bluuebunny/crossref_metadata_2025 huggingface dataset:
Synaptic Bodies in the Different Rows of Outer Hair Cells in the Guinea Pig Cochlea
Authors: Swetlitschkin R. , Vollrath L.
Published: October 2014

The afferent synapses of the outer hair cells (OHCs) of the cochlea are peculiar, insofar as some of them contain special synaptic bodies (SBs) forming the so-called ribbon synapses. These SB-containing synapses are highly variable in number, exhibiting interspecies and intraspecies differences. As quantitative data on the incidence of SBs in the different rows of OHCs are lacking and as some of the above differences may have a circadian basis, in the present study SBs were counted in guinea pigs killed at different times of the day and night. In the second turn of the cochlea, synapses with perpendicular and parallel SBs were distinguished. Perpendicular SBs, but not parallel SBs, were significantly higher in number in the first than in the third row. Circadian changes were observed for perpendicular SBs, which were higher in number in the evening than in the morning. Circadian changes were absent in the parallel SBs of the OHCs and in the SBs of the inner hair cells. These results show that the afferent synapses of OHCs are rather complex, structurally as well as temporally; the functional significance of this finding remains to be elucidated.
Ultrastructure of Mucous Blanket in Otitis Media with Effusion
Authors: Inagaki Masashi , Sakakura Yasuo , Majima Yuichi , Shimizu Takeshi , Ukai Kotaro
Published: October 2014

We used transmission electron microscopy to study the mucous blanket of the promontory from children with otitis media with effusion. The vast majority of the epithelial cells were secretory, and the rest were ciliated. The mucous blanket consisted of the electron-lucent periciliary fluid and the mucous layer. In the mucous layer, two layers were identified: An inner layer with migrating cells, and an outer layer with specks. Moreover, there was a lucent zone over the nonciliated surface that was as high as the microvilli. The thickness of the periciliary layer was predominantly as great as that of the ciliary tips, which just make contact with the mucous layer; however, the mucous layer occasionally penetrated into the periciliary space. These findings indicated that there is a mucociliary dysfunction in the middle ear caused by a decrease in the number of ciliated cells, and an abnormal interaction between cilia and mucus that would interfere with ciliary movement. Thus, such a system would fail to transport the mucous blanket.
Collagen Components of Bovine Fetal and Guinea Pig Cochlear Bone and Human Stapes
Authors: Chiang Thomas M. , Takeda Taizo , Yoo T. J. , Dixit Saryu , Ishibe Tsukasa , Sudo Naohiro , Seyer Jerome
Published: October 2014

Collagenous components were isolated chemically from fetal bovine or guinea pig cochlear bone and human stapes after stapedectomy, and the purified protein was characterized by immunoblot assay and amino acid analysis. The results of this study suggest that these are mixtures of type I and type II collagens. The presence of type II collagen in the human stapes also was demonstrated by immunohistologic methods using monoclonal antibody. The presence of type II collagen in these tissues is significant, since it has been postulated as an autoantigen in autoimmune inner ear disease.
Integration of Titanium Implants in Irradiated Bone Histologic and Clinical Study
Authors: Jacobsson Magnus , Tjellströum Anders , Albrektsson Tomas , Thomsen Peter , Turesson Ingela
Published: October 2014

Nine patients who had undergone combined surgical and radiologic treatment for malignant tumors had skin-penetrating titanium implants inserted in the bone tissue in the treated region at various time intervals after irradiation. The absorbed dose to the implant region varied between 25 and 86 Gy normalized to five fractions of 2.0 Gy/wk, according to the cumulative radiation effect formula. The time interval between irradiation and fixture insertion varied from 9 months to 37 years. Of the 35 fixtures installed, only five were lost because of lack of osseointegration. The follow-up time from implant insertion ranged from 15 to 44 months.
Development of Congenital Laryngeal Atresias and Clefts
Authors: Zaw-Tun Harry I. A.
Published: October 2014

Congenital supraglottic laryngeal obstruction still is being described as subglottic stenosis. There are three clearly defined types of congenital laryngeal atresia, which result from arrest at consecutive developmental stages. Type 1 consists of a supraglottic obstruction, absent vestibule, and stenotic infraglottis, and type 2 is a supraglottic obstruction that separates a shallow primitive vestibule above from a nonstenotic infraglottis. These two types usually are accompanied by other defects, many of them severe. In type 3, a perforated membrane partly obstructs the glottis. Arrest of the dorsal advance of the chondrifying cricoid before the ends meet to form the dorsal lamina results in a complete laryngeal cleft, and incomplete fusion of the ends may leave a notch and/or foramen within the lamina. Failure of the interarytenoid tissue to develop will produce a local cleft, and maldevelopment of the cricoid cartilage or infraglottic submucosa can result in true subglottic stenosis without supraglottic obstruction.
Lateral Cervical (Branchial) Cyst Epithelia Express Upper Digestive Tract-Type Cytokeratins
Authors: Wild Gerd Artur , Wille Gabriele , Mischke Dietmar
Published: October 2014

