bluuebunny/crossref_metadata_2025 huggingface dataset:
Bilateral sudden deafness following combined insecticide poisoning.
Authors: Harell Moshe , Shea John J. , Emmett John R.
Published: October 2006

A case of combined poisoning due to exposure to an aerosol containing both malathion and methoxychlor (sold under the trade name OrthoTM Orchard Spray in the United States) is presented. The following unusual features occurred in the course and outcome of the poisoning: slow onset of symptoms and signs, bilateral profound and permanent sensorineural hearing loss, and residual peripheral neuropathies in the extremities. The possible potentiation of the usually low toxicity of malathion is suggested and discussed.
Facial palsy: Interpretation of neurologic findings.
Authors: May Mark , Hardin William B.
Published: October 2006

A review of the otoneurologic findings in 500 patients with facial paralysis revealed their importance for diagnosis, prognosis, and understanding the pathophysiology of Bell's palsy.

Diagnosis. The presence of simultaneous bilateral palsy, facial paralysis associated with lateral rectus palsy, slowly progressive facial weakness with or without hyperkinesis, and facial paralysis that showed no recovery after six months excluded Bell's palsy from the diagnosis. Ipsilateral recurrent palsies were another indication to suspect an underlying cause, since a tumor of the facial nerve caused the paralysis in 30% of the patients with this finding. Signs such as intact forehead movement, alterations in facial sensation, and corneal hypesthesia — although often associated with lesions in the cerebral cortex, cerebellopontine angle, or internal auditory canal — were also found in patients with Bell's palsy.

Prognosis. A spontaneous complete recovery following Bell's palsy occurs in about 70% of the patients; but in the presence of a dry eye or dysacousis, the prognosis for a complete recovery drops to 10 and 25%, respectively.

Pathophysiology. It is proposed that the wide range of neurologic findings associated with Bell's palsy is due to a viral polyneuropathy. This is a disorder that primarily involves sensory nerves, and the facial motor deficit results from involvement of the sensory fibers carried with the facial nerve within the fallopian canal.
Surgical approach to tumors of the nasal cavity
Authors: Pope Thad H.
Published: October 2006

In the past there has been a general reluctance among rhinologists to remove the entire lateral nasal wall for fear of causing drastic disturbances of nasal physiology. It has been our observation that the physiological disturbances are fairly minimal if the patient, following surgery, uses nasal saline irrigations daily. Sometimes a nasal siphon or water pik is required to prevent crusting. It has also been noted that when the septum is removed, a chronic antritis on the contralateral side will usually occur. It has been our practice to do an antrostomy on the uninvolved side when the septum has been removed for any reason.

Ophthalmologists have shown some reticence to having the entire bony support of the medial wall of the orbit and half the floor removed. This does necessitate transecting the lacrimal duct at its neck. We have, however, seen no trouble with epiphora following this provided the sac was allowed to drain into the open nasal cavity. The trochlea is by necessity deprived of its support; however, the periostium seems to provide adequate support here and we have noticed no troublesome permanent problems with function of this muscle. The periorbita, which has been robbed of its osseous support, quickly epithelializes with nasal mucosa and becomes a part of the nasal cavity. Requirements for intranasal douching with saline have varied; however, we have had no problems with bothersome crusting following b.i.d. nasal irrigations. In cases where a small portion of the inferior turbinate could be preserved, there was always extreme hypertrophy of this remnant which usually brings the nasal physiology back to a nearly normal state which seldom requires any special care whatever.

This paper presents primarily a method of approaching tumors of the sinonasal area, especially when there is difficulty in determining whether the lesion arises from the septum or lateral wall of the nose.
Anatomical consequences of CO2 laser surgery of the guinea pig ear
Authors: Lyons George D. , Webster Douglas B. , Mouney Daniel F. , Lousteau Ray J.
Published: October 2006

A modified American Optical (Model 100) CO2 laser was used to produce lesions in the tympanic membranes, ossicles, and cochlear capsules of guinea pigs. Even with the lowest available intensities and durations (0.4 watts, 50 msec), there was damage to the inner ear. Although laser surgery of the ear can avoid mechanical trauma and bleeding as well as increase accuracy, the use of commercial lasers in ear surgery should be avoided until a proven unit is avaliable.
Drug therapy in otomycosis: Anin vitrostudy
Authors: Lawrence Thomas L. , Ayers Leona W. , Saunders William H.
Published: October 2006

Otomycosis represents a small percentage of clinical external otitis. This well documented entity is often a stubborn clinical problem and, in contrast to bacterial external otitis, there is no otic preparation with specific antifungal activity. In response to this lack of otic preparations, we have surveyed in vitro a variety of available preparations to determine the general spectrum of activity against appropriate bacterial and fungal species. An agar‐disc diffusion system was used testing the drugs against (1.) bacteria common in external otitis, and (2.) a variety of yeast and filamentous fungi.

