bluuebunny/crossref_metadata_2025 huggingface dataset:
Velocity of Rapid Eye Movements and Vertigo of Central Origin
Authors: Pyykkö Ilmari , Wennmo Carsten , Henriksson Nils-Gunnar , Schalén Lucyna
Published: October 2014

Peak velocities of voluntary saccades and fast phases of different qualities of nystagmus were studied in 20 normal subjects, 5 patients with pontine lesions and 5 patients with lesions in the frontal cortex. The peak velocity of saccades was related to the amplitude of the eye movement, the alertness of the subject and whether the subject could see the target or not. The effect of the age was not significant. The quick phases of caloric, optokinetic and angular acceleration induced nystagmus were equally rapid but somewhat slower than that of vestibular nystagmus recorded in standardized visual surrounding. In the same visual condition saccades were always faster than quick phases of nystagmus. Patients with cortical lesions had normal velocities in saccades and quick phases of nystagmus. Patients with pontine disorders had significantly reduced saccadic and quick phase velocity, and some of the patients exhibited dissociations between velocity pattern of rapid eye movements. The velocity difference between saccades and quick phases probably reflects different pontine mechanisms while the somewhat higher velocity in quick phase of vestibular nystagmus recorded in light is probably related to higher attention evoked by vestibular-visual interaction.
Perineural Metastases from Squamous Cell Carcinoma of the Face
Authors: Green Nathan , Landman Michael
Published: October 2014

Perineural metastasis from squamous cell carcinoma of the facial skin can cause disabling pain, paresis, soft tissue tumefaction bone destruction, impaired function and impaired vision. Two patients with perineural metastases were treated with palliative megavoltage irradiation and interstitial therapy. The meastases were controlled. Pain improved; cosmesis, function and vision were preserved.
Analysis of Factors Affecting Complications of Carotid Ligation
Authors: Konno Akiyoshi , Togawa Kiyoshi , Iizuka Keiji
Published: October 2014

A study of 156 patients subjected to common carotid ligation in the treatment of head and neck carcinoma was made to investigate the influence of selected factors on cerebral complications. In the analysis complications were grouped as death or coma; death, coma, hemiplegia or monoplegia; and transitory cerebral symptoms. Primary independent variables included method of occlusion (abrupt, gradual); duration of occlusion; and collateral circulation via the external carotid artery (intact, ligated external carotid artery). Death or coma occurred in 24 cases (15.4%) and complications including death, coma, hemiplegia or monoplegia occurred in 47 cases (30.1%). Although no statistically significant difference between abrupt and gradual occlusion cases was noted, the incidence of cerebral complications was significantly lower for the group with gradual carotid occlusions performed over 13 days (6.3%) than for those with abrupt occlusions or gradual occlusions performed in less than five days. The incidence of death or coma following carotid artery occlusion was 10.5 % in cases with an intact external carotid artery, as against 25.5% in those with a ligated external carotid artery, a statistically significant difference. Cerebral complications occurred within 48 hours after carotid occlusion in 35 of 47 cases (74.5%) in which complications developed. In the remaining 12 cases (25.5%) complications developed after 48 hours. There was no difference between abrupt and gradual occlusion cases in the incidence of complications after 48 hours.
Alternaria Sinusitis
Authors: Shugar Martin A. , Montgomery William W. , Hyslop Newton E.
Published: October 2014

Alternaria is a fungus of the class Deuteromycetes and the family Dematiaceae. Fungi of this genus have generally been regarded as nonpathogenic and as contaminants when isolated from clinical specimens. Hypersensitivity to Alternaria spores, however, has long been recognized as a cause of allergic pulmonary disease. More recently, the organism has also been demonstrated to have potential for opportunistic invasion of immunosuppressed and debilitated patients. Presented is a case in which this organism was repeatedly isolated from naso-oral tissue specimens from an otherwise healthy patient. The organism was seen in biopsies from a granulomatous hyperplastic destructive disease of the maxilla and soft tissues of the face which extended to the ethmoid sinus and fistulized through the hard palate. The clinical course, pathophysiology and therapeutic approach are discussed. The management of this disease requires a multidisciplinary approach involving the otolaryngologist, infectious disease specialist and pathologist.
Aerobic and Anaerobic Bacteria in Tonsils of Children with Recurrent Tonsillitis
Authors: Brook Itzhak , Yocum Paula , Friedman Ellen M.
Published: October 2014

