bluuebunny/crossref_metadata_2025 huggingface dataset:
Cardiac complications of microsurgery of the larynx: Etiology, incidence and prevention
Authors: Strong M. Stuart , Vaughan Charles W. , Mahler Donald L. , Jaffe Donald R. , Sullivan R. Craig
Published: September 2006

In no surgical arena is the cooperation and mutual understanding of the anesthesiologist and surgeon more important than in endolaryngeal surgery; here in the narrowest part of the airway, they compete for a share of the limited space available! The anesthesiologist must understand the requirements for optimal operating conditions but more importantly, the surgeon must understand the requirements for safe general anesthesia if unnecessary complications are to be avoided.

Cardiac infarction, myocardial ischemia and arrhythmias, may occur during or after microsurgery of the larynx; they are most likely to be precipitated by pressure stimulation of the deep receptors of the larynx during suspension of the laryngoscope. The reflex pathway that produces the arrhythmia includes the superior laryngeal nerve and the cardio‐in‐hibitory fibers of the vagus. It appears that the complications are most often induced by the surgical manipulation and potentiated by abnormal blood gases.

A small bore cuffed endotracheal tube appears to be an eminently satisfactory way of providing control of the airway and good operating conditions.

The incidence of cardiac complications was studied in 540 patients and found to be 6.8 percent in the high risk group and 1.9 percent in the group without a preoperative history of cardiac disease.

These figures are somewhat higher than those reported by Tarhan, et al., in their study of the incidence of myocardial infarction following surgery of various types under general anesthesia.

To keep these complications to a minimum, constant vigilance must be maintained by the surgeon and anesthesiologist, especially on the cardiac monitor and airway. If arrhythmias appear, steps must be taken immediately to remove the cause, otherwise myocardial ischemia and infarction are very likely to follow.
The management of subglottic laryngeal stenosis by resection and direct anastomosis
Authors: Gerwat John , Bryce Douglas P.
Published: September 2006

The causes and relative incidence of stenosis in the trachea and subglottis are described. The special difficulties encountered in the subglottic region are discussed and references made to various treatments described in the past.

An operation designed to produce a one‐stage cure with preservation of vocal cord function is described in detail. This consists of exposure of the laryngo‐tracheal complex and examination of the lesions directly. If suitable for excision, the upper line of resection is made at the lower border of the thyroid cartilage anteriorly and through the posterior cricoid lamina below the crico‐thyroid joints posteriorly. This is carried out only after identifying the recurrent laryngeal nerves on each side and tracing them up to the crico‐thyroid joints. Anastomosis of upper trachea to the remaining larynx is performed after mobilizing the two ends. At the upper end, this is achieved by the laryngeal drop procedure previously described by Bryce (1972). A stent may be inserted if the anastomosis requires support. A check suture preventing neck extension is not considered necessary.

Postoperatively, a tracheostomy is maintained until the danger of aspiration has passed or until a stent is removed three weeks later. Naso‐gastric feeding is required for the first few days.

Four case histories are presented.

Pre‐operative radiographic assessment has been found to be misleading in most cases and the final decision on the procedure can be determined only at the time of surgery.
Schwann cell tumors of the facial nerve
Authors: Conley John , Janecka Ivo
Published: September 2006

An unusual group of tumors originating from Schwann cells of the facial nerve has been studied. Twenty‐three neurilemmomas were found in 17 patients. Nine originated in the temporal bone, and the remaining 14 tumors arose from the peripheral portion of the facial nerve. All tumors were treated by excision, with partial or total resection of the facial nerve. The resultant facial nerve deficit was then reconstructed with a hypoglossal nerve crossover or a free autogenous nerve graft.
Localized enlargement of the thyroid gland presenting as a pyriform sinus mass.
Authors: Snyder G. Gordon , Toomey James M.
Published: September 2006

Mass lesions of the hypopharynx and pyriform sinus are usually malignant neoplasms. Benign tumors do occur but are uncommon. In a review of the literature, no case of impingement of a thyroid mass upon the hypopharynx and pyriform sinus was found. An unusual case of localized enlargement of the superior pole of the thyroid gland which impinges on the hypopharynx and pyriform sinus is presented.
Frontal sinus disease. I. An historical perspective on research
Authors: Schenck Nicholas L.
Published: September 2006

The surgical approach to frontal sinus disease has been subject to much variation in the past 100 years. The variety of procedures is actually based on very few experiments in which the results are often conflicting.

A review of basic research in the pathogenesis and treatment of frontal sinus disease reveals that with the exception of the osteoplastic fat obliteration procedure, the classical experimental method of laboratory evaluation prior to clinical implementation has been, for the most part, ignored. The response to infection of the ciliated sinus mucosa and its role in the further propagation of frontal sinusitis is poorly understood. The conditions under which the sinus mucosa regenerates have not been clearly defined, nor has complete reformation of the mucosa membrane been consistent experimentally or clinically.

The presumptive role of the nasofrontal duct in the pathogenesis of frontal sinusitis and mucocele is based solely on inference from clinical material.

The variations of frontal osteoplasty each have limitations in reliability and prevention of recurrent disease.

