply and the inclusion of the underlying muscle adds sorely needed bulk to the resected area. The trapezius musculocutaneous flap is one of the most versatile. Its color and texture match for facial reconstruction is excellent. Moreover, the pliability of the cutaneous component lends itself well to lining the oral cavity ond the oropharynx.

The trapezius musculocutaneous flap is an outstanding advance in head and neck reconstructive surgery. The discovery that it can be successfully pedicled superiorly greatly enhances its versatility.
Bacterial tracheitis ‐ two‐year experience
Authors: Jorgensen Keith , Friedman Ellen M. , Healy Gerald B. , Mcgill Trevor J. I.
Published: October 2006

Inflammatory illnesses of the pediatric airway cause significant morbidity and mortality. Bacterial tracheitis is a distinct entity with features common to both croup and epiglottitis. Ten patients between the ages of 3 months and 12 years were treated at Children's Hospital, Boston, MA., for bacterial tracheitis. The clinical presentation and medical management is discussed. Seven of the patients required both direct laryngoscopy and bronchoscopy; one patient required urgent intubation; and one patient required indirect laryngoscopy. In one patient the diagnosis was based on clinical and radiographic findings in conjunction with tracheal aspirates. Seven of the 10 patients did well with aggressive medical management. Three patients required endotracheal intubation. No patient required tracheotomy, and there were no cardiopulmonary arrests. It is of particular interest that although the patients in this series presented in a manner similar to that of patients in other published series, the management is significantly different and the overall outcome is significantly better.
An in vivo model for squamous cell carcinoma of the head and neck
Authors: Baker Shan R.
Published: October 2006

In recent years, the successful grafting of human tumors into immune deprived animals has spurred the hopes of developing a reliable in vivo model for evaluation of human cancer. The nude mouse has created new perspectives in many different areas of cancer research, and has proved to be the most useful recipient of any animal system for tumor heterotransplantation. This study determined which of several squamous cell carcinoma (SCC) cell lines would reproducibly grow as heterotransplants in nude mice, and allowed an opportunity to determine whether characteristics of the tumor changed as a result of propagation in tissue culture.

Sixteen (76%) of the 21 SCC lines heterotransplated in nude mice remained as viable tumor nodules. Nine (43%) of these lines reproducibly produced progressively enlarging tumor masses. Five (24%) SCC lines failed to grow as heterotransplants. The average lag phase between implantation and the beginning of growth for all SCC lines tested was approximately 7 weeks and emphasizes the need for prolonged observation of nude mice following SCC heterotransplantation. The rate and pattern of growth of SCC in nude mice appears to be related specifically to the tumorogenic factors of a given cell line. The concurrent presence of other SCC or non‐SCC tumors in a given mouse do not appear to influence the growth of a specific cell line. In addition, specific host factors that might vary from one mouse to another did not alter the growth patterns of SCC. Histological examination of the SCC lines successfully heterotransplanted in nude mice showed similar histological appearances to the original tumor in the human host.
Uterine carcinoma metastatic to the larynx
Authors: Messmer James M. , Ritchie William W. , Whitley Donald P. , Gopelrud Dean R.
Published: October 2006

Involvement of the larynx with metastatic disease is a rare occurrence. Batson's plexus was first proposed to explain metastatic disease to the head and neck from distant primaries, but more recent studies suggest that tumor cells in the thoracic duct may spread to the cervical region by way of retrograde flow through afferent cervical lymphatic vessels.
Surgery of the incompetent nasal valve
Authors: Goode Richard L.
Published: October 2006

One of the causes of nasal airway obstruction during inspiration is an incompetent nasal valve. An incompetent valve is one that collapses during quiet normal breathing due to narrowing of the valve area, a loss of upper and/or lower lateral cartilage support, or a combination of these. The most common etiology is a previous rhinoplasty; trauma and aging are other causes. Treatment is surgical and consists of replacing what is missing with similar tissue. If only the vestibular skin is scarred, a skin graft is used. If cartilage alone is missing, a cartilage graft is inserted. If both skin and cartilage are absent, a composite graft from the concha is the best choice.
T‐lymphocytes phenotype and functions in patients with head and neck cancer
Authors: Pierri Ivana , Cordone Giovanni , Piccardo Cristina , Rogna Silvia , Barabino Andrea , Indiveri Francesco
Published: October 2006

We studied the phenotype of T‐lymphocytes isolated from 18 patients with head and neck cancer, their capacity to express Ia antigens upon activation by lectin in vitro, their capacity to function either as responder or stimulator cells in autologous mixed lymphocyte reaction, and thier capacity to cooperate with the normal adherent suppressor cells (NASC).