The epithelial lining of lateral cervical cysts (LCCs) was analyzed for keratin polypeptide composition by means of high resolution gel electrophoresis and immunoblotting using polyclonal rabbit antikeratin antisera of defined specificity. The keratin phenotype expressed in branchial mass epithelia was found to be homologous to the profiles obtained for the squamous epithelium of corresponding palatine tonsils, but was clearly different from related polypeptide complements of both epidermis and simple (columnar) epithelium. The presence of particular keratin members (pairs 5/14 and 4/13) strongly indicates that branchial mass inner lining derives from keratinocytes that are programmed to form a stratified squamous epithelium and reveal, at least biochemically, an upper digestive tract or esophageal type of differentiation. On the basis of these data and the recent finding that a neck lymph node is involved as a target tissue in LCC formation, hypotheses concerning branchial mass histogenesis in general appear to be highly unsettled. We propose an alternative model that may explain the conflicting clinical, anatomic, and morphologic findings associated with LCC disease.
Histologic Investigation of Hyperphonated Canine Vocal Cords
Authors: Gray Steven , Titze Ingo
Published: October 2014

Vocal cord injury and its effect on the larynx are topics of considerable importance, yet a clear understanding of acute vocal cord injury from excessive phonation remains elusive. The inability to develop an animal model for vocal abuse has hampered research in this area. This project describes the development of a canine model for acute vocal cord injury from excessive phonation. The method of phonation consisted of a humidified, temperature-controlled, constant flow of air delivered subglottally by an external compressor. A small group of dogs underwent phonation for 2 and 4 hours. Vocal cord injury is described using histologic techniques. Damage to the vocal cords, other than hemorrhage (rare in dogs) and edema, proved to be too elusive for routine microscopy. Scanning and transmission electron microscopy showed extensive surface damage with destruction and loss of the surface microridges and premature desquamation of the vocal cord squamous epithelium. Injury extended to the lamina propria, where the collagen fibers were detached from the basement membrane.
Nasal Histamine and Heparin in Chronic Rhinitis
Authors: Wilson Janet , Reilly Karen , Salter Donald , Yap Peng Lee , Dawes Joan , Barnetson Ross , Murray Jonathan , Maran Arnold
Published: October 2014

Histamine and heparin, both free and cellular, were assayed in the nasal mucosa of 11 atopic and 15 nonatopic patients undergoing turbinectomy for chronic rhinitis. There was no significant difference between the free and cellular histamine levels of the atopic and nonatopic patients. There was also no significant difference between the free heparin levels of atopic and nonatopic patients. Mean cellular heparin was, however, significantly greater in the nonatopic group. This finding, together with the results of mast cell counting, suggests either that in atopic patients heparin stores are already depleted prior to turbinectomy, or that in nonatopic individuals nasal mast cells contain an excess of heparin in nonreleasable stores.
Metastatic Thyroid Carcinoma Presenting as Distal Spinal Cord Compression
Authors: Goldstein Steven I. , Kaufman David , Abati Andrea D.
Published: October 2014

The prognosis of metastatic thyroid carcinoma is dependent on the age of the patient, the histologic characteristics of the neoplasm, and the site of metastasis. A more favorable prognosis is found in patients less than 40 years old with follicular carcinoma and without any bony metastases. Metastatic thyroid carcinoma presenting as distal spinal cord compression is extremely rare. We report one such case and review the literature. As reported in the literature, the combination of decompressive laminectomy followed by total thyroidectomy and radioactive iodine therapy has proved to be effective in the treatment of patients with thyroid carcinoma metastatic to the distal vertebral bodies.
Histopathologic Study of Eustachian Tube in Cleft Palate Patients
Authors: Shibahara Yoshihiro , Sando Isamu
Published: October 2014

We studied eight temporal bones from eight individuals with cleft palates (CPs) and eight age-matched control temporal bone specimens from our collection. We used the eustachian tube (ET) and its surrounding structures in serial vertical histologic sections. The findings observed in CP specimens were as follows: 1) the angle between axial lines through the tensor veli palatini (TVP) muscle and the superior portion of the ET lumen was narrow, 2) the angle between axial lines through the lateral lamina and the medial lamina of the cartilage was wide, 3) the angle between axial lines through the TVP muscle and the lateral lamina of the cartilage was narrow, and 4) the angle between axial lines through the superior part and the inferior part of the ET lumen was wide. From these findings, we assume that the ET dysfunction that occurs in individuals with CP is the result of abnormalities of the ET and its cartilage and of abnormal anatomic relationships of these structures to the TVP muscle.
Effects of Lidocaine and Procaine on Canine Nasal Blood Vessels
Authors: Wang Hsing-Won , Jackson Richard T.
Published: October 2014

The effects of lidocaine and procaine on contractile responses of isolated canine nasal mucosal blood vessels to field stimulation and methoxamine were investigated. Analysis of cumulative dose-response curves showed that the two local anesthetics antagonized methoxamine and inhibited the field-stimulation response. The latter effect was interpreted as due to the blockade of Na+channels. This would inhibit nerve conduction induced by field stimulation. The former effect on methoxamine is probably caused by the effect of these anesthetics on the mobilization of Ca++ needed for smooth muscle contraction. Preincubation of the nasal mucosa with low doses of procaine or lidocaine shifts the methoxamine dose-response curve to the right. With higher doses, the maximal response is also reduced. The shift of the dose-response curve showed that procaine or lidocaine can change the α-adrenergic receptor affinity. Commercial 1% lidocaine with 1:100,000 epinephrine also inhibits field stimulation and antagonizes methoxamine contractions. Lidocaine can increase the basal tone of nasal mucosa, while procaine cannot. From these results, we conclude that procaine and lidocaine have common mechanisms in blocking Na+ channels but differ in their ability to modify Ca++ stores or channels.
Evaluation of Therapeutic Potential of Interleukin 2- Expanded Tumor-Infiltrating Lymphocytes in Squamous Cell Carcinoma of the Head and Neck
Authors: Boscia Roseanne , Johnson Jonas T. , Chen Kangnian , Whiteside Theresa L.
Published: October 2014

