bluuebunny/crossref_metadata_2025 huggingface dataset:
A Surgical Alternative to Internal Maxillary Artery Ligation for Posterior Epistaxis
Authors: Anderson Robert G. , Shannon Donelson N. , Schaefer Steven D. , Raney Lewis A.
Published: November 2015

Posterior epistaxis is a disease of varying magnitude and is associated with considerable morbidity. Surgical management often consists of transantral ligation of the internal maxillary artery and its branches, with or without ligation of the ethmoidal arteries. Ten patients underwent an alternative surgical procedure in which the nasopharynx and posterior nasal cavity were indirectly examined for bleeding sites with a large laryngeal mirror. Nasal septal reconstruction with mobilization of the anterior cartilaginous septum from the maxillary crest allowed lateral displacement of the septum with excellent visualization of the lateral nasal walls. Hemorrhage was controlled by electrocoagulation of bleeding sites with a disposable, malleable suction electrocautery. No complications occurred in this group of 10 patients and no further epistaxis has been reported during a follow‐up of 17 to 35 months.
Stapedectomy Revision Following Sensorineural Hearing Loss
Authors: Lippy William H. , Schuring Arnold G.
Published: November 2015

This study analyzes 71 stapedectomies that resulted in a sensorineural hearing loss, followed by a revision stapedectomy on the suspicion of an oval window fistula. The cases were divided between two primary stapedectomy techniques: a stainless steel Robinson prosthesis on a vein graft and a wire prosthesis with Gelfoam. The major differences between the surgical findings of the two groups were the fistula rate with the wire prosthesis was 10 times that with the Robinson prosthesis; the wire prosthesis was longer than necessary in 21% of the cases in which it was used; there was no finding of excess length with the Robinson prosthesis; and after revision stapedectomy, dizziness was lessened in 20% of the patients in the Robinson prosthesis group, in 60% of those in the wire prosthesis group, and in 75% of those with fistula. Surgical directions are given for revision stapedectomy following a sensorineural hearing loss.
TORPs and PORPs: Causes of Failure – a Report on 446 Operations
Authors: Sheehy James L.
Published: November 2015

This is a review of the causes of failure in 5½ years of personal experience with TORPs and PORPs. Prosthesis extrusion, the cause of failure in less than 5% of 446 TORP and PORP operations, usually was the result of a mucous membrane or eustachian tube problem. Severe sensorineural hearing impairment occurred in less than 1%, and these were operations in which the oval window was opened. Unsatisfactory hearing was the cause of failure in 18%.
Caloric Tests
Authors: Hart Cecil W.
Published: November 2015

The caloric test is still the most useful vestibular test by far. Rotatory tests may allow more accurate control of the stimulus and the response parameters may vary less in normal individuals, but only the caloric test allows individual testing of each ear. By various means described in this article, it is possible to minimize potential sources of error and thus maximize the reliability of the test. Although the test allows a good measure of horizontal semicircular canal function and, by inference, an estimate of labyrinthine disease, the fact that the reflex arc traverses the vestibular nerve and brain stem renders this pathway liable to damage by central vestibular disease. Thus the electronystagmographic recording of the caloric nystagmus response may show a variety of changes, depending on the site and nature of the central vestibular lesion. Some of these changes are discussed.
A Discussion of the Dynamic Illegible “E” Test: A New Method of Screening for Aminoglycoside Vestibulotoxicity
Authors: Longridge N.S. , Mallinson A.I.
Published: November 2015

Although aminoglycoside antibiotics have been successful in controlling infections, the side effects of these drugs include vestibulotoxicity that can be irreversible. In a patient with intact visual and proprioceptive systems, the effects can be compensated for, but in a patient with impairment of one of these systems, loss of vestibular function can be devastating. There is little if any agreement in the literature about how to monitor patients undergoing therapy with these drugs. A reading test is described. It uses the ability of the vestibulo‐ocular reflex to stabilize an image during head movement. The test is quantified using change in visual acuity with head movement to monitor damage to the vestibular system. Patients with loss of vestibular function are incapable of performing the test. Some evidence points to the test being more sensitive than standard caloric irrigations. We propose that it be used to monitor patients receiving aminoglycoside antibiotics.
Placebo Effect in Tinnitus Management
Authors: Duckert Larry G. , Rees Thomas S.
Published: November 2015

Masking devices, lidocaine, and analog oral forms of lidocaine have all been reported as being effective forms of therapy to relieve tinnitus. Many studies, however, have used single‐blind protocols and were possibly biased by placebo effects. To investigate the contributions of a placebo effect in clinical tinnitus studies, 25 tinnitus patients who had received a placebo injection in a previous double‐blind lidocaine study were contacted on the pretense that they would receive a test dose of lidocaine; the 20 who responded were included in this study. A 5 cc bolus of placebo saline solution instead of lidocaine was then administered to each patient. Forty percent of the patients reported a change in their tinnitus following the placebo injection. The results of this study serve to point out the inherent flaws in straight clinical trials, and that the success rates achieved in such uncontrolled clinical investigations may be biased by the placebo effects.
Intraoperative Auditory Brain Stem Response Monitoring During Ultrasonic Aspiration of Posterior Fossa Tumors
Authors: Mangham Charles A. , Holmberg Tristan L. , Skalabrin Theresa A.
Published: November 2015