The T‐lymphocytes isolated from these patients have several functional defects including an impaired capacity to activate allogeneic lymphocytes in mixed lymphocyte reactions (MLRs), a lack of a proliferative capacity in autologous MLRs, an impaired sensitivity to inhibition by NASC, and an impaired capacity to express Ia antigens upon activation by mitogens in vitro.

These data indicate that, in patients with head and neck cancer, immune function is characterized by a defect in T‐lymphocytes functions which concerns the process of cell to cell cooperation.
Simultaneous manometry and electromyography in the pharyngoesophageal segment
Authors: Van Overbeek Jos J. M. , Wit Hero P. , Paping Richard H. L. , Segenhout Hans M.
Published: October 2006

Whether the occlusion between hypopharynx and esophagus is established by anatomical relations and tissue elasticity or by a functional resting tone of the muscle fibers is not quite clenr. This study describes simultaneous electromyography (EMG) and electromanometry in the pharyngoesophageal segment to solve this problem and investigate the complex mechanism of deglutition. To register the EMG from the hypopharyngeal constrictor muscle and the upper esophageal sphincter (UES), two copper wire electrode pairs with hooked bare ends were used. These electrodes were introduced into the muscles through a rigid esophagoscope. It is demonstrated that at rest muscle activity is present in the UES. This activity disappears during the relaxaton period. Simultaneous manometry and EMG is a valuable supplement to diagnostic procedures in dysphagia patients.
The effect of surgery on natural killer cell activity in head and neck cancer patients: In vitro reversal of a postoperatively suppressed immunosurveillance system
Authors: Schantz Stimson P. , Romsdahl Marvin M. , Babcock George F. , Nishioka Kenji , Goepfert Helmuth
Published: October 2006

Curative surgery diminished natural killer (NK) cell activity in 17 patients with previously untreated squumous cell carcinoma of the head and neck (37% ± 17%, preoperatively vs. 21% ± 11%, postoperatively; p<0.001). this operatively induced suppression was dependent on the presence of a nylon wool adherent cell population. with the removal of this surgically generated suppressor population from the in vitro assay, postoperative suppression of natural killer activity was significantly diminished (21% ± 13%, vs. 30% ± 23%, p<0.01). the capability of fully restoring postoperatively suppressed nk cell activity was subsequently demonstrated by the synergistic effect of removing a nylon wool adherent suppressor population and stimulating nk cells with a naturally occurring immunopotentiator, tuftsin (from 21% ± 13% to 41% ± 23%; p <0.0001).

In utilizing biological response modifiers in the perioperative period in the cancer patient, the interaction of these agents and the surgically generated suppressor cell population needs to be considered.
Malignant transformation in non‐irradiated recurrent respiratory papillomatosis
Authors: Solomon Diane , Smith Robert R. L. , Kashima Haskins K. , Leventhal Brigid G.
Published: October 2006

The clinical, radiogrnphic and post mortem findings occurring in a 6‐year‐old female with a four‐year history of recurrent respiratory papillomatosis (RRP) are described. At autopsy, there were two separate foci of malignant transformation (malignant degeneration) in the bronchioloalveolar papillomata. This patient is the youngest in whom such changes have been described. Malignant transformation is a rare ocurrence and is usually seen in older patients with longstanding papillomatosis, therapeutic irradiation, or a history of smoking. Pulmonary spread represents the majority of cases with “spontaneous” malignant transformation.
Resection of upper aerodigestive tract tumors involving the middle cranial fossa
Authors: Close Lanny Garth , Schaefer Steven D. , Anderson Robert G. , Mickey Bruce E. , Samson Duke S.
Published: October 2006

Benign and malignant neoplasms of the upper aerodigestive tract that invade the middle cranial fossa are frequently considered unresectable due to the proximity of the cavernous sinus and internal carotid artery, and to the inaccessibility of this region via conventional surgical approaches. We report our experience using a combined, lateral intracranial and infratemporal fossa procedure for the management of these tumors in four patients. Successful removal of neoplasm associated with minimal morbidity was accomplished in 3 patients, 2 with angiofibromas and 1 with an adenoid cystic carcinoma. The postoperative course of the fourth patient was complicated by meningitis which resulted in the patient's death five months following resection of an adenocarcinoma.
Acute mastoiditis: A review of 34 patients
Authors: Rubin John S. , Wei William I.
Published: October 2006