Tumor-infiltrating lymphocytes (TILs) were isolated from surgically excised squamous cell carcinoma of the head and neck. Immunohistology showed that the tumor was infiltrated by T-lymphocytes, many of which were activated as judged by the expression of the following surface antigens: HLA-DR, transferrin receptor, and receptors for interleukin 2 (IL2). Fresh TILs were unable to lyse natural killer cell (NK)-resistant and NK-sensitive tumor cell targets in chromium-release cytotoxicity assays. Tumor-infiltrating lymphocytes as well as autologous peripheral blood lymphocytes were cultured in media containing natural IL-2. Tumor-infiltrating lymphocytes proliferated better than autologous peripheral blood lymphocytes and exhibited sustained growth and antitumor effector function in long-term cultures. The IL2-expanded culture of TILs contained mostly CD8 + (suppressor/cytotoxic) T-lymphocytes with the morphology characteristic of lymphokine-activated killer cells. The ability to expand TILs with augmented antitumor activity in long-term cultures indicates that these cells could be therapeutically useful. Potential application of human TILs to adoptive immunotherapy of squamous cell carcinoma of the head and neck is discussed, and recent advances in immunotherapy with IL2-activated TILs are reviewed.
Pathology Consultation Accessory Parotid Gland
Authors: Batsakis John G.
Published: October 2014

Accessory parotid glands may be found in approximately 20% of patients and are heir to all diseases affecting the parotid gland proper. Between 1% and 7% of all parotid neoplasms arise from the accessory glands, and 50% of these are histologically malignant
Correction of Segmental Tracheal Stenosis in Children
Authors: Healy Gerald B. , Jonas Richard A. , Schuster Samuel R. , McGill Trevor J. I.
Published: October 2014

Segmental tracheal stenosis in children may be either acquired or congenital in nature. Acquired injuries usually involve a previous tracheostomy site or an area just superior to the carina. Congenital stenosis may occur in any location and often is associated with pulmonary agenesis. Surgical correction may be undertaken relatively safely in children of any age by segmental resection. We report three patients ranging in age from 4 weeks to 3 years who were corrected successfully. The use of cardiopulmonary bypass may be indicated, especially in young infants, to facilitate resection.
Laryngotracheal Separation for Intractable Aspiration
Authors: Snyderman Carl H. , Johnson Jonas T.
Published: October 2014

Intractable aspiration may be a life-threatening problem for patients with altered laryngeal function secondary to neurologic disorders or abnormal laryngeal anatomy. Multiple surgical procedures have been devised to deal with this problem. An effective technique involves the creation of a tracheostoma and closure of the larynx at the first or second tracheal ring. Laryngotracheal separation is relatively easy to perform and potentially reversible. Experience with this technique in six patients who required laryngeal separation for intractable aspiration is described. The procedure was successful in preventing aspiration and recurrent pneumonia associated with neurologic dysfunction, unresectable neoplasm, and conservation laryngeal surgery. One patient of one has had a successful reconstruction.
Indications for the Tracheoesophageal Diversion Procedure and the Laryngotracheal Separation Procedure
Authors: Eisele David W. , Yarington C. Thomas , Lindeman Roger C.
Published: October 2014

Impaired protective function of the larynx can lead to intractable aspiration, a severe and potentially fatal disorder. If medical therapy fails to prevent intractable aspiration, surgical separation of the upper respiratory tract from the digestive tract is necessary to prevent recurrent contamination of the respiratory system in these patients. Two such surgical procedures are the tracheoesophageal diversion procedure and the laryngotracheal separation procedure. Our approach to patients with intractable aspiration and the indications for the use of these surgical procedures for the prevention of aspiration are discussed.
Thyroglossal Duct Remnants in Infants and Children: Reevaluation of Histopathology and Methods for Resection
Authors: Hoffman Mark A. , Schuster Samuel R.
Published: October 2014

Established principles for the management of thyroglossal duct remnants have been accepted widely since Sistrunk's description of the operative procedure in 1928. Nevertheless, inadequate excisions and troublesome recurrences still are encountered. We have reviewed 90 infants and children treated at The Children's Hospital in Boston over a 25-year period. Ten patients referred to our institution after an average of 2.4 prior operations per patient elsewhere suffered a recurrence rate of 30% after very wide reexcision. The remaining 80 patients who underwent primary excision at our institution had a 6.3% recurrence rate. All recurrences were managed successfully by further, wider excision. Histologic review demonstrated variability in patterns of drainage of the tract into the oropharynx, with accessory tracts and alveolar outpouchings off the main duct being present in 7.8% of specimens. This study demonstrates that the greatest opportunity for curative resection is at initial presentation, and that previous inadequate or unsuccessful excision is a major risk factor for further recurrence. The variability in microscopic anatomy of thyroglossal duct remnants can account for recurrent disease after lesser procedures, and underscores the importance of wide dissection above the hyoid bone. Our operative methods are illustrated.
Rib Cartilage Grafts for the Treatment of Posterior Glottic and Subglottic Stenosis in Children
Authors: Zalzal George H.
Published: October 2014