Tonsils were obtained from 50 children suffering from recurrent tonsillitis. Patients' ages ranged from 2.5 to 17 years (mean 6 years); 29 were males and 21 females. The tonsils were sectioned in half after heat searing of the surface and the core material was cultured for aerobic and anaerobic microorganisms. Mixed aerobic and anaerobic flora was obtained in all patients, yielding an average of 7.8 isolates (4.1 anaerobes and 3.7 aerobes) per specimen. There were 207 anaerobes isolated. The predominant isolates were 101 Bacteroides sp (including 10 B fragilis group, and 47 B melaninogenicus group), 39 Fusobacterium sp, 34 Gram-positive anaerobic cocci (25 Peptococcus sp and 9 Peptostreptococcus sp) and 16 Veillonella sp. There were 185 aerobic isolates. The predominant isolates were 41 α-hemolytic streptococci, 24 Staphylococcus aureus, 19 β-hemolytic streptococci (11 group A, 4 group B, and 2 each group C and F), 14 Haemophilus sp (including 12 H influenzae type B) and 5 H parainfluenzae. Beta-lactamase production was noted in 56 isolates recovered from 37 tonsils. These were all isolates of S aureus (24) and B fragilis (10), 15 of 47 B melaninogenicus (32%), 5 of 12 B oralis (42%), and 2 of 12 H influenzae type B (17%). Our findings indicate the polymicrobial aerobic and anaerobic nature of deep tonsillar flora in children with recurrent tonsillitis, and demonstrate the presence of many β-lactamase-producing organisms in 74% of the patients.
Tracheomalacia in an Infant with Multiplex Congenita (Larsen's) Syndrome
Authors: Grundfast Kenneth M. , Kanter Robert , Mumtaz Anwar , Pollack Murray
Published: October 2014

An infant born with multiplex congenita (Larsen's) syndrome developed respiratory distress 30 days following tracheostomy for relief of upper airway obstruction. The infant had structural and functional abnormalities of the thoracic cage. Tracheobronchoscopy revealed excessive compliance of the trachea with a tendency for collapse of the tracheal rings and obliteration of the tracheal lumen. Continuous positive airway pressure in the range of 20–25 cm H2O was used to maintain patency of the tracheal lumen and assure adequate ventilation. Hemodynamic and pulmonary barometric complications often observed when high levels of positive airway pressure are utilized in infants were not observed.
Video Laryngoscopy Using a Rigid Telescope and Video Home System Color Camera
Authors: Yanagisawa Eiji , Casuccio J. Richard , Suzuki Masafumi
Published: October 2014

A simple but reliable method of videotaping the larynx using the Nagashima rigid laryngoscope (telescope) and a low-cost home video color camera is described. Video laryngoscopy using this technique is a useful office procedure. The video material obtained was of high quality and of great value for teaching, voice analysis, preoperative and postoperative evaluation and documentation of various laryngeal disorders.
Histochemical Characteristics of Muscle Fiber Types in the Posterior Cricoarytenoid Muscle
Authors: Malmgren Leslie T. , Gacek Richard R.
Published: October 2014

The muscle fiber type composition of the human posterior cricoarytenoid muscle (PCA) was examined using a large battery of histochemical techniques. Staining for myosin ATPase (pH 9.9) indicated that the muscles were composed of 52% ± 11.8 SD type 1 (slowly contracting) fibers and 48% ± 11.9 SD type 2 (rapidly contracting) fibers. In order to obtain information concerning the probable fatigue resistance of the type 2 fibers, serial sections were processed to determine the relative extent of ATPase inactivation at various pH levels in the acid range and to obtain data concerning the relative activities of oxidative and glycolytic enzymes and their substrates. The great majority of the type 2 fibers were of the 2A (fatigue resistant) fiber type. This indication of a capacity for prolonged activity was substantiated by the presence of high activities of succinic dehydrogenase, a mitochondrial enzyme which is involved in oxidative metabolism. Type 2C fibers (generally considered to be an undifferentiated fiber type) were also present but relatively rare. The overall enzyme profiles of many of the muscle fibers in the human PCA differed from those typical of fibers having the same alkaline ATPase and acid ATPase characteristics in most other mammalian muscles. Since muscle fiber biochemistry reflects the activity pattern of the motor unit, these unusual enzyme profiles may be the result of activity patterns that are associated with the inspiratory cycle and/or patterns of activity that are relatively specific to the PCA. Four of the ten muscles examined had unequivocal evidence of muscle fiber type grouping, a manifestation of partial denervation followed by reinnervation. This is interesting since most of the cases were in the fifth decade. Muscle fiber type grouping has been shown to occur selectively in certain other human muscles and to increase with age, eventually resulting in muscle atrophy. This suggests the possibility that the human PCA is for some reason selectively vulnerable to partial denervation and indicates the need for more extensive data concerning the relationship of muscle fiber type grouping in the PCA and other laryngeal muscles to age.
Significance of Positive Bronchial Cytology in Presence of Squamous Cell Carcinoma of Upper Aerodigestive Tract
Authors: Johnson Jonas T. , Turner Joseph , Dekker Andrew , Myers Eugene N.
Published: October 2014

The otolaryngologic literature reflects the high incidence of second primary neoplasms found in patients with a squamous cell carcinoma of the upper aerodigestive tract. Most commonly the second tumor is bronchogenic in origin. Routine panendoscopy (direct laryngoscopy, bronchoscopy, esophagoscopy) has been recommended in patients presenting with a squamous cell carcinoma primary in the upper aerodigestive tract. We have questioned the usefulness of obtaining bronchial washings during bronchoscopy in a patient who has an established primary in the upper aerodigestive tract. Perhaps false-positives would occur due to desquamation of tumor cells into the tracheobronchial tree. The authors address the incidence of false-positive washings encountered in a prospective evaluation of bronchial cytology encountered in 100 consecutive patients with primary squamous cell carcinoma of the upper aerodigestive tract who do not have primary bronchogenic carcinoma. A single false-positive (1 %) was encountered. It is concluded that epithelial carcinoma of the larynx and upper aerodigestive tract rarely shed identifiable tumor cells into the tracheobronchial tree. When malignant cells are found with bronchial washings, every effort should be made to localize a second primary tumor in the lung.
Neural Generators of Brainstem Evoked Potentials Results from Human Intracranial Recordings
Authors: Møsller Aage R. , Jannetta Peter J. , Møsller Margareta B.
Published: October 2014

