bluuebunny/crossref_metadata_2025 huggingface dataset:
The Surgical Management of Labyrinthine Fistulae in Chronic Otitis Media with Cholesteatoma
Authors: Gacek Richard R.
Published: January 2017

The author's series of 168 consecutive cases of chronic otitis media from the years 1965 to 1972 were reviewed with regard to the occurrence and management of pathological fistulae in the bony labyrinth. Fourteen cases (incidence 8.3%), of which nine involved only the semicircular canals and five involved primarily the cochlear wall occasionally associated with a semicircular canal fistula, were examined particularly in terms of postoperative sensorineural hearing loss following removal of cholesteatoma matrix from the fistula. The results indicated that the matrix can be removed with reasonable safety from most small semicircular canal fistulae. Only when the cholesteatoma matrix is firmly adherent to a large area of membranous semicircular canal is removal not recommended. When the cholesteatoma was removed from three cochlear fistulae, sensorineural hearing loss resulted. In two cases with cochlear fistula, hearing was preserved when the cholesteatoma matrix was not removed from the fistulized area. These results have been used to formulate guidelines for the surgical management of pathological fistulae of the bony labyrinth.
Histopathologic Findings following Surgical Procedures for Stapedial Ankylosis
Authors: Nager George T. , Jafek Bruce W.
Published: January 2017

The histopathologic findings in the temporal bones of four patients with otosclerosis who had stapes operations, each according to a different surgical technique, are discussed. The four surgical methods employed included: 1) stapes interposition with a vein graft; 2) polyethylene strut over a vein graft; 3) fenestration of an obliterated oval window with a teflon piston; and 4) wire prosthesis over a remaining, shattered footplate. The first, third and fourth method provided a very satisfactory seal for the oval window. The polyethylene strut, on the other hand, protruded deeply into the vestibule and was about to perforate through the thinned vein graft. In the three remaining patients, the vestibular end of the prostheses was in fairly good alignment with the level of the oval window. Within the middle ear cavity all prostheses were invested in a thin coat of endothelial cells and connective tissue. Whereas the ring of the teflon piston prosthesis caused no bony atrophy, the stainless steel wire had induced a localized deossification at its site of attachment on the incus. The third and fourth cases disclosed some adhesions in the perilymphatic space around the oval window. All temporal bones revealed no injury to, or rupture of the utricle or saccule.
Functional Morphology of the Lining Membrane of the Middle Ear and Eustachian Tube
Authors: Lim David J.
Published: January 2017

A large part of normal middle ear cavity and Eustachian tube is provided with a mucociliary transportation system which is considered the first line of defense of the middle ear. Secretory cells of the normal mucosa of the middle ear and the tube can be classified into three main types: mucous, mixed and dark granulated (or serous). This may mean that the secreta of the mucosa is biochemically diverse and/or in a dynamic state. The presence of immunoglobulin-producing plasma cells (IgA, IgG and IgM) and macrophages in the Eustachian tube and the middle ear mucosa supports the concept that the middle ear is protected by an immunologic defense system. Normal mucosal epithelial cells of the middle ear and the tube possess the ability to transport macromolecules by intact epithelial cells toward connective tissue layer where the macromolecules are either phagocytized by histiocytes or enter into capillary system. The macrophages of regional lymph nodes also picked up the macromolecules. Demonstration of lamellar substances similar to phospholipids in the secreta of the tube and middle ear mucosa of the guinea pig suggests the presence of auditory surface-active agent(s) (surfactant). Close association between secretory cells of the mucosa and acid phosphatase is demonstrated by cytochemical method. It is suggested that secretory enzymes such as lysozyme and acid phosphatase may be either produced or transported by secretory cells of the middle ear mucosa. These enzyme secretions are considered a part of the enzymatic defense system of the middle ear.
Secretory Otitis Media: Protein and Enzyme Analyses
Authors: Palva T. , Raunio V. , Nousianen R.
Published: January 2017

Analysis of 69 mucus middle ear fluids of cases of secretory otitis media showed that the total protein concentration and LD, MD and acid phosphatase activity were all significantly higher than in serum. Alkaline phosphatase activity was similar in middle ear fluids and serum whereas esterase activity in serum was significantly higher than in middle ear fluids. Isoenzyme analyses showed different patterns for LD and MD in the ear fluids and serum and a tissue esterase fraction appeared only in the ear fluids. On Sephadex® G 200 chromatographic analysis the ear fluids were shown to consist of increased amounts of macromolecular proteins. These data prove that the middle ear mucosa secretes some of the protein components of the ear fluid. Early paracentesis and removal of adenoids are recommended in acute otitis media to prevent the development of secretory otitis media.
Production of Mucus in the Middle Ear and Eustachian Tube
Authors: Tos Mirko
Published: January 2017