Aqueous Merthiolate and Cresylate demonstrated good non‐specific antimicrobial activity, while nystatin and clotrimazole demonstrated specific antifungal activity. Otic preparations can now be used which have demonstrated in vitro effectiveness and give an alternate means of therapy to the now empirically selected otic preparation used for otomycosis.
The etiology of laryngeal papillomatosis
Authors: Quick Cedric A. , Faras Anthony , Krzysek Richard
Published: October 2006

Sophisticated virological techniques are described for isolating whole virus, free viral DNA, or integrated viral DNA. Based upon preliminary results, it is suggested that the virus responsible for laryngeal papillomatosis is not the same as the virus responsible for cutaneous papillomatosis lesions and, for the most part, it exists in the integrated DNA form.
The frey syndrome: A review and double blind evaluation of the topical use of a new anticholinergic agent
Authors: Hays Leonard L.
Published: October 2006

The symptom complex of localized facial gustatory sweating and flushing during mastication (The Frey syndrome) is a common sequela of parotidectomy with facial nerve dissection.

A thorough review of the literature concerning the Frey syndrome is reported. The procedure of tympanic neurectomy has received special emphasis with a review of 73 cases of tympanic neurectomy. The treatment modalities available, if tympanic neurectomy fails, are discussed. Important guidelines for the safe use of topical therapy to control gustatory sweating are presented as an alternative to surgical therapy.

The author studied 129 post parotidectomy patients in whom 60% noted symptomatic gustatory sweating, and approximately one‐fourth of these symptomatic patients requested topical anticholinergic therapy, with one patient electing tympanic neurectomy.

The only form of medical treatment presently available utilizes the topical application of scopolamine, a drug having potentially significant central nervous system side effects if systemically absorbed. In an effort to find an effective drug for topical application with a more favorable therapeutic index than scopolamine, glycopyrrolate was investigated. Glycopyrrolate was compared in varying concentrations to topical scopolamine in a personally conducted double blind clinical trial involving 16 patients.

Initial results of this investigation suggest that topical glycopyrrolate in concentrations of 0.5% and 1.0% provide complete effective control of gustatory sweating for at least several days duration after a single application. There have been no significant side effects with the use of topical glycopyrrolate to date. Commercial topical antiperspirants were also investigated and found to be of limited benefit.
Altered bacterial flora and clinical course with intraoral cancer
Authors: Rice Dale H. , Weimert Thomas A.
Published: October 2006

Nineteen consecutive patients with intraoral cancer were cultured and tested for cell‐mediated immunity. They were then treated and followed for three years. The recurrence rate for those patients with normal flora was similar to that reported for dinitrochlorobenzene (DNCB) reactors; and the recurrence rate for those patients with abnormal microorganisms was similar to that reported for DNCB non‐reactors.
Symposium: Value and cost analysis of recent ear tests. The value and cost analysis of the eng as of 1978
Authors: Rubin Wallace
Published: October 2006

The use of ENG in office practice and its use as a helpful, time‐saving procedure is discussed. The following practical clinical questions are answered: 1. Is the vestibular mechanism normal or abnormal? 2. Is the vestibular pathology peripheral or central? 3. Is the peripheral disease right or left sided? Cost analysis of ENG in office practice is presented.
Symposium: Value and cost analysis of recent ear tests. Air caloric testing in otitis media (preliminary studies)
Authors: Paparella Michael M. , Rybak Leonard , Meyerhoff William L.
Published: October 2006

On certain occasions it becomes inportant to evaluate vestibular function in a patient with otitis media. The potential application of the air caloric test in evaluating such patients was examined. Patients with unilateral otitis media before and after surgery were studied to answer certain clinical questions. More questions were raised than answers provided. The preliminary conclusions from this study are:

Patients with tympanostomy tubes or small perforation of one ear may show a caloric response in the perforated ear equal to that of the intact ear.

Patients with a large tympanic membrane perforation on one side may show hyperactive caloric responses on the perforated side.

Patients with a moist ear may show inverted horizontal nystagmus to warm air caloric testing. This applies to patients with a large perforation or mastoidectomy cavity.

Patients with a dry open mastoid or fenestration cavity are likely to show a hyperactive caloric response on the side of previous surgery, accompanied by vegetative symptoms. This size of the cavity appears to be less important than the presence of the cavity per se.

Patients may be safely tested in the early postoperative period.
Symposium: Otologic surgery reassessment after 25 years. Otosclerosis surgery: Reassessment Of Its Value in 1978
Authors: Brookler Kenneth H.
Published: October 2006

Today, surgical correction is the treatment of choice for the hearing loss associated with footplate otosclerosis. Experience with stapes surgery reveals this to be functionally and economically superior to the long‐term use of hearing aids. There is, however, a predictable rate of surgical complications. Sensorineural hearing loss, dizziness and/or facial nerve palsy have an immense social and economic impact upon the patient, the family and the surgeon.

Otosclerosis surgery will be presented in the perspective of benefits, untoward results, and alternate forms of treatment. A cost analysis of the foregoing will shed light on the future of otosclerosis surgery.
Assessment of surgical procedures for ménière's disease
Authors: Snow James B. , Kimmelman Charles P.
Published: October 2006

There are numerous surgical procedures for the treatment of Meniere's disease, and the current status of their efficacy is controversial. A review of the literature is presented as a basis for the evaluation of the relative merit of these procedures. Emphasis is placed on endolymphatic sac procedures, sacculotomy, vestibular neurectomy and labyrinthectomy.

