bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of Eustachian Tube Ligation on Auditory Nerve Responses to Clicks
Authors: Wiederhold Michael L. , Martinez Serge A. , Scott Robert E. C. , Defries Hugh O.
Published: January 2017

Auditory nerve responses to condensation and rarefaction clicks were recorded from the external ear canal of cats using a closed acoustic system. Repeated control recordings from both ears formed a baseline for each of four animals used in this study. After a baseline had been established, the Eustachian tube on one side was ligated and serial recordings of N1 responses were performed for up to 140 days postligation. By comparing the shift which occurred in the N1 latency-vs-click level plots after ligation, the equivalent hearing loss was determined. In all cases where the Eustachian tube was successfully ligated, the loss was progressive for the first 20 days, then usually showed some transitory improvement. The loss stabilized after 60 days, varying from 15 to 40 dB in different animals. In addition to N1 recordings, serial tympanograms were also measured. These indicated negative middle ear pressure in the first two days postligation and the presence of middle ear fluid by one week postligation.
Fibrous Histiocytoma of the Trachea
Authors: Cohen Seymour R. , Landing Benjamin H. , Isaacs Hart
Published: January 2017

Intratracheal tumors are rare in children. A case is reported of a two-year-old female child with a fibrous histiocytoma of the trachea which caused severe respiratory obstruction and persistent right middle lobe pneumonia. Fibrous histiocytomas are basically benign tumors of histiocytes and have been mistaken for other tumors such as fibroma, sclerosing hemangioma, neurilemoma, fibromatosis, hemangiopericytoma, fibrosarcoma, and some primitive sarcomas. Fibrous histiocytomas have not been reported in the trachea or bronchi. The patient was treated with endoscopic removal of the tumor, and has remained free of disease to this date.
Wegener's Granulomatosis Causing Laryngeal and Tracheobronchial Obstruction in an Adolescent Girl
Authors: Cohen Seymour R. , King Karen Koster , Landing Benjamin H. , Isaacs Hart
Published: January 2017

A 12-year-old girl presenting with a painful neck mass and ulcerated gingival lesions was found to have Wegener's granulomatosis involving the gingivae, paranasal sinuses, ears, mastoids, larynx, trachea, bronchial tree, lungs, kidneys and joints. The initial illness and two subsequent exacerbations were treated with intravenous and oral cyclophosphamide and prednisone. Secondary infections have been managed with establishment of good drainage and use of appropriate antibiotics. The patient is well with a normal sedimentation rate 4½ years after the onset of her disease.
Estimates of Essential Neural Elements for Stimulation through a Cochlear Prosthesis
Authors: Clopton Ben M. , Spelman Francis A. , Miller Josef M.
Published: January 2017

Electrical stimulation of afferent auditory pathways through electrodes placed within and outside of the cochlea were used to study stimulation and design parameters relevant to a cochlear prosthesis. In the acute guinea pig preparation, the tract response evoked in brachium of the inferior colliculus by electrical stimulation to an ear provided estimates of the effectiveness of various electrode placements. Stimulation between an electrode in the cochlea and a site along the eighth nerve was characterized by the lowest thresholds Stimulation between intracochlear electrodes was somewhat less effective, and stimulation between external electrodes at the nerve, cochlear nucleus, or distant point was least effective. Thresholds, expressed as current, rose at approximately 6 dB per octave for stimulus frequencies from 1 kHz to 16 kHz. Thresholds below 10 μ A rms were seen for optimal placements. These observations suggest that the neural elements being stimulated are the cell bodies of the spiral ganglion cells.
Endoscopy of the Pharyngeal Eustachian Tube
Authors: Jaumann M. P. , Steiner W. , Berg M.
Published: January 2017

Transnasal endoscopy and transoral nasopharyngoscopy as routine examinations of the nasopharynx, tubal tori and pharyngeal part of the eustachian tube prove to be very useful. Some observations about the anatomy and the physiological movements of the tubal torus differ from the contemporary concept of the tubal opening mechanism. As measurements showed they do not necessarily correlate with tubal dysfunction or a patulous tube.
Eustachian Tube Function and Retraction of the Tympanic Membrane
Authors: Holmquist Jörgen , Renvall Ulf , Svendsen Pål
Published: January 2017

The medial displacement of the tympanic membrane or the retracted tympanic membrane is a common clinical finding. Also, retractions are looked upon as the precursor of middle ear cholesteatoma. In current otologic literature there seems to be some dispute whether the retractions of the tympanic membrane are caused by negative intratympanic air pressure or by shrinkage of middle ear adhesions pulling the tympanic membrane or part of it medially. In this study only ears with posterior/superior retractions of the tympanic membrane were investigated. Tympanometry revealed that only 33% of the ears did have middle ear pressure within ± 100 mm H2O. After insertion of a polyethylene tube through the tympanic membrane, the eustachian tube function was tested using the air pressure equalization technique. None of the ears could change the negative air pressure upon swallowing. Planometric measurements on the x-ray of the mastoid air cell system of the present material deviate from those of a normal material, indicating a significantly smaller air volume in the present material. It may be concluded that dysfunction of the eustachian tube and a small air volume of the mastoid are characteristic features of an ear with posterior/superior retraction of the tympanic membrane.
Persistent Effusions of the Middle Ear
Authors: Teele David W. , Healy Gerald B. , Tally Francis P.
Published: January 2017

