bluuebunny/crossref_metadata_2025 huggingface dataset:
Treatment of Superficial Vein Thrombosis with Standardized Application of Essaven Gel
Authors: De Sanctis M.T. , Cesarone M.R. , Incandela L. , Belcaro G. , Griffin M.
Published: January 2017

The aim of this randomized, placebo-controlled study was to evaluate the effect of local treatment with Essaven gel (EG) in comparison with placebo in 30 patients with superficial vein thrombosis (SVT). The 4-week study evaluated the average skin temperature and an analogue symptomatic score. Below-knee SVT was associated with large varicose veins. In patients treated with active EG the decrease in score and in the average, composite skin temperature was significantly larger than in the placebo and control groups. No intolerance was observed. The decrease in score and temperature in the placebo group was mainly due to skin manipulation and massage. In conclusion, treatment with EG in SVT improves symptoms and decreases skin temperature faster. This study confirms earlier observations on the effective use of EG in SVT.
Treatment of Superficial Vein Thrombosis: Clinical Evaluation of Essaven Gel
Authors: Incandela L. , De Sanctis M.T. , Cesarone M.R. , Ricci A. , Errichi B.M. , Dugal M. , Belcaro G. , Griffin M.
Published: January 2017

The aim of this randomized, placebo-controlled study was to evaluate the effect of local treatment with Essaven gel (EG), in comparison with placebo in 30 patients with superficial vein thrombosis (SVT). The 8-week study evaluated SVT with an analogue clinical/sympto matic score. SVT was associated with varicose veins. In patients treated with active EG the decrease in score was significantly larger (p < 0.02) than in the placebo group. No intolerance was observed. The decrease in score in the placebo group was due to spontaneous resolution and to skin manipulation and massage. In conclusion local treatment with EG in SVT improves signs/symptoms much faster than placebo. This study confirms earlier observation on the effective, local use of EG in SVT.
From Symptoms To Leg Edema: Efficacy Of Daflon 500 mg
Authors: Nicolaides Andrew N.
Published: January 2017

This article reviews the mechanisms by which micronized purified flavonoid fraction (MPFF; Daflon 500 mg) acts on symptoms as well as on edema in patients with chronic venous disease, in the light of new advances in the understanding of the pathophysiology of this chronic condition. Deterioration of venous wall tone followed by valve dysfunction leading eventually to varicose veins are the key pathophysiologic features that produce venous hyper tension. Both mechanical and biological factors are responsible for the deterioration of the venous wall in large veins. These are decreased shear stress and hypoxia of the media and of the endothelium, which act as triggering factors for biochemical reactions leading to inflam mation. There is a body of evidence that inflammation in chronic venous insufficiency (CVI) plays a role right from the early stages of venous dysfunction and venous valve restructuring. The whole process of venous wall stretching and dilation is painful and may present as leg heaviness, a sensation of swelling, and paresthesia. Daflon 500 mg relieves symptoms, edema, and red blood cell aggregation, which cause paresthesia and restless legs. At the level of the microcirculation, dysfunction of microvessels is observed, characterized by an increase in capillary permeability followed by skin changes. The earliest manifestation of microcirculatory disorder is edema. At this level, Daflon 500 mg acts favorably on microcirculatory complica tions by normalizing the synthesis of prostaglandins and free radicals. It decreases bradykinin- induced microvascular leakage and inhibits leukocyte activation, trapping, and migration. Its efficacy in decreasing CVI edema and ankle swelling has been proven in rigorous studies that are reviewed in this paper. Daflon 500 mg, a well-established oral flavonoid that consists of 90% micronized diosmin and 10% flavonoids expressed as hesperidin, may be prescribed from the very beginning of the disease for the relief of pain and edema, and in any CVI patient presenting with symptoms as well. Daflon 500 mg is thus the first-line treatment for edema and symptoms of CVI at any stage of the disease. At advanced disease stages, Daflon 500 mg may be used in conjunction with sclerotherapy, surgery, and/or compression therapy or as an alternative treatment when other treatments are not indicated or not feasible.
Application of Ambulatory 24-Hour Multiprobe pH Monitoring in the Presence of Extraesophageal Manifestations of Gastroesophageal Reflux
Authors: Shaw Gary Y.
Published: January 2017

The recognition of extraesophageal manifestations of gastroesophageal reflux (GER) has gained acceptance in recent years. Objective measurements of acid reflux have been aided greatly by the advent of multiprobe pH monitoring. The development of the multiprobe pH monitor has enabled researchers and clinicians to objectively measure acid exposure in the pharynx and upper esophagus. The indications for use of this diagnostic technique for a variety of extraesophageal manifestations of GER are outlined.
Shaw Scalpel in Revision Cochlear Implant Surgery
Authors: Roland J. Thomas , Fishman Andrew J. , Waltzman Susan B. , Cohen Noel L.
Published: January 2017