A review of 34 patients presenting with acute mastoiditis was undertaken. Prior treatment was noteworthy for lack of medical or surgical drainage at the time of initial otitis media. Typical findings, in hospital, included postauricular edema and tenderness, displaced auricle, and distorted tympanic membrane. X‐rays were not diagnostic, nor were they helpful in determining who was a surgical candidate. Treatment was individualized. Patients with obvious subperiosteal abscesses, and those who did not respond rapidly to enteric antibiotics, underwent early mastoid surgery. The remaining patients received enteric antibiotics, had drainage established, and were carefully followed. Most resolved without mastoid surgery.

Patients with a history of antecedent ear disease were examined separately from those without such history. The former group required mastoid surgery more often than the latter and had poorer outcome.
Thermal biofeedback and the treatment of tinnitus
Authors: Walsh William M. , Gerley Peter P.
Published: October 2006

Thermal biofeedback and general relaxation procedures were employed to treat 32 patients with subjective tinnitus. Each patient received eight 1‐hour biofeedback sessions over an eight‐week period, while listening to standard Jacobsonian type relaxation tapes. Sixty‐five percent of the patients experienced a reduction of their symptoms. While none reported worsening of their symptoms, only two reported total symptom abatement. Findings suggest relaxation and peripheral vascular circulation arc inversely related to the intensity of tinnitus symptoms. The probability that an individual will benefit from biofeedback appears related to his/her ego strength (Es). No differences were noted between the performance of male and female patients. Although not fail‐safe, biofeedback and relaxation treatment are excellent management tools in the treatment of tinnitus.
Fluorescein angiography of the tympanic membrane
Authors: Applebaum Edward L. , Deutsch Elise C.
Published: October 2006

Little is known about the dynamic vasculature of the tympanic membrane, despite the fact that it is within easy view of the otolaryngologist. An understanding of its blood supply dynamics may lead to a better understanding of the tympanic membrane's physiological properties and response to surgery. Also, certain patterns of blood flow may correlate with disease entities and be of diagnostic value. Currently, we have done 30 fluorescein angiograms of the tympanic membrane. The fluorescein angiograms from a normal ear and from ears with several types of ear pathology are described.
Endolymphatic sac surgery for meniere's disease: A composite study of 339 cases
Authors: Huang Tsun‐Sheng , Lin Ching‐Chen
Published: October 2006

This paper analyzes 339 consecutively performed endolymphalic mastoid sac shunts. Regardless of the method used, vertigo was controlled and hearing either improved or stabilized in approximately 70% of the cases. Overall, vertigo was controlled in approximately 80% of the cases. Similar results were obtained in cases of Meniere's syndrome and vestibular Meniere's disease.

It is suggested here that, regardless of the method employed, there remains a high likelihood that the symptoms will recur, and the question is raised as to whether sac surgery may merely induce a temporary remission of the disease process. Consequently, it is hereby proposed that there is a need to devise a method to permanently drain the endolymph in order to more effectively control the disease on a permanent basis. Until this is achieved, however, sac surgery would appear to be the most appropriate surgical treatment for Meniere's disease.
Perilymph fistula: The iowa experience
Authors: Seltzer Sharon , Mccabe Brian F.
Published: October 2006

Ninety‐one patients with demonstrable perilymph fistulas presented with an amazing array of signs and symptoms ranging from unilateral tinnitus and aural fullness to sudden‐and‐profound hearing loss, roaring tinnitus, and whirling vertigo. Between 1977 and 1984, 214 exploratory tympanotomies for suspected perilymph fistula (PLF) were performed on 177 patients. One hundred six primary (initial) fistulas were found in 95 ears and 26 recurrent fistulas were identified. Eighty‐two percent of the 91 patients with PLF had auditory symptoms, 8% with auditory symptoms as the sole complaint. Eighty‐one percent of the patients had vestibular symptoms, 12% with vestibular symptoms alone. The type of hearing loss and the nature of the vestibular symptoms were widely variable. Of the 58 patients with preoperative auditory symptoms, 49% had improved hearing (23% improved to serviceable range), after closure of PLFs. Ninety‐five percent of the patients who presented with vestibular symptoms had elimination of or decrease in their dizziness to the extent that it no longer interfered with their daily activities. The highest incidence of recurrent fistula was associated with grafts using fatty tissue. Patients with Mondini deformity were at particularly high risk for fistula recurrence.
Skull base lesions: a classification and surgical approaches
Authors: Kumar Arvind , Valvassori Galdino , Mafee Mahmood , Jafar Jafar
Published: October 2006