The development of a canine frontal sinus model with which to examine several of these problems is discussed.
Reconstructive flaps in otolaryngology
Authors: Mcfarland Guy E.
Published: September 2006

The modern day otolaryngologist commonly faces reconstructive problems related to tissue loss secondary to neoplasms, trauma, infections and congenital deformities.

Basic understanding of tissue types and flap configuration will allow the otolaryngologist to handle these problems adequately. Basic principles such as tissue texture, color, and varieties of flaps will be covered.

Major emphasis will be placed on reconstructive flaps for the lips, nose and cheek.
Lathyrogenic effects of vitamin a in the rat embryo
Authors: Yarington C. T. , Stivers F. Edward
Published: September 2006

The effects of large doses of vitamin A during gestation on the embryo rat are described. Cleft palate formation, dose‐related disorganization of mandibular and maxillary growth due to abnormal cartilage deposits, and relative macroglossia are described. The previously described lathyrogenic and teratogenic affects of vitamin A in high doses is confirmed and further study suggested for possible deformities of the developing ear.
Treatment of laryngeal and ear strictures by microcauterization
Authors: Kirchner Fernando R. , Duff Wallace E.
Published: September 2006

Post surgical and traumatic cicatricial stenosis of the ears and larynx are among the most disabling complications in otolaryngology. It is common knowledge that open procedures are mandatory when these stenoses are produced by the collapse of the superstructures supporting these cavities. Some strictures, however, are produced only by bands of adhesions or transposed cicatricial tissue. These stenoses may be corrected through surgical operations of a more conservative nature. This paper describes the practical applications of a surgical adjunct, the microcautery, in the rehabilitation of these latter patients. To date, about 25 patients have been treated successfully with this instrument.
Corticosteroid therapy in stapedectomy: A clinical study
Authors: Hendershot Edward L.
Published: September 2006

An earlier monkey experiment, in which half the animals received short and long‐acting corticosteroids following stapedectomy, encouraged the author to conduct a study on human patients, in an effort to alleviate serous labyrinthitis. The results show that the group receiving steroids fared less well than the control group.

From this study, it is concluded that long‐acting corticosteroids are contraindicated in patients undergoing stapedectomy.
Surgical classification for chronic otitis media
Authors: Pratt Lindsay L.
Published: September 2006

A surgical classification is proposed for patients with chronic otitis media. Its purpose is to facilitate the preoperative classification of patients to enable an orderly evaluation of subsequent operative procedures. In addition, it provides for a method for classifying surgical reconstruction procedures.

The preoperative phase of the classification is structured around describing the pathology within the ear and the functional disturbances within the upper respiratory tract. This is accomplished by inquiring about the age of the patient, the apparent etiology of the chronic otitis media, the intactness of the tympanic membrane and the presence or absence of tympanosclerosis and cholesteatoma. Notation is recorded of associated functional disturbances within the upper respiratory tract as they relate to etiology.

The postoperative phase of the classification incorporates Wullstein, Zollner's and Farrior's classifications to describe the anatomy of the ear following the surgical removal of the disease and the type of the functional repair employed.
Reconstruction of ossicles by tissue glue (histoacryl) in dogs
Authors: Siedentop Karl H.
Published: September 2006

While performing tympanoplasties, in 30–40 percent of the cases, the ossicular assembly does not heal as positioned, or, if healed, it will break down later, and the grafted tympanic membrane may separate from the ossicular chain.

Histoacryl (2‐Cyano‐Butyl‐Acrylate) was used in 20 middle ears of dogs to determine how this tissue adhesive would react. It was hoped that it might be found safe and useful for use in the human.

Surgically on all dogs glue was used in the experimental ear; in the opposite or control ear, the identical operation was performed without glue. The histological sections were obtained 10 weeks following surgery. Structures united with tissue adhesive were: 1. fascia to tympanic membrane; 2. cartilage to footplate; 3. bone to footplate; and 4. incus interposition between malleus and stapes.

Examination of 12 histological slides reveal it is clearly demonstrable that Histoacryl is harmless to middle and inner ear structures, is absorbed within a short period of time, and creates stable tissue union. It is believed proven safe for use in human middle ears.
Biphase external fixation: Technique and application
Authors: Rontal Eugene , Meyerhoff William , Wilson Kent
Published: September 2006

External fixation of facial fractures was first introduced during the Second World War when the lack of antibiotics required rapid immobilization of fracture segments at a site distal from the fracture itself. Although limited, indications for external fixation still exist and include mandibular fractures associated with loss of mandibular tissue and of osteitis, mandibular defects following resection for carcinoma and complicated Le Forte and zygomatic fractures. Advantages of external fixation include stabilization of bone fragments at a point remote from the pathologic process, minimal operative time, and an unobstructed oral cavity.
Nasal manifestations of wegener's granulomatosis
Authors: Mcdonald Thomas J. , Deremee Richard A. , Kern Eugene B. , Harrison Edgar G.
Published: September 2006