Vestibular neurectomy and surgical labyrinthectomy provide high rates of improvement in vertigo. The hearing is frequently made worse by vestibular neurectomy. Endolymphatic sac procedures result in improvement in vertigo less frequently. They are most likely to improve hearing. Although sacculotomies are associated with improvement in vertigo in approximately 80% of patients, they are associated with high rates of hearing loss.
Nutritional concepts in the management of the head and neck cancer patient. I. Basic concepts
Authors: Sobol Steven M. , Conoyer J. Michael , Zill Roberta , Thawley Stanley E. , Ogura Joseph H.
Published: October 2006

Proper nutritional management has assumed an increasingly important role in the care of cancer patients in recent years. Head and neck cancer creates disturbances in host nutritional balances. Profound nutritional depletion and cachexia are induced by local and distant effects of head and neck carcinoma. Radiation, chemotherapy and surgery tend to compromise the host further by compounding these nutritional deficits. This paper reviews the factors responsible for the malnutrition associated with head and neck malignancy, and discusses the current methods available for identifying and following the nutritionally depleted patient.
Surgical correction of complete tracheoesophageal cleft
Authors: Pettit Paul N. , Butcher R. Brent , Bethea Morrison C. , King Terry D.
Published: October 2006

Laryngotracheal esophageal cleft is a rare congenital anomaly that should be considered in the differential diagnosis of any neonatal respiratory distress aggravated by feeding. Diagnosis is difficult and repeat endoscopic examinations may be necessary. In complete clefts, immediate surgical repair is indicated with combined approach through the chest and neck and incorporation of part of the esophageal wall into the repair. Because the cleft may be associated with esophageal atresia and/or tracheal esophageal fistula, it should be suspected in patients who have persistent symptoms after successful repair.
Later stages of development of the periotic duct and its adjacent area in the human fetus
Authors: Spector Gershon J. , Lee Dwight , Carr Charles , Davis Gustave , Schnettgoecke Virginia , Strauss Melvin , Rauchbach Erol
Published: October 2006

The later stages of development (16–40 weeks in utero) of the periotic duct and its adjacent areas in the human fetus indicate that the critical stages of development occur in four specific time related stages over a six‐week period (20–26 weeks). First, the petrous apex ossifies to separate the inferior cochlear vein into the canal of Cotugno and forms the medial wall of the cochlear aqueduct (22 weeks); second, the canalicular otic capsule fuses with the cochlear otic capsule to obliterate Hyrtl fissure and forms the lateral wall of the cochlear aqueduct (24 weeks); third, progressive bone deposition to the medial surface of the membranous labyrinth and cochlea at the petrous apex elongates the periotic duct and cochlear aqueduct (32 weeks in utero); and fourth, active arachnoid tissue ingrowth into the periotic duct occurs at 20–24 weeks and 34–40 weeks in utero. The terminal event is widening of the CNS opening of the periotic duct at 32 weeks in utero.

The periotic duct and cochlear aqueduct length increase with gestation from 26 weeks until term. The periotic duct width remains the same throughout the gestation. The cochlear aqueduct width diminishes with gestational age. The periotic duct remains patent throughout 16‐40 weeks in utero.
Recurrent vestibulopathy
Authors: Leliever William C. , Barber Hugh O.
Published: October 2006

Recurrent vestibulopathy is defined as an illness of unknown cause characterized by more than a single episode of vertigo of duration characteristic of that occurring with hy‐drops but without auditory or clinical neurological symptoms or signs. Eighty‐six patients with this condition were diagnosed in the Dizziness Unit, and data on age and sex distribution, natural history and caloric pattern are presented. On follow‐up of mean duration 3.5 years, 6 cases evolved to classic Ménière's disease, and 4 to benign positional vertigo, but none developed brain disease. The prognosis regarding vertigo is generally good. We consider the term recurrent vestibulopathy a logical designation of a distinctive clinical disorder with unknown cause but with probable peripheral vestibular origin, and hope that its use would spur research into previously unrecognized causes of recurrent vertigo.
Multichannel cochlear implant. Preliminary results in man
Authors: Michelson Robin P. , Schindler Robert A.
Published: October 2006

Cochlear implantations of multichannel electrode arrays have been recently undertaken at the University of California, San Francisco in several totally deaf investigational subjects. One patient was extensively tested with a psychoacoustical battery and is the subject of this communication. Speech testing with CID sentences and open sets of spondee words revealed that this totally deaf subject could achieve approximately 40 to 50% discrimination level with his implant device alone in the absence of visual cues. This represents the first time that speech discrimination has been definitely shown in a cochlear implant subject, and this result has important implications for the future of cochlear implantation.
Revision stapedectomy: A review of 258 cases
Authors: Sheehy James L. , Nelson Ealph A. , House Howard P.
Published: October 2006

We reviewed the records of 258 revision stapedectomy operations performed at the Otological Medical Group during an eight year period.

Displacement of the prosthesis to the inferior edge of the window was the commonest cause of failure (41%) and occurred predominately in wire‐Gelfoam® pad cases. An oval window fistula, a short prosthesis or bony closure of the window were causes of failure in 9% each. Incus necrosis was the cause of failure in 5%.