Posterior glottic and subglottic stenosis from endotracheal intubation in children can be managed endoscopically with varying success. Open surgical treatment offers a better potential for correction with a single procedure in moderate and severe cases. The open method consists of splitting the scar and cricoid cartilage posteriorly to the level of the interarytenoid muscle, then stenting the incised cricoid open with a rib cartilage graft. Use of this method is described, and results in 12 cases are reported. Decannulation was achieved in ten patients. In all patients who were decannulated, good exercise tolerance, freedom from aspiration, and an adequate voice quality were achieved.
Acute Epiglottitis in Adults
Authors: Shih Lucy , Hawkins Donald B. , Stanley Robert B.
Published: October 2014

Acute epiglottitis was diagnosed infrequently in adults until the late 1960s and early 1970s. Because it is relatively rare, it may present a problem to the physician who sees an adult with sore throat and dysphagia, but does not think of epiglottitis. In this paper we report our experience with 48 cases of acute epiglottitis in adults between the years 1963 and 1987. A discussion of the diagnosis and treatment of adult epiglottitis is presented. An adult with acute painful dysphagia should be considered to have epiglottitis until the diagnosis is proven otherwise.
Osteoradionecrosis of the Head and Neck: A Case of a Clavicular-Tracheal Fistula Secondary to Osteoradionecrosis of the Sternoclavicular Joint
Authors: Stofman Guy M. , Lowry Louis D. , Cohn John R. , Jabourian Zaven
Published: October 2014

Radiation therapy is an integral part of treatment for head and neck cancer, but its use is not without complications. We describe the first reported sternoclavicular-tracheal fistula resulting from osteoradionecrosis (ORN) at the medial clavicle. This ORN resulted from definitive radiation therapy for a primary pyriform sinus squamous cell carcinoma. The diagnosis of ORN was made by fiberoptic bronchoscopy. The physiologic damage of ORN is based on a compromised blood supply and altered metabolism of bone formation secondary to effects of ionizing radiation. Treatment requires meticulous hygiene, antibiotics, and debridement as conservative therapy. Radical surgery and reconstruction may be indicated in refractory cases. A thorough preirradiation assessment of patients is mandatory to decrease the incidence of radiation-induced ORN.
Kirschner Wire Migration through the Jugular Foramen
Authors: Sanders Anthony D. , Wolff Allan P. , Ciric Ivan , Mikhael Michael
Published: October 2014

Kirschner wires commonly are used to provide interosseous fixation. Although they usually retain their intended position, migration of these sharply pointed metal pins has been reported.
Cervical Ranulas
Authors: Batsakis John G. , McClatchey Kenneth D.
Published: October 2014

Cervical ranulas, known also as plunging or burrowing ranulas, are an outcome of extravasated sublingual gland mucin that has gained access to the soft tissues of the neck. These pseudocystic lesions may be localized or extensive, and they require surgical excision of the sublingual gland for effective management
Vestibular Atelectasis
Authors: Merchant Saumil N. , Schuknecht Harold F.
Published: October 2014

The temporal bone collection at the Massachusetts Eye and Ear Infirmary includes specimens from several cases in which the only reasonable explanation for vertigo is collapse of the walls of the ampullae and utricle, a disorder we have termed vestibular atelectasis. The clinical histories and temporal bone studies support the existence of a primary type that may have a paroxysmal or insidious onset, and a secondary type that occurs in association with other inner ear disorders. The principal clinical symptom is chronic unsteadiness, precipitated or aggravated by head movement, and sometimes associated with short episodes of spinning vertigo. It is presumed that the collapsed membranes interfere with the motion mechanics of the cupulae and otolithic membranes.
Magnetic Resonance Imaging of the Posterior Cranial Fossa
Authors: Valvassori Galdino E. , Guzman Mariano
Published: October 2014

Magnetic resonance imaging has acquired a leading role in the assessment of the posterior cranial fossa, base of the skull, and neck. Several technical improvements, such as further refinement of surface coils, fast scanning, and paramagnetic agents, have enhanced the diagnostic capability of this imaging technique. It is extremely useful in the differentiation of pathologic processes arising from or involving the petrous pyramids, such as congenital cholesteatomas, cholesterol granulomas, and glomus tumors. It is the study of choice for both extra- and intra-axial lesions in the posterior cranial fossa. The magnetic characteristics of the most common lesions are reviewed in this paper.
Differential Clinical and Radiographic Features of Cholesterol Granulomas and Cholesteatomas of the Petrous Apex
Authors: Smith Peter G. , Leonetti John P. , Kletzker G. Robert
Published: October 2014

Cholesterol granulomas and cholesteatomas are expansile, destructive lesions of the petrous apex that occur more frequently than we previously realized. Having obscure causes, they grow silently, often reaching impressive proportions, until they encroach on adjacent cranial nerves or the otic capsule. The lesions have distinguishing histopathologies, early clinical manifestations, and neuroradiographic features that, when integrated, allow for a critical preoperative differentiation. Cholesterol granulomas are treated effectively through internal marsupialization into the mastoid or middle ear cavity. Cholesteatomas, however, are managed usually by a much more aggressive and complicated exteriorization or exenteration. Selected case reports are used to emphasize salient clinical and radiographic features and perioperative management.
Adenomas of the Temporal Bone
Authors: Eby Thomas L. , Makek Miro S. , Fisch Ugo
Published: October 2014