A review of 52 recent cases of Wegener's granulomatosis has clarified the clinical manifestations and has emphasized the otolaryngologist's role in its early diagnosis. All the cases satisfied the currently accepted criteria for the condition: the presence of primary necrotizing vasculitis in a patient with a typical clinical course. Among the 52 patients, 31 patients had nasal lesions. The typical manifestation was persistent nasal obstruction in a middle‐aged patient with no history of nasal disorder. In the early stages, intranasal examination may reveal only diffuse nasal mucosal swelling, without tissue destruction. Systemic symptoms are malaise, night sweats, intermittent pyrexia, and migratory arthralgias; an abnormally high sedimentation rate is also frequent. Later, the typical nasal findings are diffuse destruction of the mucosa and foul‐smelling crusts. The tissue underlying the crusts is extremely friable. Perforations of the nasal septum are also common. Adequate biopsy of representative tissue is important. The condition is treatable; currently, corticosteroids with or without cyclophosphamide are being used. Of the 52 patients, 31 are alive; 10 are dead, and current information is unavailable on 11 patients.

Polymorphic reticulosis (PMR, lethal midline granuloma, or malignant midline reticulosis) was noted in 16 other patients during the same period. Differentiation between PMR and Wegener's granulomatosis is important because, although they can resemble each other clinically, they are morphologically distinct and respond to different forms of therapy (Wegener's granulomatosis to immunosuppressive drugs and PMR to irradiation).

The otolaryngologist has an important role in the early diagnosis of Wegener's granulomatosis because of the high incidence of nasal involvement and because of the variations in clinical manifestations, which depend on the stage of the disease.
Viruses: Causative agents of cancer
Authors: Sheinin Rose
Published: September 2006

Evidence accumulated over a period of 60 years has clearly established that a number of different viruses cause neoplasia (of a broad spectrum) amongst a variety of animals. Although it is known that viruses do produce self‐limiting proliferative human diseases, complete verification of a human viral carcinogen remains to be provided. This paper presents an overview of the conceptual and practical tools for the detection of tumor viruses, which have derived from experimental model systems. It indicates how these are being applied to studies of human malignant disease, with special reference to assessing a possible viral etiology for laryngeal cancer.
Description of a team approach to the rehabilitation of the laryngectomized speaker
Authors: HOOPS H. Ray , Clarke Wayne M. , Martin Daniel E.
Published: September 2006

This article describes the multi‐disciplinary approach to rehabilitation of the laryngectomee followed by the Michigan Cancer Foundation‐Wayne State University Laryngectomee Clinic. The program serves a patient population in excess of 100 each year in a total rehabilitation paradigm. The rehabilitation effort centers around an intensive speech rehabilitation program encompassing as much as 10 hours of speech therapy per week.

This effort is supplemented by a professional staff including a psychologist, social work staff, audiologist, public health nurse, vocational rehabilitation specialist, and a trained laryngectomized esophageal speech teacher. The contribution of each member of the team and the benefits of a unified approach are described.
Some scientific foundations for voice restoration
Authors: Snidecor John C.
Published: September 2006

Laryngeal cancer, though not high in incidence, may have a devastating effect on the affected individuals' total adjustment. Esophageal speech, while a desirable form of substitute speech, cannot be learned by all, thus requiring a re‐evaluation of the artificial larynx and consideration of such special operations as that of Dr. Ryoso Asai. The acoustical characteristics and deficiencies of all pseudo voices are stated and discussed. The female voice is generally identified as such. Methods for the prognosis of learning speech include a systemic questionnaire for pre‐evaluation which was based on behavior patterns of the laryngectomee.
Restoration of voice after laryngeal surgeries
Authors: Koike Y. Asuo , Iwai H. Itoshi , Morimoto Masanori
Published: September 2006

Some aspects of speech deficiency in Japanese‐speaking patients who had undergone surgeries for laryngeal malignancy were studied. Surgical procedures included reconstructive surgeries after total laryngectomy and conservation surgeries. A series of listener‐judgments and some acoustic analyses of speech were made. The recorded voices of the patients were more or less hoarse. The median speaking pitch varied greatly from patient to patient, and often assumed an unusual value. The average articulation score for five Japanese vowels was computed for each subject. The score varied from patient to patient, and was thought to be useful in quantitatively evaluating speech quality. It was shown that certain glottal consonants such as /h/ can be affected by laryngeal surgeries. It was emphasized that the larynx should be regarded not only as a generator or a vibrator, but also as an articulator which produces consonants. The listening tests also revealed that the intonation pattern of Japanese two‐syllable nouns can be influenced by laryngeal surgeries, and that distinction among certain words may become impossible as a result. This type of speech problem may require serious consideration in some language environments.
Post‐laryngectomy vocal rehabilitation using expired air and an external fistula method
Authors: Edwards Nigel
Published: September 2006

The advantages and problems of fistula speech in post‐laryngectomy vocal rehabilitation are discussed.