An anatomic classification of lesions affecting the skull base is proposed according to which this region can be divided into amidline compartmentand two lateral compartments: apetrotemporaland aninfratemporal.The majority of lesions studied radiographically in 56 patients were confined to one of these anatomic subdivisions. The advantages of such a classification are discussed. The surgical approaches to these compartments and to the anterior middle and posterior cranial fossae are described relative to the lesions we have encountered.
Necrotizing otitis externa occurring concurrently with epidermoid carcinoma
Authors: Mattucci Kenneth F. , Setzen Michael , Galantich Peter
Published: October 2006

Malignant external otitis (nccrotizing otitis externa) is an infectious process which occurs most often in middle‐aged and elderly diabetic patients and is characterized by cultures positive for Pseudomonas and granulation tissue at the junction of the bony and cartilaginous portion of the external auditory canal. Epidermoid carcinoma of the external auditory canal is also seen most often in the middle‐aged and elderly population. To the best of our knowledge, no case of acute necrotizing otitis externa occurring concomitantly with epidermoid carcinoma of the external auditory canal has been documented.

A case is presented and discussed here and the importance of biopsy of the external auditory canal is stressed.

Theoretical considerations of the possible relationship between these two disorders are discussed.

This case illustrates the need to discontinue the use of the term “malignant external otitis” and replace it with the term “necrotizing otitis externa.”
Supraorbital and supratrochlear notches and foramina: anatomical variations and surgical relevance
Authors: Webster Richard C. , Gaunt James M. , Hamdan Usama S. , Fuleihan Nabil S. , Giandello Philip R. , Smith Richard C.
Published: October 2006

The anatomy of the supraorbital and supratrochlear notches and foramina has been studied in 111 human skulls. Of 108 skulls, 49.07% had bilateral supraorbital notches, 25.93% had bilateral supraorbital foramina, and 25% had a notch on one side and a foramen on the other side. Of 101 skulls, 97.03% had bilateral supratrochlear notches, 0.99% had bilateral foramina, and 1.98% had a notch on one side and a foramen on the other side. The methods of study and clinical relevance are discussed, along with the varying nomenclature used in the literature for defining the supraorbital and supratrochlear structures. Knowledge of the anatomy of the region is important for those doing forehead and brow lift surgery in order to avoid injuring the neurovascular bundles passing through these notches and foramina.
Chronic cough in infants and children
Authors: Holinger Lauren D.
Published: October 2006

Chronic cough is an important, sometimes frustrating problem, often encountered by the otolaryngologist‐head and neck surgeon. Thirty‐eight infants and children under age 16 with a normal chest roentgenogram were evaluated for chronic cough persisting for longer than 4 weeks. Specific therapy (rather than symptomatic treatment) of chronic cough lead to a resolution or control of the cough in 33 (87%). Cough‐variant asthma was by far the most common cause of chronic cough, followed by sinusitis, aberrant innominate artery, psychogenic cough, and subglottic stenosis. In addition to a detailed history, physical examination, and chest roentgenogram, endoscopy, paranasal sinus roentgenograms, and pulmonary function studies with methacholine challenge testing were particularly effective for establishing a precise diagnosis.

Chronic cough is best managed by determining the precise cause of the cough, then specifically treating the underlying disorder. Children with persistent cough and a normal chest roentgenogram should be referred promptly for evaluation by an otolaryngologist when the primary physician's initial efforts at diagnosis and treatment are unsuccessful. Endoscopy is under‐utilized in practice and its importance is understated in the literature. It is particularly helpful in establishing a precise diagnosis in infants under 18 months of age.
Head and neck manifestations of saecoidosis
Authors: Dash Greg I. , Kimmelman Charles P.
Published: October 2006

The records of 42 consecutive patients with biopsy‐proven head and neck sarcoidosis were reviewed. A female preponderance of 7.4 to 1 was found. The average age at onset for women was higher than that for men (42 vs. 24 years). The presenting signs and symptoms were noted, and correlations between these and the incidence of abnormal chest radiograph and laboratory findings were examined. Pulmonary involvement was most common in patients with periorbital manifestations or cervical lymphadenopathy.