Three cases of primary adenomas of the petrous bone are presented and compared to an adenoma arising from the external ear canal. In contrast to other adenomatous tumors, these caused slowly progressive inner ear symptoms without other signs, hence making differentiation from other benign lesions difficult. In one case, association with von Hippel-Lindau disease is suspected because of a strong family history and recent discovery of a similar lesion in the opposite ear. Bone destruction was found radiographically and clinically with vascular tumor tissue and cysts permeating the bone, causing adjacent bone destruction and remodeling. The histopathologic examination demonstrated this to be a benign process, however, with no direct tumor invasion or other signs of malignancy. Subtotal petrosectomy is a proven approach for complete removal of these tumors. Review of the literature revealed no previous reports of benign adenomas originating in the petrous bone.
Anatomic Considerations in the Posterior Approach to the Internal Auditory Canal
Authors: Roland Peter S. , Wright Charles G. , Meyerhoff William L. , Mickey Bruce
Published: October 2014

We dissected 30 human temporal bones in order to establish a reliable method for avoidance of the membranous labyrinth in acoustic neuroma surgery. We believe that the variability of the surgical landmarks is sufficient to make complete reliance on anatomic measurements quite treacherous. Fine-cut computed tomograms were evaluated, and it was determined that measurements taken from such scans can define the anatomy of individual temporal bones. We conclude that hearing conservation surgery for acoustic neuroma is a relatively difficult surgical exercise and that complete familiarity with the anatomy and use of all available landmarks is required for successful tumor removal and hearing conservation. Success can be improved further by using measurements taken from the individual patient's preoperative CT scan.
Preservation of Hearing in Acoustic Tumor Surgery: Audiologic Indicators
Authors: Josey Anne Forrest , Glasscock Michael E. , Jackson C. Gary
Published: October 2014

Preservation of hearing in patients with acoustic nerve tumors can be a goal when tumor size is small and residual hearing is intact. Overall success rates for preservation have been reported to be 20% to 40%. The overall success rate in this series is 30.7%. However, indicators of intact auditory brain stem response (waves I-III-V), good speech discrimination score, and intact acoustic (stapedial) reflex were associated with a 68.2% rate of success. Thus, a comprehensive audiologic evaluation is a guideline for selecting and counselling patients with acoustic tumors before hearing preservation procedures.
Gamma Knife: An Alternative Treatment for Acoustic Neurinomas
Authors: Kamerer Donald B. , Lunsford L. Dade , Møller Margareta
Published: October 2014

Despite surgical advances and technologic means of better monitoring seventh and eighth nerve function intraoperatively, there remains a group of patients for whom alternative methods of treatment are desirable. These include the elderly, those with bilateral tumors or tumors in only hearing ears, individuals with medical contraindications to major surgery, and those who refuse surgical resection. The University of Pittsburgh became the fifth world center and the first in the United States to install the “gamma knife” for stereotactic radiosurgery. On the basis of the pioneering work done at the Karolinska Institute in Stockholm, acoustic tumor patients who fulfill the above criteria are being treated. A tumoricidal single treatment closed-skull radiation dose is given through 201 sharply focused cobalt 60 sources, minimizing the effects on surrounding brain or other tissues. Our early results are discussed and compared to those from more than 200 cases in Stockholm. Complications and expected long-term results are presented.
Incidence of Cholesteatoma with Cleft Palate
Authors: Dominguez Steven , Harker Lee A.
Published: October 2014

The overall incidence of cholesteatoma in Iowa has been estimated to be 6.01/100,000 population, or less than 0.01 %. However, in patients with cleft palate seen at the University of Iowa Cleft Palate Clinic between 1947 and 1968 and followed for at least 10 years, the risk of developing cholesteatoma was 9.2%. In order to determine whether this high risk of cholesteatoma is still valid, a comparable retrospective study was undertaken of 153 patients with cleft palate who were born between 1969 and 1977, were enrolled in the University of Iowa Cleft Palate Clinic within 1 year of birth, and were followed by the interdisciplinary team for a minimum of 10 consecutive years. Cholesteatoma occurred in four patients (2.6%), a substantial decrease in the risk of developing cholesteatoma in a well-defined and longitudinally followed population.
Utility of Near-Total Laryngectomy for Supraglottic, Pharyngeal, Base-of-Tongue, and other Cancers
Authors: DeSanto Lawrence W. , Pearson Bruce W. , Olsen Kerry D.
Published: October 2014

This report emphasizes the utility of the near-total laryngectomy for those patients in whom conventional conservation surgery is an option but may be oncologically or physiologically unsafe. The near-total operation can be offered for supraglottic cancer, pharyngeal cancer, and, more commonly, primary glottic cancer with cord fixation. Its application is described for patients who are candidates for conventional conservation surgery but are compromised physiologically by age or poor general health and for patients in whom tumor extent would not permit safe conventional conservation surgery.
Glomus Vagale Tumors
Authors: Biller Hugh F. , Som Peter , Lawson William , Rosenfeld Richard
Published: October 2014