On the basis of quantitative studies of the mucus elements in 144 temporal bones and more than 5,000 biopsies the mucus producing capacity of the mucosa in the middle ear and Eustachian tube under normal conditions as well as in acute and chronic middle ear diseases is reviewed. In completely normal middle ears there was a very low goblet cell density and no mucous glands. Production of mucus does take place, but it is very slight. In acute conditions the goblet cell density in the Eustachian tube and middle ear increases, and metaplastic changes of the mucosa may occur, with formation of subepithelial and intraepithelial mucous glands. In chronic diseases, such as secretory otitis, there is a high gland and goblet cell density, which explains the increased production of mucus. In adhesive otitis the gland density is great, it is true, but most glands have become inactive and have degenerated. In chronic suppurative otitis, cholesteatoma, and sequelae to chronic otitis the goblet cell and gland density is moderately increased, but there are very marked individual variations which explain the great difference in the production of mucus. In active chronic diseases the mucus elements may increase enormously, and the mucus producing capacity of the epithelium may reach the heights of that of the respiratory mucosa.
The Biopathology of Secretory Otitis Media
Authors: Sadé Jacob
Published: January 2017

Recent investigations have identified the viscous middle ear effusions in secretory otitis media as being of the same nature as true mucus — the “backbone” of which is glycoproteins. The source of the mucus are mucus producing cells found in the normal middle ear lining and producing excessive amounts of mucus in pathological states. The nature of the pathological state which leads to excessive mucus production is an inflammation associated with deficient ventilation of the middle ear. Ventilation deficiency of the middle ear is a pathophysiological phenomenon which is not associated with hermetic blockage of the Eustachian tube. The “ex-vacuo” theory which assumes the tube to be blocked — the effusion to be a proteinous transudate and the middle ear devoid of mucus secreting elements, is no more tenable. Middle ear effusions can be approached by looking at them as questions of: 1) mucus clearance; 2) excessive mucus production; 3) middle ear ventilation and 4) etiology of middle ear inflammation. Clearance of mucus from the middle ear is governed by the mucociliary system, where the number of cilia and specificity of mucus are known today to be critical for clearance. Excessive amounts of mucus are secondary in the middle ear, as in all other mucosa in the body, to a metaplastic process. Mucosal stem cells can differentiate into mucus cells, ciliated cells, and keratin producing cells. In the presence of inflammation, especially when oxygen tension is low (and CO2 tension is high) mucosal stem cells differentiate into numerous mucus producing cells which have been shown, in the middle ear, to be responsible for the excessive mucus production. The nature of the mechanism of middle ear ventilation in health and disease is not yet known, though it is in all probability related to the function of the Eustachian tube muscles.
Histopathologic Findings following Surgical Procedures for Stapedial Ankylosis
Authors: Nager George T. , Jafek Bruce W.
Published: January 2017

The histopathologic findings in the temporal bones of four patients with otosclerosis who had stapes operations, each according to a different surgical technique, are discussed. The four surgical methods employed included: 1) stapes interposition with a vein graft; 2) polyethylene strut over a vein graft; 3) fenestration of an obliterated oval window with a teflon piston; and 4) wire prosthesis over a remaining, shattered footplate. The first, third and fourth method provided a very satisfactory seal for the oval window. The polyethylene strut, on the other hand, protruded deeply into the vestibule and was about to perforate through the thinned vein graft. In the three remaining patients, the vestibular end of the prostheses was in fairly good alignment with the level or the oval window. Within the middle ear cavity all prostheses were invested in a thin coat of endothelial cells and connective tissue. Whereas the ring of the teflon piston prosthesis caused no bony atrophy, the stainless steel wire had induced a localized deossification at its site of attachment on the incus. The third and fourth cases disclosed some adhesions in the perilymphatic space around the oval window. All temporal bones revealed no injury to, or rupture of the utricle or saccule.
Frequency Responses of Hearing Aids and Their Effects on the Speech Perception of Hearing-Impaired Subjects
Authors: Pascoe David Pedeo
Published: January 2017

Eight hearing-impaired subjects were tested with a binaural master hearing aid. This aid has “on-the-head” miniature transducers and has an adjustable frequency response. Five frequency responses were used, two of them were defined by their response in a 2-cm3 coupler: 1) uniform coupler gain (UCG), and 2) 6 dB per octave rise (6 dB). The other responses were defined in terms of functional gain (difference between unaided and aided thresholds): 3) uniform functional gain (UFG); 4) uniform hearing level (UHL); and 5) a simulation of a commercial hearing aid (AS). A significant difference between coupler and functional gain was seen. Discrimination was tested with a special closed-set word list which includes fifty monosyllabic words with a high percentage of voiceless phonemes. Discrimination scores were consistently better with the UHL response. The lowest scores were obtained with the AS response. The average difference in scores between these two responses was 18.4%. Further testing replicated these results and also compared the effects of a different type of word list phonetically balanced (PB); with these lists, the above-mentioned difference in scores was smaller in quiet (5.9%) but larger in noise (20.9%).
Frequency Responses of Hearing Aids and Their Effects on the Speech Perception of Hearing-Impaired Subjects
Authors: Pascoe David Pedro
Published: January 2017