Recordings were made from the auditory nerve near its entrance into the brainstem during neurosurgical operations for cranial nerve disorders. The recorded compound action potentials in response to 2000 Hz tonebursts at 90 dB were characterized by a negative peak with a latency of 3.0 to 3.7 ms. When these compound action potentials were compared with the brainstem evoked potentials (BSEP) recorded from the scalp during the operation or before the operation, it was found that the latency of the main peak of the compound action potential matched the latency of the vertex negative wave located between waves II and III (P2) and the potentials recorded from the nerve were found to match the N2P2N3 complex of the scalp-recorded BSEP. The results indicate that the auditory nerve is the neural generator of the two first peaks in the human BSEP, in contrast to the results of experiments in animals which show that the second peak originates in the cochlear nucleus.
Endolymphatic SAC Enhancement Surgery for Menière's Disease an Extension of Conservative Therapy
Authors: Paparella Michael M. , Goycoolea Marcos
Published: October 2014

It is our hypothesis that the primary goal of endolymphatic sac surgery in cases of intractable Menière's disease or syndrome is for the purpose of enhancing absorption of endolymph. Our experience includes 251 cases over a period of 15 years. In this report we discuss rationale, current methods, and results in a series of 176 cases since 1974.
Endolymphatic Duct Obstruction from a Jugular Bulb Diverticulum
Authors: Jahrsdoerfer Robert A. , Cail Wayne S. , Cantrell Robert W.
Published: October 2014

Herniation of the jugular bulb into the middle ear is uncommon. Extension of a jugular bulb diverticulum into the petrous pyramid is rare. In ten previously reported cases in the literature, only the radiographic appearance of the lesion was stressed. Of interest to otolaryngologists is the fact that in seven of the cases there was an ipsilateral sensorineural hearing loss. Other symptoms included tinnitus and vertigo. One patient had been diagnosed as having Menière's disease. We document an additional case (a patient who had “classical Menière's disease”) and report the first known surgical exploration of this venous anomaly. The diverticulum extended high into the petrous bone and was found to obliterate the distal segment of the endolymphatic duct. To our knowledge, this is the first time that a cause and effect relationship has been recognized between endolymphatic hydrops and a jugular bulb diverticulum. We propose that the diverticulum, by obstructing the endolymphatic duct, was directly responsible for the Menière's-like symptoms.
Comparative Study Using Computed Tomographic Thin-Section Zoom Reconstructions and Anatomic Macrosections of the Temporal Bone
Authors: Beatty Charles W. , Harris Lowell D. , Suh Ku Won , Reese David F.
Published: October 2014

Thin-section (1.5 mm) high-spatial-resolution computed tomography (CT) in combination with computerized high-resolution image reconstruction is an effective, noninvasive means of studying patients with a variety of temporal bone abnormalities. To determine what degree of definition and anatomic accuracy could currently be obtained by using these techniques, we performed thin-section CT and high-resolution image reconstruction with use of two fresh-frozen cadaver head specimens. We then compared these images with the actual anatomic macrosections subsequently obtained from the specimens. We concluded that high-resolution CT scans of the temporal bone can produce accurate, highly detailed, diagnostic images of the internal auditory canal, vestibule, cochlea, vestibular aqueduct, semicircular canals, ossicles, and middle ear space.
Experimental Viral Infections of the Inner Ear
Authors: Davis Larry E.
Published: October 2014

Rubella, cytomegalovirus, mumps, and rubeola viruses cause deafness in man and are believed to reach the inner ear through viremic spread. Although several experimental studies of viral infection of the inner ear have been described, all require the virus inoculum to reach the labyrinth directly rather than through hematogenous spread. In this model, reovirus, type 3, infected the cell bodies of cochlear and vestibular ganglia of infant hamsters following a viremia induced by intraperitoneal inoculation. This model provides the first experimental evidence for viremic spread to the inner ear.
A Case of Cysticercose Cerebri
Authors: Millen Steven J. , Pulec Jack L.
Published: October 2014

Cysticercosis is an unusual disease entity in the United States. A case is reviewed in which a young Mexican-American female presented to an otologist's office with a headache and vertigo. Her symptoms were a manifestation of a single larval Cysticercus cyst which had become lodged in the fourth ventricle resulting in an obstructive hydrocephalus and a fatal course. The epidemiology of this disease traces the life cycle of the pork tapeworm from man, normally the definitive host, to the pig, the intermediate host. It is noteworthy that the disease cysticercosis in humans is a deviation from the parasite's normal life cycle in which man serves as the intermediate host. The literature is reviewed. The broad clinical spectrum of this disease's presentation can extend from a single headache to multiple nerve palsies and convulsions. The importance of radiographic evaluation complement fixation testing and CSF evaluation in making a diagnosis is stressed. There is no known medical treatment for this disease. Surgical procedures such as primary excision and shunts to relieve intracranial pressure have had mixed results. The prognosis depends on the location and the number of infesting larva. Special note is made of this disease's endemic status in Mexico and other Latin American countries and the role that this may play in medicine practiced in the southwest United States considering the ever-increasing immigration from this area.
Standardization of Acoustic Reflex Latency
Authors: Mangham Charles A. , Burnett Patricia A. , Lindeman Roger C.
Published: October 2014

