bluuebunny/crossref_metadata_2025 huggingface dataset:
Paraneoplastic cerebellar disorders
Authors: Baloh Robert W.
Published: September 2022

Paraneoplastic cerebellar degeneration typically begins with rapidly progressive ataxia of the trunk and extremities. Antineuronal antibodies are found in about half the patients. The most specific autoantibody is an anti‐Purkinje cell antibody found in women with gynecologic tumors. Even after the tumor is removed, the cerebellar deficit persists in most patients.
Extraparotid Warthin's Tumor: Clinical Manifestations, Challenges, and Controversies
Authors: Astor Frank C. , Hanft Kendall L. , Rooney Patricia , Benson Corazon A. P. , Flores Toribio , Lavertu Pierre
Published: September 2022

Extraparotid Warthin's tumors continue to challenge the head and neck surgeon's diagnostic and therapeutic skills. A series of six extraparotid Warthin's tumors are presented to illustrate the need to keep a high index of suspicion for this lesion in the workup of cystic masses involving cervical levels II and III or in the event of a concomitant neck mass and a parotid Warthin's tumor. Discussion of the debate surrounding the embryogenesis and histogenesis of extraparotid Warthin's tumors follows. Clinical guidelines are suggested for the diagnosis, treatment, and follow‐up of patients with extraparotid Warthin's tumors.
Ethics of Cochlear Implantation in Young Children
Authors: Balkany Thomas , Hodges Annelle V. , Goodman Kenneth W.
Published: September 2022

Certain leaders of the Deaf community are attempting to generate opposition to cochlear implants in children by pitting the rights of deaf children and their families against the needs of deaf society. They have labeled physicians as unethical and CIs as “child abuse,” resulting in misunderstanding, anger, and violence. However, the arguments of these leaders are internally contradictory: they hold that deafness is not a disability but support disability benefits for the deaf; they maintain both that cochlear implants do not work and that they work so well that they are “genocidal” (i.e., they will eliminate deafness). Their positions oppose the ethical principles of beneficence and autonomy as they relate to self‐determination and privacy. Ethical standards hold that the best interests of the child precede those of a special interest group and that parents have the responsibility to determine their children's best interests.
Epidermal Growth Factor Regulates Topoisomerase II Activity and Drug Sensitivity in Human KB Cells
Authors: Allen Gregory C. , Lubas Scott , Wax Mark K. , DeVore Russell F.
Published: September 2022

Because of its unique DNA‐cleaving and strand‐passing activities, topoisomerase II is involved in many aspects of DNA metabolism, including replication, transcription, recombination, and repair. The cytotoxic potential of topoisomerase II–targeted drugs, such as etoposide, is related to their ability to stabilize covalently linked enzyme‐DNA complexes, which are intermediates in the enzyme's catalytic cycle. Epidermal growth factor receptor is expressed on the cell surface of the majority of squamous cell carcinomas, and epidermal growth factor binding is known to stimulate a number of cellular transduction pathways, including tyrosine kinase, protein kinase C, and phospholipase C. Because topoisomerase II is a proliferation‐dependent protein and has been shown to be a high‐affinity substrate for many of these cellular transduction pathways, the effects of epidermal growth factor on cellular regulation and sensitivity to etoposide were studied with the human oral cavity squamous cell line, KB. Topoisomerase II catalytic activity was rapidly and transiently inhibited after the addition of epidermal growth factor to the cellular growth media. Western blot on nuclear extracts did not demonstrate alterations in topoisomerase II polypeptide levels to account for changes in catalytic activity. Epidermal growth factor treatment also led to the formation of stabilized, covalently linked enzyme‐DNA complexes. Furthermore, epidermal growth factor‐induced, topoisomerase II–mediated DNA strand breaks were additive to those induced by etoposide. This study indicates that epidermal growth factor specifically regulates the catalytic and DNA‐cleaving activities of topoisomerase II in KB cells. This may direct clinical strategies for circumventing the intrinsic cellular resistance to chemotherapy commonly observed in squamous cell carcinomas of the head and neck.
Airborne Pollutants and the Immune System
Authors: Albright Joseph F. , Goldstein Robert A.
Published: September 2022

The effects of airborne pollutants on the immune system have been most widely studied in the respiratory tract. Entry may occur as a volatile gas (ozone, benzene), as liquid droplets (sulfuric acid, nitrogen dioxide), or as particulate matter (diesel exhaust, aromatic hydrocarbons). The subsequent interaction with the immune system may result in local and systemic responses, and studies have shown examples of disease occurring from both overactive immune responses and immunosuppression. For the most part, airborne pollutants (small molecular weight chemicals) have to be coupled with other substances (proteins or conjugates) before they can be recognized by the immune system and exert their effects. Fortunately, this encounter rarely causes immunologically mediated human disorders. The following briefly reviews some of the disorders that may occur. Immunologically nonspecific inflammation of the lung can occur after inhalation of ozone in anyone given sufficient dose and time of exposure. Immunologically specific cell‐mediated (T lymphocyte) reactions appear to predominate in chronic beryllium disease, which results in a granulomatous form of lung disease. Beryllium alone does not appear to be antigenic but requires chemical linkage with a larger molecule. Mercury‐induced autoimmune disease (immune system attacks self‐antigens) affecting kidneys and lungs has been demonstrated in animal models (changes similar to those seen in people with Goodpasture's syndrome). Immunosuppression can be demonstrated after exposure to polycyclic aromatic hydrocarbons (2,3,7,8‐tetrachlorodibenzo‐p‐dioxin). Hypersensitivity (or allergic) reactions can occur after exposure to toluene diisocyanate (occupational asthma). In summary, airborne pollutants may cause a wide spectrum of immunologically mediated disorders. There is clearly an underlying genetic basis for the susceptibility to immunologic disease resulting from exposure to pollutants, but knowledge in this area is rudimentary at present. Studies have been impeded by lack of appropriate in vitro models, as well as difficulties in identifying the biologically active substance.
Sharp Dissection, Electrosurgery, and Argon‐Enhanced Electrosurgery in Porcine Skin Flaps
Authors: Bateman Scott N. , Noorily Allen D. , McGuff H. Stan
Published: September 2022