Eight hearing-impaired subjects were tested with a binaural master hearing aid. This aid has “on-the-head” miniature transducers and has an adjustable frequency response. Five frequency responses were used, two of them were defined by their response in a 2-cm3 coupler: 1) uniform coupler gain (UCG), and 2) 6 dB per octave rise (6 dB). The other responses were defined in terms of functional gain (difference between unaided and aided thresholds): 3) uniform functional gain (UFG); 4) uniform hearing level (UHL); and 5) a simulation of a commercial hearing aid (AS). A significant difference between coupler and functional gain was seen. Discrimination was tested with a special closed-set word list which includes fifty monosyllabic words with a high percentage of voiceless phonemes. Discrimination scores were consistently better with the UHL response. The lowest scores were obtained with the AS response. The average difference in scores between these two responses was 18.4%. Further testing replicated these results and also compared the effects of a different type of word list phonetically balanced (PB); with these lists, die above-mentioned difference in scores was smaller in quiet (5.9%) but larger in noise (20.9%).
Middle Ear Effusions: Definitions
Authors: Mawson Stuart R.
Published: January 2017

Evolution of nomenclature used in middle ear effusions for the last hundred years is researched and followed. It is concluded that in the light of present knowledge the term sero-mucous otitis media is the most appropriate for the nonpurulent effusions here under discussion.
Anatomy of the Normal and Cleft Palate Eustachian Tube
Authors: Dickson David R.
Published: January 2017

This report presents preliminary findings from a study of cleft palate and noncleft palate human fetuses to determine whether differences in Eustachian tube and cranial base structures could be found which might explain the universal appearance of otitis media in infants with cleft palate. Differences were found which are consistent with the previous hypothesis of reduced elasticity in the Eustachian tube. Principal findings included medial to lateral compression of the tube and reduced tubal width.
Ultrastructure of the Middle Ear Mucosa
Authors: Hentzer Erwin
Published: January 2017

Histologic studies of recent years have definitely concluded that the epithelium of the middle ear is a modified respiratory epithelium with ciliated and secretory cells, including goblet cells. These cells, like the ciliated cells, are developd from the basal cell and are just ordinary secretory cells completely filled with secretory granules. For different reasons it is postulated, that the dark secretory granules are prestages of the actual secretory product presenting as light granules and that dark and light granules do not represent different secretory capacities of the cell. The subepithelial layer which consists of loose connective tissue is a structure of just as great importance as the epithelial layer.
Functional Morphology of the Mucosa of the Middle Ear and Eustachian Tube
Authors: Lim David J.
Published: January 2017

A review of available histological, histochemical and ultrastructural data on middle ear mucosa and the Eustachian tube was made to provide a broad cellular basis for understanding middle ear effusions. The presence of mucociliary defense system in a large part of the Eustachian tube and middle ear is seen as the first line of defense. Secretion by the mucosa has a profound biological significance. Immunoglobulins A, G, and even E and M are produced locally by the mucosa and may contribute to the immunodefense of the middle ear. Secretory lysozyme is also produced by the mucosa and may contribute enzymatic defense of the ear. Mucosal immunoglobulins and lysozyme are significantly elevated in the effusions, which would imply that local defense systems are hyperactive in OME. It also appears that these increases are related to the increase of the secretory cell population. It is also suspected that auditory surface-active agent is produced locally and may facilitate normal function of the tube. The middle ear also can transport macromolecules very rapidly across intact mucosal epithelium. The large numbers of tissue and wandering macrophages found in the mucosa and effusions would also imply that the middle ear is capable of efficient phagocytosis, which may be involved in processing antigen.
Goblet Cell Population in the Normal Middle Ear and Eustachian Tube of Children and Adults
Authors: Tos Mirko , Bak-Pedersen K.
Published: January 2017

On 54 temporal bones from entirely normal prematures and newborn infants, children, and adults, 30,000 to 90,000 counts of goblet cells were done in different parts of the Eustachian tube and middle ear. In the Eustachian tube, normal prematures showed a very low density of goblet cells in all localities, increasing in the pharyngeal parts gradually through childhood and reaching in the normal adult a very high density in the pharyngeal orifice. There are no differences in density between the medial and lateral wall, but in some parts a decrease of density towards the tubal roof. In the middle ear the density is low in normal prematures, increasing slightly in infants, and decreasing again during the age range 7–14 years and in adults. Goblet cells are present in all middle-ear localities, but in markedly decreasing density in this sequence: hypotympanum anteriorly, posteriorly, promontory anteriorly, in the middle, epitympanum, niche of oval window, antrum, niche of round window, mastoid process, incus, and promontory posteriorly.
Clearance of Middle Ear Effusions and Middle Ear Pressures
Authors: Sadé J. , Halevy A. , Hadas E.
Published: January 2017