A pilot study of laryngectomees has shown the practical advantages and low risk of a primary one‐stage external vocal fistula construction at the time of laryngectomy, allowing very early fistula speech. These results indicate the need for an intensive program to develop a definitive surgical procedure and prosthesis, with a view to applying the method to all types of laryngectomees.
The vascular supply of the cervical skin with reference to incision planning d̊
Authors: Freeland A. P. , Rogers J. H.
Published: September 2006

Wound breakdown, especially following preoperative radiotherapy, is a complication following neck surgery. The anatomy of the blood supply of the neck skin, which is an important factor in neck incision planning, was determined by silicone rubber injection studies. Some of the more common incisions interrupt the cervical blood supply, which descends from the facial and occipital arteries and ascends from the transverse cervical and suprascapular arteries, and this is discussed in relation to wound breakdown.
Supraglottic cancer
Authors: Bocca E.
Published: September 2006

Supraglottic cancer, because of the embryological development of the larynx, and of the arrangement of its lymphatic network, tends to remain limited within the vestibule of the larynx and the pre‐epiglottic space also in its advanced stages of evolution. The cancer spread may superiorly involve the epilarynx, the vallecula, the base of the tongue, and the pyriform fossa; however, inferiorly, the invasion of the glottis is quite exceptional (1 percent of cases); therefore, supraglottic laryngectomy is the operation of choice.

The lower the location of cancer in the vestibule, the safer the indication. The higher location generally requires an extension of surgical excision toward the tongue, arytenoids and hypopharynx.

In view of the high percentage of lymph node metastases, supraglottic laryngectomy should be associated with neck dissection, mainly bilateral, also in cases with no evidence of enlarged lymph nodes.

Supraglottic laryngectomy has been performed in 240 cases in the course of the last 14 years and the five‐year cure rate has been 79 percent. Five postoperative deaths have been recorded.

Rehabilitation time for the breathing and swallowing function has been three weeks as an average. Complications, such as fistula or infection have been exceedingly rare: uneventful recovery followed in all cases.
Anastomosis between the two facial nerves
Authors: Scaramella L. F.
Published: September 2006

A case of traumatic facial palsy incurred during the removal of an acoustic neuroma via a sub‐occipital craniectomy is presented. The palsy was rehabilitated to a satisfactory degree by anastomosing the normal to the paralyzed facial nerve using an autoplastic peripheral nerve graft of suitable length to join the two.
Neurologic implications of glomus tumors in the head and neck
Authors: Spector Gershon J. , Gado Mokhtar , Ciralsky Robert , Ogura Joseph H. , Maisel Robert H.
Published: September 2006

Seventy‐six patients with glomus tumors were evaluated. The incidence of cranial nerve paralysis is 37 percent and the incidence of intracranial extension is 14.6 percent. Jugular foramen syndrome is associated with 50 percent, and hypoglossal nerve involvement with 75 percent incidence of posterior fossa extension. Horner's syndrome is associated with 50 percent of middle cranial fossa invasion. The incidence of CNS tumor involvement with cranial nerve paralysis (not including VIIth nerve) is 52 percent.
Stevens‐johnson syndrome: Twenty‐three cases and their otolaryngologic significance
Authors: Nathan Marshall D.
Published: September 2006

Stevens‐Johnson syndrome is a symptom complex characterized by mucosal, ocular, and cutaneous lesions. Prodromal symptoms of upper respiratory infection or pharyngitis are most common. These are followed by target lesions of skin, sloughing of mucous membranes, and ocular inflammation.

Twenty‐three cases are presented. Most patients (61 percent) were between 10 and 39 years of age. Relapses occurred in three patients. Five patients developed pneumonia, and theere were two fatalities. Over one‐half of the patients had serious ocular complications.

The etiology of this syndrome is uncertain. Multiple allergic factors, drugs (especially long‐acting sulfonamides), and infectious agents (most recently mycoplasma pneumoniae) have been implicated. This study does not support any single cause. The use of systemic steroids is generally accepted by most authors. The death rate in this study (10 percent) is essentially unchanged from early reports on patients without steroid therapy. The complications rate directly attributable to steroids is significant in this study group.

The major complications of this syndrome are ocular. Aggressive topical management of ocular inflammation is required; however, the morbidity rate remains high despite these measures.

The otolaryngologist should be aware of this syndrome as the early symptoms, and the acute complications may require his awareness of the natural and treated courses of this disease.
Unilateral deafness with subsequent vertigo
Authors: Wolfson Robert J. , Leiberman Alberto
Published: September 2006

The association between the characteristic clinical picture of endolymphatic hydrops and pre‐existent profound sensori‐neural hearing loss of long duration, has not been previously reported. Several cases are reported to illustrate this clinical syndrome. Labyrinthectomy was found to be curative. A plea is made for better recognition of this clinical entity.
Prevention of meatal stenosis in conchal setback otoplasty
Authors: Small Allen
Published: September 2006

The conchal setback is a useful technique for correcting many prominent ear deformities. A disadvantage of the technique in some cases is meatal stenosis of the external auditory canal. By excising a portion of meatal cartilage, this problem is prevented. The technique is illustrated and postoperative result is shown.
Conservation surgery for epidermoid carcinoma of the marginal area (Aryepiglottic fold extension)
Authors: Ogura Joseph H. , Spector Gershon J. , Sessions Donald G.
Published: September 2006