Sharp scalpel dissection, electrosurgery, and argon‐enhanced electrosurgery (argon beam coagulation) were used to elevate random pedicled skin flaps in a randomized, blinded fashion with a porcine model. A total of 72 flaps on 9 pigs were examined. Flap survival was quantified, and histology was also reviewed 2 and 6 weeks after surgery. No significant difference among the three techniques was noted in terms of area or length of surviving flaps. There were also no histologic differences noted with regard to fibrosis, inflammatory infiltrate, or necrosis. We conclude that the use of electrosurgery during surgical dissection of random pedicled skin flaps is not detrimental to wound healing or tissue survival, and it provides benefits such as decreased blood loss, absence of the need for sharp instruments in the surgical field, and faster operative times.
Role of Allergy in Eustachian Tube Blockage and Otitis Media with Effusion: A Review
Authors: Bernstein Joel M.
Published: September 2022

Recent studies continue to support a role for allergy in the pathogenesis of otitis media with effusion. Although a variety of mechanisms have been proposed to relate these two disease conditions causally, none has been completely validated by experimental or clinical studies. This review suggests that the observed relationship between allergy and otitis media with effusion is caused by mediators of inflammation and cytokines and colony‐stimulating factors released by mucosal mast cells and other inflammatory and epithelial cells in the nose and nasopharynx. These mediators produce blockage of the eustachian tube through a number of mechanisms, which may include local injury or vascular‐ or neural‐mediated changes in the eustachian tube opening pressure and in middle ear perfusion. It is likely that the nasal allergic response in patients predisposes to eustachian tube blockage and, if prolonged, causes changes in gas absorption in the middle ear space. This gas exchange primarily involves nitrogen absorption, which may take several days to develop. This persistent underpressure will then lead to middle ear effusion. Irrespective of the theoretical mechanism, the relationship between allergy and otitis media with effusion will remain controversial until well‐controlled clinical studies are conducted documenting that in select populations antiallergy therapy is efficacious in preventing or limiting the duration of otitis media with effusion.
Systematic Approach to Electrode Insertion in the Ossified Cochlea
Authors: Balkany Thomas , Gantz Bruce J. , Steenerson Ronald L. , Cohen Noel L.
Published: September 2022

Ossification of the fluid spaces of the cochlea occurs often in candidates for cochlear implantation, especially children. When noted before surgery on computerized tomography, ossification previously was thought to contraindicate cochlear implantation because of possible mechanical obstruction and uncertainty about the level of function that could be achieved by stimulating an ossified cochlea. However, during the preceding 6 years, techniques have been developed that permit implantation in ossified cochleas. We present a systematic approach that has been developed to treat the three clinically important categories of cochlear ossification: round window niche obliteration, inferior segment obstruction, and upper segment obstruction. Case reports are presented for each of these three drill‐out procedures, demonstrating results often similar to those expected for implantation of the nonossified cochlea.
Neural Cell Adhesion Molecule in Adenoid Cystic Carcinoma Invading the Skull Base
Authors: Gandour‐Edwards Regina , Kapadia Silloo B. , Barnes Leon , Donald Paul J. , Janecka Ivo P.
Published: September 2022

Neural cell adhesion molecules (N‐CAMs) are expressed in neuromuscular tissues, neuroblastoma, and small cell lung carcinoma. Adenoid cystic carcinoma may invade the skull by either direct extension or neural involvement, particularly along the second and third divisions of the trigeminal nerve (V2 and V3). Eighteen patients with adenoid cystic carcinoma that invaded the skull base were studied. The tumors were graded into predominantly solid (3), cribriform (11), or tubular‐trabecular (4) patterns, and neural involvement was evaluated histologically. Paraffin sections were examined by use of monoclonal antibodies for N‐CAM and Ki‐67, a proliferation marker, with the avidin‐biotin‐peroxidase method. Fifteen (83%) tumors showed perineural involvement; in the remaining three cases no nerves were present for histologic examination. Fourteen (93%) of 15 tumors with perineural involvement were reactive with N‐CAM. Proliferation, measured by the presence of nuclear Ki‐67, was markedly increased in tumors with predominantly solid patterns. We demonstrated that N‐CAM is expressed in adenoid cystic carcinoma. The role of N‐CAM as a neurodeterminant that facilitates the spread of adenoid cystic carcinoma along nerves, however, remains unanswered and warrants further study.
Cochlear Immunoglobulin in the C3H/lpr Mouse Model for Autoimmune Hearing Loss
Authors: Trune Dennis R.
Published: September 2022