The use of an ultrasonic aspirator may decrease the morbidity associated with the surgical removal of Intracranial tumors by reducing the duration of surgery. In this study we monitored the auditory brain stem response (ABR) during ultrasonic surgical aspiration of 20 posterior fossa tumors. Twelve subjects had a transient decrement in the ABR during use of the ultrasonic aspirator; one had a temporary sensorineural hearing loss contralateral to the side of the surgery. Monitoring of the ABR during use of the ultrasonic aspirator in the posterior fossa helped minimize the risk of injury to normal structures. Changes in latency, amplitude, and Interpeak Interval of the ABR waves alert the surgeon to the need to adjust the aspirator settings or the conditions in the operative field before continuing to use the tool.
Surgical Treatment of Giant Hemangiomas of the Head and Neck
Authors: Shikhani Alain H. , Shehadi Sameer I.
Published: November 2015

This article is a review of 22 cases of giant hemangiomas of the head and neck treated at the American University of Beirut Medical Center over a 20‐year period 1964 to 1984. All these cases were treated by surgical excision. Two maneuvers designed to reduce blood loss during the operation are described: the placement of strangulating silk sutures around the periphery of the hemangioma, and temporary occlusion of the ipsilateral external carotid artery. These cases were studied as to age, sex, site, size of hemangioma, histopathologic characteristics, mode of treatment, and results. A review of the literature and current modes of treatment of hemangiomas of the head and neck is also presented and our results are compared with those in other published reports. The surgical approach as a primary and definitive treatment for these giant hemangiomas is emphasized.
Magnetic Resonance Imaging of the Larynx: A Correlation with Histologic Sections
Authors: Wortham Donald G. , Hoover Larry A. , Lufkin Robert B. , Fu Yao S.
Published: November 2015

To date, high‐resolution computed tomographic (CT) scanning has proved to be the most valuable preoperative study for the evaluation of the anatomic extent of head and neck cancers. Now, with the development of magnetic resonance (MR) imaging, the prospect of having an equally reliable test without associated radiation exposure has emerged. This study is designed to compare MR images of the larynx with corresponding histologic sections obtained by step‐serial sectioning of whole organ specimens. Images were generated by a 0.3 Tesla permanent magnet MR imager. Additional correlation with CT scans was obtained when possible. CT resolution proved to be slightly superior in the axial plane but markedly inferior to MR imaging in the coronal and sagittal planes. Overall, MR imaging appeared to have good resolution of the larynx.
Squamous Metaplasia in the Trachea: The Tracheotomized Rabbit as an Experimental Model and Implications in Recurrent Papillomatosis
Authors: Shikowitz Mark J. , Steinberg Bettie M. , Winkler Barbara , Abramson Allan L.
Published: November 2015

Squamous metaplasia following tracheotomy has been well documented. Most studies have dealt primarily with changes at—or adjacent to—the cuff site and have failed to evaluate its effect in the distal trachea. We have used rabbits as experimental models for the induction of tracheal squamous metaplasia, using uncuffed tracheotomy tubes. Rabbits were routinely killed 24, 36, 48, 72, 120, and 168 hours posttracheotomy, and the entire larynx, trachea, and main‐stem bronchi were step‐sectioned for histologic examination. Patchy areas of squamous metaplasia were found in all rabbits with tracheotomy equal to or longer than 48 hours. The metaplasia appeared to increase with time of intubation. Induction of squamous metaplasia (following tracheotomy as a contributing factor to the spread of laryngeal papillomatosis) is discussed.
Incendiary Characteristics of a New Laser‐Resistant Endotracheal Tube
Authors: Hayes David M. , Gaba David M. , Goode Richard L.
Published: November 2015

Endotracheal tube fires are the most frequent complication of laser surgery of the larynx. We investigated the incendiary characteristics of a new laser‐resistant endotracheal tube, compared to polyvinyl chloride (PVC) and red rubber (RR) tubes, with different gas mixtures. A CO2 laser was focused on each tube and the probability of fire was assessed with oxygen fractions (FiO2) of 30%, 40%, 50%, 70%, and 100%, the balance being N2 or N2O. The laser‐resistant tube could not be penetrated by a single laser pulse, regardless of laser energy or gas composition. PVC and RR tubes were readily ignited, the probability of ignition being related to oxygen concentration and laser energy. Nitrous oxide readily supported combustion. We suggest that laser surgery of the larynx can be most safely performed with a laser‐resistant endotracheal tube and with gas mixtures containing the minimal safe O2 concentration (without nitrous oxide).
Influence of Embryonal Fusion Lines for Recurrence of Basal Cell Carcinomas in the Head and Neck
Authors: Granström Gösta , Aldenborg Frank , Jeppsson Pål‐Henry
Published: November 2015

A reinvestigation of 171 basal cell carcinomas of the head and neck treated by surgical excision revealed 23 recurrences. Recurrence rate in one group of basal cell carcinomas, situated on embryologic fusion lines, was statistically higher than in other groups of basal cell carcinomas situated on other parts of the face and on the capillitium which served as control. Histopathologic subclassification of the recurrent basal cell carcinomas revealed a higher incidence of nodular type with infiltrative margin and of the infiltrative type. Basal cell carcinomas situated in fusion lines tended to grow deeper than in other sites. It was concluded that embryologic fusion lines in the face provide risk zones for spread and recurrence of basal cell carcinomas. Subclassification of basal cell carcinomas should be performed in the routine histopathologic reporting of these neoplasms as a means of predicting recurrence.
A Simple Autologous Fibrinogen Glue for Otologic Surgery
Authors: Moretz William H. , Shea John J. , Emmett John R. , Shea John J.
Published: November 2015