The use of traditional electrocautery is prohibited in revision or replacement cochlear implant surgery because of the concern for end organ tissue damage. Additionally, electrical current spread to the malfunctioning device could interfere with an accurate cause-of-failure analysis. Clinical reports have confirmed the utility of the Shaw scalpel for dermatologic, ophthalmic, and head and neck surgery. The Shaw scalpel is a thermally activated cutting blade that provides a bloodless field through immediate capillary and small vessel hemostasis. Avoidance of wound and flap complications is of primary concern in cochlear implant surgery. The long-term wound healing compared favorably to that of other surgical cutting instruments in several experimental reports. We have routinely used the Shaw scalpel in revision cochlear implant surgery and in primary surgery whenever electrocautery was contraindicated. We have retrospectively evaluated 22 cases in which the Shaw scalpel was used for cochlear implant revision and primary surgery. The chart review included patient demographics, the indication for surgery, the contraindication for electrocautery, intraoperative surgical notes, the wound healing evaluation, the evaluation for alopecia, and postoperative speech understanding. No significant complications occurred intraoperatively, and the long-term wound healing results were no different from those obtained with conventional surgical techniques. The explanted devices were undamaged, and valuable diagnostic information could be obtained. All patients performed at or better than their preoperative levels on speech recognition testing. Our results indicate that the Shaw scalpel is a relatively safe, easy-to-use, and effective instrument.
Cochlear Implantation in Jervell and Lange-Nielsen Syndrome
Authors: Green J. Douglas , Schuh Mary Jo , Maddern Bruce R. , Haymond Jody , Helffrich Richard A.
Published: January 2017

Jervell and Lange-Nielsen syndrome represents a rare, autosomal recessive cause of congenital deafness. Affected patients have a characteristic prolongation of the QT interval on electrocardiogram, along with cardiac arrhythmias, recurrent syncopal episodes, and a predisposition to sudden death. We present the first reported case of cochlear implantation in a child with Jervell and Lange-Nielsen syndrome. Special perioperative precautions were required, including cardiac monitoring for 48 hours, perioperative beta blockade, and special anesthetic considerations. Because sudden patient death has been associated with exposures to loud sounds in patients with prolonged QT syndrome without hearing loss (Ward-Romano syndrome), initial cochlear implant stimulation was performed with cardiac monitoring. This patient has responded well to cochlear implantation with 11 months of implant use. The patient has achieved limited open-set word comprehension and significantly improved speech, as is expected for her age. Although the patient had no problems with cardiac arrhythmias at surgery, she has since experienced a syncopal episode requiring placement of an automatic pacemaker and defibrillator. The implant has continued to work well despite the pacemaker and defibrillator. Cochlear implantation can be relatively safely performed in patients with Jervell and Lange-Nielsen syndrome, provided proper precautions are followed.
Recognition of Sentences in Noise by Normal-Hearing Listeners Using Simulations of Speak-Type Cochlear Implant Signal Processors
Authors: Loizou Philipos C. , Dorman Michael F. , Tu Zhemin , Fitzke Jeanette
Published: January 2017

To assess whether more channels are needed to understand speech in noise than in quiet, we processed speech in a manner similar to that of spectral peak–like cochlear implant processors and presented it at a dB signal-to-noise ratio to normal-hearing listeners for identification. The number of analysis filters varied from 8 to 16, and the number of maximum channel amplitudes selected in each cycle varied from 2 to 16. The results show that more channels are needed to understand speech in noise than in quiet, and that high levels of speech understanding can be achieved with 12 channels. Selecting more than 12 channel amplitudes out of 16 channels did not yield significant improvements in recognition performance.
I. Internal Superior Laryngeal Nerve Afferent Activity during Respiration and Evoked Vocalization in Cats
Authors: Clark Keith F. , Farber Jay P.
Published: January 2017

The purpose of this project was to identify and categorize patterns of activity of the internal branch of the superior laryngeal nerve during vocalization evoked by midbrain stimulation in cats anesthetized with α-chloralose. Unit activity was isolated from the cut distal end of the internal branch of the superior laryngeal nerve by means of floating bipolar electrodes that retained their contact with nerve fibers despite movement due to vocalization. The phases of respiration and vocalization were determined with a diaphragm electromyogram, a photoglottogram, and a microphone recording. Five groups of discrete afferent activities were defined according to relationships between the spike activity and the phases of vocalization. Group 1 cell activity peaked just before phonation, during expiratory airflow (n = 26). Group 2 cells (n = 19) followed a vocal fold vibratory pattern during phonation. Group 3 cell activity (n = 6) peaked during phonation, but did not follow vocal fold vibration. Group 4 cells (n = 3) were active during inspiration between phonations. Group 5 cells (n = 4) showed both inspiratory and expiratory modulation. These results indicate that laryngeal afferent activity responds to phonation-specific events during vocalization. This stereotyped afferent information might be used by the central nervous system to modulate vocalization.
II. Effect of Recurrent Laryngeal Nerve Paralysis on Superior Laryngeal Nerve Afferents during Evoked Vocalization
Authors: Clark Keith F. , Farber Jay P.
Published: January 2017