Immunoglobulin staining was conducted in cochlear tissue from the C3H/lpr autoimmune strain mouse to better understand the local immune processes underlying autoimmune inner ear disease. This mouse is a model for spontaneous systemic lupus erythematosus with coincident elevated cochlear thresholds. Cochleas were examined from C3H/lpr mice at 2 months of age, before disease onset, and at 8 months of age, when systemic disease and hearing loss are manifested. Sections of these cochleas, along with cochlear sections from age‐matched C3H/HeJ nonautoimmune controls, were immunocytochemically stained for IgG and IgM to identify areas of abnormal immunoglobulin activity. IgM immunoreactivity was similar in control and autoimmune cochlear tissue and did not appear to vary with disease progression. Staining was limited to the inside of capillaries in the stria vascularis and other areas within the cochlea. Similar staining patterns were seen in control animals stained for IgG. However, C3H/lpr mice with autoimmune disease showed extensive IgG immunoreactivity spreading out from the stria vascularis capillaries into the extracapillary spaces. This increased permeability suggested that breakdown of the blood labyrinth barrier was coincident with systemic autoimmune disease.
Removal of Jugular Foramen Tumors: The Fallopian Bridge Technique
Authors: Pensak Myles L. , Jackler Robert K.
Published: September 2022

Despite recent advances in neuroradiographic and electrophysiologic assessment, the surgical extirpation of lesions of the bony skull base remains challenging. Moreover, as surgeons have gained experience in removing tumors from the irregular osteologic confines of the skull base, attention has been directed toward preservation of vital neural and vascular structures traversing the operative field. This report describes the creation of a fallopian bridge with preservation of the facial nerve in removing tumors that arise within or juxtaposed to the jugular fossa. Thirty‐five patients are reported herein with analysis of pathology, surgical approach, and outcome. An algorithm for use of the fallopian bridge, as opposed to facial nerve mobilization and rerouting, is presented with particular emphasis on limitation of this selective procedure.
Undifferentiated carcinoma of nasopharyngeal type of the laryngopharyngeal region
Authors: Zbären P. , Borisch B. , Läng H. , Greiner R.
Published: September 2022

Undifferentiated carcinoma of nasopharyngeal type (lymphoepithelioma) is an extremely rare malignancy in the laryngohypopharyngeal region. We found reports of only 13 such tumors in the English language literature. We present the findings of four additional cases, one hypopharyngeal and three laryngeal in origin. The three laryngeal tumors were characterized by submucosal spread. The tumors were classified T3 (2x) and T4 (2x) with cervical lymph node metastases at initial presentation in all cases. In three of our four cases the Epstein‐Barr virus was demonstrated by the Epstein‐Barr virus‐encoded RNAs in situ hybridization.
Tinnitus suppression in cochlear implant patients
Authors: Ito Juichi
Published: September 2022

Tinnitus is sometimes suppressed by cochlear implantation. Tinnitus conditions were examined in 60 adult patients who underwent cochlear implantation in 1990 or later. Before surgery, 90% of these patients reported some type of tinnitus. The patients completed a questionnaire evaluating the loudness and duration of the tinnitus, immediately after the first electrical stimulation and 2 months later. The loudness of tinnitus was suppressed in 65% of the patients at first evaluation. Two months later, the tinnitus was suppressed in 93% of the patients. As for the duration of tinnitus, at first evaluation the tinnitus duration was suppressed in 41% of the patients. Two months later, the duration of tinnitus was suppressed in 61% of the patients.
Test‐Retest Reliability of Vestibular Autorotation Testing in Healthy Subjects
Authors: Guyot Jean‐philippe , Psillas Georges
Published: September 2022

Vestibulo‐ocular reflex rotational chair testing in the high‐frequency range is seldom performed because it requires specialized and powerful systems. But today a new method of sweep‐frequency vestibulo‐ocular reflex testing, the Vestibular Autorotation Test system (Western Systems Research, Inc., Pasadena, Calif.), based on active head movements increasing from 2 to 6 Hz, is available on the market. The goal of this study was to evaluate the test‐retest variability of this test in healthy subjects. Twelve young adults (22 to 42 years old) without any history of auditory or vestibular dysfunction were included in the study. Subjects underwent five tests under standardized conditions with a 1 ‐week interval. Each test consisted of three measurements of the gain and phase of the vestibulo‐ocular reflex in the horizontal and vertical planes. Statistical analysis shows that the test‐retest reliability of the Vestibular Autorotation Test is poor. Therefore this method cannot be used routinely to evaluate precise vestibulo‐ocular reflex anomalies.
Endoscopic treatment of allergic fungal sinusitis
Authors: Quraishi Huma A. , Ramadan Hassan H.
Published: September 2022

Fungal sinusitis has been seen increasingly in immunocompetent individuals. The literature has stressed the importance of diagnosing these cases. Surgical debridement is the treatment of choice. Six immunocompetent individuals with allergic fungal sinusitis were seen at West Virginia University between January 1992 and December 1993. After adequate evaluation, endoscopic surgical debridement was performed. After surgery they were treated with systemic or topical steroids and oral antibiotics for several weeks. Two patients required a second procedure within a year. Four of our six patients had positive fungal cultures forAspergillusorCurvularia.None of our patients had evidence of invasive disease on histopathology, and systemic antifungal therapy was not required. Patient course and response will be discussed in detail along with a brief review of allergic fungal sinusitis.
Factors predictive of poor compliance with follow‐up care after facial trauma: A prospective study
Authors: Stewart Michael G. , Chen Amy Y.
Published: September 2022