A simple method of concentrating a patient's own fibrinogen for use with a thrombin/calcium solution—to produce a coagulum‐type tissue glue for otologic surgery—is presented. The principal advantages of this system include a simple modification of the cryoprecipitate technique, which can be easily performed in any hospital laboratory using a minimal amount of the patient's blood, and the use of autologous fibrinogen, which completely rules out the possibility of transmission of hepatitis or AIDS viruses. Useful tips on preparation and use of this autologous tissue glue, based on experience over the past 2 years, will be presented.
Carcinoid tumor of the larynx: Case report and review of the world literature
Authors: Snyderman Carl , Johnson Jonas T. , Barnes Leon
Published: November 2015

The clinical, light microscopic, and ultrastructural features of a carcinoid tumor occurring in the larynx of an 80‐year‐old man are presented and compared with 22 laryngeal carcinoids described in the world literature. These 23 tumors occurred in persons from 45 to 80 years of age (mean age was 61 years) and were three times more common in men than in women. Hoarseness was the most common presenting symptom. Sixty‐one percent of the tumors were supraglottic, 26% were transglottic, 4% were glottic, 4% were subglottic, and 4% were unspecified. At least 15 (65%) of the patients are known to have developed metastases. Nine of these (60%) presnted with only regional lymph node metastases, one of which was occult. Surgery is the treatment of choice, with the extent dependent on the stage of disease. Radiation therapy appears ineffective, and chemotherapy is largely untested. The 2‐ and 4‐year determinate survival rates were 59% and 25%, respectively.
Postauricular Undersurface Tympanic Membrane Grafting: Some Modifications of the “Swinging Door” Technique
Authors: Schwaber Mitchell K.
Published: November 2015

Following Palva's1 original description of the technique, the “swinging door” tympanoplasty was modified and reported by several otologic surgeons, including Glass‐Cock,2,3 Fisch,4 Smyth,6 Pennington.6 The basic technique involves the elevation of superiorly based and inferiorly based canal skin flaps, or “swinging doors.” After dividing the posterior anulus, the flaps are rotated anteriorly, a maneuver that provides ample exposure of the middle ear and greatly simplifies underlay fascia grafting. The purpose of this article is to review this basic technique and to describe additional modifications that further simplify tympanoplasty grafting. These modifications include (1) canal flap advancement, (2) the use of multiple fascia grafts, (3) techniques for securing the graft to the malleus handle, and (4) the use of tragal cartilage in grafting. With this technique, a 95% take rate was observed at 3 months, and the graft was firmly attached to the malleus handle in all cases.
Middle Ear Cilia Activity as a Determinant of Tympanostomy Tube Placement
Authors: Wacker Douglas F. , Howe Maridel L.
Published: November 2015

Three hundred and twenty‐six patients with diagnoses of serous otitis media—or mucold otitis medid—were reviewed for the presence or absence of middle ear cilia activity. This study strongly suggests that if active cilia can be observed, ventilating tubes are not needed. This easily observed activity in the anterior‐inferior quadrant offers the otolaryngologist an accurate tool for determination of the future health of the middle ear.
Vestibular Responses to Pressure Variations: A Review
Authors: Britton B. Hill
Published: November 2015

A selected review of the literature concerning different forms of pressure stimulation of the normal and abnormal vestibular labyrinth is presented. On the basis of this review, it can be stated that there are definite vestibular signs and symptoms associated with pressure stimulation. The exact mechanisms remain in doubt. The responses, however, appear to be mediated through the vestibular hair cells.
The Unrecognized Rotation of the Vestibular and Cochlear Nerves from the Labyrinth to the Brain Stem: Its Implications to Surgery of the Eighth Cranial Nerve
Authors: Silverstein Herbert , Norrell Horace , Haberkamp Thomas , McDaniel Alan B.
Published: November 2015

The cochlear and vestibular nerves rotate 90 degrees from the inner ear to the brain stem. Most of the rotation occurs within the internal auditory canal (IAC); only minimal rotation occurs in the cerebellopontine (CP) angle. At the labyrinthine end of the IAC, the cochlear nerve—which at first lies anterior to the inferior vestibular nerve (saccular nerve)—rapidly fuses with the inferior vestibular nerve. It then rotates to become inferior as the nerves leave the porus acousticus. The cochleovestibular (C‐V) cleavage plane lies in a superior‐inferior direction in the lateral IAC and rotates to become anterior‐posterior in the CP angle. In 25% of patients in whom no C‐V cleavage plane can be seen, it is not possible to completely transect all vestibular fibers. The surgical implications are that (1) the most complete vestibular neurectomy can be done only in the lateral IAC, (2) the cochlear and inferior vestibular nerves, because of their intimate association, should not be separated in the mid‐IAC, in order to prevent damage to the cochlear nerve, and (3) to create a complete denervation of the vestibular labyrinth, only the posterior ampullary nerve along with the superior vestibular nerve should be transected.
Computerized Nuclear Morphometry: A Reproducible Cytopathologic Marker of Head and Neck Cancer
Authors: Davis R. Kim , Fox Cecil , Heffner Dennis K.
Published: November 2015