Acoustic reflex latency can be prolonged in subjects with an acoustic tumor. Before reflex latency becomes employed clinically, methods for latency measurement should be standardized to reduce variability. In this investigation, the temporal characteristics of reflex latency were examined in humans and in monkeys. A method of latency determination that minimizes variability is described.
Typhoid Fever and Cochleovestibular Lesions
Authors: Escajadillo J. Ramón , Alatorre Guillermo , Zárate Arturo
Published: October 2014

Six cases of pathologically confirmed cochleovestibular lesions due to typhoid fever are presented- The lesions occurred between the second and third weeks of the disease (5 of 6 cases), in the left ear more commonly than in the right (4 of 6 cases), and in females more often than in males (5 of 6 cases). Some of the lesions were reversible. Factors believed to be significant for development of these lesions include host susceptibility, endotoxins, arteritis, and ischemia.
Monophasic Extraskeletal Mandibular Fixation in Head and Neck Surgery
Authors: Schaefer Steven D. , Wessberg George A. , Heaton Steuart L.
Published: October 2014

Stabilization, reconstruction, and rehabilitation of certain mandibular fractures or continuity defects may be facilitated by external skeletal fixation. The utilization of a convenient and inexpensive monophasic extraskeletal fixation appliance in select instances of mandibular trauma or head and neck surgery is described herein and illustrated with case reports.
Conditioned Middle Ear Muscle Tinnitus
Authors: Collard Mary E. , Wagner Cynthia A. , Tingwald Fred R.
Published: October 2014

A case of bilateral middle ear muscle contraction tinnitus associated with eye blinks is presented. It is hypothesized that the association represents a conditioned middle ear muscle response.
Diagnosis and Conservative Surgical Management of Chondrosarcoma of the Larynx
Authors: Hicks Julius N. , Walker E. Earl , Moor E. Eugene
Published: October 2014

Tumors of cartilage rarely occur in the larynx. Most laryngologists see no more than one of these tumors. Therefore, information about the general knowledge, early diagnosis, and surgical treatment of these tumors accumulates slowly. In this paper we will discuss one type of cartilaginous tumor: chondrosarcoma of the cricoid cartilage. We will review general diagnostic information about this tumor, present a case report, and describe a method of conservative surgical excision.
Primary Management of Laryngeal Trauma
Authors: Schaefer Steven D.
Published: October 2014

The management of 87 laryngeal trauma patients over the past 17 years is reported. During the last four years, 35 of these patients were prospectively studied by the author after drawing upon the treatment policies of the earlier experience. The results of this study demonstrate a successful program to preserve or restore the phonatory and airway function of the acutely injured larynx.
Treatment of Severe Subglottic Stenosis without Tracheotomy
Authors: Holinger Lauren D.
Published: October 2014

Subglottic stenosis in neonates, infants and children is one of the most challenging problems confronting the pediatric otolaryngologist today. Small patients with congenital or acquired stenosis severe enough to require tracheotomy must undergo repeated endoscopic procedures or laryngotracheal reconstruction; weeks, months, or years may be required to attain a lumen large enough to permit decannulation. During 1981, six infants and children with severe subglottic stenosis were managed without tracheotomy. The surgical technique employed involves endoscopic excision of the offending subglottic tissue using the CO2 laser and suspension microlaryngoscopy. Intraoperative intubation is avoided by using an insufflation technique for general anesthesia which permits unobstructed visualization of the larynx, thereby avoiding laryngeal trauma and edema.
Polytomography and Congenital Anomalies of the Ear
Authors: Wright J. William , Wright J. William , Hicks George
Published: October 2014

Conventional radiography and even high resolution computerized axial tomography leave much to be desired in demonstrating the minutiae of the anatomy of the temporal bone. Multidirectional tomography remains the examination of choice radiographically in cases of congenital anomalies of the temporal bone. Details of the inner, middle and even external ear in the presence of atresia are more clearly delineated by this method than any other to date. Such information is of inestimable value to the surgeon in the diagnosis and surgical correction of anomalies of the temporal bone. Important features of the vestibule, semicircular canals, cochlea, facial nerve, internal auditory canal, temporomandibular joint, pneumatization of the temporal bone, tegmen, tympanic cavity, ossicles, oval and round windows, jugular bulb and carotid artery and the external ear canal are discerned most clearly by multidirectional tomography.
The Homograft Tympanic Membrane after 12 Years
Authors: Wehrs Roger E.
Published: October 2014

The homograft tympanic membrane has been utilized in reconstructive middle ear surgery since 1968. Previous reports describing its preservation and use were published in 1971, 1972, 1976 and 1978. Throughout this time the same preservative of 70% ethyl alcohol and the same surgical technique of covering the transplant with canal skin or fascia has been employed. These transplants have been used to supplement, not replace, other grafting tissues, and to improve the graft-take rate and hearing results. The graft-take rate has averaged over 90% for the past 12 years and 98% for the past 5 years. The hearing results have been satisfactory in 69 to 95% of the cases depending on the associated ossicular reconstruction. Furthermore these results have been consistent and have not deteriorated with the passage of time.
Esophagology: An Update
Authors: Olsen Arthur M.
Published: October 2014