We performed a prospective study of 59 consecutive patients with facial trauma who were treated at an urban public hospital. We obtained demographic and clinical data before treatment, then recorded compliance with clinic follow‐up care. As expected, young, minority male patients, victims of assault, and blunt mechanisms of injury predominated in our series, and midface fractures and soft tissue injuries were most commonly seen. Thirty‐one (52%) patients were admitted, and 28 (48%) were treated as outpatients. Although 66% of patients kept their initial follow‐up appointment, only 46% of patients were seen to completion of the follow‐up period. We used univariate and multivariate analyses to identify factors predictive of poor compliance with follow‐up care. Factors predictive of poor compliance with the initial follow‐up appointment identified in the multivariate analysis were orbital injury site (p < 0.001), Caucasian race (p = 0.007), and not having a telephone at home (p = 0.043). Factors predictive of poor compliance with completion of follow‐up were failure to keep initial appointment (p < 0.001), and treatment with observation, suture only, or open reduction internal fixation only (p = 0.018). Age, marital status, employment status, education level, and hospital admission of the patient were not predictive of compliance with follow‐up care. Because compliance with follow‐up care may be poor, patients with facial trauma should be managed aggressively initially. In particular, patients with orbital fractures, and those treated with watchful waiting only may have poorer long‐term compliance with follow‐up care. (Otolaryngol Head Neck Surg 1997;117:72–5.)
Principles of Facial Reconstruction
Authors: Papel Ira D.
Published: September 2022

Editor's Note: The reviewers have rated the books on a scale of one to five stars. The highest ratings are given to books that fulfill their objectives and skillfully convey information to the chosen audience. Books are judged on appropriateness and completeness of detail for the targeted audience, quality of writing, editorial skill (especially multiauthored books), illustrations, and photography. If is hoped this code will aid the reader in selecting books for his or her permanent library. The rating scale is as follows: ***** Outstanding, a classic, should be on the shelf of anyone interested in the subject; **** Strong, well‐written book with major contributions in some areas; *** Informative book that should be read, if not owned, by individuals with interest in the field; ** Some worthwhile information, but with deficiencies in writing style or completeness; * Major shortcomings, not recommended.

Principles of Facial Reconstruction, by Wayne F. Larrabee, Jr, and David A. Sherris. 256 pages with illustrations. Lippincott‐Raven, Philadelphia, 1995. $95.00.
Nitric Oxide is a Mediator of Neurogenic Vascular Exudation in the Nose
Authors: Lane Andrew P. , Prazma Jiri , Baggett Henry C. , Rose Austin S. , Pillsbury Harold C.
Published: September 2022

Rhinorrhea is a troublesome symptom of rhinitis seen commonly by otolaryngologists. The sources of nasal fluid production are glandular secretions and exudation from submucosal blood vessels. This study was designed to investigate the role of nitric oxide in neurogenically mediated vascular exudation in the nose. A rat model of the nasonasal reflex was developed in which one nasal cavity was challenged with histamine while albumin exudation was measured on the contralateral side. Histamine challenge was associated with a significant rise in albumin leakage, indicating an increase in vascular permeability. Perfusion with a nitric oxide synthase inhibitor (N‐nitro‐L‐arginine methyl ester (l‐NAME)) in the nasal cavity contralateral to nasal challenge was found to block albumin exudation on that side. This inhibition was overcome by the addition of L‐arginine, the natural substrate of nitric oxide synthase, to the perfusate. Treatment of the ipsilateral nasal cavity with l‐NAME did not significantly decrease the contralateral response. These findings indicate that NO is an important mediator of the effector arm of the nasonasal reflex that increases vascular permeability but is not involved in the sensory nerve afferent pathway. Further elucidation of the role of NO in nasal physiology may lead to novel pharmacotherapeutic approaches to the treatment of allergic and nonallergic rhinorrhea.
Sensory Discrimination in the Larynx and Hypopharynx
Authors: Aviv Jonathan E.
Published: September 2022

The traditional approach to evaluating swallowing disorders has focused on upper aerodigestive tract motor function. The evaluation of the sensory apparatus in the larynx and pharynx as part of the workup of dysphagia has heretofore not been addressed. The purpose of this work is to discuss a new, noninvasive method to measure sensory discrimination in the supraglottic larynx and hypopharynx. An air pulse, of precise duration and pressure, was delivered through a flexible fiberoptic telescope to the submucosally situated superior laryngeal nerve along the anterior wall of the pyriform sinus. Three hundred sixty trials were conducted in 30 healthy adults. The average sensory discrimination was 2.24 ± 0.28 mm Hg. Brief air‐pulse stimulation is a safe, reliable means of determining supraglottic and hypopharyngeal sensory discrimination thresholds.
Pathophysiology and Indications for Medialization Thyroplasty in Patients with Dysphagia and Aspiration
Authors: Flint Paul W. , Purcell Laura L. , Cummings Charles W.
Published: September 2022