Recent reports of isolation of bacteria from effusions of the middle ear taken from asymptomatic children have suggested a possible role for persistent bacterial infection in the etiology of prolonged effusions. To investigate the significance of anaerobic bacteria in such effusions, we obtained 51 samples of middle ear effusion (MEE) from 30 children. After careful cleansing of the tympanic membrane with 70% alcohol, we performed tympanocentesis prior to performing a myringotomy. Fastidious bacteriologic methods failed to yield a single anaerobic isolate from any of these specimens. We conclude that anaerobic infection of MEE is exceedingly uncommon.
Attachment of Streptococcus Pneumoniae to Human Pharyngeal Epithelial Cells in Vitro
Authors: Andersson B. , Peterson C-M. , Nylén O. , Svanborg-Edén C.
Published: January 2017

The aim of this study has been to develop a test system for attachment of pneumococci to pharyngeal cells. Cells scraped from a healthy person were washed and quantitated, bacteria added and after incubation the suspension was washed and the number of adhering bacteria counted. Among strains from different infectious foci the highest number of strains with adhesive capacity was found in the otitis media group. Capacity to attach to the pharyngeal mucosa might be a virulence factor of pneumococci causing otitis media. There was a lack of distinct relation between capsular serotype and adhesive capacity indicating that the polysaccharide is not primarily responsible for the binding to epithelial cells. If attachment to the pharyngeal mucosa is a first step necessary for colonization and subsequent invasion of the tissues, then antibiotics in the secretions preventing such colonization might be of protective value in otitis-prone children.
Complement and C1q Binding Substances in Otitis Media
Authors: Prellner Karin , Johnson Ulf , Nilsson Nils-Ingvar , Laurell Anna-Brita
Published: January 2017

Complement activation, as shown by increased amounts of complexes composed of Clr-Cls-Cl IA, and abnormal complexes of Clr-Cls were demonstrated in serum from patients with acute pneumococcal and chronic otitis media, serous or mucoid respectively. C1q binding substances were shown in middle ear effusions and in sera from patients with chronic serous otitis media. Presence of immune complexes and/or bacterial products capable of binding Clq results in formation of Clr-Cls-C1 IA complexes and may also cause the generation of Clr-Cls complexes. Such a dissociation of the C1 component will compromise the important opsonic function of the classical pathway.
Relation between Nasal and Middle Ear Allergy Experimental Study
Authors: Yamashita Toshio , Okazaki Nobuhiro , Kumazawa Tadami
Published: January 2017

This study was undertaken to clarify the relation between nasal allergy and otitis media with effusion and to observe histologically the allergic changes in the eustachian tube itself in animals. Allergic changes in the eustachian tube and tympanic cavity were clearly observed histologically when the antigen had been introduced into the tympanic cavity of sensitized guinea pigs. On the other hand, administration of the antigen into the nose produced marked allergic changes in the nose and pharynx but no change in the eustachian tube or tympanic cavity. In view of these findings, it is suggested that allergy of the nose bears little direct relation to that of the middle ear and the eustachian tube.
Biochemical and Immunochemical Characteristics of Middle Ear Effusions in Relation to Bacteriological Findings
Authors: Juhn S. K. , Huff John S. , Giebink G. Scott , Mills Elaine L.
Published: January 2017

Experimental otitis media was produced in chinchillas by eustachian tube obstruction or pneumococcal infection. Sequential changes in the histology of the middle ear mucosa and enzyme profile of the middle ear effusions (MEE) were studied. In serous otitis media (SOM) which followed tubal obstruction, the subepithelial space was widened by edema and capillary dilatation, and the middle ear space was filled with serous fluid. Slight hyperplasia of epithelial cells was also observed. The subepithelial space remained widened with mild fibrous change and capillary dilatation, and slight hyperplasia of epithelial cells persisted 42 days after obstruction. In purulent otitis media (POM), which followed inoculation of pneumococci into the middle ears, metaplasia of the epithelial layer from flat to columnar cells was observed. The subepithelial space was widened with loose fibrous connective tissue proliferation, vascular dilatation and inflammatory cell infiltration. Both lactate dehydrogenase (LDH) and lysozyme levels in MEE were higher in the POM group than in the SOM group. When bacterial enzymes, hyaluronidase and lipase activity were measured in MEE and plotted together with the percentage of positive culture of the MEE at different times after the experimental infection, the enzyme activities decreased with the clearing of bacteria and along with the resorption of inflammatory changes of middle ear mucosa evidenced by histology. In human MEE studies, immunoglobulins (IgG, IgA, IgM) of MEE were higher than in serum except IgM in serous MEE. The IgG content of MEE in the culture-negative group was higher than in the culture-positive group. Possible mechanisms for this difference were discussed.
Identification of Otitis Media with Effusion in Children
Authors: Cantekin Erdem I. , Stool Sylvan E. , Bluestone Charles D. , Beery Quinter C. , Fria Thomas J. , Sabo Diane L.
Published: January 2017