The evaluation of patients with suspected sarcoidosis should include history and physical examination, chest radiograph, PPD and skin tests to rule out energy, serum chemistry profile, erythrocyte sedimentation rate, and angiotensin converting enzyme level. The diagnosis is confirmed by appropriate histologic examination. Corticosteroid treatment is indicated for patients with uveitis, restrictive pulmonary disease, or other serious systemic manifestations.
Effect of adenoidectomy upon children with chronic otitis media with effusion
Authors: Gates George A. , Avery Christine A. , Prihoda Thomas J.
Published: October 2006

To investigate the mechanism whereby adenoidectomy influences the subsequent course of patients with chronic otitis media with effusion, we analyzed, on the basis of adenoid size, the outcomes of 476 children randomly assigned to receive, after paracentesis and aspiration of the middle ear, either no treatment, tympanostomy tubes, adenoidectomy, or both. The two groups receiving adenoidectomy did significantly better than those who did not, and the effect was independent of adenoid size. This suggests that reduction of the adenoidal bacterial reservoir may be the mechanism whereby adenoidectomy is effective.
Otitis media, auditory sensitivity, and language outcomes at one year
Authors: Wallace Ina F. , Mccarton Cecelia M. , Bernstein Richard S. , Grevel Judith S. , Stapells David R. , Ruben Robert J.
Published: October 2006

The relationship among otitis media, auditory sensitivity, and emerging language was examined in a group of 1‐year‐old children who were prospectively followed since birth. Pneumatic otoscopy was used to document the otologic status of the children's ears at each medical visit. There were 13 babies with normal ratings in each ear at 80% more of their visits (designated as “otitis free”) and 12 babies with bilaterally positive otoscopy results at 30% or more of their first year visits (designated “otitis positive”). In comparison to the otitis free infants, the group of otitis positive babies demonstrated reduced auditory sensitivity as measured by auditory brain stem response (ABR) and poorer expressive language abilities. However, differences in receptive language were not detected. These results suggest that otitis media may have an impact on auditory sensitivity and developing language as early as 1 year of age.
Analysis of pressure generation and bolus transit during pharyngeal swallowing
Authors: Mcconnel Fred M. S.
Published: October 2006

Current pharyngeal deglutition theory has stressed the role of the pharyngeal constrictors as producing a peristaltic wave responsible for bolus propulsion through the pharynx. This thesis presents data obtained using manofluorography which supports the significance of tongue and laryngeal motion in swallowing. The usage of the term peristalsis to describe the constrictor contraction is challenged.

The results of this quantitative study of swallowing in normal subjects, laryngectomized patients, and patients with restricted tongue motion show that tongue driving pressure and the negative pressure developed in the pharyngeal esophageal segment appear more important than the peristaltic‐like pressure of the constrictors. Bolus transit is really dependent upon these two pressures. This model for analysis has clinical significance because it permits quantification of the pharyngeal swallowing mechanism.
Parotid masses: Evaluation, analysis, and current management
Authors: Byrne Maria N. , Spector J. Gershon
Published: October 2006

Two hundred thirty‐one sequential parotid masses seen from January 1982 to July 1986 were reviewed for their clinical presentation, diagnostic evaluation, pathologic findings, and therapeutic approach. The results were compared with the previously reported findings on parotid masses.

There were 146 (63.2%) benign tumors, 60 (21.6%) malignancies, and 35 (15.2%) nonmalignant lesions. Tumors were classified according to their histopathologic diagnosis. An asymptomatic mass was the most common presentation. Radiological evaluation was mainly with computed tomography. The primary surgical procedure was parotidectomy with facial nerve preservation. A selected group of patients was referred for radiation therapy.

Our study demonstrated that non‐neoplastic lesions contribute a significant number of masses in the differential diagnosis of parotid tumors. Metastatic squamous cell carcinoma was the most frequently encountered malignancy. Deep lobe tumors were twice as common as previously reported.
Experimental autoimmune inner ear disease
Authors: Soliman Ahmed M.
Published: October 2006

A guinea pig animal model of autoimmune inner ear disease is presented. The functional, anatomical, and immunological inner ear changes were tested electrophysiologically, histologically and by the immunofluorescence test.

Using a homologous crude inner ear antigen (CIEAg) we were able to induce endolymphatic hydrops, vasculitis, mild cellular infiltration of the endolymphatic sac, and occasional spiral ganglion degeneration. Threshold shift was seen in 20% of the tested ears. Specific fluorescence was revealed around the modiolar vessels and in the basilar membrane. The endolymphatic sac and duct showed occasional fluorescence in the epithelial and/or subepithelial layers.