Medialization thyroplasty is generally considered a phonosurgical procedure for voice augmentation in patients with glottic insufficiency. This article addresses specifically the issue of dysphagia and aspiration in patients with laryngeal paralysis. A retrospective review of patients undergoing medialization thyroplasty is performed. From 1991 to 1995, 84 patients at The Johns Hopkins Medical Institutions underwent medialization thyroplasty for unilateral vocal fold motion impairment. At presentation 48 patients had isolated recurrent laryngeal nerve injury, 26 with combined superior laryngeal nerve/recurrent laryngeal nerve injury and 10 with idiopathic nerve injury. Sixty‐one percent of patients had swallowing difficulties. The severity of symptoms is greater in the superior laryngeal nerve/recurrent laryngeal nerve group. Before surgery 13 patients were dependent on feeding tubes. Nine patients improved to the point at which all alimentation was taken by mouth and tube feedings were discontinued after medialization thyroplasty. One patient was subsequently converted to a full oral diet after cricopharyngeal myotomy. Three patients remained dependent on feeding tubes. The pathophysiology of dysphagia including clinical and experimental observations is reviewed. In addition, the nonsurgical and surgical approaches to treatment of patients with laryngeal paralysis are reviewed.
Laryngotracheal Reconstruction without Stenting
Authors: Younis Ramzi T. , Lazar Rande H.
Published: September 2022

Many surgical procedures, including laryngotracheal expansion with or without grafting, have been suggested for repairing laryngotracheal stenosis in children, and although a variety of stents have been described, the practice of prolonged stenting continues to diminish. We describe 21 pediatric patients with moderate‐to‐severe subglottic or tracheal stenosis who had laryngotracheal reconstructions with anterior rib cartilage grafts without stenting or intubation. The patients were between 6 months and 7 years of age at the time of surgery. All patients were extubated in the operating room after the procedure was terminated. One patient required reintubation in the intensive care unit for 48 hours after surgery, and another patient required a tracheotomy. Wound infection occurred in one patient. Most patients were discharged to their homes 3 to 5 days after surgery. We report the indications, technique, results, and complications of laryngotracheal reconstruction using a rib graft without stenting.
Factors that Predict Metastasis of Papillary and Follicular Thyroid Cancers in Taiwan
Authors: Lin Jen‐Der , Huang Hong‐So , Chen Shin‐Cheh , Chao Tzu‐Chieh
Published: September 2022

The purpose of this study is to explore the relationship of postoperative thyroglobulin level and other clinical factors with tumor metastasis. Analysis of 281 pathologic lesions verified patients with papillary and follicular thyroid cancer who received their primary treatment at Chang Gung Memorial Hospital. Clinical information—including postoperative thyroglobulin levels, age, sex, primary tumor size, clinical staging, surgical methods, surgical findings, chest x‐ray findings, and 131I uptake—were stored in the computer. Actual survival rate and univariate and multivariate analyses of these factors with the relationship of distant metastases were undertaken. Twenty‐three patients in this study died of distant metastases from the thyroid cancer. Of these patients, 30.4% were older than 60 years. In contrast only 8.5% of patients in the survival group were older than 60 years (p < 0.05 in χ2). All of the papillary thyroid cancer patients with distant metastases displayed thyroglobulin levels higher than 25 ng/ml, but only 24% (41 of 173 cases) of those without distant metastases had thyroglobulin levels higher than 25 ng/ml. In 12 follicular thyroid cancer patients with distant metastases, 11 patients' serum thyroglobulin levels were higher than 25 ng/ml. In contrast, only 7 of 33 patients with follicular thyroid cancer without distant metastases displayed similar thyroglobulin levels. Univariate analysis revealed that age, postoperative thyroglobulin levels, chest x‐ray findings, pathologic type, and tumor size are associated with distant metastases. One‐month postoperative serum thyroglobulin level could be used as a prognostic factor for papillary and follicular thyroid cancer patients with distant metastases.
Venous Channels of the Petrous Apex: Their Presence and Clinical Importance
Authors: Gadre Arun K. , Brodie Hilary A. , Fayad Jose N. , O'Leary Michael J.
Published: September 2022

A methyl methacrylate casting technique was used to make detailed casts of the intracerebral venous system of four human cadaver specimens. Seven of the eight petrous apices studied were diploeic (n = 5), or pneumatic (n = 2) and had venules coursing in the anterior petrous apex. These venules form conduits connecting the cavernous to the inferior petrosal sinus or the jugular bulb and have not been previously described. In addition to the air cell system of the petrous apex, these venules may represent pathways for the spread of infection and the development of petrous apicitis, Gradenigo's syndrome, and the rare otogenic cavernous sinus thrombophlebitis. Their presence also may help explain the location of cholesterol granulomas, which afflict this area of the skull base.
Ultrasonic Tonsillectomy: Rationale and Technique
Authors: Weingarten Charles
Published: September 2022