In an effort to establish the diagnostic value of otoscopy, tympanometry, and the middle ear (ME) muscle reflex in the identification of otitis media with effusion (OME), the diagnostic findings by these three methods were compared with the findings at myringotomy in 333 children (599 ears). The study showed that even experienced clinicians had some difficulty in identifying those ears with effusion (sensitivity) and had even greater difficulty in making a diagnosis of those ears without an effusion (specificity). However, tympanometry, employing patterns that have been validated with myringotomy findings, was found to be more accurate. On the other hand, assessment of the ME muscle reflex as a diagnostic method was unacceptable due to an extremely low specificity (52%). An algorithm derived from the combination of the three methods had highest sensitivity (97%) and specificity (90%).
Possible Long-Term Consequences of Middle Ear Effusion
Authors: Brooks Denzil N.
Published: January 2017

Three studies will be reported in this paper and the suggestion made that there may be a connection between the findings. The first study concerns the middle ear status of 48 children treated in 1966/67 for middle ear effusion and followed up after ten years. Prior to treatment the median HL was 20 dB (SD = 13 dB) and at follow-up the median HL was 8 dB (SD = 5 dB). However, the otologic and tympanometric findings were less encouraging. Abnormal tympanic membranes (TM) were observed in almost half the children, the rate of abnormality relating to the number of surgical interventions made. However, the TM changes may be due either to the treatment or the disease itself. The second study concerns 104 children monitored by impedance testing over a ten-year period and tends to support the hypothesis that the effusion itself is the probable cause of the changes in the TM. The third study relates to applicants for hearing aids. Excluding those with clearly defined conditions such as otosclerosis, noise trauma and Meniére's disorder, etc, two clear groups emerged, one with uncontaminated sensorineural (SN) loss, the other with mainly SN loss but with a significant conductive overlay. Though the median hearing losses of the two groups are the same, the average age for the SN group (77; SD = 7 years) is 12 years greater than that of the “conductive” group (65; SD = 14 years). Few of the SN group can recall auditory dysfunction in childhood, but the majority of the conductive group have clear recall. It seems probable that middle ear disorders in childhood may give rise to auditory impairment in the elderly such that when combined with age-associated hearing loss the need for prosthetic aid arises at a much lower age.
Mouse Brainstem Auditory Nuclei Development
Authors: Webster Douglas B. , Webster Molly
Published: January 2017

The cross-sectional areas of brainstem auditory neurons were measured in a postnatal developmental series of mice. There is no demonstrable neuronal growth between days 1 and 3. Between days 3 and 12 the neuronal somas grow rapidly to their adult size. Most of this growth occurs prior to any cochlear physiological activity and all of it occurs before cochlear maturation. Most brainstem auditory neurons of 45-day-old mice postnatally deprived of sound or with conductive losses are of a size comparable to normal nine-day-old mice.
Active and Conservative Treatment of Acute Otitis Media; Prospective Studies
Authors: Qvarnberg Y. , Palva T.
Published: January 2017

Two Finnish prospective studies of acute otitis media are reviewed, one consisting of 158 and the other of 248 patients. Treatment with myringotomy in combination with antibiotics gave results which were better than those obtained by antibiotics alone. If the patients had a history of two or more earlier attacks of acute otitis media, healing rates were poorer irrespective of the method of therapy, and treatment without myringotomy could not be adhered to even if planned. Mastoid roentgenograms showed partial or total cloudiness in many ears and proved to be a good method of recognizing the cases in which the disease was likely to run a prolonged course.
Penicillin and Acute Otitis
Authors: Thomsen J. , Meistrup-Larsen K. I. , Larsen P. K. , Sørensen H. , Mygind N.
Published: January 2017

The effect of peroral penicillin V (55 mg/kg/day) on acute otitis media was investigated in 149 children between the ages of one and ten years in a double-blind, placebo-controlled investigation. The parameters of the disease employed were symptom scores for earache, the use of analgetics, otoscopy, as well as tympanometry. The children were followed up for three months. Penicillin had a significant effect on pain on the second day of treatment. The acute course of the disease was satisfactory in 69% of the children in the placebo group and in 86% in the penicillin group. In patients with pneumococci or hemolytic streptococci in the rhinopharynx, the pain already disappeared after one to two doses of penicillin, whereas the treatment had no effect on the patients with Haemophilus influenzae. There was no difference between the penicillin and placebo groups with regard to the results of otoscopy and tympanometry after one week, one month and three months. No serious complications were observed. It is concluded that an attitude of “masterful inactivity” with regard to the treatment of acute otitis media is justifiable, and in the majority of cases advisable, provided sufficient analgesic treatment is given and also that the patient can be closely followed. As there are still many unanswered questions more controlled investigations are warranted.
Nonsurgical Management of Otitis Media with Effusion
Authors: Gottschalk G. Howard
Published: January 2017