Twenty-six children presenting bilateral secretory otitis media (SOM) had ventilating tubes inserted into both middle ears. Mucus was, however, aspirated only from one ear, the right side. The vast majority of ears right and left were seen to have cleared their effusion equally well regardless of whether they were aspirated on not. This experiment points toward the essential intactness of the mucociliary system and the patency of the lumen of the Eustachian tube in SOM. Promotion of middle ear clearance through ventilation, which reminds one of the second opening in a beer can, does obviously suggest the relief of some negative pressure. Direct manometric measurements of SOM middle pressure were performed in 41 ears showing negative pressure averaging —1.7 mm H2O, this range being two orders of magnitude less than tympanometric measurements. Normal ears did not have even such a small negative pressure. The validity of these direct manometric measurements was checked against a model of the middle ear. Tympanometry, which is a valid diagnostic tool, does indicate in all probability the presence of middle ear effusion due to its rheologic effects on the drum and ossicles rather than the measure of actual middle ear pressures. This is determined by the fact that direct needling of the middle ear, or even the insertion of a ventilating tube, did not change tympanometric values but aspiration of part of the effusion did: indeed the latter tended to bring manometry to normal values.
Biological Mediators of Inflammation in Middle Ear Effusions
Authors: Bernstein Joel M.
Published: January 2017

Four biological mediators of inflammation have been found in middle ear effusions from patients with otitis media with effusion. They are chemotactic factor(s), macrophage inhibition factor(s), activated complement and prostaglandins. The potential role of these mediators has been discussed in relation to their potential for maintaining inflammation in the middle ear cleft after Eustachian tube dysfunction.
Secretory IgA and Antibody Activities in Middle Ear Effusions
Authors: Mogi Goro
Published: January 2017

Secretory IgA (SIgA) was isolated from pooled middle ear effusions (MEE) and its antigenicity and subunit structure were found to be identical to those of SIgA in saliva, nasal secretion and colostrum. The calculated percentage of SIgA in the total IgA of effusions was approximately 11%. Although the SIgA antibodies against streptolysin and staphylolysin were very low when compared to that of IgG class in effusion, this finding confirmed that MEE is at least partially a result of local immunologic reactions. The IgE concentration did not become elevated in both the MEE and serum obtained from patients with otitis media with effusion. Specific reaginic activity against mites was found in 5 of 56 (8.9%) MEE. Our findings would not suggest the significant role of atopic allergy in the formation of MEE.
Biochemical Characteristics of Middle Ear Effusions
Authors: Juhn S. K. , Huff John S.
Published: January 2017

Biochemical composition of middle ear effusions (MEE) and serum was compared both in experimentally induced middle ear inflammation in squirrel monkeys and in otitis media in humans. The MEE and serum protein concentrations were similar in the animal experiments. In human MEE the total protein concentration of both serous and mucoid effusions was higher than the proteins of the serum. Higher concentrations of potassium and lower concentrations of glucose in human MEE than in serum were also observed. Activities of various oxidative (lactate dehydrogenase, malate dehydrogenase) and hydrolytic (leucine aminopeptidase, alkaline and acid phosphatase, and lysozyme) enzymes in MEE and serum were compared. The ratio of enzyme activity between MEE and serum (MEE/Serum) was greater than one in all enzymes studied. Mucoid MEE had higher activity of enzymes than serous effusions in general. Lactate dehydrogenase isoenzyme patterns were compared on electropherogram. Isoenzyme fractions 1 and 2 were each smaller in MEE than in serum whereas 4 and 5 had a significantly higher activity in MEE than in serum. Higher activities of enzymes in MEE as compared with serum are consistent with the hypothesis that MEE results from inflammatory processes occurring in the middle ear cavity. The enzymes of MEE seem to have multiple origins, namely, 1) enzymes normally present in blood, 2) enzymes from the inflamed middle ear mucosa, and 3) enzymes from leucocytes present in effusions.
Immunology and Microbiology in Acute Otitis Media
Authors: Sloyer John L. , Ploussard John H. , Howie Virgil M.
Published: January 2017

Various immunological parameters were measured in serum, middle ear fluid (MEF), and lymphocytes from peripheral blood and MEF of infants with acute otitis media due to S. pneumoniae or H. influenzae. Approximately half of 131 patients had IgE specific antibody to the infecting bacterium as determined by the indirect fluorescent antibody (IFA) technique. Seventy-one percent of these IgE positive patients had IgE specific antibody in the MEF. Total IgE concentration was found to be from an average of 1.5 to 3.0 times higher in the MEF when compared to the simultaneously drawn serum. In addition, antibody to pneumococcal capsular polysaccharides and to pneumococcal C-carbohydrate was demonstrated in the MEF by radioimmunoassay. When MEF specific antibody was compared to serum antibody it appeared that antibody to C-carbohydrate was more concentrated in the MEF. That this antibody was of the IgE class was suggested by IFA but not conclusively proven. Evidence exists that conditions for enhanced IgE synthesis is concomitantly associated with a decrease in T-cell activity. T-cell function in MEF derived lymphocytes as determined by rosette formation and by phytohemagglutinin (PHA) stimulation was approximately one-tenth that of the peripheral blood lymphocytes. However, that T-cells may participate in the immune response to polysaccharides was suggested by the observation that polysaccharide stimulated peripheral blood lymphocytes from infants immunized with octavalent pneumococcal capsular vaccine underwent protein synthesis two to three times that of the PHA stimulated cells. The clinical significance of this finding as well as the nature of the cell responsible for the increased protein synthesis remains to be established. It is hypothesized that acute otitis media results from local synthesis of bacteria specific IgE antibody which is enhanced by a paucity of local T-cell activity.
Microbiology in Serous Otitis Media
Authors: Lundgren Kaj , Rundcrantz Hans
Published: January 2017