Because of the great interest in the problem of gastroesophageal reflux, much emphasis has been placed on factors which control the competence of the lower esophageal sphincter (LES). Much study has been devoted to the effect of hormones and drugs on the LES. Of the various diagnostic methods available, 24-hour pH testing seems to offer the most information regarding reflux and its complications. Medical therapy should be given a careful trial before surgical procedures for reflux are considered. Diagnostic esophagoscopy is usually performed with fiberoptic instruments. Open-tube esophagoscopes are still preferable for most types of endoscopic therapy. However, flexible fiberscopes may be used for injection of esophageal varices and for laser coagulation of bleeding lesions or even tumors. Guide wires may be introduced through flexible scopes to aid in the dilation of esophageal strictures and also to aid in the placement of prosthetic tubes in patients with obstructing cancers. The performance of esophagoscopy by practitioners of several disciplines has resulted in fragmentation of the specialty. Ideally, all esophagoscopists should be competent with both open-tube and fiberoptic scopes and should be familiar with all of the newer knowledge of the physiology and pharmacology of the esophagus and its sphincters.
Scanning Electron Microscopic Examination of Nonbeating Cilia
Authors: Dudley James P. , Eisner Lance , Cherry James D.
Published: October 2014

When cilia stop beating, their role in moving mucus ceases, but it is uncertain if nonmotile cilia preserve their external architecture and are thus capable of maintaining an additional role of retarding microbial access to the cell. Cilia of chicken embryo tracheal organ cultures were observed until their activity stopped. When examined with scanning electron microscopy, ciliary axonemes did not appear to differ significantly from normally functioning cilia when observed at lower magnifications. Since their density can remain essentially unchanged, nonbeating cilia may still have a role in protecting respiratory membrane from toxic microorganisms.
Home Care of the Pediatric Patient with a Tracheotomy
Authors: Ruben R. J. , Newton L. , Jornsay D. , Stein R. , Chambers H. , Liquori J. , Lawrence C.
Published: October 2014

Forty-seven infants and children with tracheotomies were cared for at home for a follow-up period of 1,581 months. There were two relevant fatalities which gave a death rate of 0.13 deaths per 100 months. The average age at the time of tracheotomy was 13 months and the tracheotomy was in place for an average of 33 months per patient. The ability to care for these children was provided through coordinated, intensive training and a home-care program in which the inpatient nurse, nurse practitioner, social worker, pediatrician, and otorhinolaryngologist worked as a team.
Brainstem Conduction Abnormalities in Spasmodic Dysphonia
Authors: Schaefer Steven D. , Gerling Irvin J. , Finitzo-Hieber Terese , Freeman Frances J.
Published: October 2014

Twelve spasmodic dysphonia patients were evaluated by three different auditory brainstem response parameters; 75 % were abnormal. Three of the 12 had prolonged wave I-V interpeak latency. Seven had pathologic wave V latency shifts at a high stimulus rate. Amplitude ratios were normal for all subjects. The authors hypothesize that spasmodic dysphonia is a disorder of variable cranial nerve symptom presentations, and offer several possible models to account for its sporadic representation in the nervous system.
Esophageal Dysfunction in Patients with Contact Ulcer of the Larynx
Authors: Öhman Lena , Tibbling Lita , Olofsson Jan , Ericsson Gärda
Published: October 2014

Vocal abuse is the best-known etiological factor in contact ulcer. Other factors, such as hiatus hernia and gastroesophageal reflux have been discussed. A 12-year study of 58 male patients (mean age 52 years) with present or previous contact ulcers, is reported. Forty-three patients were investigated with esophageal function tests, ie, esophageal manometry including pH monitoring, acid-perfusion test, and acid-clearing test. Esophageal dysfunction was found in 74% which is significantly higher than the 30% found in the general population.
Laser Vidian Neurectomy
Authors: Williams J. David
Published: October 2014

Laser vidian neurectomy appears to offer the technical advantages of a less traumatic, more precisely controlled method of operating in an anatomical area which creates, by its location, technical difficulties in accessibility. Results indicate that postoperative patient comfort is greater, affording the opportunity to perform surgery on an outpatient basis. Results of laser vidian neurectomy are no different than those using conventional techniques.
Clinical Utility of Bronchoalveolar Lavage in the Assessment of Interstitial Lung Disease
Authors: Martin W. J. , Sanderson D. R.
Published: October 2014

Bronchoalveolar lavage is a new bronchoscopie technique which permits assessment of changes in the cellular traffic in the alveolar spaces. One hundred and fourteen patients underwent bronchoalveolar lavage at the Mayo Clinic during a 16-month period. Whereas control subjects had a predominance of alveolar macrophages (93 ± 1%) with few lymphocytes (5 ± 1%), 35 subjects with idiopathic pulmonary fibrosis had a marked increase in the number of polymorphonuclear leukocytes (17 ± 2%), and 32 subjects with sarcoidosis had a marked increase in the number of lymphocytes (26 ± 2%). Further identification of these lymphocytes by the immunofluorescent detection of cell-surface antigens revealed the lymphocytes, in all 13 cases of sarcoidosis examined, to be from the T-helper subclass. Bronchoalveolar lavage represents an easy method to monitor the “alveolitis” in these disorders, and offers promise as a quantitative means by which to assess disease “activity” as well as the response to therapy.
Congenital Laryngeal Atresia
Authors: Woo Peak , Karmody Collin S.
Published: October 2014