Carcinoma of the marginal areas (aryepiglottic fold extension) behaves differently from supraglottic cancer. The majority are T3 and T4 lesions. On a selected basis partial laryngopharyngectomy and neck dissection shows a good survival figure of 62 percent.
Conservation surgery for epidermoid carcinoma of the supraglottic larynx
Authors: Ogura Joseph H. , Sessions Donald G. , Spector Gershon J.
Published: September 2006

The determinant survivals for supraglottic subtotal laryngectomy and neck dissection in T1, T2, T3 and T4 are 83 percent, 79 percent, 70 percent and 67 percent respectively with an overall success rate for primary surgery of 79 percent. The salvage rate is 47 percent for an overall success rate of 82 percent.
Glottic cancer with extension to the arytenoid
Authors: Ogura Joseph H. , Sessions Donald G. , Ciralsky Robert H.
Published: September 2006

Hemilaryngectomy with removal of a greater part or all of the arytenoid was done in 79 patients with good functional results with an overall cure rate and salvage rate of 94 percent. The survival rate for the primary modality of therapy was 90 percent.
Symposium: Management of tumors of the parotid gland. II. Diagnosis of parotid gland swelling
Authors: Quinn Harold J.
Published: September 2006

Diagnosis of parotid gland swellings can be approached by attempting to answer the following questions:

1. Is it parotid?

2. Is it inflammatory or neoplastic?

3. If it is neoplastic, is it benign or malignant?

Diagnosis is made by following the classical physical diagnostic procedures of inspection, palpation, and auscultation. These are followed by radiographic procedures, such as plain films, sialography and technetium scanning. Since approximately one in four parotid neoplasms is malignant, a definitive step should be biopsy. Excisional biopsy is recommended.
Symposium: Management of tumors of the parotid gland: III. Management of the facial nerve
Authors: Trible William M.
Published: September 2006

The facial nerve is protected in parotid surgery by finding the main trunk first and peripherally dissecting free the branches. The most constant landmark is the groove between the mastoid and the bony ear canal. Wide exposure of this groove should be obtained without “tunnelling”. The thick (2–3 mm) white trunk is dissected forward using the electric stimulator before cutting parotid tissue. Nerve injury is more common in the peripheral branches.

Nerve location in recurrent parotid tumors is more difficult. The main trunk may be found more posteriorly than in the previous surgery, but often peripheral branches must be identified crossing the masseter, facial vessels, or the parotid duct; retrograde dissection to the trunk follows.

For proven invading malignancy, the trunk or branches may be sacrificed, but immediate grafting should be attempted usually with the greater auricular nerve.
Symposium: The Supra‐tip in rhinoplasty: A dilemma: I. Theories and causes of Supra‐tip convexities
Authors: Patterson Carl N.
Published: September 2006

Supratip convexities following rhinoplasty present a challenge to the surgeon. The correct diagnosis as to cause is necessary for proper correction. The pertinent anatomy of this area — the theories, causes, suggested methods of prevention and correction — are presented.
Symposium: The Supra‐tip in rhinoplasty: A dilemma: III. Supra‐tip soft‐tissue rounding after rhinoplasty: Causes, prevention and treatment
Authors: Anderson Jack R.
Published: September 2006

1. During rhinoplasty the surgeon can easily set in motion changes which produce soft‐tissue rounding of the supra‐tip area postoperatively.

2. Preventive as well as therapeutic measures are discussed.
Recurrent adenotonsillitis: A new concept
Authors: Sprinkle Philip M. , Veltri Robert W.
Published: September 2006

An update of original data is presented. These data continue to confirm the physiological effect of adenotonsillectomy on the abnormal oropharyngeal and nasopharyngeal microflora of children with recurrent adenotonsillitis. A new concept suggesting a bacterial‐viral etiology of recurrent adenotonsillitis is presented. The advantages of such a concept are reviewed.
Surgical elimination of drooling
Authors: Toremalm N. G. , Bjerre I.
Published: September 2006

Drooling involves great practical problems in the care of patients with cerebral paralysis and mental deficiency. Different types of medical and surgical treatments have been used. In 17 disabled patients chorda tympani has been cut bilaterally in order to reduce the production of saliva, especially from the submandibular and sublingual glands. The loss of taste on the anterior part of the tongue seems to contribute to the reduction of salivation. Fifteen patients have been observed postoperatively during two to four years. Five patients have been cured, two are considerably improved and seven partially improved. The effect of nerve section was illustrated by Tcm99 scintigraphy in two additional cases before operation and six months postoperatively. No complications were observed.
Mondini defect in association with multiple congenital anomalies
Authors: Sekhar H. K. Chandra , Sachs M.
Published: September 2006

A case of bilaterally symmetrical genetic aplasia conforming to Mondini type of congenital deformity in a 12‐day‐old child is presented with the help of temporal bone sections. Cochlear changes include a stunted modiolus, deficient interscalar septum between the middle and upper coils forming a scala communis cochleae, a degenerated organ of Corti and reduced spiral ganglion cells and dendrites. The vestibule is malformed, with membranous labyrinth being deficient. The utricle and semicircular canals are absent. There is no oval window or stapedial footplate, and the facial nerve is hypoplastic. An interesting feature is the unusual association of bilateral bony choanal atresia, atrial septal defect, cleft lip, absence of olfactory bulbs in the brain, and congenital ophthalmic anomalies.
Effects of anoxia and ethacrynic acid upon ampullar endolymphatic potential and upon high energy phosphates in ampullar wall
Authors: Kusakari J. , Thalmann R.
Published: September 2006