Less than 50% of the operations resulted in postoperative conductive deficit of 10 db or less. The results were better than this in incus bypass procedures, in revisions of cases in which a tissue graft was used over the oval window and in revisions of ears initially operated on elsewhere.

Severe sensorineural hearing impairment was the result in 7% of the operations and half of these impairments were dead ears. The majority of these adverse results followed a repeat drill out of obliterative otosclerosis or followed reopening of the oval window in patients with a postoperative inner ear problem other than a fistula.

We concluded that 1. revision stapedectomy is a less satisfactory procedure than primary stapedectomy; 2. there is rarely an indication for a repeat drill out of obliterative otosclerosis; and 3. the oval window membrane usually should not be disturbed in revision stapedectomy in a patient with inner ear symptoms unless there is a fistula.
Pulmonary complications of tonsillectomy as originally described by Samuel J. Crowe, M.D
Authors: Catlin Francis I.
Published: October 2006

The incidence of pulmonary complications of tonsillectomy is very low today in comparison to the early part of the 20th Century. Much of the credit belongs to Samuel Crowe and his colleagues who demonstrated that pulmonary complications could be prevented by the use of improved instrumentation and techniques which were based upon sound scientific principles. A historical review of anesthesia and the mouth gags of the early 1900's is included with a brief history of the development of the Crowe‐Davis mouth gag. A review of the recent literature reveals few published papers about pulmonary complications. Those that are available show incidence figures similar to those of Dr. Crowe.
Radiological techniques for small acoustic tumors — A re‐evaluation
Authors: Kaseff Leon G. , Perkins Rodney , Hambley William H.
Published: October 2006

Small acoustic neuromas are not detected on conventional, computed tomography (CT) brain scans. Eighteen patients with proven acoustic tumors and negative CT brain scans were studied retrospectively to re‐evaluate current radiological techniques. We found that the conventional mastoid plain film or thin section tomography is an accurate, cost effective, screening test for acoustic tumors. When these screening studies are positive and agree with the clinical and audiometric examinations, a CT brain scan should then be performed. If the latter is negative, Pantopaque® myelography or air‐CT should follow. The decision to proceed to invasive studies has been helped by such tests as brain stem audiometry.

Since no single, noninvasive X‐ray test currently exists to diagnose the small acoustic tumor, screening X‐ray studies are indicated before the use of invasive, expensive studies. A protocol for the radiological work‐up of small acoustic tumors is suggested.
Cryocauterization in the treatment of subglottic hemangioma in infants
Authors: Jokinen Kalevi , Palva Antti , Kärjä Juhani
Published: October 2006

Cryocauterization seems to be an effective method of treating the subglottic hemangioma of infants. A series of five patients is presented. Cryotherapy, at temperatures of —40°C or —70°C for 60 or 30 seconds respectively, was given at intervals of 2 weeks, 3‐6 sessions being required. During this time the child usually had to remain tracheos‐tomized. No therapeutic or late complications were recorded. The patients have been followed up from 8 to 3 1/2 years, and none of them have shown disturbances of laryngeal development or predisposition to stricture.
Hearing changes following stapedectomy: A six year follow‐up
Authors: Ginsberg Irwin A. , Hoffman Sanford R. , White Thomas P. , Stinziano Gerald D.
Published: October 2006

Audiometric findings of 2405 stapedectomized individuals were subjected to computer analysis. Results are reported in yearly intervals for six years postoperatively. Air and bone conduction thresholds were significantly improved and showed excellent stability over the period of investigation. The high success rate and sustained improvement affirms the use of the Teflon® wire piston as the prosthesis of choice for stapedectomy p rocedure.
Tuberculous laryngitis: A series of 37 patients
Authors: Bailey C. Martin , Windle‐Taylor Paul C.
Published: October 2006

A series of 37 cases of tuberculous laryngitis is reviewed to assess the diagnostic features of the disease.

The condition generally presents in males of late middle age who have pulmonary tuberculosis, although the pulmonary disease is seldom advanced. The presenting symptom is usually hoarseness, and the laryngoscopic appearances frequently mimic a tumor or chronic non‐specific laryngitis: few patients correspond to the classical descriptions of the disease found in old texts. Histological examination of biopsy material is usually the diagnostic procedure, emphasizing the difficulty of diagnosis in the general population.
Unilateral sudden hearing loss after open heart surgery: A detailed study of seven cases
Authors: Plasse Harvey M. , Mittleman Myles , Frost J. Ormond
Published: October 2006

Seven of the 7000 patients who underwent cardiopulmonary bypass at Bellevue and University Hospitals between 1969 and 1978 developed sudden loss of hearing in one ear immediately after surgery. Four of the seven patients showed subsequent improvement in hearing but none recovered completely. None had vertigo. All were male. The most likely cause is particulate microemboli generated by cardiopulmonary bypass.
Laryngeal tuberculosis
Authors: Espinoza Carmen G. , Montano Pedro , Saba Sabiha R.
Published: October 2006