Two specimens of laryngeal atresia were studied. In the first case stenosis was hard due to noncanalization of the anterior cricoid cartilage. In the second case there was a soft stenosis from limited canalization of the endoluminal soft tissue. Additionally, the first case had a posterior cleft with a persistent pharyngotracheal duct. The stenotic soft-tissue elements in both cases contained striated muscle fibers that interdigitated across the midline. The mucosa on the inferior surface of the hard stenosis was grossly thickened and contained large mucous glands. The embryologic significance of these anomalies is discussed. Presumably these cases represent anomalies caused by different enbryologic events.
Glottographic Measurement of Vocal Dysfunction
Authors: Hanson David G. , Gerratt Bruce R. , Ward Paul H.
Published: October 2014

Objective measurement of vocal function is important in evaluating phonatory disorders, planning treatment, and documenting the effects of therapy. Glottographic measurement, ie, measures that describe glottal movement, can be performed and analyzed relatively easily, and can be related to the pathophysiology of vocal dysfunction. In our clinic, simultaneous recording of acoustic, photoglottographic and electroglottographic signals is being used in the evaluation of patients with voice disorders associated with neurologic impairments. Our experience with these measures indicates that they may provide detailed information about the vibratory patterns of the vocal folds, which appears to differentiate some phonatory characteristics among patients with differing types of disorders.
Congenital Laryngeal Hemangioma
Authors: Benjamin Bruce , Carter Peter
Published: October 2014

Congenital subglottic hemangioma consistently occurs in a site below the vocal cord. It is a distinct clinical entity with typical clinical features. However, congenital hemangioma in other sites can cause airway obstruction. An anatomical classification is proposed on the basis of review of 23 consecutive cases. It is important to accurately identify the site and distribution of the lesion before commencing treatment. Radiation has been an acknowledged form of treatment, and in our hospital we have confirmed that radiation therapy, either by external beam, or by insertion of a radioactive gold grain, gives good results. The theoretical possibility of radiation-induced malignancy in the thyroid gland is reduced to an absolute minimum by use of a radioactive grain for localized tumor-dose with minimum radiation of surrounding tissue.
Training Singing Children during the Phases of Voice Mutation
Authors: Blatt Irving M.
Published: October 2014

Development of singing ability in children is well documented and frequently fraught with admonitions to postpone formal training until the age of 17 or 18 years for boys and 16 years for girls, when voice change is usually complete and the risk for damaging developing structures is minimal. The author contends that the interval of voice mutation, a time of rapid physical change, is precisely the period when the young singer should pursue human musical instrument training under tutelage of singing teachers knowledgeable and experienced in the training techniques described herein and with the guidance of an otorhinolaryngologist to evaluate and monitor fitness. Voice mutation is viewed as a natural process of maturation, which can be enhanced by a formal training program.
Teflon Injection of the Vocal Cord: Complications, Errors, and Precautions
Authors: Lewy Robert B.
Published: October 2014

An effort is made to summarize errors and complications in Teflon vocal cord surgery. This represents accumulated experience from 240 cases. Concentrated advice and precautions are given to improve results and expectations of the surgery.
Care of the Ear Canal and Mastoid
Authors: Ruggles Richard L. , Abols Inese
Published: October 2014

Zinc sulfate has been used for therapy of granulations of the trachea and ear that have not responded to usual treatment. This paper will report on current indications for zinc sulfate and the resulting success in managing granulomata of the ear canal and mastoid bowl. Some mastoid bowls have been large and hard to clean, especially in the posterior and lateral parts. A method of cleaning using indirect otoscopy and curved aspirators in conjunction with adequate lubrication will be described. Treatment of otalgia in both the ear canal and mastoid bowl due to otitis externa sicca and results of proper lubrication and avoidance of patient instrumentation to restore the normal wax will also be discussed.
Intermittent Exposure to Noise: Effects on Hearing
Authors: Sataloff Joseph , Sataloff Robert T. , Yerg Raymond A. , Menduke Hyman , Gore Robert P.
Published: October 2014

Most studies of the effects of noise upon hearing have dealt with continuous noise exposure. Previous reports on intermittent exposure to noise concluded that it causes less damage to hearing than does continuous exposure to noise of the same intensity. In this investigation, 12,000 workers were screened to find 295 subjects who met the strict criteria of the study. Most of the subjects were exposed to jackhammer noise at peak levels of 118 dBA. Intermittent exposure to intense noise results in very severe loss in high frequencies but relatively little or no hearing loss in the lower frequencies even after many years of exposure. This differs substantially from the effects of continuous exposure to noise of the same intensity. It remains to be determined whether this pattern of hearing results from intermittent exposure to all sorts of noise or only from the kinds of sources investigated in this study.
The round Window Membrane: Otological Observations
Authors: Paparella Michael M. , Schachern Patricia A. , Choo Young Bin
Published: October 2014