The ampullar endolymphatic potential (AEP) was studied in the guinea pig during ischemia and asphyxia and following systemic application of ethacrynic acid. In addition the specialized and nonspecialized portions of the ampullar wall were analyzed for ATP and P‐creatine at different conditions of metabolic interference. Under control conditions the AEP amounted to + 4.6 ± 1.2 mV. In both types of hypoxia the decline of the AEP proceeded on a much slower time scale than that of the cochlear endolymphatic potential (CEP), and the maximum negativity reached was considerably less. Quantitative analysis of both types of ampullar wall tissue indicated a much slower decline in hypoxia of ATP levels than in the stria vascularis. Changes in P‐creatine levels were considerably more rapid. The AEP became reduced and changed polarity also by intoxication with ethacrynic acid (EA), but higher dosages (above 70 mg/kg) were necessary than for effects upon the CEP and much longer time periods were required for attainment of maximum negativity. The maximum negativity of the AEP was significantly greater at a dosage of 100 mg/kg of EA than during ischemia. At the point of maximum depression of the AEP P‐creatine levels in both types of ampullar tissue were unchanged, but ATP levels were significantly reduced in the specialized portions of ampullar wall.
A modified stapedectomy crimper
Authors: Seda Hector J.
Published: September 2006

A modified instrument for crimping the stapes prosthesis is described. This instrument allows direct visualization of the prosthesis during the crimping maneuver lessening the possibility of damage to the incus or to the wire prosthesis.
Symposium: Methods of reconstruction in tympanoplasty: II. Maintenance of the anterior sulcus — tympanic membrane relationships in tympanoplastic surgery
Authors: Bailey H. A. Ted
Published: September 2006

A technique for closure of tympanic membrane perforation which preserves the normal anterior sulcus‐tympanic membrane relationships is described. This underlay fixation technique provides a high graft take, good conization of the drum, prevention of lateralization of the reconstructed drum and elimination of tenting or blunting of the anterior sulcus. The reconstructed tympanic membrane presents a near normal appearance with good physiological and acoustic properties.
Symposium: Methods of reconstruction in tympanoplasty: V. Prevention of blunting the anterior canal drum head contour — plester technique
Authors: Singleton George T.
Published: September 2006

A technique of grafting tympanic membrane perforations which incorporates the sandwiching of a temporalis facial graft between the epithelial and connective tissue layers of the remaining drumhead is presented.
Ossicular chain reconstruction
Authors: Glasscock Michael E.
Published: September 2006

This study represents a review of 121 patients who underwent ossicular chain reconstruction during a five‐year period. They depict a general cross section of the sequelae of chronic otitis media. There was no selection of “favorable” cases. Ninety have been followed for one year or more. Hearing results in the most favorable cases (malleus handle and stapes arch present), were improved by the employment of a sculptured, fitted incus prosthesis between the handle and capitulum. Postoperative hearing was improved to within 10 db of the postoperative bone level in about half of the cases. Hearing was 20 db or better in more than 80 percent.
The use of tragal cartilage in ossicular reconstruction
Authors: Spencer James T.
Published: September 2006

Readily available tragal cartilage has been found to be a very beneficial autogenous graft source for construction of prostheses to correct those defects in the ossicular chain that frequently occur when the incudostapedial joint is destroyed by middle ear pathology, particularly by the retraction of the posterior, superior quadrant of the tympanic membrane against and/or around the incudostapedial connection. This is true whether there be only erosion of the incus just at the joint, or whether there is erosion of the entire long process of the incus together with the superstructure of the stapes. The various types of deformity and the particular tragal cartilage prosthesis tailored for each deformity, and designed for maximum gain in hearing, are presented together with representative pre‐ and postoperative audiograms for the variety of types.
Ototoxicity of tobramycin sulfate
Authors: Prazma Jiri , Postma Duncan S. , Pecorak John B. , Fischer Newton D.
Published: September 2006

Fifty‐four healthy guinea pigs were studied histologically for evaluation of Tobramycin sulfate ototoxicity. They were treated with 50, 100, 150 and 200 mg/kg/day under different schedules. Loss of hair cells occurred when dosage of 1,200 mg/kg was reached. Animals receiving 700 mg/kg were without damage to the inner ear. Outer hair cell loss occurred first in the basal turn, spreading upward. Inner hair cell loss began in the apical turn, progressing downward. When a total dose of 1,400 mg/kg was reached by (two) different schedules the higher daily dose produced about twice the hair cell loss; therefore, the ototoxic effect depends on the total dose but even more on the increased blood concentration.
Avoiding complications in radical neck dissection
Authors: Thomas Yarington C. , Yonkers A. J. , Beddoe G. M.
Published: September 2006