Otitis media with effusion can be successfully treated without the use of middle ear ventilation tubes. Middle ear inflation will, if performed properly, empty most ears as effectively as direct suction through a myringotomy incision. Over 12,000 patients with middle ear effusion have responded to conservative treatment which includes medical management aided by middle ear inflations using a modification of the classic politzerization technique. The technique of controlled middle ear inflation is described and the proper medical management discussed. The avoidance of oral decongestants is stressed as is the proper diagnosis and treatment of the etiological factors causing the formation of the fluid.
Results after Treatment of Otitis Media with Effusion
Authors: Muenker G.
Published: January 2017

Otitis media with effusion will be observed in every fifth child admitted for adenoid surgery; in children with cleft palates the incidence is 50%. With adenoidectomy alone, normal hearing can be restored in 50% and improved in further 25% of the patients. Over a 12-year period 1,683 patients with otitis media with effusion were treated with adenoidectomy and with insertion of tympanostomy tubes in those cases where adenoidectomy proved to be ineffective. Since the tubes only substitute tubal function, recurrences have to be expected in more than 30% after spontaneous extrusion of the tubes. Of all recurrences, 93% occur within two years after tube insertion. With thorough follow-up and repeated insertion of tubes, deterioration of the middle ear can be avoided and hearing kept normal. Impaired bone conduction does not reflect inner ear damage, but will improve with ventilation of the middle ear. Infections occur in 15% (5% postoperatively, 10% later); persistent perforations in 2.5% and cholesteatoma in 0.9%.
Immunofluorescent Study on Middle Ear Mucosa
Authors: Mogi Goro , Maeda Shoichi , Watanabe Noritake
Published: January 2017

To clarify the developmental course of the immunological defense system in the middle ear, immunoglobulin-forming cells of different classes and secretory proteins, such as secretory component (SC) and lactoferrin (Lf), were investigated in the middle ear mucosa of 20 developing and 5 normal adult guinea pigs by use of direct immunofluorescence technique. Changes in the middle ear mucosa were also observed after antigenic challenges directly to the tympanic cavity of 6 developing and 39 adult guinea pigs. IgA- and IgM-forming cells began to appear in the tubal mucosa at the seventh postnatal day, while it was scarcely possible to find IgG1- and IgG2-forming cells in developing guinea pigs. Immunoglobulin-forming cells of all classes increased in the middle ear mucosa after the antigenic stimuli. The injection of antigens to the tympanic cavity of developing animals induced the most striking accumulation of immunoglobulin-forming cells in the middle ear mucosa. Results of this study showed that local synthesis of IgA, as well as other classes, is latent in the middle ear, that the middle ear of immature animals is vulnerable to antigenic stimuli, and that the middle ear of developing animals possesses potential immune responsiveness.
Tympanosclerosis
Authors: Schiff Maurice , Catanzaro Antonio , Poliquin Jacques F. , Ryan Allen F.
Published: January 2017

Tympanosclerosis is a disease which affects the tympanic membrane (TM) and middle ear. The locus for the essential pathology is in the connective tissue component of the drum which is the lamina propria. In the middle ear, the pathology is in the basement membrane. In the early stages there is a minimal involvement of the mesenchymal component, usually seen as a small white macula, or scar, in the drum. In advanced disease, the hyalinization of the mesenchymal component together with the attraction of the calcium ion leads to a thick, dense, calcified scar.

The theory of pathogenesis for this disease entity is that the connective tissue component of these structures is stimulated by infection, inflammation, or trauma involving some degree of local immunological hypersensitivity. With severe middle ear infection, the mucosa of the inner surface of the drum becomes permeable, and the ground substance of the lamina propria becomes edematous taking up water together with components of complement from the middle ear disease. The abnormal middle ear secretions contain the immunoglobulin components capable of participating in the process. If there is any damage to the connective tissue, the adsorption and repair permits the body to react immunologically against the destroyed tissue, thereby sensitizing this area.

Experiments were performed with the guinea pig in which the tympanic membrane was removed and the lamina propria isolated and prepared as an immunological antigen. When this material was injected into the rabbits, a high, satisfactory antiguinea pig tympanic membrane antibody was formed (anti-GPTM). It was then possible to remove this anti-GPTM antibody from the serum. The tissue specificity was determined by immunofluorescent staining which showed it to be adsorbed onto the TM, middle ear mucosa, as well as the basement membrane of the respiratory tract. The guinea pigs which were passively sensitized with anti-GPTM antiserum demonstrated the binding of the antibodies on the tympanic membrane when subject to trauma, infection, or cautery. The manifestation was in the anatomical area related to the injury. Complement fixation was, likewise, demonstrated.