Dissection using ultrasonic aspiration is characterized by its unique tendency to spare fibrous and vascular structures during removal of parenchymal lesions. This preliminary study was undertaken to evaluate the feasibility and efficiency of tonsillectomy using the ultrasonic aspirator. Tonsillectomy was performed on 23 patients using the ultrasonic aspirator. Pericapsular removal of the tonsil was easily accomplished with complete preservation of the tonsillar pillars and minimal peritonsillar trauma. The ability to identify significant vasculature before transection, and the constant aspiration integrated into the ultrasonic aspirator allowed excellent visualization of the operative field at all times. No postoperative complications were noted and recovery was typical for tonsillectomy patients. The ultrasonic aspirator may increase the efficiency and margin of safety of tonsillectomy.
Squamous cell Carcinomas of the Head and Neck Cultured in Floating Collagen Gels: 1. The Maintenance of Stromal and Epithelial Elements in Vitro without Fibroblast Overgrowth
Authors: Burford‐Mason Aileen P. , Irish Jonathan C. , MacKay Allison J. , Gullane Patrick J. , Bassett Ralph , Dardick Irving
Published: September 2022

The study of the molecular biology of head and neck squamous cell carcinomas has been heavily reliant on the analysis of cell lines. This is largely because the maintenance of primary cell cultures is difficult. However, being monoclonal, cell lines are not representative of the primary tumor because of the loss of tumor cell heterogeneity. We report a technique for primary culture of squamous cell carcinomas with maintenance of epithelial and stromal cell components without overgrowth of the fibroblast cells. Phenotypic markers for fibroblasts and squamous cells were present up to 45 days after initiation of culture, and expression of epidermal growth factor receptor and involucrin in cultures paralleled that in the primary tumor. In vivo, tumor stromal elements are thought to play an important role in the support of epithelial cell growth. In the collagen gel system the preservation of the stromal cell component likely improves culture viability and growth. More importantly, this culture system allows the in vitro tumor to more accurately reflect the tumor from which it was derived, and it permits the study of primary squamous cell carcinomas under in vitro conditions.
Contemporary Management of Deep Neck Space Infections
Authors: Gidley Paul W. , Ghorayeb Bechara Y. , Stiernberg Charles M.
Published: September 2022

Deep neck infections continue to be seen despite the wide use of antibiotics. These infections follow along fascial planes to create deep neck space abscesses. The clinical presentation often points to the space involved. Understanding the regional anatomy gives the surgeon the ability to treat these grave infections. The records of 24 patients with a diagnosis of deep neck space abscess admitted to Hermann Hospital between 1988 and 1993 were reviewed. Fifty percent of the patients had received antibiotics for an infection of the ear, nose, or throat before the development of a neck space abscess. Ten patients had parapharyngeal abscesses, seven had retropharyngeal abscesses, six had submandibular space abscesses, and one had parotid space abscess. Thirty‐five organisms were isolated in 18 cases (1.9 isolates per patient). The most common organism cultured was Streptococcus (13 of 18), followed by Staphylococcus (6 of 18), Bacteroides (5 of 18), Micrococcus (2 of 18), and Neisseria (2 of 18). One case each of Candida, Enterobacter, Enterococcus, Peptostreptococcus, Proteus, Proprionobacter, and Pseudomonas was cultured. Six patients had no growth on culture but did have organisms found on Gram's stain. The operative techniques and antibiotics used are discussed. The main complications of jugular vein thrombosis, carotid artery rupture, and mediastinitis are described, as well as an unusual case of meningitis from a large retropharyngeal‐parapharyngeal abscess.
Safe Pediatric Outpatient Sedation: The Chloral Hydrate Debate Revisited
Authors: Malis David J. , Burton Deborah M.
Published: September 2022

Diagnostic imaging in the pediatric patient frequently requires sedation. The use of chloral hydrate, the standard agent for many years, has recently come under severe scrutiny. The American Academy of Pediatrics (AAP) published guidelines for the elective sedation of pediatric patients; however, compliance with the AAP guidelines is not compulsory. A review of the medical literature shows a wide range of medications used for pediatric sedation, along with a diversity in the protocols available for monitoring the cardiopulmonary status of the patient. When ordering computed tomography and magnetic resonance imaging scans, pediatric otolaryngologists indirectly are exposing their patients to the sedation practices and monitoring protocols of their referral imaging center. A questionnaire regarding the sedation protocol for routine, outpatient, computed tomography or magnetic resonance imaging scans in children aged 5 years or younger was sent to staff radiologists at 36 pediatric medical centers throughout the United States. A variety of sedation practices were elicited. The complete survey results are presented, including monitoring practices, complication, and success rates. Despite concerns about its safety, chloral hydrate remains a frequently used and safe method of pediatric outpatient sedation.
Computerized Dynamic Posturography: What have we Learned from Space?
Authors: Black F. Owen , Paloski William H.
Published: September 2022

Computerized dynamic posturography (CDP) has been under development since 1970. Several reviews summarize key basic and clinical research studies and outline important clinical uses of CDP along with research applications. This report summarizes new information about the otolith control of posture obtained from the study of astronauts. The dynamics of recovery of postural control upon return from orbital flight provide insight to the peripheral vestibular and central nervous system components of vestibular compensation. The dynamics of postural compensation should aid the clinician in the diagnosis and management of imbalance of vestibular origin. (Otolaryngol Head Neck Surg 1998; 118:S45‐S51.)
Cardiovascular Effects of Microgravity: Evolution of Understanding
Authors: Short H. David
Published: September 2022