Computerized nuclear morphometry (CNM) has been compared with the standard histopathologic grading of squamous cell carcinoma in patients who have undergone chemotherapy for head and neck cancers. Statistics were significant between the histopathologic and CNM readings that were done. CNM represents an objective method of quantitating the histopathologic readings of nuclear pheomorphism and cancer differentiation to allow these criteria to be used as prognostic indicators in squamous cancers. CNM readings of individual biopsy specimens from patients were shown to characterize each tumor. This may represent a cytopathologic method for tracking a cancer through whatever course of therapy is given.
Electrically Evoked Brainstem Responses in Cochlear Implant Recipients
Authors: Miyamoto Richard T. , Brown D. Douglas
Published: November 2015

Electrical stimulation of the auditory nerve in the profoundly deaf population through implanted cochlear prostheses has increased the need for reliable electrophysiologic assessment tools. We have recorded electrically evoked brainstem responses (EABRs) in 21 subjects who have received a 3M/House cochlear implant. Recordings have been made, both intraoperatively and postoperatively, in the laboratory setting. The recording technique, methods of stimulus artifact suppression, and results of our measurements are described. Clinical applications of this technology are suggested.
Part I. DNA Flow Cytometry as a Prognostic Indicator in Head and Neck Cancer
Authors: Goldsmith Manning M. , Cresson David H. , Arnold Larry A. , Postma Duncan S. , Askin Frederic B. , Pillsbury Harold C.
Published: November 2015

The prognostic significance of deoxyribonucleic acid (DNA) flow cytometry has been investigated for many solid tumors, but few data have been accumulated for squamous cell carcinomas of the head and neck. To our knowledge, we report the largest number of patients (69) with head and neck primary carcinomas to be studied by DNA flow cytometry. In the first part of this study, we reviewed 109 consecutive patients with laryngeal or hypopharyngeal primary carcinomas which were treated at North Carolina Memorial Hospital during the period of 1981 to 1984. The final analysis comprised 139 DNA histograms (mean coefficient of variation: 8.02) on paraffin‐embedded specimens from 48 patients. Of the 48 patients with primary carcinomas, 24 had glottic, 18 had supraglottic, and 6 had carcinomas from the piriform sinus. Patients had follow‐up for a minimum of 12 months, with a mean follow‐up period of 23 months. Twenty‐three of the 48 primary carcinomas (48%) were clearly aneuploid, and the remaining 52% were tetraploid (22%) or diploid (30%). We have concluded that patients with clearly aneuploid primary carcinomas had significantly better prognoses than those with diploid tumors (p = 0.008). High DNA amounts (greater than 40% of cells beyond the diploid peak, DNA G1GO) also correlated with a favorable prognosis when compared with low DNA amounts (p <0.01), and this remained significant when the clinical outcome was adjusted for staging of the primary site (T), nodal status, and stage of disease. Ploidy was the most significant prognostic variable for the laryngeal group of patients. In the second part of the study, twenty‐one patients with oral cavity squamous cell carcinomas were studied in a similar fashion as the group with laryngeal carcinomas. In this group, a low DNA amount, with 40% as the cutoff point, was associated with a favorable prognosis (p = 0.024), and this remained significant while controlling for I, nodal status, and stage of disease. Numbers were too small to permit evaluation of the impact of ploidy in this group, but there was a slight trend toward aneuploidy and tetraploidy, correlating with a poor treatment outcome (p = 0.228). DNA amount was the most significant prognostic variable for the group of patients with oral cavity carcinomas. We conclude that DNA flow cytometry may be a powerful prognostic indicator in malignant conditions of the head and neck. The implications of these data for the management of head and neck cancer are discussed.
Part II. The Prognostic Significance of Stromal Eosinophilia in Head and Neck Cancer
Authors: Goldsmith Manning M. , Cresson David H. , Askin Frederic B.
Published: November 2015

The pathologies of 82 head and neck tumors were examined for histologic features suggestive of poor prognoses. Twelve descriptive histopathologic variables, including two grading scales for malignant tumors, were correlated with DNA flow cytometric data and clinical outcome. We found no correlation between the grading scales and DNA flow cytometric data or clinical outcome. Only one of the histopathologic variables—stromal eosinophilia—was found to significantly correlate with favorable outcome (p =. 018). Stromal eosinophilia may be an important new prognostic indicator for head and neck cancer.
The Course of Laryngeal Papillomatosis Modified by CO2 Laser Surgery
Authors: Wetmore Stephen J.
Published: November 2015

Although carbon dioxide laser therapy has been the preferred treatment for laryngeal papillomatosis for the past 10 to 15 years, only one major study has been published on the effect of laser surgery on the course of this disease. This report presents 46 patients who were treated by laser microlaryngoscopy during a 7(1/2) year period at the University of Arkansas for Medical Sciences. Among the 37 patients with adequate follow‐up, 13 (35%) have gone into remission. The remission rate was 69% among patients who had exhibited laryngeal papillomatosis for 5 years or less, compared with a 10% remission rate in patients who had the disease for more than 5 years. None of the patients went Into remission at puberty.
Effects of Dexamethasone and Oxymetazoline on “Postintubation Croup”: A ferret model
Authors: Woods Charles I. , Postma Duncan S. , Prazma Jiri , Sidman James
Published: November 2015