As reported previously, it remains our conclusion that the radical neck dissection can be performed expediently in a reasonable period of time, usually without the need of blood replacement, and is not characterized by major physiologic disability or wound complications secondary to the neck dissection alone. The presence of preoperative radiation, composite resections entering the oral cavity or pharynx, and systemic disease or debilitation, however, vastly enhance the risk of significant life threatening complications and prolong hospitalization; therefore, the use of postoperative radiation therapy in combined treatment, the use of planned fistulas and generally accepted reconstructive techniques, and a careful evaluation of the methods and technique for protection of the carotid artery are recommended.
Tracheostomy in infants and young children
Authors: Hawkins Donald B. , Williams Everard H.
Published: September 2006

Seventy‐three tracheostomies performed in children three years of age and under in a 52‐month period are discussed. Thirty‐six were under one year of age. Forty‐one were performed for upper airway obstruction, 23 for ventilation or suction, and nine for a combination of upper airway obstruction and lower bronchopulmonary disease.
Laryngeal papillomatosis: Immunologic and viral basis for therapy
Authors: Bone Robert C. , Feren Alan P. , Nahum Alan M. , Winkelhake Bonnie G.
Published: September 2006

The distressing nature of laryngeal papillomatosis and lack of clinical progress in its treatment are reviewed. Presently accepted and investigative methods of therapy are reviewed with special attention being given to immune therapy. Support for the concept of a viral etiology is discussed and other etiologic agents considered. Known and possibly significant roles of wart virus antibodies are discussed and the importance of complex interplay between maternal and fetal immune systems explored as a possible explanation for some puzzling aspects of laryngeal papillomatosis.

Finally, a proposed experimental design is outlined, the purpose of which is to provide a useful animal model to investigate immune changes in laryngeal papillomatosis, as well as effects of surgical or medical therapy.
The cochlear implant: Basic principles
Authors: Brackmann Derald E.
Published: September 2006

In recent years the cochlear implant has been a subject of much discussion and controversy. The clinician has often been confused by the conflicting reports of success and failure. In this paper the development of the cochlear implant is reviewed and its present status summarized. It is hoped that the clinician may thereby gain an understanding of this device so that he can better evaluate its present and future status.

Selection of Patients for Cochlear Implantation.

The cochlear implant will benefit only those patients with hair cell loss who have remaining viable auditory neurons. In order to determine whether viable neurons remain, an electric current is passed through a small needle which is placed onto the promontory through the tympanic membrane. If patients experience an auditory sensation as a result of this electrical stimulation, it is felt that they are suitable candidates for a cochlear implant.

Feasibility of Long‐Term VIIIth Nerve Stimulation.

Information Transfer by Electrical Stimulation.

Single‐channel stimulation produces only periodicity pitch, and information transfer is insufficient for speech discrimination.

Present Status of the Cochlear Implant.

To the present time 15 patients have been implanted with a unipolar electrode under the direction of the Ear Research Institute. These patients have all benefited from their devices. They are able to perceive background sounds and receive a cadence or rhythm to speech which makes the device helpful in lipreading. None of the patients have developed significant speech discrimination.

Future of the Cochlear Implant.

It is our opinion that the present single‐channel cochlear implant is a clinically useful device. Work is continuing on the thorough evaluation and rehabilitation of patients with this device.

Development of a multiple‐channel electrode and stimulator is the goal of several groups active in the cochlear implant field. The theoretical model for the future cochlear implant is an eight or more channel device with each electrode stimulating a different population of nerve fibers. The stimulator will separate the incoming signal into eight or more frequency bands and then differentially stimulate the separate electrodes with a coded signal.

It is hoped that sufficient information may thereby be provided for understanding of speech. Preliminary studies give hope that this may be possible.
Carcinoma of the external auditory canal
Authors: Crabtree James A. , Hill Britton B. , Pierce Max K.
Published: September 2006

Successful management of carcinoma of the external auditory canal depends upon four factors: 1. early diagnosis is imperative if a high cure rate is to be expected; 2. correct evaluation of the extent of the malignancy; 3. adequate surgery based upon correct evaluation; and 4. postoperative radiation in certain selected cases.

In this review of 35 cases, two factors were used to determine whether the disease was localized or extensive. When extension occurs into the mastoid as deep as the middle ear cleft or into the facial nerve, it should be designated as extensive tumor. Tumors which do not go as deep as the facial nerve or involve the mucosa of the middle ear should be designated as localized tumors.

In localized tumors, it is possible to perform a wide en bloc resection of the bony and cartilaginous external auditory canal including the tympanic membrane and malleus, and if necessary, including the superficial lobe of the parotid. Postoperative radiation is indicated when the pathological specimen shows unclear margins in the surgical dissection.