Eighteen patients with glomus vagale tumors treated by surgical resection are reviewed. Computed tomography and magnetic resonance imaging are diagnostic. Arteriography is used to determine multicentric tumors. The incidence of multicentric tumors in this series was 40%. Adequate surgical exposure is necessary for removal of the tumor without injury to the carotid artery. Vagal paralysis was present in all cases postoperatively and resulted in dysphagia and aspiration. Cricopharyngeal myotomy and Teflon injection aided in rehabilitation of deglutition. Curability with surgery is high, but radiation therapy is recommended in selected patients.
Management of Patients with Glottic and Subglottic Stenosis Resulting from Thermal Burns
Authors: Flexon Phillip B. , Montgomery William W. , Cheney Mack L. , Turner Pamela A.
Published: October 2014

A series of 11 laryngeal burn patients is reviewed. Various methods of laryngeal burn management are detailed, including steroid usage, laser therapy, and reconstruction with local flaps, grafts, and stents.
Cartilaginous Tumors of the Trachea and Larynx
Authors: Neis Paul R. , McMahon Michael F. , Norris Charley W.
Published: October 2014

Cartilaginous tumors of the larynx are uncommon, with approximately 250 having been reported in the literature. Only 28% of these were chondrosarcomas, and the remainder, chondromas. Cartilaginous tumors occur even more rarely in the trachea, with eight chondromas and four chondrosarcomas having been reported. A review of the literature with an outline of a reasonable treatment philosophy for these tumors is presented, as well as three case reports of chondrosarcoma of the larynx and one of chondroma of the trachea, which demonstrate common characteristics of these tumors. We also describe a new technique used on one of these patients in which an autologous rib cartilage graft and pyriform fossa mucosal flap are used to reconstruct the cricoid ring after resection of more than two thirds of its circumference, allowing decannulation and good voice postoperatively.
Advantages of the Rotary Door Flap in Laryngotracheal Reconstruction: Is Skeletal Support Necessary?
Authors: Eliachar Isaac , Welker Keith B. , Roberts Jay K. , Tucker Harvey M.
Published: October 2014

Most attempts at laryngeal reconstruction have sought to reestablish skeletal support. Bone and cartilage grafts have been used for this purpose, but they have often failed to maintain position in the larynx and/or trachea following reconstruction, and they tend to be reabsorbed. The rotary door flap can provide an undelayed, one-stage epithelial resurfacing of the larynx and trachea while simultaneously restoring luminal support without the need for transfer of cartilage or bone. Luminal support for the trachea is provided by the bulk, turgor, and anterior traction of the intact sternohyoid muscle, which serves as the carrier for the rotated skin island. During inspiration the intact muscle, whose points of attachment are anterior to the plane of the larynx and trachea, contracts and tends to open the airway to provide dynamic luminal support. The need for internal stenting is minimized. The technique is described and experience in 20 patients is presented.
Surgical Correction of Dysphonia Due to Bowing of the Vocal Cords
Authors: Koufman James A.
Published: October 2014

This report reviews laryngoplastic techniques for correction of bowing of the vocal cords, with special consideration to the anatomic details of the anterior commissure. I present a new technique in which the glottic gap is closed by bilateral medialization. This technique may be superior to those described previously, since the correction achieved at the time of surgery is maintained by the placement of Silastic.
Endoscopy and the KTP/532 Laser for Nasal Sinus Disease
Authors: Levine Howard L.
Published: October 2014

One hundred twenty-eight patients have undergone nasal/sinus operations using endoscopes and the KTP/532 laser. The pathologic processes have included turbinate dysfunction, nasal ethmoid polyps, hereditary hemorrhagic telangiectasia, granulomatous disease (sarcoid), nasal granulation secondary to cocaine abuse, and nasal papilloma. Early follow-up indicates rapid healing with minimal crusting, edema, scar formation, and complications and good resolution of disease.
Isolated Pulmonary Nodules in Head and Neck Cancer Patients
Authors: Sercarz Joel , Holmes E. Carmack , Ellison David , Calcaterra Thomas C.
Published: October 2014

Not infrequently, a patient with newly diagnosed head and neck cancer is noted on preoperative chest radiography to have a solitary pulmonary nodule. It is initially unclear whether the pulmonary nodule is a benign lesion or a metastatic or primary lung malignancy. Considerable controversy exists regarding the evaluation of such patients as well as the treatment, assuming that the pulmonary lesion is malignant. We have reviewed the UCLA experience with patients who had head and neck cancers and pulmonary cancers no more than 5 years apart, and reviewed the literature on early stage lung cancer. We present a rational approach to the workup and treatment of patients with head and neck cancer and a pulmonary nodule on chest radiography.
Partial Laryngectomy and Radiotherapy for Supraglottic Cancer: A Conservative Approach
Authors: Spaulding Cynthia A. , Levine Paul A. , Constable William C. , Cantrell Robert W.
Published: October 2014