It is now established that serous otitis media (SOM) is an inflammatory reaction of the mucosa of the middle ear. A number of microbiological factors are contributory causes. It is clear, among other things, that the microbiologic environment in the nasopharynx in SOM is the same as that in acute otitis media. Neither adenoidectomy and tonsillectomy nor treatment with conventional chemotherapeutics has proved effective for eradicating pathogenic bacteria from the nasopharynx. Intense research to find new antibiotics and effective means may be one way of getting us out of our present therapeutic dilemma. Other possibilities are to try to produce polyvalent bacterial vaccines and to increase our knowledge of the immunology of the nasopharynx.
Physiology of the Eustachian Tube
Authors: Ingelstedt Sven
Published: January 2017

A method for studying the middle ear mechanics is described. The method permits continuous recording of the volume deviation of the drum in relation to the neutral position, both on change in the ambient pressure and in the pressure in the middle ear. One hundred and two volunteers with normal hearing, i.e., a normal audiogram and normal ear findings, were tested repeatedly. This is the most detailed and extensive investigation hitherto performed on healthy volunteers with the aid of a sophisticated, reliable scientific method not suitable for clinical use.
Normal Gas Exchange in the Human Middle Ear
Authors: Elner Å.
Published: January 2017

Different kinds of biological gas pockets and the special character of the middle ear as a gas pocket are discussed. The pattern of gas absorption from the normal middle ear and from ears with blocked Eustachian tubes is presented. The amount of gas leaving the ear by diffusion and the resulting underpressure from this process are determined. The composition of air in the ear is compared to that in experimental gas pockets and the role of the partial pressures of CO2 and O2 in secretory otitis media is discussed.
Study of the Ventilation of Middle Ear Using Radioactive Xenon
Authors: Kirchner Fernando R. , Robinson Ralph , Smith Robert F.
Published: January 2017

The greatest contribution of nuclear medicine has been to make possible dynamic measurements of regional function. It is conceivable that if this technology could be successfully used to measure the ventilation and clearance of the middle ear, answers to some of the most crucial problems in otology may be found. The objectives of this paper are threefold: 1) A descriptive account of radiotracers and radiodetectors with emphasis on Xenon133. 2) The development of scintillographic techniques for the dynamic study of the ventilation of the ear and sinuses. 3) The methods that are being explored for the quantification of these functions.
Concepts on the Pathogenesis of Middle Ear Effusions
Authors: Bluestone Charles D. , Beery Quinter C.
Published: January 2017

Several concepts related to the pathogenesis of middle ear effusions are postulated. The mechanisms proposed are based on an understanding of fluid mechanics. A flask with a long, narrow neck is presented as a model of the Eustachian tube-middle ear-mastoid system. Fluid flow into and out of the flask is dependent upon the pressure gradient, compliance of the narrow neck and whether or not the bulbous portion is intact. It is suggested that locking of the tube may be dependent upon the speed of the application of the negative pressure and the compliance. Eustachian tube opening appears to be related not only to active muscle forces but may also be dependent upon the presence of a pressure gradient which passively assists tubal function. It is proposed that middle ear effusions result from reflux, aspiration or insufflation of nasopharyngeal secretions (acute otitis media), or from persistent functional or mechanical Eustachian tube obstruction (secretory otitis media) or both.
Improved Diagnosis of Middle Ear Effusions Employing the Objective Otoscope
Authors: Lovette Spencer
Published: January 2017

A new quantitative diagnostic otoscope presently under development supplements the conventional otoscopic examination with a quantitative pneumatic system and objective measurements derived from tympanometry. The instrument provides information to assist in the diagnosis of the presence of middle ear effusion (MEE), the middle ear pressure and tympanic membrane status during the visual examination. Uncertainty introduced by subjective judgement involved with traditional pneumatic otoscopy is eliminated enabling a more rapid and accurate diagnosis. Clinical evaluations were performed in which 92% accuracy was achieved for the diagnosis of the presence of MEE in 38 ears. The results were verified at myringotomy. The instrument is being designed for use by physicians and paraprofessionals.
Identification of Allergic Factors in Middle Ear Effusions
Authors: Clemis Jack D.
Published: January 2017

Allergic factors are important, but not the only etiologic force in middle ear effusion. Nor do bacterial and viral infections, nasopharyngeal mass lesions, neuromuscular or regional anatomic abnormalities rank as sole etiologic factors. Some children have multiple components to their problem that requires specific identification before a workable approach to management can be tailored for each of them. Identification and management of allergic factors requires special skills and a greater commitment of time. Yet the marked increase in total yield when allergic techniques are added to the armamentarium of the otolaryngologist make these factors both worthwhile and satisfying.
Comparative Study of Various Ventilating Tubes
Authors: Crysdale William S.
Published: January 2017