We tested the hypothesis that vocal fold paresis leads to a substantial reduction in activity from the internal branch of the superior laryngeal nerve (iSLN) during respiration and evoked vocalization. The iSLN afferent activity was measured before and after recurrent laryngeal nerve paresis by cold block in decerebrate cats during spontaneous respiration and electrically evoked vocalization. Response rate patterns of 33 iSLN single units from 11 cats were categorized into 5 groups based on responses to vocalization. Only 24% of single units during spontaneous respiration and 18% during evoked phonation displayed activity pattern changes as a result of paresis. Those fibers affected were heterogeneous in discharge pattern, but none of the units that followed voice frequency lost this characteristic when the motor nerve was cooled. The relative insensitivity of iSLN activity to motor paralysis suggests that the receptors studied are coupled to tissue such that passive interaction rather than active muscular contraction is the major stimulus.
Some Critical Developments in Acquiring Native Language Sound Organization during the First Year
Authors: Jusczyk Peter W.
Published: January 2017

Although infants are born with rather sophisticated capacities for discriminating and categorizing speech sounds, they still must learn about the sound organization of their native language. Before 6 months, infants show relatively little sensitivity to native language versus non-native language sound organization. Shortly thereafter, infants recognize which sounds and sound sequences and rhythmic patterns are likely to appear in native language words. Knowledge of these features plays a critical role in how and when infants segment words from fluent speech. Word segmentation abilities develop rapidly between 7.5 and 10.5 months. Initially, English-learners segment words using stress cues. Soon after, they learn to use other potential cues to word boundaries. As their lexicons develop during the second year, they begin to use information about known words in segmenting and learning new words.
Effects of Age at Implantation in Young Children
Authors: Kirk Karen Iler , Ying Elizabeth , Miyamoto Richard T. , O'Neill Tara , Lento Cara L. , Fears Beverly
Published: January 2017

This study examined the effects of age at implantation on the development of communication abilities in children with early implantation. The 73 participants were prelingually deafened, received a cochlear implant before 5 years of age, and used current cochlear implant technology. The children were administered a battery of speech and language outcome measures before implantation and again at successive 6-month postimplant intervals. A mixed model analysis was used to examine the rate of growth in word recognition and language skills as a function of age at time of implantation. The results revealed significant improvements in communication skills over time. Spoken word recognition improved at a faster rate in the oral children with early implantation. However, the children who underwent implantation before 3 years of age had significantly faster rates of language development than did the children with later implantation. The oral children demonstrated more rapid gains in communication abilities than did the children who used total communication.
Cochlear Implants and Infants: Expectations and Outcomes
Authors: Wright Maree , Purcell Alison , Reed Vicki A.
Published: January 2017

This study followed the communication and motor development of 3 profoundly deaf infants who underwent cochlear implantation. All infants were receiving auditory habilitation at the Sydney Cochlear Implant Centre, Australia, with the view to acquiring oral language skills and had English-speaking, hearing parents. Their progress was tracked with a battery of measurement tools before and after cochlear implantation. The results indicated noticeable growth in receptive language and motor skills after operation. Although expressive language improved, the rate of growth was much slower than changes in other areas. Although some areas of the subjects' communication skills remained delayed, the importance of tracking their progress according to their hearing age, as well as the chronological age, was evident.
Phonomicrosurgery in Singers and Performing Artists: Treatment Outcomes, Management Theories, and Future Directions
Authors: Zeitels Steven M. , Hillman Robert E. , Mauri Marcello , Desloge Rosemary , Doyle Patricia B.
Published: January 2017