Several studies recommend the use of steroids and racemic epinephrine for treatment of postintubation croup. Few controlled clinical or laboratory studies, however, support their effectiveness, and many questions remain about their use. The present study was undertaken to develop a reproducible animal model for postintubation croup and to perform initial controlled studies of the effects of dexamethasone (4 mg/kg) and the long‐acting vasoconstrictor oxymetazoline (0.01 solution). An animal model for intubation trauma was developed with ten 10‐week‐old ferrets. Two models were created to reflect the spectrum of trauma—from simple mucosal contusion to mucosal ulceration. The first was to surgically strip mucosa in a circumferential manner at the level of the cricoid ring; the second was intubation trauma to the glottic and subglottic regions by use of a circular brush. Neither dexamethasone nor oxymetazoline had any statistically significant effect on subglottic edema in the mucosal stripping model. In the brush intubation model, oxymetazoline decreased subglottic edema at 2, 4, and 8 hours (P < 0.05), while dexamethasone and combination therapy decreased edema at 2,4, 8, and 24 hours (P < 0.05). At 24 hours, combination therapy was demonstrated to be the most effective in reducing subglottic edema. Oxymetazoline was as effective as dexamethasone and combination therapy at 2, 4, and 8 hours (P < 0.05). In this preliminary study, we have established the potential usefulness of the brush intubation model for the study of this disorder. This model was shown to have a reproducible and reversible lesion. The mucosal stripping model was not shown to have reversible lesion and—while further study needs to be performed—may only be useful as a model for very severe cases of this disorder. These initial studies also demonstrated high‐dose dexamethasone and oxymetazoline to be effective in treatment of subglottic edema secondary to mucosal trauma. They also indicate that combination therapy is a more effective treatment than either agent alone.
Successful Replantation of Amputated Nose and Auricle
Authors: Fuleihan Nabil S. , Natout Mohamed Aliy. , Webster Richard C. , Hariri Nazih A. , Samara Milhem A. , Smith Richard C.
Published: November 2015

Amputations of the nose and of the auricle present difficult management problems. Application of simple reattachment techniques, followed by aggressive medical therapy which consists of cooling, anticoagulation, antibiotic coverage, and multiple stab incisions in the amputated tissues, have resulted in the successful replantation of major portions of an amputated nose and an amputated auricle with satisfactory cosmetic results.
Laryngeal Chemoreflex: Anatomic and Physiologic Study by use of the Superior Laryngeal Nerve in the Piglet
Authors: Goding George S. , Richardson Mark A. , Trachy Ronald E.
Published: November 2015

The laryngeal chemoreflex (LCR) was investigated in 21 piglets (ages 6 to 80 days old) with the use of physiologic and histologic techniques. The central projection of the superior laryngeal nerve (SLN) was determined in 14 animals by use of horseradish peroxidase‐wheat germ agglutinin. Ipsilateral labeling of the solitary tract nucleus was seen. The caudal extent of the labeling varied with age. Sensory labeling of the nucleus ambiguus was present bilaterally in three younger animals and unilaterally in older piglets. Bilateral labeling of the nucleus dorsomedialis was seen in all ages. Apneic and cardiovascular response to water stimulation of laryngeal mucosa and the laryngeal adductor reflex (LAR) were examined in 16 piglets. Blunting of the apneic and cardiovascular response was seen after sacrifice of a single SLN. Hypoxia did not significantly affect the LAR or apnea duration in animals with only one intact SLN. A contralateral LAR was found in younger animals. Relevance to the LCR is also discussed.
Retrosigmoid‐internal Auditory Canal Approach vs. Retrolabyrinthine Approach for Vestibular Neurectomy
Authors: Silverstein Herbert , Norrell Horace , Smouha Eric E.
Published: November 2015

A new procedure, the retrosigmoid‐internal auditory canal (RSG‐IAC) vestibular neurectomy, has been developed, presented, and compared with the retrolabyrinthine vestibular neurectomy (RVN). The RSG‐IAC involves a 3 cm retrosigmoid craniotomy removal of the posterior wall of the internal auditory canal (IAC) to the singular canal, with transection of the superior vestibular nerve and the posterior ampullary nerve. This effects a complete denervation of the vestibular labyrinth and preserves the patient's hearing. All 11 patients with Meniere's disease were cured of vertigo. Hearing was preserved to within 10 dB of the preoperative pure‐tone average (PTA) in 9 of 11 cases. There were no serious complications and no cases of facial paralysis or total hearing loss. The major postoperative problem is persistent headache that necessitates medication. These results compare favorably with—and may be better than those noted after—the RVN procedure. The RSG‐IAC vestibular neurectomy is an important improvement in the evolution of vestibular neurectomy for the treatment of vertigo. A prospective study is now in progress to determine which procedure—the RSG‐IAC or RVN—best fulfills the goals of vestibular neurectomy.
Cystic Fibrosis—An Otolaryngologic Perspective
Authors: Cepero Ralph , Smith Richard J.H. , Catlin Francis I. , Bressler Kyle L. , Furuta Glenn T. , Shandera Kevin C.
Published: November 2015