This is a retrospective study of 33 patients with supraglottic cancer treated with partial laryngectomy and moderate-dose radiotherapy at the University of Virginia from 1967 through 1986. All patients had a 2-year minimum follow-up. Ten patients received preoperative radiotherapy, and 23, postoperative radiotherapy. The 2-year adjusted survival rate was impressive at 97%. Local control at 2 years was 96%, including one patient who was salvaged with total laryngectomy. Control of the neck was 90% at 2 years. Ninety percent of the patients alive at 2 years had a functional voice. One patient required a completion laryngectomy for chronic aspiration. Conservation surgery with radiotherapy provides excellent survival as well as locoregional control rates with preservation of function in selected patients with supraglottic cancer. This approach may be especially helpful in the management of bulky T2 lesions as well as T4 lesions with minimal vallecula or base of tongue involvement.
Sectional Anatomy of the Larynx: Implications for the Transcutaneous Approach to Endolaryngeal Structures
Authors: Lipton Richard J. , McCaffrey Thomas V. , Cahill Donald R.
Published: October 2014

A transcutaneous, transcricothyroid membrane approach to endolaryngeal structures is used for several techniques such as placement of electrodes for laryngeal electromyography and transcutaneous Teflon injection of the paralyzed vocal fold. The purpose of this study is to examine the sectional anatomy of the larynx with respect to the cricothyroid membrane and describe a suitable transcutaneous approach to endolaryngeal structures. Sixteen whole organ cadaveric larynges were frozen in clear gelatin to facilitate sectioning. Specimens were sectioned in the transaxial, sagittal, and coronal planes as well as 30°, 45°, and 60° from the transaxial plane. For clinical orientation, the transaxial plane was defined as 90° from the most anterior plane of the cricothyroid membrane. Sections were examined and angles and depths of penetration were measured with respect to the transcutaneous approach to endolaryngeal structures.
Blood Transfusions and Recurrence in Head and Neck Cancer
Authors: Jackson Robert M. , Rice Dale H.
Published: October 2014

Recent reports in the general surgery literature have shown decreased survival with blood transfusions in abdominal cancer surgery. We reviewed our experience with 100 consecutive patients, all of whom had 5-year follow-up, to see if this held true for head and neck cancer. The detailed report covers site and stage. In summary, however, the recurrence rate for all cancers of the larynx was 14% for those who did not receive blood and 65% for those who did. For cancer of the oral cavity, pharynx, and nose or sinus, the recurrence rate was 31% without transfusions and 71% with transfusions. It would appear that the use of blood transfusions somehow adversely affects the patient's survival. Further study needs to be done to elucidate the mechanism.
Otitis Media in the First Year of Life in Two Eskimo Communities
Authors: Stewart Joseph L.
Published: October 2014

Severe otitis media of early onset is particularly prevalent among Eskimo infants. An investigation of health records of all infants born in 1984 and served by two health facilities was undertaken to assess the relative significance of three particular variables associated with this problem: 1) sex versus age, 2) sex versus severity, and 3) sex versus other health conditions. Ninety-five percent of the children in one locale and 74.4% in the other had at least one episode during the first year of life. While none of the comparisons were statistically significant, infants at the northernmost community were generally more severely affected; females in each community were found to have 1) fewer and less severe episodes of disease, 2) the first episode at a later age, 3) fewer episodes during the year, and 4) fewer episodes of bilateral disease.
Lack of Effect of Carbonic Anhydrase Inhibition on Direct Measurements of Endolymph Bicarbonate
Authors: Isaacs John H. , Merwin Gerald E. , Pessah Ness , Maren Thomas H.
Published: October 2014

In the past, sodium, potassium, and chloride have been measured in endolymph directly, but bicarbonate has been measured only indirectly. We sampled endolymph directly while monitoring endocochlear potentials in normal and methazolamide-treated guinea pigs. Bicarbonate was determined in samples by use of a method that depends on reduction of NADH to NAD linked to malate formation from oxaloacetate. In 11 normal animals, the bicarbonate in endolymph was 20.2 m M ± 4.4 m M (mean ± standard deviation); in six of these, plasma bicarbonate was 23.1 m M ± 3.5 m M. Nine animals treated with methazolamide (carbonic anhydrase inhibitor) had an endolymph bicarbonate of 19.5 m M ± 3.9 m M; plasma bicarbonate in five of these was 25 m M ± 3.2 m M. Carbonic anhydrase inhibition did not significantly affect endolymphatic bicarbonate levels.
Effect of Vocal Fold Augmentation on Laryngeal Vibration in Simulated Recurrent Laryngeal Nerve Paralysis: A Study of Teflon and Phonogel
Authors: Trapp Terrence K. , Berke Gerald S. , Hanson David G. , Bell Theodore S. , Ward Paul H.
Published: October 2014

Flaccid laryngeal nerve paralysis may be treated by vocal fold augmentation with Teflon injection, which is successful to various degrees depending on the subjective interpretation of the patient or clinician. A new material, Phonogel, consisting of cross-linked bovine collagen, is available but not approved for human use in this area. Ten dogs were submitted to videostroboscopy, photoglottography, electroglottography, and acoustic analysis in the normal state, with simulated recurrent laryngeal nerve paralysis, and with injection of either Teflon or Phonogel. A statistical comparison and the advantages and disadvantages of each material are discussed in relation to this study and its clinical use.
Surgical Experience with Juvenile Nasopharyngeal Angiofibroma
Authors: Maharaj Daya , Fernandes Carlos M. C.
Published: October 2014