Controlled animals which were not traumatized, or were not passively sensitized, included those which were injected with IgG from rabbits not sensitized against GPTM. They showed no fixation of antibody or complement in the TM. Following injury the antibody and complement bound to the TM provide the necessary elements for the subsequent immunopathologic disease entity known at tympanosclerosis.
Priorities in Service Delivery to the Communicatively Disadvantaged: Habilitation Needs
Authors: Silverman S. Richard
Published: January 2017

The bewildering patchwork or organization and organizing principles involved in the delivery of services to the communicatively disadvantaged requires an amalgam of effort. Also helpful would be a clearer understanding of magnitudes, characteristics and habilitation needs of certain subgroups such as the language disabled, the multiply handicapped and the moderately handicapped. Since this conference is concerned primarily with scientific contribution, it is suggested that we are in a transition from intuitive approaches to habilitative procedures to those derived from scientific investigations. This is pointedly documented in the area of language which cuts across all types of communicative disorders, as well as in such areas as early identification, sensory aids, career education, parent guidance, media use and mental health. It is important, too, for scientists to communicate clearly with their many publics.
Review of Recent Research on the Selection of Frequency-Gain Characteristics for Hearing Aids
Authors: Lippmann Richard
Published: January 2017

Following the Harvard master hearing aid study in 1947 there was little research on linear amplification. Recently, however, there have been a number of studies designed to determine the relationship between the frequency-gain characteristic of a hearing aid and speech intelligibility for persons with sensorineural hearing loss. These studies have demonstrated that a frequency-gain characteristic that rises at a rate of 6 dB/octave, as suggested by the Harvard study, is not optimal. They have also demonstrated that high-frequency emphasis of 10–40 dB above 500–1000 Hz is beneficial. Most importantly, they have demonstrated that hearing aids as they are presently being fit do not provide maximum speech intelligibility. Percent word correct scores obtained with the best frequency-gain characteristics tested in various studies have been found to be 9 to 19 percentage points higher than scores obtained with commercial aids owned by subjects. This increase in scores is equivalent to an increase in signal-to-noise ratio of 10 to 20 dB. This is a significant increase which could allow impaired listeners to communicate in many situations where they presently cannot. These results demonstrate the need for further research on linear amplification aimed at developing practical suggestions for fitting hearing aids.
Efferent Components of the Auditory System
Authors: Warr W. Bruce
Published: January 2017

The origins and terminations of the olivocochlear bundle, which provides an efferent innervation to the organ of Corti, are described on the basis of experiments using axonal transport of tracer substances and light microscopy in the cat. The cells of origin were labeled by the retrograde tracer horseradish peroxidase which was injected unilaterally into the cochlea. Labeled cells in the superior olivary complex could be dichotomized according to their location (lateral or medial), their size (small or large), and their preferred side of projection (uncrossed or crossed). All labeled olivocochlear neurons exhibited a positive reaction for acetylcholinesterase. To determine the cochlear projections of the neurons, injections of a radioactive amino acid were made into either the lateral or medial olivocochlear cell group. After allowing time for synthesis and axonal transport of radio-labeled protein to reach synaptic endings in the cochleas, the tissue sections of these specimens were processed for autoradiography. The results indicate that lateral olivocochlear neurons project to the region beneath the inner hair cells of both sides, whereas medial olivocochlear neurons project to the region beneath the outer hair cells of both sides. These findings are in substantial accord with previous experimental work but suggest that the organ of Corti receives a dual efferent innervation which is organized according to the location and morphology of its cells of origin. Accordingly, it is proposed that the two efferent components of the cochlear innervation described here be referred to as the lateral and medial olivocochlear systems, replacing the current designations of crossed and uncrossed olivocochlear bundles, the latter which are demonstrably heterogeneous in their origins and terminations and, probably, also in their functions.
Laryngeal Surgery in the Pediatric Patient
Authors: Fearon Blair
Published: January 2017

The primary concern in laryngeal surgery in the infant and child is to relieve airway obstruction, rather than phonation. Because airway obstruction above the larynx may simulate or be confused with laryngeal pathology, these are described as the signs and symptoms of laryngeal disease. Although tracheotomy in the infant is frequently said to be a cause of a long-term problem, the procedure can be carried out in the smallest premature quite safely and without an extubation problem. The author's method of performing the operation is described. Most laryngeal surgery in the child is performed by the endoscopic approach, special scopes being used for special purposes. In addition to conventional instrumentation the cryoprobe and CO2 laser are employed. The author's method of treating glottic and subglottic stenosis is outlined.
Morphophonemic Processes in Children
Authors: Lybolt John
Published: January 2017

Classification of preschool children as language-delayed or articulation-impaired, as though these deficit areas were independent, has seldom been challenged. Three groups of ten preschool children were selected to represent normally developing, articulation-impaired, and language-delayed subjects. Their productions of /s/, /z/, /t/, and /d/ were assessed in tasks requiring application of articulatory and grammatical rules. Each group had difficulty applying both articulatory and grammatical rules, normal-speaking children performing best and language-delayed children applying the rules least consistently. Each group evidenced similar response patterns which conformed to developmental expectations.
Language Deficiency in Children
Authors: Morehead Donald M. , Morehead Kerstin E. , Morehead William A.
Published: January 2017

Research in cognition and language has provided useful constructs which suggest that specific deficits underlie language deficiencies in children. In addition, this research has provided procedures that determine what a child knows about language at a particular level of development and has established a sequence of linguistic development that maps the specific content and structure of training programs. Two new areas of research offer additional approaches to assessment and remediation. One approacch focuses on the actual principles and strategies that normal children use to learn language, making it possible to determine which methods are most efficient. The second research approach looks at the contextual conditions adults and children provide the first language learner. Preliminary work suggests that the natural conditions found universally in first language learning may be the best indicators of how to proceed with language-deficient children.
Language Stimulation Group
Authors: Hixson Peter K.
Published: January 2017