The findings were discussed in light of the other models immunized with various forms of inner ear antigens. Similarities between the detected specific fluorescence and the fluorescence revealed by sera of patients with cochleovestibular disorders were discussed.
The effect of hyperbaric oxygen therapy on oral mucosal carcinoma
Authors: Mcmillan Terry , Calhoun Karen H. , Mader Jon T. , Stiernberg Charles M. , Rajaraman Srinivasan
Published: October 2006

Hyperbaric oxygen is sometimes used in the course of treatment in head and neck cancer patients. This study was undertaken to investigate the effect of hyperbaric oxygen on oral cavity carcinogenesis in an animal model. Dimethylbenzanthracene was applied three times weekly to induce oral squamous cell cancers. The group that received simultaneous hyperbaric oxygen had fewer tumors, but the tumors were larger than the dimethyl‐benzanthracene‐only group. We concluded that hyperbaric oxygen has a tumor‐suppressive effect during the induction phase of oral carcinoma and appears to have a stimulatory effect during the proliferative phase of carcinoma in this animal model.
The autonomic innervation of the human vocal cord: Neuropeptides
Authors: Basterra J. , Dilly P. N. , Martorell M. A.
Published: October 2006

Three methods have been used to study the sympathetic and parasympathetic innervation of the vocal cord: paraformalde‐hyde‐induced fluorescence, electron microscopy, and the peroxidase‐antiperoxidase technique. Each method has been successful in determining adrenergic fibers, autonomic endings, and the neuropeptides VIP and NPY, respectively. The close relationship between these neuropeptides and the autonomic endings (adrenergic and cholinergic), and the presence of the neuropeptides in the chorion of the vocal cord, around glands and vessels, gives new evidence that autonomic innervation plays a role in the functioning of this part of the larynx.
The diagnosis and follow‐up of pediatric sinusitis: Water's view radiography versus ultrasonography
Authors: Revonta Matti , Kuuliala Ilkka
Published: October 2006

Water's view plain film radiography was compared with ultrasonography in the diagnosis and follow‐up of acute maxillary sinusitis in 85 children (170 sinuses). At the first visit, the concordance of the two modalities was 91%, but 20 days later, when the symptoms and signs had disappeared, it was only 76%. At the latter date, the concordance between radiography and clinical findings was 71% and between sonography and clinical findings, 93%. The two modalities studied appear to be equally useful in the initial diagnosis of acute maxillary sinusitis. The loss of back‐wall echo correlates well with symptomatic improvement of acute sinusitis. Sonography is also nonionizing and inexpensive, and the examination is simple to repeat.
Effects of short‐term endotracheal intubation on vocal function
Authors: Mayo Robert , Beckford Neal S. , Wilkinson III Albert , Tierney Michael
Published: October 2006

Transient voice change associated with endotracheal intubation has generally been attributed to vocal fold trauma. To assess the role of altered vocal fold function in transient voice change, a study was designed to evaluate the audio‐acoustic, endoscopic, and laryngostroboscopic characteristics of the postintubation voice. Vocal function of 10 patients undergoing short‐term outpatient surgical procedures using general anesthesia and endotracheal intubation were studied preoperatively and postoperatively. A second group of 10 patients that did not have surgery or general anesthesia was used as an age‐matched control. Fundamental frequency, frequency perturbation, electroglottography, en‐doscopy (including laryngeal stroboscopy), and subjective speech analysis by experienced listeners were used to assess vocal function.

No consistent differences in fundamental frequency were observed, although patient‐to‐patient variation was marked. Statistically significant increases in cycle‐to‐cycle fundamental frequency variation (jitter) were found postoperatively in the majority of the postintubation patients (P<0.05). Electroglottography, laryngeal endoscopy, and stroboscopic laryngoscopy did not demonstrate consistent changes in glottic mucosal function. Listener judgments characterized the postintubation voice change by decreased intensity, increased roughness, and lowered affect without consistent changes in pitch. The perception of decreased affect in the voices (characterized by reduction in pitch variation, vocal stress, and increases in pause times) was a strong perceptual marker for change in the postintubation voice. Objective measures of laryngeal function suggest that the glottic contribution to postintubation voice change is minimal and that this dysphonia is probably multifactorial.