Our experience with 18 cases of juvenile nasopharyngeal angiofibroma (jna) over a period of 9 years is discussed. All cases were managed surgically: 17 via a transpalatal approach and one case by a combined transpalatal, lateral rhinotomy, and transantral approach. In this series there were two recurrences following primary surgical procedures and these required a second procedure. There were no major complications and all 18 patients are alive. We believe that surgical excision should be the treatment of choice for jna and that radiotherapy should be used adjunctively for cases wherein intracranial extension of the tumors prevents total excision.
Secretory IGA and Bacterial Adherence to Nasal Mucosal Cells
Authors: Kurono Yuichi , Fujiyoshi Tatsuya , Mogi Goro
Published: October 2014

The ability of Streptococcus pyogenes to adhere to nasal mucosal cells was investigated by an in vitro assay system in order to clarify the actual role of secretory IgA in mucosal immunity in the nose. The number of bacteria adhering to isolated mucosal cells was significantly larger in patients with chronic sinusitis than in normal control subjects. The ability of bacteria to adhere, however, was significantly lower in the group of subjects having specific secretory IgA antibody activity to the M protein than in those having no secretory IgA activity. Findings demonstrated that mucosal immunity preventing or blocking the adherence of bacteria is impaired in patients with chronic sinusitis.
Flexible Transbronchial Needle Aspiration for the Diagnosis of Sarcoidosis
Authors: Wang Ko Pen , Johns Carol J. , Fuenning Charles , Terry Peter B.
Published: October 2014

To determine the value of transbronchial needle aspiration biopsy in the diagnosis of sarcoidosis, we reviewed a 1-year experience of consecutive patients with sarcoidosis presenting with hilar and/or paratracheal adenopathy. The sensitivity of transbronchial needle aspiration biopsy in obtaining specimens of noncaseating granulomas was 90%. This yield exceeds that of most published reports of transbronchial lung biopsy and bronchial mucosal biopsy and suggests that transbronchial needle aspiration biopsy may be a valuable diagnostic tool in the evaluation of these forms of sarcoidosis.
Parapharyngeal and Retropharyngeal Space Diseases
Authors: Batsakis John G. , Sneige Nour
Published: October 2014

The involvement by a disease process of the parapharyngeal and retropharyngeal spaces poses significant diagnostic and therapeutic problems. Neoplasms, the majority histologically benign, comprise the greatest number of parapharyngeal space lesions. Inflammatory lesions and metastases to lymph nodes are the preponderant disorders affecting the retropharyngeal space.
Recurrent Tonsillitis: Histologic and Bacteriologic Evaluation
Authors: Bieluch Virginia M. , Chasin Werner D. , Martin Elizabeth T. , Tally Francis P.
Published: October 2014

Histologic and bacteriologic evaluations of tonsils removed at surgery from ten patients with a diagnosis of recurrent tonsillitis were performed. The bacteriology was complex, with an average of 6.3 aerobic bacteria and 3.3 anaerobic bacteria isolated from each patient. Histologic sections revealed chronic cryptitis, with intact tonsillar architecture. These findings provide a possible explanation for the failure of commonly used antibiotic regimens to eradicate recurrent infection from this site.
Dimensions of the Extended Facial Recess
Authors: Young Yi-Shyang , Nadol Joseph B.
Published: October 2014

The variability of the dimensions of the facial recess and extended facial recess with age, sex, and degree of pneumatization was measured in 87 temporal bones serially sectioned in the horizontal plane. Although some statistically significant differences in dimensions were identified, the absolute differences were small compared to the range of measurements. The mean dimensions were very similar in all groups studied. The clinical relevance of the data to mastoid surgery and cochlear implantation is discussed.
Otologic Histopathology of Fabry's Disease
Authors: Schachern Patricia A. , Paparella Michael M. , Shea Donald A. , Yoon Tae H.
Published: October 2014

Fabry's disease is a rare progressive X-linked recessive disorder of glycosphingolipid metabolism. The accumulation of glycosphingolipids occurs in virtually all areas of the body, including the endothelial, perithelial, and smooth-muscle cells of blood vessels, the ganglion cells of the autonomic nervous system, and the glomeruli and tubules of the kidney. Although otologic symptoms have been described in these patients, to our knowledge there have been no temporal bone histopathologic reports. We describe the clinical histories, audiometric results, and temporal bone findings of two patients with this rare disorder. Both patients demonstrated a bilateral sloping sensorineural hearing loss audiometrically. Middle ear findings of seropurulent effusions and hyperplastic mucosa were seen in all four temporal bones. Strial and spiral ligament atrophy in all turns, and hair cell loss mainly in the basal turns, were also common findings. The number of spiral ganglion cells was reduced in all temporal bones; however, evidence of glycosphingolipid accumulation was not observed in the spiral ganglia.
Effect of Temperature on Fixation Suppression Ability in Normal Subjects: The Need for Temperature-and Age-Dependent Normal Values
Authors: Jacobson Gary P. , Henry Kenneth G.
Published: October 2014

The purpose of the present investigation was to determine whether temperature has an effect on the magnitude of fixation suppression (FS) in normal subjects. The subject population consisted of 23 patients ranging in age from 35 to 74 years (mean age of 58.13 years). Each subject received a conventional vestibulometric test battery that included bithermal caloric testing and the FS test. The warm caloric media elicited larger nystagmus slow-phase eye velocities than the cool caloric media. Following warm caloric irrigations, FS was significantly smaller than that following cool caloric irrigations. It also worsened as a function of subject age. The results suggest that separate normal upper limits for FS need to be determined for cool and warm caloric testing. They also suggest that FS ability may decrease with age.