The understanding of cardiovascular effects of spaceflight has evolved throughout the course of the American manned spaceflight program. Originally descriptive in nature, the present understanding is based on empiric measurements of vascular volume, cardiac output, vascular reflexes, and peripheral and central autonomic control. More detailed understanding of cardiovascular effects has allowed us to separate those symptoms from symptoms caused by musculoskeletal or neurovestibular abnormalities. (Otolaryngol Head Neck Surg 1998;118:S52‐S54.)
The Multichannel Auditory Brain Stem Implant: Performance in Twenty Patients
Authors: Otto Steven R. , Shannon Robert V. , Brackmann Derald E. , Hitselberger William E. , Staller Steven , Menapace Christine
Published: September 2022

The auditory brain stem implant has been used effectively to provide hearing sensations to individuals deafened by bilateral auditory nerve tumors (neurofibromatosis type 2). During tumor removal, the auditory brain stem implant is implanted into the lateral recess of the fourth ventricle by a translabyrinthine approach and is intended to stimulate auditory neurons of the cochlear nucleus complex. A new eight‐electrode multichannel auditory brain stem implant was developed and evaluated in 20 patients who had at least 3 months' experience with the device. Mild nonauditory sensations (primarily tingling in the head or torso) were encountered in some instances but could be managed by changing the stimulus characteristics or excluding electrodes. Testing of perceptual performance indicated significant benefit from the device for communication purposes, including sound‐only sentence recognition scores in three patients ranging from 49% to 58% and ability to converse on the telephone. These results indicate that significant auditory benefit can be derived from direct multichannel electrical stimulation of the auditory portion of the human brain stem.
Growth of Human Paragangliomas in the Subrenal Capsule of the Nude Mouse
Authors: Gulya A. Julianna
Published: September 2022

Paragangliomas are generally benign, highly vascular, and slowly growing tumors of neural crest lineage that occur disproportionately in women. Surgery can manage small tumors expeditiously, but extirpation of large tumors is associated with morbidity and even mortality. Radiation therapy offers relatively good tumor control but also presents development of a secondary malignant neoplasm as a possible consequence. Cancer chemotherapeutic agents have been used only in rare metastasizing paragangliomas because they also are associated with considerable morbidity. A better understanding of the biology of human paragangliomas, to encompass the molecular biology of these tumors, is essential for the development of a less morbid, tumor‐targeted therapy. This preliminary investigation is aimed at testing the hypothesis that the subrenal capsule of the nude mouse is a viable model for in vivo study of the molecular biology of human paragangliomas. None of the five tumors implanted survived for the duration of the study period. Accordingly, the nude mouse subrenal capsule does not appear to be useful in the study of human paragangliomas.
The HPV 6 E6/E7 Transforming Genes are Expressed in Inverted Papilloma
Authors: Harris Monte O. , Beck Jill C. , Lancaster Wayne , Gregoire Lucie , Carey Thomas E. , Bradford Carol R.
Published: September 2022

A role for human papilloma virus (HPV) infection in the pathogenesis of head and neck neoplasms has gained support in recent years. Expression of two early‐region HPV genes, E6 and E7, is widely accepted as essential for viral‐induced carcinomas of the genital tract. These oncoproteins interact with the products of the cellular tumor suppressor genes, p53 and retinoblastoma, and inactivate them. Examining E6/E7 transforming gene expression is an important step toward elucidating the pathogenesis of HPV in head and neck neoplasms. We introduce nasal inverted papilloma (IP) as a novel system for evaluating viral genomic expression and transforming gene regulation of tumorigenesis by virtue of its association to HPV infection and potential for malignant progression. We describe here a reverse transcriptase‐polymerase chain reaction approach for the detection of HPV E6/E7‐specific transcripts in RNA extracted from IP. A primer pair flanking previously mapped HPV 6 E6/E7 splice donor/acceptor sites was used to direct amplification of cDNA. Reverse transcriptase‐polymerase chain reaction experiments generated products representing the 1.2 Kb E1∧E4 splice transcript and a smaller unclassified fragment in IP from two patients. These results provide evidence for HPV 6 E6/E7 expression in IP with the potential to encode transforming proteins.
Audiologic Manifestations of Noonan Syndrome
Authors: Qiu William W. , Yin Shengguang S. , Stucker Fred J.
Published: September 2022

A comprehensive audiologic study of a family with Noonan syndrome is reported together with a review of 20 cases of this syndrome with regard to hearing sensitivity and middle ear status. An incidence of progressive sensorineural hearing loss at the high frequencies is found for 50% of the ears. It is emphasized that early audiologic management may improve the quality of life for patients with Noonan syndrome.
Cyclandelate in the Management of Tinnitus: A Randomized, Placebo‐Controlled Study
Authors: Hester T. Oma , Theilman Gary , Green William , Jones Raleigh O.
Published: September 2022

Cyclandelate is a vasodilating agent that, like papaverine, acts directly on the smooth muscles of blood vessels. The drug has been used primarily as an adjunctive treatment for various peripheral vascular diseases; some studies advocate its use for treating ischemic cerebrovascular disease. Early nonrandomized and uncontrolled studies suggest that cyclandelate is efficacious in treating tinnitus. Recent personal communications regarding cyclandelate's effectiveness in treating tinnitus prompted this study. Fifty‐nine adult patients with constant tinnitus for more than 1 year were randomly selected for this prospective, placebo‐controlled, double‐blind study with a treatment period of 3 months. Audiometric testing with tinnitus pitch and loudness matching was performed before initiation of treatment and at the end of treatment, and frequent questionnaire evaluations were performed during the treatment period. Four patients in the cyclandelate group and three in the placebo group reported a subjective reduction in the loudness of their tinnitus. Audiologic testing before and after treatment showed no significant changes in tinnitus pitch or loudness. Although cyclandelate treatment was beneficial for some patients and the decrease in subjective loudness scoring was significant for the cyclandelate group, the impact of its effect did not appear to warrant its continued use by those patients. A significant percentage of patients could not tolerate the drug because of side effects.
Passage to India: The Search for Genes Causing Autosomal Recessive Nonsyndromic Hearing Loss
Authors: Zbar Ross I. S. , Ramesh Arabandi , Srisailapathy C. R. Srikumari , Fukushima Kunihiro , Wayne Sigrid , Smith Richard J. H.
Published: September 2022