In less than 20 years, insertion of middle ear ventilating tubes has become perhaps the most common operative procedure. It was not possible to find a study that adequately compares the performance of the many different types of tympanostomy tubes available. The ideal ventilating tube is defined; it has not yet been designed.
Adenoidectomy in Relation to Otitis Media
Authors: Bluestone Charles D. , Beery Quinter C.
Published: January 2017

Past studies of the efficacy of adenoidectomy in the management of children with otitis media have been inconclusive due to significant limitations in experimental design. At the Children's Hospital of Pittsburgh, the effect of adenoidectomy on the outcome of otitis media is currently being studied in a prospective manner. An attempt is being made to document and to control those factors cited as lacking in the previous studies. This report describes the techniques for assessment of nasal and Eustachian tube function and for the completeness of adenoidectomy.
Blue Ear Drum and its Management
Authors: Paparella Michael M.
Published: January 2017

The “blue ear drum” generally refers to a condition in which blood or blood products are found in the middle ear. After all possible causes for hemotympanum, including blood dyscrasias and trauma are searched for and ruled out, the patient may have chronic serous otitis media accompanied by bloody effusion. Treatment for all of these patients is conservative, consisting of medical therapy and, if need be, myringotomy and insertion of ventilation tubes. In spite of proper treatment, rarely the condition may progress, over a long period of time, to a state of intractability. Characteristic findings are a hypocellular mastoid, hyperplastic and metaplastic mucoperiosteal lining, including the presence of glands and cysts and Cholesterin granuloma. The recommended procedure is a modified radical mastoidectomy, placement of silicone rubber sheeting in the middle ear and insertion of a ventilation tube. It is to be emphasized that mastoid surgery is rarely indicated for these patients and only after all else has failed.
Cochlear Implants
Authors: House William F.
Published: January 2017

Cochlear implants seem to be the first long step in the search for a mechanical prosthesis that would restore hearing to the profoundly deaf. While present developments with implants appear to have been successful in providing deafened individuals with a reasonably wide range of information, the ultimate goal, the full comprehension of discriminable speech, is still beyond our grasp. The present monograph is essentially a history of how we arrived at this point in the development of cochlear implants. It begins with the original observations of Djourno and Eyriès, the first animal and human studies, and the early work of House and Urban with a small sample of subjects. The problems, failures, and initial successes are detailed, as well as an account of the engineering developments in which the hard wire electrode system with the external button was finally replaced by the more sophisticated internal induction coil with the “take-home” stimulator. Early in the project, it became clear that many specialists needed to be involved both for the purposes of evaluation and training of implant subjects. The first such individuals were rehabilitation experts and their program for defining objectives, procedures and evaluation is discussed. Since implants were likely to have potentially profound cognitive, emotional and social effects, a team of psychologists became participants. Their preliminary program and initial study is outlined. Finally, this history concludes with some observations about where we have been, the current stage of development, and plans for the future. It is our optimistic view that we are on the threshold of an important advance in the treatment of the profoundly deafened.
Scanning Electron Microscopic Study of the Organ of Corti in Normal and Sound-Damaged Guinea Pigs
Authors: Soudijn Eduard R.
Published: January 2017

A method was evolved by which the organ of Corti could be examined in its entirety with the scanning electron microscope, the organ meanwhile retaining its spiral form. This made it possible to assess traumatic effects on the cochlea and qualify lesions in terms of extent, localization and pattern. It was also found possible eventually to cut the same specimen into sections for cellular and subcellular studies. The number of guinea pigs examined totalled 91, divided into three groups. The first group was used to study the anatomy of the organ of Corti with special reference to normal variations and artifacts. Unmistakable indications were found that the longest stereocilia of the inner hair cells are linked to the tectorial membrane. The animals of the second group were exposed to pure tones of high intensity, whereupon, lesions of the organ of Corti were described according to intensity, time, and frequency. Three different types of otologic drills were used to perform mastoidectomies on temporal bones and on the cadaver. The noise produced was analyzed as to intensity and frequency range. It was found that the drill with the lowest rpm (and highest torque) produced the highest noise intensities, at levels which can be traumatic to the human organ of hearing. The animals of the third group were exposed to the amplified noise produced by otologic drills of three different types. The resulting lesions in the organ of Corti were examined by the method described for scanning electron microscopy and compared. In spite of the wide variation in individual lesions, patterns of degeneration of three different types could be distinguished. The high-speed and the very-high-speed drill inflicted less damage on the organ of Corti than the low-speed drill. It is therefore advised to refrain from using the latter drill in prolonged operations.
Spiral Migration Theory of Organ of Corti Development
Authors: Marovitz William F. , Shugar Joel M. A. , Khan Khalid M.
Published: January 2017