With localized tumors, en bloc resection of the external auditory canal offers a high cure rate. In extensive lesions, an en bloc dissection removing the bulk of the tumor mass, followed by irradiation, seems to offer at least as good a prognosis as more radical surgery.
Pre and post‐glycerol special audiometric tests battery results in endolymphatic hydrops
Authors: Swanson Sylvia N. , Arenberg I. Kaufman , Carver William F. , Spector Gershon J. , Stroud Malcolm H.
Published: September 2006

The glycerol test for endolymphatic hydrops was administered to 17 patients exhibiting classical symptoms of Ménière's disease. A complete battery of audiometric tests including the SISI, TTD (Rosenberg variation), ABLB, Sweep Frequency Békésy, two tests of speech discrimination (Rush Hughes and Northwestern), and air and bone conduction thresholds were administered pre and post‐glycerol ingestion in order to determine the effect of osmotic diuresis. Improvement in pure‐tone sensitivity and speech discrimination scores were most often observed. Among the special audiometric tests only the SISI scores exhibited changes, however, these could be related to the threshold changes. There were no significant differences observed in the threshold tone decay tests nor in the ABLB. The sweep frequency Békésy test revealed only the changes which were observed in pure‐tone sensitivity.
Cerebrospinal fluid rhinorrhea via the fossa of rosenmuller
Authors: Jaffe Burton , Welch Keasley , Strand Roy , Treves Salvador
Published: September 2006

Traumatic cerebrospinal fluid fistulas in children are not rare as described by Harwood‐Nash1 and Caldicott, North, and Simpson.2 Those involving the sphenoid bone apparently are rare, particularly in early childhood.
Hemangiomas of the salivary glands
Authors: Nussbaum Moses , Tan Sergio , Som Max L.
Published: September 2006

Five salivary gland hemangiomas in adults are reported. The feasibility of preoperative diagnosis on clinical and radiologic grounds is emphasized. Adult hemangiomas are of the cavernous type and can be differentiated from infantile capillary hemangiomas clinically as well as histologically. Cavernous hemangiomas in the adult should be treated by surgical excision.
An endolaryngeal method of vertico‐lateral transposition of the vocal cord for bilateral abductor paralysis
Authors: Langnickel Rainer
Published: September 2006

An endolaryngeal method of vertico‐lateral elevation and fixation of the vocal fold in the treatment of bilateral recurrent laryngeal nerve paralysis is described. In 62 patients on whom this operative procedure was performed, a considerable improvement in respiration at the same time as almost unchanged phonation has been obtained in 61 cases. The results are illustrated by sonograms and respirometric examinations. Laryngograms demonstrate the function of the newly created glottis.
The vascular anatomy of the eustachian tube in the guinea pig
Authors: Voorhees Richard L.
Published: September 2006

Vascular anatomy of the eustachian tube has received little attention in the world's medical literature.

Forty guinea pigs were perfused with Berlin Blue as a contrast medium and the eustachian tube microvascular architecture visualized through surface preparations. A diffuse, dense two‐layered capillary network was found which followed the distribution of mucous glands. Five animals suffering from suppurative otitis media showed marked capillary congestion with increased vessel to tissue density. Relationships to gross arterial and venous supply as found in the human are discussed.
Metastatic disease of the temporal bone
Authors: Stucker Fred J. , Holmes William F.
Published: September 2006

This paper discusses metastatic disease of the temporal bone, and illustrates its discussion with a case history.

The incidence, signs, symptoms, and treatment generally recorded are discussed. The histopathology of such lesions, as well as a documentation of those organ systems most likely to provide temporal bone metastatic spread, is noted. As with primary neoplasias of the temporal bone, metastatic disease may coexist with or mimic chronic otitis media. It is the wary surgeon who carefully analyzes his patient, the history, the intensity of signs, particularly pain — and, therefore, is prepared for the exigencies of recognizing neoplasia with or without associated chronic otitis media.
The use of homograft stapes
Authors: Smith Mansfield F. W. , Dobie Robert
Published: September 2006

Homograft stapes were used for ossicular reconstruction in 43 ears over a three‐year period. The average hearing improvement was 7.9 db. These cases were divided into two groups: those with an intact posterior canal wall and those with an open mastoid cavity. The latter group fared better, with an average improvement of 15 db.

Fourteen of the 43 ears were subsequently re‐explored. Satisfactory bony union between the homograft stapes and recipient footplate was found in eight cases, four cases showed poor bony union, and bony resorption of the homograft had occurred in two patients with eustachian tube dysfunction. This technique offers promise for reconstruction of the ear with a loss of the stapes arch, especially in the presence of an open mastoid cavity and thus a shallow middle ear.
Observations on the biochemical effects of transfusion of citrate‐phosphate‐dextrose stored blood in man
Authors: Miller Robert N. , Engelhardt Robert , Collins John A. , Slatopolsky Eduardo , Ladenson Jack H.
Published: September 2006

Preliminary data on the biochemical effects of the transfusion of three units of CPD blood in man is presented. Free (ionized) calcium was found to decrease approximately two minutes following initiation of the transfusion of CPD stored blood at a rate of 50 ml/min. Due to mixing problems, arterial and not venous specimens were found necessary to monitor accurately the severity of these decreases. Parathyroid hormone in the peripheral blood was found to increase two to four minutes after the initiation of transfusion. Decreases in blood pressure were observed during transfusion. The blood pressure recovered when the transfusion was stopped and did not decrease any further after restarting the transfusion, even when comparable free calcium levels were achieved. Insulin levels were found not to increase or decrease consistently, and only modest changes in plasma potassium were observed.