The membrane of the round window serves as a barrier between the middle and inner ear and has a well-established role in cochlear physiology. It is important in many otological conditions; otitis media, otosclerosis, trauma, sequelae to drugs reaching the middle ear, tumors, congenital dysplasia, sudden deafness. We here describe the first electron microscopic findings in round window membranes from adult humans, and various conditions in reference to these findings. Since surgical lesions are made in this membrane during cochlear implantation, and by some otologists in treating vertigo, preliminary findings of a lesioning experiment in animals are presented. Interestingly, early healing resulted from a mesothelial cellular reaction in the adjacent scala tympani, with formation of clots, while in the middle ear the epithelial cellular layer sealed the edges of the perforation, leading to formation of an indentation (“pocket”). Subsequently, the middle layer of the membrane contributed to healing.
Carcinoma Ex Lymphoepithelial Lesion
Authors: Batsakis John G.
Published: October 2014

Carcinoma ex lymphoepithelial lesion is a poorly differentiated, nonkeratinizing carcinoma presumably arising from the epimyoepithelial islands of the lymphoepithelial lesion of the major salivary glands. Parotid origin dominates the statistics concerning site of origin. There is no relationship of the carcinoma to systemic rheumatic disease or Sjögren's syndrome.
Neurogenic Dysphonia
Authors: Hartman David E.
Published: October 2014

Disorders of phonation and resonation subsequent to damage to the central or peripheral nervous system (neurogenic dysphonia) typically occur with alterations in other aspects of motor speech: articulation, prosody, and respiration. Deficits in voice initiation or coordination of resonation with speech that occur without significant neuromuscular impairment following a lesion to Broca's area are compatible with a motor speech programming disorder, or apraxia of speech. Conversely, damage to upper or lower motor neurons subserving motor speech results in a group of neuromuscular speech disorders, the dysarthrias, which have signs including aberrations of phonation and resonation which can be differentiated. The neuropathologic and perceptual characteristics of neurogenic dysphonia are elucidated, and suggestions are provided for their identification and differentiation.
Development of Intercellular Junctions in the Vestibular End-Organ
Authors: Bagger-Sjöbäck Dan , Anniko Matti
Published: October 2014

The intercellular junctions and the tight junctions in particular are considered to be of great importance for the function of the inner ear. The two fluid compartments of the inner ear, the perilymphatic space and the endolymphatic space, need to be effectively separated from each other in order to maintain the ionic gradients between the two. The tight junctional structures have been described in mature animals of several species. In the present article the development and maturation of the intercellular junctions are described in the mouse embryo. Junctional elements are already present in the 12th gestational day otocyst. Over the next few days, the otocyst is differentiated into a cochlear portion and a vestibular portion. The tight junctions in the vestibular portion gradually attain their mature appearance. It seems as if the tight junctions of the supporting cells develop slightly faster than those of the hair cells. At the time of birth, all epithelial cells have obtained mature appearance. The tight junctions are fully developed on the supporting cells as well as the hair cells. Small gap junctions are present in the 14th gestational day specimens. Two days later the hair cells and the supporting cells are well differentiated; small to medium-sized gap junctions are present only on the supporting cells at this stage. At the time of birth larger gap junctional aggregates have developed on the supporting cells.
Surgery for an Improved Multiple-Channel Cochlear Implant
Authors: Clark Graeme M. , Pyman Brian C. , Bailey Quentin E. , Webb Robert L. , Shepherd Robert K.
Published: October 2014

An improved multiple-channel cochlear implant has been developed. The titanium container with enclosed electronics, the receiver coil, and the connector are embedded in medical-grade Silastic. The upper half of the implant has a diameter of 35 mm and a height of 4.5 mm, and the lower half a diameter of 23 mm and a height of 5 mm. The electrode array has also been designed to reduce the possibility of breakage due to repeated movements over many years. The surgery involves drilling a bed in the mastoid bone for the receiver-stimulator, and fixing the proximal electrode under the mastoid cortex. Gentle insertion of the electrode array through the round window and along the scala tympani is achieved with a specially designed microclaw.
Posterior Cleft Larynx Associated with Hamartoma
Authors: Cohen Seymour R.
Published: October 2014

Two patients with a thus far unreported unusual lesion of the larynx, a hamartoma in association with an isolated posterior cleft, are presented. Obstruction in association with aspiration of liquids, recurrent bronchitis with pneumonia, and severe obstructive laryngeal disease were cardinal symptoms of this anomaly. One child had 13 pairs of ribs and the other had Opitz-Frias (G) syndrome, a rare genetic disorder. The cases are reviewed in detail, endoscopic findings are described, and the literature and embryology are reviewed. After endoscopic removal of the hamartoma, both children were relieved of the obstruction, thrived, and no longer had recurrent pneumonia. The aspiration of liquid foods continued when fluids were gulped or taken too rapidly.
Multidirectional and Computerized Tomography of the Vestibular Aqueduct in Meniere's Disease
Authors: Valvassori Galdino E. , Dobben Glen D.
Published: October 2014