A mitotic zone has previously been demonstrated on the luminal surface of the posteromedial wall of the otocyst in the plane of the endolymphatic duct and at the junction of cochlea with primitive saccule. In this experiment the application of fluorodeoxyuridine (FudR) (an antimitotic agent) demonstrates the existence of a discrete synthetic zone for the otocyst which lies nearby to the otic zone of mitosis. Cells labeled by FudR and, therefore, in the mitotic synthetic (S) phase are always found away from the lumen (antiluminal surface) when the animals are sacrificed soon after injection. Cellular migration from synthetic zone through the luminal mitotic area and beyond is hypothesized. Once cellular division is completed the cells appear to follow a spiral course (from medial to lateral) over the anterior wall of the otocyst. The cells continue their spiral course entering the thin side of the cochlear base. From this strategic location the cells migrate around the sides of the cochlea to reach and to form the pseudostratified wall and complete the thin side of the cochlear duct. The pitch of this migration pattern is similar to the helical pitch of the mature cochlear duct and may be responsible for the adult configuration.
Some Unresolved Problems concerning the Cochlear Nerve
Authors: de Nó R. Lorente
Published: January 2017

Three types of afferent fibers innervate the hair cells of the organ of Corti: 1) specific radial fibers which establish contacts with a very few neighboring internal hair cells; 2) spiral fibers, each one of which establishes contact with a number of external hair cells distributed throughout long segments of the cochlea; and 3) unspecific radial fibers which are collaterals arising radially at irregular intervals from fibers of the ganglionic spiral bundles and which establish contact with internal hair cells. The existence of spiral ganglionic bundles of fibers oriented apicalward has long been described, and the fact that a number of ganglionic spiral fibers give off radial collaterals to innervate internal hair cells was illustrated by Cajal and by Lorente de Nó. However, those structural details are not mentioned in the modern literature. In the ventral nucleus there are neurons with efferent axons which join the trapezoid body and cells with short axons ramified within the ventral nucleus itself. Two types of cells with efferent axons are illustrated and described, the spherical or bushy cell and the basket cell; and it is shown that branches of division of the two types of efferent axons form association tracts which end in the tuberculum acusticum. Also, the fact is illustrated that fibers having their cells of origin in that tuberculum form association paths which end in the ventral nucleus by means of extensive ramifications which form numerous synaptic endings. The dendritic and fibrillar plexuses in the ventral nucleus are described, an analysis is made of the relationships between the two plexuses and of the synaptic junctions that mediate transmission of nerve impulses. The synaptic junctions belong to a considerable number of types and in all illustrations the important fact repeatedly appears that one and the same fiber may form synaptic endings of widely different sizes and shapes located either on the same neuron or, more frequently, on different neurons. The intimate structure of each type of synaptic ending cannot be revealed by light microscopy, but only light microscopy can reveal to which kind of fiber the synaptic endings do belong. The presentation is concluded with a brief and preliminary discussion of physiological corollaries of certain general features of the anatomy of the acoustic system.
1. An Improved Method for Processing Early Rat Otocysts for the Electron Microscope
Authors: Schulte Trina , Khan Khalid M. , Marovitz William F.
Published: January 2017

Various methods of dissection, fixation, osmication, sectioning and staining were tested in order to develop an acceptable technique for preparing 9, 10, 11, and 12-day-old rat otocysts for electron microscopic study. The general problems associated with embryonic tissue — Difficult handling, high water content and poor stainability are discussed, and concrete methods of preparation which significantly decrease these difficulties are proposed. The specific fixation and sectioning requirements of rat otocyst are also described in the elaboration of a method which will be used in subsequent studies of the organogenesis of rodent ear.
3. Scanning Electron Microscopic Appearance of Rat Otocyst of the Twelfth Postcoital Day Elaboration of a Method
Authors: Marovitz William F. , Khan Khalid M.
Published: January 2017

A method for removal, fixation, microdissection, and drying of early rat otocyst for examination by the scanning electron microscope is elaborated. Tissues were dissected, fixed as for conventional transmission electron microscopy and dried by critical point evaporation using amylacetate as the transitional fluid and carbon dioxide as the pressure head. Otocysts were either dissected at the time of initial fixation, or subsequent to drying. The otocyst of the 12th postcoital day was used as a model system in this preliminary report. Critical point drying retained the overall configuration and the fine ultrastructural detail of the otocyst. The interior otocystic surface was visualized and cilia bearing cells of the luminal surface were identified. Most if not all of these cells had a conspicuous, but short kinocilium which terminated in an ovoid bulb. The scanning electron microscopic appearance was correlated to the transmission electron microscopic image seen in the second paper in this Supplement.
Auditory Prostheses in Perspective
Authors: Bilger R. C. , Black F. O.
Published: January 2017

The results of the evaluation of subjects presently fitted with internal auditory prostheses are summarized. Based on these results, the role of single-channel prostheses as a treatment for acquired deafness is discussed in terms of the auditory expectation for a single channel and of subject selection.
Present Otologic Status of Subjects Implanted with Auditory Prostheses
Authors: Black F. O. , Myers E. N.
Published: January 2017