Hereditary hearing impairment affects approximately 0.05% of all children born in the United States. It is most commonly autosomal recessive, nonsyndromic, and monogenic (autosomal recessive nonsyndromic hearing loss [ARNSHL]). Although the number of disease loci is not known, some estimates exceed 100. Using a strategy of homozygosity mapping to localize ARNSHL genes by screening consanguineous families for chromosomal regions that are homozygous by descent, we have mapped several genes in multiplex, nuclear, consanguineous families in Tamil Nadu, India. From the mean frequency of the ARNSHL genes in this population, the total number of disease genes is estimated to be 57.
Educational Outcomes of an Otitis Media Workshop for Primary Care Providers in Latin America
Authors: Villaseñor Alberto , Arriaga Moisés A. , Eavey Roland D. , Santos José Ignacio , Chissone Edgar
Published: September 2022

Otitis media is a prevalent condition that can be diagnosed and treated by primary care providers skilled in otoscopy. Previous analysis demonstrated that brief, intensive instruction at one site in rural Mexico improved the test scores of health care providers and changed long‐term practices (Eavey R, et al. Otolaryngol Head Neck Surg 1993;109:895‐8). We wanted to confirm these test score findings at other sites. A didactic course on otitis media with a practical otoscopy workshop was conducted at six Mexican locations and in one Venezuelan city by an interdisciplinary group of physicians. The same coded test was given immediately before and after the course. The Wilcoxon test for significance of intra‐subject performance before and after intervention was used as a nonparametric assessment. At all seven sites (n = 190 subjects), test scores demonstrated statistically significant improvement (range = p < 0.001 to p < 0.0001). We conclude that this educational method consistently improved short‐term knowledge of otitis media and that further teaching efforts and a longer term practice‐impact study are warranted.
Drop deformation during diffusiophoresis
Authors: McKenzie Brian E. , Chu Henry C.W. , Garoff Stephen , Tilton Robert D. , Khair Aditya S.
Published: September 2022

Diffusiophoresis refers to the motion of a colloidal particle in a solute concentration gradient, animated by particle–solute interactions. We present a theoretical analysis of the diffusiophoretic motion of a viscous drop in a gradient of neutral solute at zero Reynolds number. In a spatially uniform gradient, the translational velocity of a spherical drop was found by Anderson et al. (J. Fluid Mech., vol. 117, 1982, pp. 107–121). Here, we show additionally that the drop experiences no tendency to deform, regardless of the magnitude of the interfacial tension at the interface of the drop and suspending fluid. Next, we consider a non-uniform gradient, where the ambient solute concentration takes the form of a quadrupole around the drop centroid. This gradient does not induce drop translation, due to symmetry, but does induce a deformation in the drop shape, which is spheroidal to first order in the capillary number

$Ca=\beta k_B T R^2 K/\gamma$

, where

$\beta$

is the magnitude of the quadrupolar variation in solute concentration,

$k_B T$

is the thermal energy,

$R$

is the drop radius,

$K$

is the Gibbs adsorption length, and

$\gamma$

is the interfacial tension. Whether the drop becomes prolate or oblate depends on whether the solute–drop interaction is attractive or repulsive. Therefore, our work shows that in principle, a drop could undergo deformation during diffusiophoresis in a non-uniform solute gradient.
Intergenerational Mobility in a Mid-Atlantic Economy: Canada, 1871–1901
Authors: Antonie Luiza , Inwood Kris , Minns Chris , Summerfield Fraser
Published: September 2022

This article uses new linked full-count census data for Canada to document intergenerational occupational mobility from 1871 to 1901. We find significant differences among Canadian regions and language groups, with linguistic minorities experiencing notably lower rates of intergenerational mobility. International comparisons place Canada midway between other economies in the Americas and the most mobile European societies. Decompositions of overall mobility show that the Canadian experience shared the New World feature of high mobility from manual occupations, but also the Old World feature of greater persistence in white-collar jobs.
U.K. Investment Trust Valuation and Investor Behavior, 1880–1929
Authors: Sotiropoulos Dimitris P. , Rutterford Janette , Tori Daniele
Published: September 2022

This study looks at the valuation of U.K. investment trusts for the 50 years following their appearance as companies in the 1880s. Based on a large and unique dataset compiled from primary sources, our calculations reveal a huge variation between the ordinary share prices of investment trusts and their underlying net asset “fundamental” values. This mismatch is a well-known puzzle in modern financial markets and has attracted a large volume of research because it casts doubt on the concept of market efficiency. We investigate possible explanations for this pricing puzzle and shed light on U.K. investor behavior before the 1930s.