Cystic fibrosis (CF) is the most common lethal genetic disorder in white patients. The protean manifestations of the disease result from exocrine gland dysfunction and include chronically debilitating pulmonary and pancreatic compromise and clinically inconsequential (although diagnostically extremely important) sweat electrolyte abnormalities. The subject of this article is the otolaryngologic manifestations of the disease, based on a retrospective analysis of 450 cases. Nasal polyposis and sinusitis occurred in 10% and 11% of patients, respectively, and polypectomy was, after laparotomy, the most common surgical procedure these children underwent. The extent of intranasal surgery for polyposis was found to be inversely proportional to the recurrence rate. A simple polypectomy was relatively ineffective treatment; when performed in conjunction with a Caldwell‐Luc and either an intranasal or extranasal ethmoidectomy, the recurrence rate was less than 13%. Otologic problems, found in 8% of patients, included chronic otitis media (2.5%) and acute otitis media (5.5%). Only five patients required pressure‐equalizing tubes. Recent genetic advances of immense importance are also described. Although the basic gene defect has yet to be elucidated, by use of a technique known as restriction‐fragment‐linked polymorphism, the gene associated with CF has been found in the middle of the long arm of chromosome 7. By following gene markers closely associated with this gene, it is possible to do carrier tests within affected families and, if certain criteria are met, perform prenatal diagnosis. Eventual isolation and characterization of the gene will follow, hopefully making prevention possible and treatment more effective.
Planning and Management of Long‐Standing Tracheostomy
Authors: Eliachar Isaac , Stegmoyer Robert J. , Levine Howard L. , Sivak Edward D. , Mehta Atul C. , Tucker Harvey M.
Published: November 2015

Long‐term effects of tracheostomy can include structural changes in the anterior tracheal wall and larynx as a result of pressure, friction, and deformation by the relationship between the curved cannula, the trachea, the larynx, and the upper border of the sternum. High‐placed stoma, flexed cervical position, and short, obese necks are predisposing anatomic relationships, in some long‐standing tracheostomies, progressive erosion of the upper anterior tracheal wall and cricoid arch is observed, often with secondary subglottic stenosis. No discussion of measures to prevent or correct these problems was found in a review of the literature. This article discusses surgical techniques to (1) prevent laryngotracheal erosion and (2) repair and reconstruct an airway that is already damaged. A superiorly based tracheostomy flap and a muscular sling are designed to buttress the tracheostomy. Results and follow‐up are also reported.
A Review of the Published Data on Steroids and Idiopathic Facial Paralysis
Authors: Stankiewicz James A.
Published: November 2015

Ever since idiopathic facial paralysis (IFP) was first described, several treatments have been tried In an effort to influence early and full recovery. Unfortunately, none of these treatments was effective. After Rothendler's case description in 1951,’ a multitude of papers have appeared that evaluate the effectiveness of steroids in idiopathic facial paralysis. My presentation reflects a close evaluation of 94 of these papers. Only a few properly controlled, randomized, prospective studies were available. Their main conclusion was that steroid treatment was not more beneficial than conventional treatment. To the contrary, several other less valid prospective and retrospective studies suggest that steroid treatment is beneficial. The definitive, statistically valid study concerning the benefits of steroids in treatment of idiopathic facial paralysis has yet to be performed. Until then, treatment of idiopathic facial paralysis continues to be controversial.
Oral Dantrolene Sodium for Tonsillectomy Pain: A Double‐Blind Study
Authors: Salassa John R. , Seaman Samuel L. , Ruff Tibor , Lenis Armando , Bellens Edward E. , Brown Aubrey K.
Published: November 2015

Tonsillectomy in adults and older children is typically accompanied by 7 to 14 days of pain. On the basis of clinical observations of patients treated perioperatively with dantrolene sodium for malignant hyperthermia, we hypothesized that pharyngeal muscle spasms are a major factor in tonsillectomy pain. We entered 113 patients, 11 years of age and older, into a double‐blind, placebo‐controlled study to evaluate the effectiveness of dantrolene sodium in reduction of tonsillectomy pain. Patients were randomly assigned either dantrolene (1.5 mg/kg per day) or placebo orally four times a day for 5 days postoperatively. On a standardized questionnaire, the patient recorded pain, diet, activity level, analgesics, and side effects, daily for 2 weeks. Also, alkaline phosphatase (alk phos) and serum aspartate aminotransferase (SGOT) levels were determined before the operation and 2 weeks after. Patients who received dantrolene had no significant differences in subjective pain, diet, or activity level scores from those of patients who received placebo. Dantrolene patients did, however, require significantly less analgesic use than placebo patients (p = 0.034, 0.015, and 0.005 for postoperative days 2, 3, and 4, respectively). There was no significant difference in side effects or changes in liver enzyme between the dantrolene and placebo groups. We conclude that dantrolene sodium, given in the dosage noted, is effective in reduction of analgesic requirements after tonsillectomy.
Malignant Nerve Sheath Tumors of the Head and Neck
Authors: Hoffmann Dieter F. , Everts Edwin C. , Smith James D. , Kyriakopoulos Damianos D. , Kessler Stephen
Published: November 2015