Thirteen persons who had functioning cochlear prostheses underwent medical evaluation. The nine males and four females ranged in age from 26 to 67 years at the time of the evaluation. Their mean age was 48.1 years. The etiology of deafness had been determined prior to implant surgical procedures in 6 of the 13 subjects. Of the remaining seven subjects, four had acquired hearing losses of unknown causes and three had congenital hearing deficits of unknown cause. All subjects participating in the study gave histories or findings compatible with severe loss or absence of vestibular function. All subjects had well-healed postauricular scars. The implant hardware was physically well-tolerated by the subjects and did not disrupt middle ear function. The implanted subcutaneous coil appeared to be well-tolerated and firmly anchored to the skull in every patient. There was no evidence of irritation to the skin or surrounding tissue. The skin surrounding a percutaneous plus which had been in place for six years in one subject showed no evidence of rejection. However, one subject who had electrode leads implanted beneath external auditory canal skin exhibited chronic external otitis. With this exception, the implant devices were clinically well-tolerated.
Present Vestibular Status of Subjects Implanted with Auditory Prostheses
Authors: Black F. O.
Published: January 2017

Electronystagmographic studies were performed on all 13 patients with the caloric stimulus series, omitted in two subjects with external otitis. Eleven of the 13 subjects exhibited normal eye movement screening tests. Of the remaining nine subjects who could be evaluated, all demonstrated markedly reduced or absent caloric-induced nystagmus responses. These results confirmed preoperative vestibular test findings performed by implant surgery teams and indicated that the vestibular systems of the patients were severely damaged.
Present Neuropsychological Status of Subjects Implanted with Auditory Prostheses
Authors: Vega A.
Published: January 2017

To assess the subject's cognitive and conceptual function, an extensive battery of neuropsychological tests were administered to each subject. Of the 13 subjects, 11 showed normal to superior cognitive and conceptual abilities; however, two of the subjects presented evidence of impaired cognitive and conceptual functioning. Subjects with right-ear implants showed asymmetry in the measures of peripheral flicker-fusion thresholds.
Human Cochlear Aqueduct and its Accessory Canals
Authors: Rask-Andersen H. , Stahle J. , Wilbrand H.
Published: January 2017

The anatomy of the adult human cochlear aqueduct and its surrounding structures, and their normal variations at tomography, microdissection and plastic molding are described. The mean length of the aqueduct is 12.9 mm and the mean width of its funnel-shaped external aperture 4.2 mm. The mean width of the narrowest portion is 0.14 mm. No difference in aqueductal width was found between the youngest and oldest age groups. Complete bony obstruction was revealed at microdissection in 3 out of 82 specimens. In the remaining 79 the entire aqueduct was patent. The aqueduct usually runs parallel to the internal auditory canal when seen from above, and the AP projection is therefore most suitable for tomography. At tomography the entire aqueduct was visualized in 60% of the specimens. The isthmic portion was not visible in 40%. Major reasons for nonvisualization of the entire aqueduct are: 1) a luminal width less than 0.1 mm, 2) a high jugular fossa, 3) a posteriorly directed aqueductal convexity (10%), and 4) bony obliteration (4%). Accessory canals close to and often wider than the aqueduct may complicate tomographic evaluation of the aqueductal patency. Nonvisualization of the aqueduct at tomography does not necessarily indicate nonpatency.
Normal and Abnormal Middle Ear Ventilation
Authors: Cantekin Erdem I. , Bluestone Charles D. , Doyle William J. , Saez Carlos A. , Phillips David C.
Published: January 2017

Studies in infants and children have suggested a functional rather than mechanical obstruction of the Eustachian tube as a predisposing factor in middle ear effusions (MEE). To simulate this condition in the laboratory, an animal model was prepared using juvenile Rhesus monkeys. The tensor veli palatini muscle was transected or expunged posterior to the hamulus of the medial pterygoid lamina. Transection of the muscle resulted in negative middle ear pressure without effusion, whereas when the muscle was expunged, the animals developed a brief episode of negative middle ear pressure followed by a persistent MEE that was sterile for bacteria. An acute bacterial MEE developed following instillation of Streptococcus pneumoniae into the nasopharynx of animals that had had a previous unilateral transection of the muscle. The condition of the middle ear was documented by impedance measurements and presence of the effusion was verified by myringotomy. Animals were periodically examined and tested for Eustachian tube ventilatory function over a period of one year. Before surgical alteration of the tensor muscle. Eustachian tube function tests demonstrated normal ventilatory function, whereas, functional Eustachian tube obstruction patterns similar to studies in children who had MEE were found during the postoperative period. Only after the development of a reliable animal model can current and future methods of management of MEE be tested under controlled laboratory conditions. These data suggest that the Rhesus monkey appears to be an excellent model for the study of normal as well as abnormal tubal function.
Tympanometric Patterns Found in Middle Ear Effusions
Authors: Cantekin Erdem I. , Beery Quinter C. , Bluestone Charles D.
Published: January 2017

In 120 ears of 67 children with a history of recurrent acute otitis media or otoscopic evidence of persistent middle ear effusion, or both, tympanograms were obtained using an otoadmittance meter and an electro-acoustic impedance bridge. Myringotomy was performed immediately following the tympanometric evaluation confirming the presence or absence of middle ear effusion. The comparison of myringotomy findings with a tympanometric pattern classification revealed 85.8% overall correct association with the presence or absence of a middle ear effusion for both instruments. In 83.3% of the cases, there was agreement in the classification of the tympanogram between the otoadmittance meter and the electro-acoustic bridge.