Tuberculosis involvement of the larynx is uncommon. However, it is a highly infectious disease and a hazard to both community and hospital staff. It should be considered in the differential diagnosis of patients presenting with chronic hoarseness. Two patients with laryngeal tuberculosis are the objective of the present report. The diagnosis was established by biopsy followed by isolation and identification of Mycobacterium tuberculosis from sputum.
Non‐traumatic cerebrospinal fluid rhinorrhea
Authors: Shugar J. M. A. , Som P. M. , Eisman W. , Biller H. F.
Published: October 2006

Non‐traumatic cerebrospinal fluid rhinorrhea is uncommon. Review of the literature revealed that 45% of cases are high pressure leaks and 55% of cases are normal pressure leaks. Meningoencephaloceles are very rare occurrences in the latter category and we present the third reported case occurring in the frontal sinus. Radiographically this lesion appeared as a mucocele because of its expansile nature, however non‐traumatic mucoceles have not been associated with cerebrospinal fluid rhinorrhea. The only non‐osseous expansile lesion of the paranasal sinuses found to be associated with this complication is the meningioencephalocele.
Maxillary sinus carcinoma
Authors: Lee Fransiska , Ogura Joseph H.
Published: October 2006

Primary site control, anatomical site of failure, survival, and complications of treatment were determined in a retrospective review of primary maxillary sinus carcinoma. Sixty‐one patients were treated by radiation followed by surgery and 35 by radiation alone. Primary tumor control was achieved in 69% of patients receiving combined treatment, 14% of patients treated with radiation alone, and in 49% of all patients. Neck nodes were the initial site of tumor recurrence in 20% of patients treated with combined treatment. Distant metastases were the first site of tumor recurrence in 8% of patients. Local control did not differ with histological type. Virtually all epidermoid and undifferentiated carcinoma recurrences occurred within 2 years, but 27% of adenocarcinomas recurred after 2 years.
Occult neoplasms in facial paralysis
Authors: Conley John , Selfe Robert W.
Published: October 2006

A review of 14 cases of occult neoplasms associated with facial paralysis indicated that when the onset was gradual over a period of weeks or months, when all of the scientific and technological investigations, including CT scanning, polytomes, neurosensory and otologic tests, sialography, lacrimation, taste, internal acoustic meatus, evaluation of the deep lobe of the parotid, and clinical examination of the parotid and neck were negative, the tumor was almost always found in association with the main trunk of the extratemporal portion of the parotid gland. Of these neoplasms, 80% were malignant tumors of the parotid gland and 15% were neurilemomas of the main trunk of the facial nerve.

The above situation is an indication for human assessment by surgical investigation of the facial nerve, with the first priority being given to the main trunk of the extratemporal portion.
Panel discussion: The management of advanced laryngotracheal stenosis. Staged tracheal reconstruction
Authors: Biller Hugh F. , Lawson William
Published: October 2006

A staged method of repair of extended tracheal and combined laryngotracheal stenosis is presented. This entails creation of a trough by exteriorization of the involved segment, implantation of an alloplastic material adjacent to it, and the subsequent hinged rotation of the embedded implant over the trough to create a semi‐rigid anterior wall to the airway. The development, indications, technique and complications of this method of tracheal reconstruction are discussed.
Panel discussion: The management of advanced laryngotracheal stenosis. Management of combined advanced glottic and subglottic stenosis in infancy and childhood
Authors: Cotton Robin T. , Richardson Mark A. , Seid Allan B.
Published: October 2006

Severe glottic and subglottic stenosis in infants and children is a formidable disease for a child and a difficult reconstructive problem for the surgeon. Twelve consecutive patients are described in this series, 7 of whom had complete airway obstruction; 9 patients have been extubated with satisfactory voices. Long‐term follow‐up indicates no cases of decreased development of the larynx.
Panel dicussion: The management of advanced laryngotracheal stenosis. Use of the hyoid graft for treatment of laryngotracheal stenosis
Authors: Thawley Stanley E. , Ogura Joseph H.
Published: October 2006

The most common cause of laryngotracheal stenosis is trauma. The stenotic area may involve the larynx, subglottis, or trachea. A hyoid bone graft has been used in 22 cases for reconstruction of the stenotic area. The hyoid graft may be used with other concomitant laryngeal procedures. A vascularized sternohyoid — hyoid graft has been used in some cases. Of the 22 cases all but 3 have been successful. The advantages of the hyoid graft are:

Firm graft to maintain the architecture of the lumen.

Accessibility in the same operating field.

Patient's own graft material decreases immune rejection possibility.

The vascularized pedicle graft decreases possibility of hyoid resorption.
Cholesteatoma in the petrous apex
Authors: Yanagihara Naoaki , Matsumoto Yasushi
Published: October 2006

Six patients with extensive cholesteatoma in the petrous pyramid are reported. All patients had a facial palsy of long duration. In five patients with a history of otitis media, radiographic examinations and surgical explorations revealed chronic inflammatory changes in the middle ear, which suggested that the cholesteatoma in the petrous pyramid was associated with a preceding otitis media. Only in one patient, without a past history of otitis media, was the cholesteatoma assumed to be of congenital origin. The cholesteatoma was totally removed in five patients using a translabyrinthine approach and in one by a middle cranial fossa approach. Control of middle ear infection, obliteration of the mastoid petrosal cavity, and facial nerve repair were supplementary but significant surgical problems.
Sleep apnea syndrome — An alternative treatment to tracheostomy
Authors: Afzelius Lars‐Erik , Elmqvist Dan , Hougaard Kjeld , Laurin Sven , Nilsson Bengt , Risberg Ann Marie
Published: October 2006

Two patients with obstructive sleep apnea syndrome had polygraphic recordings demonstrating upper airway obstruction and sleep with extremely short sleep latency, severely disturbed nightsleep resulting in sleep deprivation, and excessive daytime sleepiness.