Bloom's model of normal language development is reviewed in relation to clinical practice and is then expanded to account for disordered development. Four primary and four secondary assessment areas are then considered: language, cognition, motor, and affective development and nonverbal symbolic skills, attentional skills, social development, and physical-medical integrity. Finally, a way of integrating this evaluative information into the model of normal development is discussed and a sample curriculum is outlined.
I. Experimental Approach and Histological Criteria for Evaluating Drug Effects
Authors: Rudnick Michael D. , Ginsberg Irwin A. , Huber Pamela S.
Published: January 2017

The rationale and methodology for transtympanic drug injection have been established. By the use of phase contrast and Normarski differential interference contrast microscopy to study “surface preparations” of both cochlear and vestibular sensory structures, the degenerative cellular changes which resulted from the localized administration of aminoglycoside antibiotics have been examined toward the selection of an anatomical criterion for the measurement of ototoxicity. The “collapse” cell has been selected for this purpose because of its positive identification, persistence and inability to recover.
III. Comparative Quantitative Analysis
Authors: Ginsberg Irwin A. , Rudnick Michael D. , Huber Pamela S.
Published: January 2017

Hypotheses to explain the selective ototoxicity of aminoglycoside antibiotics may be grouped into two categories: 1) a partition effect and 2) innate hair cell selectivity. The results of this study give evidence that, in fact, both mechanisms may interplay. This conclusion is induced from the observations that following the transtympanic administration of streptomycin, dihydrostreptomycin and neomycin: 1) All three drugs elicited nearly the same topographic pattern and degree of damage in the vestibular compartment. 2) All three drugs elicited nearly the same topographic pattern but widely different degrees of damage in the cochlear compartment (neomycin > > streptomycin > dihydrostreptomycin). 3) Neomycin caused the same devastating cochlear hair cell damage as reported for its systemic administration. 4) Dihydrostreptomycin was significantly more vestibulotoxic than cochleotoxic, and streptomycin was both significantly more cochleotoxic than vestibulotoxic and significantly more cochleotoxic than was dihydrostreptomycin. The latter observations are discussed with regard to contrasts with the literature reporting the drug effects following systemic administration.
Vestibular Neuritis
Authors: Schuknecht Harold F. , Kitamura Ken
Published: January 2017

Vestibular neuritis is a discrete degenerative neuropathy of the vestibular nerve trunks. The clinical manifestations consist of one or more severe prolonged episodes of vertigo, sometimes in association with milder periodic or constant unsteadiness. The atrophic changes in the vestibular nerves are usually sufficiently severe to create vestibular test abnormalities. The clinical and pathological features are consistent with a viral etiology.
Clinical Pharmacology of the Antimicrobial Agents for Infections in the Ear, Nose and Throat
Authors: Neu Harold C.
Published: January 2017

Knowledge of which microorganisms cause infection in the ear, nose and throat must be coupled with an understanding of the susceptibility patterns of these bacteria as well as knowledge of the pharmacokinetic properties of antimicrobial agents. Even though many of the bacteria which produce community-acquired infection are susceptible to the older agents, specific problems have developed with regard to species such as Hemophilus influenzae and to Staphylococcus aureus. Hospital-acquired infections due to Enterobacteriaceae may be resistant to the penicillin drugs and to some of the older cephalosporins and aminoglycosides. Use of the new agents often requires an understanding of how rapidly the compounds are cleared from the body or if they will accumulate to toxic levels in the elderly patient with decreased renal function. This article reviews the antimicrobial activity and clinical pharmacology of agents commonly used to treat infections of the ear, nose and throat.
Antimicrobial Therapy for Chronic Suppurative Otitis Media
Authors: Fairbanks David N. F.
Published: January 2017

In chronic draining ear associated with a tympanic membrane perforation and/or cholesteatoma, the infection is that of bacterial contamination. Both aerobic and anaerobic organisms are found, notably Pseudomonas, Staphylococcus, and enteric organisms, particularly Bacteroides. The disease exists because of a structural defect in the middle ear cleft, which requires surgery as definitive treatment. Medical therapy is valuable as a temporary measure, in preoperative preparation, and in prevention and management of intracranial extension. Topical therapy with antibiotic ear drops is often helpful, but also important is local care with cleansing, drying, and antiseptic solutions or powders. Therapy is usually directed against the Pseudomonas organism with aminoglycosides and polymyxins, but Bacteroides fragilis now looms as an important pathogen in 13% of affected patients, requiring chloramphenicol. Since drugs directed against Bacteroides are ineffective against Pseudomonas, and vice versa, there is no one agent we can rely upon for treatment of both. What we are all looking for, of course, is that brand new antibiotic the FDA hasn't released yet: “panaceamycin.” It hasn't even been developed yet. None of the ones we have are a panacea; and until we get one, we will have to stick with what we have, exercise clinical judgment, and base our antibiotic selections on, if not proven culture results, then at least established microbial probabilities.
Sinusoidal Harmonic Acceleration Labyrinthine Test Clinical Experience
Authors: Simpson Roger A.
Published: January 2017