Malignant nerve sheath tumors comprise approximately 5% of all soft tissue sarcomas; only 8% to 15% of these tumors arise in the head and neck. Most tumors appear as a rapidly expanding nonpainful mass in the face or lateral neck. Reported association with Von Recklinghausen's disease varies from 26% to 70%. Wide surgical excision is generally the recommended primary treatment. Recently, there has been a trend to include postoperative radiation therapy as a primary modality.
VIP Potentiates Cholinergic Effects on the Mucociliary System in the Maxillary Sinus
Authors: Lindberg Sven , Cervin Anders , Mercke Ulf , Uddman Rolf
Published: November 2015

The neuropeptide vasoactive intestinal polypeptide (VIP), which is found in a population of cholinergic parasympathetic neurons in the airways, has no effects per se on mucociliary activity. In order to test the hypothesis that VIP may modulate cholinergic regulation of the mucociliary system, VIP was infused intraarterially (8.4 pmol/kg/min), and the response to challenges with methacholine in the maxillary sinus of rabbits were recorded with a photoelectric technique. Occurrence of VIP‐like immunoreactivity in the rabbit maxillary sinus, maxillary nerve, and sphenopalatine ganglion was investigated. Immunoreactivlty against VIP was found in nerve fibers in the subepithelial layer of the maxillary sinus and in numerous nerve cell bodies in the sphenopalatine ganglion. Infusion of VIP potentiated the mucociliary increase induced by methacholine. The mucociliary wave frequency change increased from 6.1% ± 1.7% to 13.3% ± 3.9% (0.01 μg/kg methacholine), from 11.6% ± 3.6% to 18.8% ± 2.2% (0.05 μg/kg) and from 17.0% ± 3.0% to 27.4% ± 3.6% (0.1 μg/kg). Both peak responses and response durations increased during infusions. In contrast, the vasodilating agent papaverine sulphate did not influence the mucociliary response to methacholine. The modulating effect of VIP on the mucociliary system, taken together with the morphologic observations, suggest that VIP may have a physiologic role in the regulation of the mucociliary system in the maxillary sinus.
Intracranial and Intratemporal Meningiomas with Primary Otologic Symptoms
Authors: Kumar Arvind , Mafee Mahmood , Vassalli Luca , Applebaum Edward L.
Published: November 2015

Intratemporal extensions of cerebellopontine angle (CPA) meningiomas are unusual and primary intratympanic meningiomas are extremely rare. The initial symptoms of both types are otologic. The presenting symptoms of even large meningiomas of the cerebellopontine angle can also be otologic. In this article we report the clinical features, diagnosis, and management of five CPA meningiomas, three combined intratemporal and CPA meningiomas, and one primary intratympanic meningioma.
Laryngeal Reflex Mechanism during Deglutition—Observation of Subglottal Pressure and Afferent Discharge
Authors: Shin Takemoto , Maeyama Tadatsugu , Morikawa Ikuro , Umezaki Toshiro
Published: November 2015

In this investigation, particular attention was paid to elucidate the laryngeal reflex mechanism of protective closure and the sensory function of the larynx during deglutition. For this purpose, three different experimental procedures were adopted: (1) subglottal pressure of felines was measured during deglutition using a pressure transducer; (2) subglottal pressure of human beings was measured during deglutition using a pressure transducer; and (3) afferent discharges from superior and recurrent laryngeal nerves of felines were recorded. The following conclusions appear justified. (1) Feline and human subglottal pressure during deglutition showed the following pattern. The pressure rises with onset of deglutition, temporarily drops during laryngeal elevation, rises again during the downward movement of the larynx, and drops again at the end of the glutltion. This pattern was not affected by the resection of the unilateral recurrent laryngeal nerve. (2) The superior laryngeal nerve is involved in the sensory function of the pharynx, larynx, and trachea. At least two types of afferent discharges from superficial and infernal sensory nerves are suspected. Afferent discharges from the recurrent laryngeal nerves in the larynx and trachea are not as distinct as those of the superior laryngeal nerve, and this seems to correspond with various changes in the thorax. During deglutition, afferent discharges were recorded from superior to recurrent laryngeal nerves.
Surgical Anatomy of the Lateral Nasal Wall
Authors: Calhoun Karen H. , Rotzler William H. , Stiernberg Charles M.
Published: November 2015

Both the success and safety of intranasal functional endoscopic sinus surgery depend on the surgeon's knowledge of nasal and sinus anatomy, especially the lateral nasal wall. The purpose of this study was to determine measurements and angles between lateral nasal wall landmarks. Linear and angular measurements were made to determine the mean and range distances between selected structures. The results provide a guide for the surgeon.
Infralabyrinthine Approach to the Internal Auditory Canal
Authors: Vernick David M.
Published: November 2015

Multiple surgical procedures have been developed to expose the contents of the internal auditory canal. These include the middle fossa approach, the posterior fossa approach, the retrolabyrinthine approach, and the retrosigmoid approach. Each has its own unique benefits, as well as disadvantages. A new posterior‐inferior approach to the internal auditory canal (the infralabyrinthine approach) has been developed. This approach affords exposure of at least the medial half of the internal auditory canal while remaining extradural and extralabyrinthine. By dissecting below the posterior semicircular canal, and remaining extradural, hearing is preserved. The dissection can proceed far enough laterally in the internal auditory canal to separate the cochlear and vestibular nerve divisions. Further anatomic considerations, as well as clinical applicability, will be discussed.
Vestibular compensation after labyrinthectomy and vestibular neurectomy in cats
Authors: Cass Stephen P. , Goshgarian Harry G.
Published: November 2015