Radiological investigation showed the upper airway obstruction to be caused by the tongue falling back occluding the pharynx. Nasopharyngeal intubation relieved the symptoms. The patients were trained to perform this treatment themselves every night, demonstrating that this treatment is an attractive alternative to the conventional tracheotomy.
Aerobic and anaerobic bacterial flora of normal maxillary sinuses
Authors: Brook Itzhak
Published: October 2006

The bacterial flora of non‐inflamed maxillary sinuses were studied in 12 adults. Patients' median age was 35 years (range 25 to 53 years): 8 were females and 4 were males. Aseptic aspiration of the sinus was made when the patients were under general anaesthesia for corrective plastic surgery of the nasal septum. All aspirates were cultured for aerobes and anaerobes. Anaerobes were isolated in all 12 specimen patients; in 5 patients (42%), they were the only organisms isolated, and in 7 (58%), they were recovered mixed with aerobes. There were 33 anaerobic isolates (2.75 pr specimen) and the predominant ones were: 11 Bacteroides sp. (including 6 B. melaninogenicus), 10 anaerobic gram‐positive cocci and 5 Fusobacterium sp. There were 16 aerobic isolates (1.3 per specimen) and the predominant ones were: 5 beta hemolytic streptococci, 3 alpha hemolytic streptococci, and 2 each of S. pneumoniae and hemophilus parainfluenzae. Beta lactamase production was noted in 4 isolates recovered from 3 patients. These included all isolates of S. aureus (2) and 2 of 6 isolates of B. melaninogenicus.

The presence of aerobic and anaerobic organisms in the non‐inflamed sinus demonstrates the non‐sterility of the sinus cavity. In the events that follow closure of the sinus ostium, these bacteria may become pathogenic.
Congenital laryngeal stridor secondary to flaccid epiglottis, anomalous accessory cartilages and redundant aryepiglottic folds
Authors: Templer Jerry , Hast Malcolm , Thomas J. Regan , Davis William E.
Published: October 2006

Most laryngeal anomalies are supraglottic and laryngomalacia is the most common. Cysts, bifid epiglottis and absence of the epiglottis are uncommon. An 18‐year‐old Caucasian man had long‐standing stridor caused by anomalous supraglottic structures: a small floppy epiglottis, enlarged accessory cartilages and redundant aryepiglottic folds. These structures were excised and the airway was improved.

The ventral portions of the fourth arches become the aryepiglottic folds and lateral segments of the epiglottis. A disturbance in this portion of the fourth arch may explain the anomaly. The cartilaginous contributions to the epiglottis were possibly isolated as accessory cartilages. Epiglottic anomalies may be associated with other anomalies, especially the digits of the hand. This patient had a short lingual frenulum and mild macroglossia.
Perichondritis of the auricle
Authors: Bassiouny Ahmed
Published: October 2006

A search of the literature reveals reports of only 191 cases of auricular perichondritis. The present study includes 15 further cases caused by pseudomonas and proteus. Stroud's excision technique was used in four cases and resulted in marked deformity, repeated de‐bridement, and protracted treatment. Tubal drainage was used in the remaining ears with very good esthetic results. It has been demonstrated in experimental animals and in humans that new cartilage forms in the subperichondrial auricular space in the second postoperative week, being maximum in the fourth week. In the present study tubes were retained two to four weeks to maintain an elevation of the perichondrium from what remains of the auricular cartilage to ensure homogeneous cartilage formation and provide local antibiotic treatment. Hospitalization is required for only two days. The four weeks tubal drainage method should be the method of choice for all cases of perichondritis and the excision method abandoned, even in gram‐negative infections.

A case of relapsing polychondritis is also presented because it is important to distinguish auricular perichondritis from relapsing polychondritis as the treatment of the latter is not surgical but with steriods.
Simultaneous (non‐epidermoid) neoplasms involving the head and neck
Authors: Strauss Melvin , Sharkey Francis E.
Published: October 2006

The phenomenon of multiple primary malignant neoplasms involving the head and neck is well documented. Epidermoid carcinomas constitute the majority of these neoplasms.

Case reports are made of two patients with simultaneously occurring chronic reticuloendothelial malignancies and non‐epidermoid tumors involving the head and neck. The first case is one of chronic lymphocytic leukemia (CLL) and metastatic primary retro‐peritoneal extragonadal seminoma, while the second is one of lymphocytic lymphoma (LL) and a carotid body tumor (CBT).