Responses of 135 patients subjected to Sinusoidal Harmonic Acceleration Labyrinthine Test are reported. These patients are categorized into four clinical impression disease groups: 1) classic Meniere's disease; 2) labyrinthine ischemia; 3) neurological diseases; 4) no labyrinthine or neurological disease. A case report in each category is presented. We find Sinusoidal Harmonic Acceleration Labyrinthine Test to be a useful tool in evaluation of the dizzy patient.
Clinical-Pathological Correlates of Congenital Subglottic Hemangiomas
Authors: Yoshpe Nina , Brodsky Linda , Ruben Robert J.
Published: January 2017

One hundred thirty-six cases of subglottic hemangioma in infants have been reported in the English -language literature; four additional cases are reported here. The clinical presentations, diagnostic work-ups, treatments, and outcomes are analyzed. Twenty-one patients died, 17 of whom underwent autopsy. The histology of the laryngeal pathology from seven of these patients was reviewed by the authors. Possible correlation between the pathological findings and the clinical presentation is made. Approaches to diagnosis and treatment are suggested based on these findings.
Validation of Diagnosis of Otitis Media with Effusion
Authors: Stool S. E. , Flaherty M. R.
Published: January 2017

Clinical research in otitis media requires that the investigator possess the ability to make an otoscopic diagnosis with a high degree of accuracy. A program has been instituted in which the investigators become validated to assure that their observations will be similar. In clinical practice and research, tympanometric measurements have been shown to complement the otoscopic examination; therefore, an algorithm has been developed that insures a high degree of accuracy and standardization of our data. The definitions and classification of otitis media used by the OMRC are those that were proposed at the Second International Symposium on Recent Advances in Otitis Media with Effusion.
Eustachian Tube Function in the Pathogenesis of Cholesteatoma
Authors: Bluestone C. D. , Casselbrant M. L. , Cantekin E. I.
Published: January 2017

A major goal of all of our studies is to prevent the disease and its complications and sequelae, which may be either medical or psychosocial. The former are comparatively easy to document as they can be studied by physical examination, and radiographic and audiometric means. The latter, psychosocial, are very complex and involve more suggestive measurements; hence, there are not as much hard data available. We have initiated an analysis of the literature, and have consulted experts in experimental design to advise us regarding the most appropriate approach to studying these aspects of otitis media.
Effects of Facial Nerve Compression on the Stapedial Nerve
Authors: Matsumoto Yasushi , Murakami Shingo , Yanagihara Naoaki , Fujita Hiroshi
Published: January 2017

A series of experiments on guinea pigs was conducted to determine the prognostic dependability of the stapedial reflex measurement in Bell's palsy. Comparison of the threshold of evoked electromyographic response of the stapedius muscle with that of the orbicularis oris muscle revealed that the stapedial nerve had a lower excitability than did the nerve innervating the orbicularis oris muscle. This lower excitability correlates with the histological finding that the stapedial nerve fibers have a smaller average diameter. The results indicate the resistance of the stapedial nerve to injury of the facial nerve. Functional recovery after cramping of the facial nerve tended to occur later in the stapedial nerve than in the nerve innervating the orbicularis oris muscle. The resistance of the stapedial nerve and the longer period required to recover function in this nerve were factors influencing the prognostic ambiguity of this test.
Fistulae in the Membranous Labyrinth
Authors: Kimura Robert S.
Published: January 2017

Fistulization at various parts of the membranous labyrinth has been currently in use as one of the treatments for the symptoms of Meniere's disease. The present report concerns our experience with membranous fistulae in experimental animal ears with and without manifestation of endolymphatic hydrops. The materials presented are mostly new; however, our previous data are also incorporated in order to bring this issue into better perspective. The first part describes the nonproduction aspect of endolymphatic hydrops in the rat, chinchilla, and squirrel monkey after obliteration of the endolymphatic duct in relation to the occurrence of spontaneous fistulae. The second part describes surgical fistulization of the vestibular membranous labyrinth and cochlear duct in order to prevent or control development of endolymphatic hydrops in the guinea pig, the species in which hydrops can be produced consistently. These results are tabulated and analyzed in terms of the pathological consequences that can be expected in performing fistulization of the membranous labyrinths in animals as well as in humans.
Comparative Morphometry of Mammalian Otolith Organs
Authors: Igarashi Makoto , Isago Hidemitsu , O-Uchi Toshiaki
Published: January 2017

The endolymphatic volume of the utricle and the saccule and the surface area of the saccular macula were measured in eight mammalian species, including humans. The results confirmed that all measurements increased slowly but consistently correlating with increases in body weight. However, differences in these endolymphatic volumes or macular surface areas might also be influenced by functional characteristics among different species rather than simply reflecting geometrical comparability.
Surgery for Acoustic Neurinomas: A Proposal
Authors: Montgomery William W.
Published: January 2017