Labyrinthectomy and vestibular neurectomy are two ablative procedures used for definitive control of disabling vertigo. It is not known if vestibular compensation after labyrinthectomy and vestibular neurectomy differs. We have addressed this question by examining the pattern of recovery of the vestibular ocular reflex in cats after either labyrinthectomy or vestibular neurectomy. Temporal bone jhistologic examination confirmed the surgical lesion. Our results demonstrate a reduction of the long time constant of the vestibular ocular reflex in both groups of animals. Although gain of the vestibular ocular reflex recovered substantially, it never returned to control levels in either group. In general, animals that had undergone vestibular neurectomy demonstrated greater vestibular ocular reflex asymmetries than did labyrinthectomized animals. The recovery pattern of the vestibular ocular reflex indicates vestibular compensation is more rapid after labyrinthectomy than after vestibular neurectomy. We believe this result is related to survival of the vestibular nerve after labyrinthectomy, but not after vestibular neurectomy, suggesting that the vestibular nerve can contribute to the adaptive response after labyrinthectomy.
Transcanal infracochlear approach to the petrous apex
Authors: Giddings Neil A. , Brackmann Derald E. , Kwartler Jed A.
Published: November 2015

Computerized tomography and magnetic resonance imaging have now made it possible to reliably differentiate cholesteatoma from cholesterol granuloma of the petrous apex. The treatment for cholesteatoma is complete surgical excision when possible, whereas cholesterol granuloma needs only adequate drainage for control. A new transcanal infracochlear approach for drainage of cholesterol granuloma involving the anterior petrous apex is described. Absolute measurements from 10 cadaveric temporal bones were obtained to determine the distances between the cochlea, jugular bulb, carotid artery, and facial nerve. In all specimens the petrous apex was entered without invading the cochlea, carotid, or jugular bulb. Advantages of this technique include a more direct route to the petrous apex, dependent drainage, and preservation of the normal hearing mechanism, including the tympanic membrane. Clincial indications for this technique include failure of other treatment approaches and a high jugular bulb obstructing an infralabyrinthine approach. Experience to date shows that patients experience little difficulty from the procedure.
The modified transcochlear approach to the cerebellopontine angle
Authors: Horn Karl L. , Hankinson Hal L. , Erasmus Mark D. , Beauparalant Pamela A.
Published: November 2015

We have modified the transcochlear approach to improve exposure of the anterior petrous apex, clivus, anterior cerebellopontine angle, and the prepontine region. These changes include resection of the external auditory canal, middle ear, glenoid fossa, and posterior zygomatic arch. This approach provides improved exposure of the petrous carotid artery, jugular bulb, and clivus. It offers the largest and most lateral access to the anterior cerebellopontine and prepontine region. The results of this approach in 11 patients are discussed.
The electrically evoked vestibulo‐ocular reflex: I. normal subjects
Authors: Moore Dennis M. , Hoffman Larry F. , Beykirch Karl , Honrubia Vicente , Baloh Robert W.
Published: November 2015

Recent animal studies indicate that electric currents applied through perilymphatic‐space electrodes stimulate vestibular primary afferent neurons directly. These findings suggest that electrical stimulation may provide a testing method by which the vestibular nerve and central pathways could be evaluated separately from the vestibular end‐organ. The goal of this study was to obtain normative data on human beings for an electrically evoked vestibulo‐ocular reflex (EVOR). Sinusoidal electrical stimuli (0.0125 to 0.8 Hz, 4 mA peak intensity) were applied along the interaural axis through mastoid electrodes in 10 subjects. Horizontal eye movements were recorded by an infrared limbus‐tracking device. The subjects also underwent rotational stimulation at the same frequencies so that their horizontal vestibulo‐ocular reflex (VOR) could be evaluated. Nystagmus was observed in the EVOR at lower stimulus frequencies, whereas purely sinusoidal eye deviations occurred at higher frequencies. The phase of the EVOR slow‐component eye velocity consistently lagged the stimulus. This contrasts with the phase measurements of the VOR in the same subjects, which exhibited a lead relative to head velocity. These findings suggest that currents applied to human beings may activate vestibular primary afferents independent of peripheral receptor mechanisms and thereby provide a “site‐of‐lesion” testing method by which the vestibular nerve and central pathways can be evaluated separately from the vestibular end‐organ.
Radiographic evaluation and diagnosis of the failed frontal osteoplastic flap with fat obliteration
Authors: Catalano Peter J. , Lawson William , Som Peter , Biller Hugh F.
Published: November 2015

In the absence of evidence of suppurative disease, clinical assessment of the symptomatic patient after frontal osteoplastic flap with fat obliteration is difficult because the cause of the pain is often neuralgic or from chronic vascular headache. Among 59 patients who have undergone this procedure at our institution since 1979, four required revision surgery. These patients were evaluated by computed tomographic and magnetic resonance scans, and the radiographic findings were compared with those present in 20 asymptomatic subjects. On the basis of the results of this study, we believe we can objectively identify those patients with chronic pain in whom the operation has been unsuccessful. A review of our experience with this procedure is presented along with criteria that enable early diagnosis of recurrent disease in the frontal sinus after osteoplastic sinusotomy.