The head and neck manifestations of metastatic seminoma, CBT, and CLL and LL are discussed. A review of the literature of the association of each of these entities to other tumors is presented. Also presented is the evidence for an increased incidence of malignancies associated with CLL and LL and the complicating factors introduced when reticuloendothelial malignancies occur simultaneously with head and neck neoplasms.
Effect of geniohyoid, cricothyroid and sternothyroid muscle stimulation on voice fundamental frequency of electrically elicited phonation in rhesus macaque
Authors: Sapir Shimon , Larson Charles , Campbell Cybil
Published: October 2006

Vocalizations were elicited in three anesthetized rhesus macaques by electrical stimulation of a site in the brain stem. At the same time, the laryngeal muscles — cricothyroid (CT), geniohyoid (GH) and sternothyroid (ST) — were electrically stimulated to assess their effect on the elicited phonation. Analysis of the recorded vocalizations indicated that stimulation of each of the muscles produced a substantial increase in the voice fundamental frequency (Fo), with the CT muscle causing the greatest Fo increase. Maximum elevation in Fo was obtained when the CT muscle was stimulated simultaneously with the GH or ST muscles. Changes in Fo were typically accompanied by changes in voice quality.
Irradiated autogenous mandibular grafts in primary reconstructions.
Authors: Hamaker Ronald C.
Published: October 2006

The procedure, irradiated mandibular autografts, for primary reconstruction, is presented with an immediate success rate of 88%. Eight cases have undergone primary mandibular reconstruction with the tumorous mandible irradiated to 10,000 rads in a single dose. The longest follow‐up is 2 3/4 years. The autograft has proven to be an ideal implant. Major resections of the mandible in conjunction with large myocutaneous flaps have been reconstructed utilizing this implant.
Surgery of the endolymphatic sac
Authors: Maddox H. Edward
Published: October 2006

The wide variation in reported success rates in endolymphatic sac surgery has been the subject of much controversy in literature. This series is a follow‐up of additional cases done since 1976 that were previously reported with 55% relief of vertigo on relatively long‐term follow‐ups of 24 months to 10 years. This present series is an additional 30 endolymphatic shunts that were done since that time. This group of patients as a rule had their disease for a shorter period of time. It is interesting that the long‐term relief of vertigo in this series is 70%. This is considerably better than the initial series of 66 patients previously reported. It is postulated that there are some benefits to earlier surgery in endolymphatic hydrops before the endolymphatic sac lumen becomes obliterated with fibrous tissue. It is always possible that the shorter follow‐up period in this group of patients also adds to this statistical improvement.
Comprehensive hearing aid program within an ear, nose, and throat office.
Authors: Pou Jack W. , Snelling Bobby Corbin , Vekovius William A.
Published: October 2006

Hearing air dispensing within an otolaryngological/audiological clinic is a well accepted fact, and offers total hearing care in a professional setting. The effectiveness of such a program as to wearing habits and acceptance of services rendered, to my knowledge, has not been studied. This paper discusses data obtained from a questionnaire sent out to 1100 hearing aid patients. The questionnaire was designed to study satisfaction with clinic services and costs, acceptance and adjustment, communication abilities and wearing habits.

Statistical analysis was performed by the Department of Biometry at LSU Shreveport. The information received is valuable in determining when hearing aids are most helpful and least helpful and brings out some factors which should influence one in determining who should and should not be fitted with amplification.
total obliteration of the mastoid, middle ear, and external auditory canal. A review of 27 cases.
Authors: Bartels Loren J. , Sheehy James L.
Published: October 2006

In the past 22 years, 27 patients have undergone total obliteration of the mastoid, middle ear, and external auditory canal. Most of the patients had severely diseased ears, many with multiple previous operations. When performed for chronic otorrhea, the operation resulted in a dry ear in all but two cases, though healing was prolonged in some. Secondary revisions for hearing were unsuccessful.

We review the indications for this procedure and the experience of others who have used similar techniques. Though seldom indicated, the mastoid obliteration operation results in a dry ear in almost all patients.
Perilymphatic fistulas.
Authors: Love J. Thom , Waguespack Richard W.
Published: October 2006

Since 1974, 28 ears have been surgically explored for suspected perilymphatic fistulae. Of the 28 explored ears, 23 were proven to have fistulae. Eighteen of these surgically proven fistulae were from nonsurgical injuries; 5 were poststapedectomy. Mode of injury, patient descriptive data, duration of the fistulae, as well as method and tissue used to correct the leak are examined. The low morbidity of surgically exploring suspected ears with the high percentage of positive findings leads the authors to encourage surgical exploration.
Plasmacytoma arising in the vicinity of a foreign body in the nasal cavity
Authors: Ben‐David Jacob , Fradis Milo , Podoshin Ludwig , Bartal A. H.
Published: October 2006

The development of a plasmacytoma in the vicinity of a long residing metallic foreign body in the nasal cavity is presented. In spite of the multitude of reports concerning neoplasms associated with trauma, most of which arise in chronic scars, this presentation is very rare.

It is speculated that the plasma cell proliferation, occurring nearby the foreign body, roots from an immunologic and granulomatous reaction. This case is discussed in light of the vast data on foreign body tumorigenesis obtained from laboratory animals, and the implications of this data are outlined.