Multidirectional and computerized tomography have been used for the radiographic assessment of the vestibular aqueduct in Meniere's disease. The results of studies performed by us and or other authors indicate that there is a statistically significant difference in the size of the vestibular aqueduct between the Meniere's and control groups (in Meniere's disease the vestibular aqueduct is often narrowed or obliterated); and that periaqueductal pneumatization is often decreased or absent in ears affected by Meniere's disease. Recent histological studies performed on temporal bones of patients with Meniere's disease have confirmed these radiographic observations.
Postural Disturbance in Patients with Benign Paroxysmal Positional Nystagmus
Authors: Black F. Owen , Nashner Lewis M.
Published: October 2014

Abnormal vestibular function disrupts postural and ocular muscle control system references to gravity (earth) vertical. Vestibular disorders also prevent satisfactory resolution of normally redundant, but often conflicting, visual and somatosensory spatial references required for normal postural control during active and passive body motion. Using a moving platform and visual surrounds posturography technique to systematically interact visual, somatosensory, and vestibular inputs, it was clearly demonstrated that patients with the benign paroxysmal positional nystagmus type of distorted vestibular function employ an unstable, visually dependent postural sway distinct from the postural instability associated with unilateral or bilateral vestibular functional deficits. These findings have important clinical implications for diagnosis and management of patients with vestibular disorders.
Development of the Place Principle
Authors: Rubel Edwin W , Lippe William R. , Ryals Brenda M.
Published: October 2014

Two experiments using embryonic and hatchling chickens examined how the representation of frequency along the basilar membrane changed during hearing development. In experiment 1, chicks were exposed to high intensity pure tones (500, 1,500, or 3,000 Hz) at one of three different ages. Analysis of hair cell degeneration indicated a discrete region of damage which systematically changed as a function of exposure frequency and age. With maturation, each frequency produced damage at progressively more apical locations. In experiment 2, the representation of frequency in the brain stem auditory nuclei was compared in embryonic, hatchling, and adult chickens. Microelectrode recordings indicated a systematic shift in the frequency representation. Neurons, which are activated by high frequencies in the adult, initially respond to only low frequencies. These experiments indicate how the mature pattern of frequency representation along the basilar membrane gradually emerges during the stages of hearing development.
The Supratubal Recess in Cholesteatoma Surgery
Authors: Horn Karl L. , Luxford William M. , Brackmann Derald E. , Shea John J.
Published: October 2014

Acquired attic retraction cholesteatoma involving the anterior epitympanum is infrequently encountered and even less frequently discussed in the literature. The lack of cholesteatoma in this region is mostly due to a ridge of bone extending inferiorly from the tegmen tympani, just anterior to the cochleariform process. The term “cog” was coined and popularized to refer to this bony ridge. Erosion of the cog by cholesteatoma matrix allows extension of cholesteatoma into the supratubal recess. A number of vital structures including the facial nerve, cochlea, middle fossa dura, and internal carotid artery are intimately related to the supratubal recess. A clear three-dimensional understanding of these structures is necessary to remove disease safely from this area regardless of whether the posterior canal wall is left up or taken down. We present a series of dissection illustrations of the supratubal recess and discuss the possible routes of cholesteatoma extension. A series of patients with varying degrees of involvement of the supratubal recess and related structures is presented, and the pitfalls and management of cholesteatoma in this area are discussed.
A New Autologous Fibrinogen-Based Adhesive for Otologic Surgery
Authors: Epstein Gordon H. , Zwillenberg Seth , Weisman Robert A. , Schreiber Alan D.
Published: October 2014

Many middle ear reconstructive procedures would be facilitated by use of a relatively safe surgical adhesive. A fibrinogen-based adhesive (Tisseel) has been effective in otologic surgery in Europe, but because it is derived from pooled human blood, it carries a risk of transmitting hepatitis, acquired immune deficiency syndrome, and other illnesses. This report details a new procedure for creating an autologous fibrinogen-based adhesive, obviating these risks. The fibrinogen and factor XIII component of the adhesive was isolated by polyethylene glycol precipitation from human plasma within a few hours, and was used either immediately or frozen for use up to 3 weeks later. Fifteen chinchillas had either the single donor adhesive, the commercial European adhesive, or saline placed on the oval and round windows, and no evidence of cochlear, mucosal, or ossicular damage was seen by light microscopy 30 days later. Auditory brain stem response thresholds remained stable, except in three animals that developed otitis media. Based on this investigation, autologous fibrinogen-based adhesive appears promising as a relatively safe, biological bonding material for otologic surgery, and is worthy of further study.
Choosing the Appropriate Habilitative Track for the Newly Identified Hearing-Impaired Child
Authors: Brookhouser Patrick E. , Moeller Mary Pat
Published: October 2014

Based on prospective longitudinal data collected on 38 hearing-impaired infants, this study addresses the question, “What constitutes adequate progress in habilitation of the young deaf child?” The components of the newly developed Diagnostic Early Intervention Program aimed at selecting the most appropriate habilitative-educational track for the hearing-impaired infant will be described, together with data from the first 15 children who have completed the 6-month program. The results of a multidisciplinary medical evaluation completed on these children, including audiology, otolaryngology, aural rehabilitation, pediatrics, neurology, radiology, and genetics, will illustrate the important assistance these findings provide to the decision-making process of the habilitative-educational team.