Surgery for resection of acoustic neurinomas (vestibular schwannomas) has been performed by way of the middle fossa craniotomy, suboccipital route, and translabyrinthine operation. The author has preferred the translabyrinthine operation for small tumors (less than 2 cm) for patients with poor hearing and the suboccipital approach for large tumors and for small tumors when attempting to preserve hearing. This paper proposes an operation designed for better tumor removal results, an improved technique for preservation of hearing, and fewer complications. During the first part of the operation, the posterior fossa dura posterior to the labyrinth, and also bound by the superior petrosal and sigmoid venous sinuses, is exposed by the mastoidectomy route. The mastoid is obliterated with adipose tissue. The suboccipital route is then used to resect large tumors and small tumors when attempting to preserve hearing. This operation would 1) facilitate dissection of the internal auditory meatus, 2) reduce chance for injury to the labyrinth with a resulting total hearing loss, and 3) eliminate the rather frequent (less than 10%) incidence of postoperative CSF otorhinorrhea and its complications.
Developmental Temporal Bone Anatomy and its Clinical Significance: Variations on Themes by H. F. Schuknecht
Authors: Spector Gershon J.
Published: January 2017

Fifty-eight fetal and neonatal temporal bones were studied to evaluate the mechanisms of development of the hiatus of the facial canal, hypotympanic fissures, periotic duct, tympanomeningeal fissures, and fetal inner ear vascularity. These were correlated with the clinical pathologic entities of temporal bone trauma, glomus jugulare tumor extension within the temporal bone, CNS-temporal septic conduits, and inner ear vascularity. Temporal bone developmental anatomy and histopathology provide rich sources of information on which to base the scientific and clinical study of otology.
Malignant Transformation in Inverted Papilloma
Authors: Feinmesser R. , Wiesel J. M. , Gay I. , Ben-Bassat H.
Published: January 2017

The detection of markers associated with malignancy will help in the early identification of tumors and assessment of the success of treatment in patients suffering from carcinoma. Three characteristics investigated in this study were found to differentiate a premalignant inverted papilloma from a benign simple nasal polyp.
Changing Relationships between Structure and Function in the Cochlea during Recovery from Intense Sound Exposure
Authors: Thorne Peter R. , Gavin John B.
Published: January 2017

This study examines the relationship between the morphological and electrophysiological changes in the guinea pig cochlea at intervals following exposure to intense sound (5 kHz, 125 dB SPL, 30 minutes). The cochlear compound action potential (N1) audiogram (2–30 kHz) was determined within one hour or 1, 7, 14, or 28 days after exposure. When these organs of Corti were examined by scanning electron microscopy, most (92%) showed damage to hair cells and supporting cells around the 5-kHz region. The number of damaged hair cells increased significantly (p<0.01) in the first 24 hours following exposure, but there was no significant change thereafter. In contrast, the initial extensive loss of function (maximum at 8–12 kHz) recovered partially during the first 24 hours but also showed no significant further change. All morphological lesions occurred within regions corresponding tonotopically to the N1 threshold losses, but only the larger lesions, which were observed seven or more days after exposure, fully reflected the extent of the loss of N1 thresholds. This indicates that functionally important damage to the cochlea is usually more extensive than indicated by topographical abnormalities in the organ of Corti.
Chronic Laryngeal Stenosis
Authors: Stell P. M. , Stanley R. E. , Maran A. G. D. , Murray J. A. M.
Published: January 2017

The results of treatment of 82 patients with chronic laryngeal stenosis during a 20-year period are presented. Road traffic accidents accounted for 30% of the cases and iatrogenic disease for 40%. Of the stenoses 10% were supraglottic, 20% glottic, 50%, subglottic, and 15% combined. Virtually all patients with supraglottic stenosis had a good result as regards voice and airway, and we describe the use of a laryngeal widening operation for this group of patients. Over 80% of patients with glottic stenosis achieved good results. However, patients with a subglottic stenosis did badly, and only 60% were relieved of their tracheostomies. Patients with stenosis due to previous tracheostomy or to systemic disease such as Wegener's granuloma did badly.
Delayed Lower Esophageal Perforation: Management with Celestin Tube
Authors: Asplund Charles M. , Hill Lucius D.
Published: January 2017

Rupture of the esophagus carries a high mortality rate with delayed closure in the compromised patient. In the five patients observed at the Virginia Mason Medical Center, Seattle, we had uniform success in controlling infection and in resolution of the fistula with the use of the Celestin tube. We feel this method is simple, effective, and worthy of further evaluation for treatment of the complicated esophageal perforation.
Audiological Results with Two Single Channel Cochlear Implants
Authors: Tyler Richard S. , Lowder Mary W. , Gantz Bruce J. , Otto Steven R. , McCabe Brian F. , Preece John P.
Published: January 2017

We tested six patients with single channel cochlear implants on several tests from the Minimal Auditory Capabilities battery and the Iowa Cochlear Implant Tests. All patients were able to discriminate some everyday sounds and to identify the number of syllables in the words presented. Five patients were able to identify speaker sex reliably. Surprisingly, some patients had difficulty discriminating between a modulated noise and a voice or between a question and a statement or identifying the accented word in a sentence. On several audiovisual tests, an improvement was observed for the sound plus vision condition compared to the vision only condition. This was particularly true for sentence tests, but was not uniform across patients or across tests.