Further attention should be drawn to the clinical associations of malignant processes co‐existing with long‐standing foreign bodies.
The facial nerve in congenital middle ear malformations
Authors: Jahrsdoerfer Robert A. , Charlottesville
Published: October 2006

The two most common anomalies of the facial nerve encountered in patients with a congenital malformation of the middle ear are displacement of the nerve and lack of a bony cover, two conditions that place the nerve at risk of being injured by the unwary surgeon. Malformations of the stapes are often found in association with facial nerve anomalies and may range from underdevelopment to complete absence. A congenital absence of the oval window is not uncommon.

The position of the facial nerve in relation to the location and maturation of the ossicles will determine the method of ossicular chain repair. Creation of a new oval window by drilling may require the surgeon to purposely displace the facial nerve to ensure a more direct alignment of the prosthesis with the vestibule. Any part of the incus or malleus may be contoured by drilling to accommodate the loop end of the wire‐piston prosthesis.

An aberrant course of the facial nerve was found in 13/54 (24%) ears having a congenital malformation of the middle ear. All 54 ears had a patent external ear canal and an identifiable tympanic membrane. Patients with atresia or stenosis of the external ear canal were specifically excluded from this study.
Rare complications following ethmoidectomies: A report of eleven cases
Authors: Maniglia Anthony J. , Ryan Chandler J. , Jarrard Goodwin W. , Flynn John
Published: October 2006

Intranasal ethmoidectomy is one of the most difficult operations to teach residents. An accurate knowledge of the regional topographic anatomy is of utmost importance. Friedman and Kerr reported complications of 1000 cases of consecutive intranasal ethmoidectomies performed at the Mayo Clinic from 1957 to 1972. The complication rate was 2.8%. Meningitis, cerebrospinal fluid rhinorrhea, loss of olfaction, and nasolacrimal duct obstruction were reported. No blindness, loss of occular motility, excision of brain tissue or intracranial vessel damage occurred in their series.

We are reporting a series of 8 cases of very rare complications following intranasal ethmoidectomies:

Optic nerve damage resulting in total blindness (3 cases).

Loss of occular motility (2 cases).

Cerebrospinal fluid leak resulting in 8 episodes of pseudomonas meningitis and epidural abscess (1 case).

Cavernous sinus — internal carotid artery fistula (1 case).

Anterior cranial fossa brain damage resulting in death (1 case).

These cases, which were either referred to us or came up for our review, are described in detail. A search of the world literature demonstrates a lack of emphasis on such complications. The pitfalls of intranasal ethmoidectomy are considered and ways to avoid such dreadful complications are discussed.
Symposium on low frequency harmonic acceleration, the rotary chair: Responses to low‐frequency harmonic acceleration in patients with acoustic neuromas
Authors: Olson James E. , Wolfe James W. , Engelken Edward J.
Published: October 2006

There has been increased interest in harmonic acceleration (HA) for the evaluation of vestibular pathology in recent years. The purpose of this study was to determine the value of harmonic acceleration testing in 24 patients with surgically proven acoustic neuromas.

All patients were tested preoperatively and postoperatively, and none were lost to follow‐up. Thirteen were tested one year or more after surgery. For rotational evaluation, each patient was seated in an enclosed chair driven by a D.C. torque motor turntable system and rotated utilizing five low frequency sinusoids (.01 ‐ .16 Hz). Slow eye movements in response to acceleration were analyzed by analog and digital computer techniques. Output measures were the phase relationships between the input stimulus velocity and the slow phase eye movement velocity and labyrinthine preponderance (LP) or asymmetry.

Preoperative results showed that caloric examination identified 79% of patients with tumors and HA 67% (2 standard deviation criteria). When both tests were evaluated together they identified 91% of all patients with tumors. Of the 4 small tumors (less than 2 cm), HA identified 4 and caloric examination 2. All patients were tested approximately 7 days postoperatively and had statistically significant shifts in their phase and LP measures. The shifts in phase were stable up to 3 years after surgery; however, the LP returned toward normal values. These findings indicate that the vestibular system can compensate but not repair itself after the loss of one labyrinth. In those patients who continued to be symptomatic 1 year or more after surgery, the LP did not return to normal values.

Harmonic acceleration testing complemented caloric testing in the identification of patients with tumors and objectively demonstrated patients with continued symptomatology after surgery.
Argon laser destruction of cutaneous telangiectatic lesions
Authors: Lyons George D. , Owens Robert E. , Mouney Daniel F.
Published: October 2006

An ophthalmological slit lamp argon laser was used on 8 patients with multiple cutaneous and mucosal telangiectases; 6 patients had telangiectatic lesions of various etiologies and 2 had hereditary hemorrhagic telangiectasia (Osier‐Weber‐Rendu disease). Bleeding from trauma was the primary symptom with cosmesis as a secondary consideration. The telangiectatic lesions were photocoagulated using the argon laser with precise microscopic control. The optimum dose was determined by varying the spot diameter, beam power, shutter speed and number of applications until the lesions were visually ablated. All treatments were accomplished on an outpatient basis with no anesthesia or sedation and minimal reported patient discomfort. No lesions have recurred over a 12 month follow‐up.