Phonomicrosurgery in performing artists has historically been approached with great trepidation, and vocal outcome data are sparse. The vocal liability of surgically disturbing the superficial lamina propria (SLP) and epithelium must be balanced with the inherent detrimental vocal effect of the lesion(s). A prospective investigation was performed on 185 performing artists who underwent phonomicrosurgical resection of 365 lesions: 201 nodules, 71 polyps, 66 varices and ectasias, 13 cysts, 8 keratotic lesions. 2 granulomas, 2 Reinke's edema, and 2 papillomas. Nearly all patients with SLP lesions reported improvement in their postsurgical vocal function. This subjective result was supported by objective acoustic and aerodynamic measures. All postsurgical objective vocal function measures fell within normal limits, including a few that displayed presurgical abnormalities. However, given the relative insensitivity of standard objective measures to assess higher-level vocal performance-related factors, it is even more noteworthy that 8 of 24 objective measures displayed statistically significant postsurgical improvements in vocal function. Such changes in objective measures mostly reflect overall enhancement in the efficiency of voice production. Phonomicrosurgical resection of vocal fold lesions in performing artists is enjoying an expanding role because of a variety of improvements in diagnostic assessment, surgical instrumentation and techniques, and specialized rehabilitation. Most of these lesions are the result of phonotrauma and arise within the SLP. Successful management depends on prudent patient selection and counseling, ultraprecise technique, and vigorous vocal rehabilitation. Furthermore, an understanding of the vocal function and dysfunction of this high-performance population provides all otolaryngologists who manage laryngeal problems with valuable information that they can extrapolate for use in their practices.
Prosthetic Stimulation of the Auditory System with Intraneural Electrodes
Authors: Arts H. Alexander , Jones Derek A. , Anderson David J.
Published: January 2017

Prosthetic electrical stimulation of the auditory system is presently accomplished either via scala tympani electrode arrays or via cochlear nucleus surface electrode arrays. Many of the early cochlear implant studies, however, used electrode arrays placed within the auditory nerve itself — either within the modiolus or within the trunk of the nerve. For many reasons, such intraneural electrode arrays were abandoned in favor of intrascalar arrays. There remain, however, several theoretical and practical reasons why intraneural arrays might be advantageous, and recent developments in electrode technology solve many of the problems posed by early attempts at intraneural stimulation. In this article, we review the history and current status of intraneural auditory stimulation, and present some preliminary results of this mode of stimulation in an animal model.
Evolution of Medical Management of Chronic Rhinosinusitis
Authors: Vining Eugenia M.
Published: January 2017

Chronic rhinosinusitis (CRS) is a surprisingly common, poorly defined, and notoriously difficult-to-treat disease. It has a complex pathophysiology that often, but not always, involves nasal or paranasal sinus infection. Anatomic variations that predispose the sinuses to obstruction may play a role, but are unusual sole causes of chronic disease. Other possible causative factors include allergic or nonallergic inflammation, mucociliary dysfunction, aspirin intolerance (Samter's triad), immunodeficiency, and cystic fibrosis. Although a majority of patients achieve long-term relief from CRS after successful endoscopic sinus surgery, a significant proportion do not, and are likely to benefit from sustained postsurgical medical therapy. Medical therapy for CRS may include treatment with corticosteroids, antibiotics, antifungal agents, antihistamines, leukotriene modifiers, nasal decongestants, mucolytics, and nasal irrigations. The selection of appropriate medical therapy is based on endoscopic evaluation, sinus cultures, and symptoms. Computed tomography, the imaging standard for evaluation of the sinuses, provides information about the extent and distribution of mucosal disease beyond what is visible endoscopically. Because it fails to provide information on the origin of the mucosal changes, computed tomography provides limited information to guide medical therapy.
Progress in Sinonasal Imaging
Authors: Zinreich S. James
Published: January 2017

Imaging of sinonasal structures has evolved from standard radiographs to the much more complicated and informative techniques used today. The plain radiograph was useful when the surgical techniques practiced were primarily aimed at the maxillary and frontal sinuses. With a better understanding of the mucociliary clearance of the nasal cavity and the paranasal sinuses, the surgical technique was shifted to the ethmoid sinuses and became more focal, thus needing a better understanding and display of the intricate morphology of the nasal cavity and paranasal sinuses. Polytomography was a step above plain radiographs and was first used in the display of the regional anatomy for the development of functional endoscopic sinus surgery. Polytomography was quickly replaced by computed tomography, as this imaging technique provides a much more detailed view of the sinonasal architecture than does polytomography. Magnetic resonance imaging has also shown usefulness in imaging this morphological area, as it provides better soft tissue resolution, but it does not allow good visualization of bony structures. Newer computer systems with software capable of reconstructing the digitized information into a 3-dimensional display further enhance our understanding of the regional morphology and afford an improved means of correlating the imaging and endoscopic information. Furthermore, stereotactic navigation systems allow surgeons the ability to visualize the endoscope-instrument tip position, as instruments are actively being used during surgery, on the computed tomographic and/or magnetic resonance images. There is a persistent trend toward reducing the size of the imaging equipment to render it more mobile (computed tomography) and adapt it for operating room use.
Neural Activity in the Vestibular Nuclei of the Cat
Authors: Ryu J. H. , McCabe B. F.
Published: January 2017

The responses of 600 single neurons in the vestibular nuclei of the cat to a constant angular acceleration (4°/sec2) or ice water caloric stimulation were investigated, and neurons were classified according to their responses. Animals were anesthetized and activity was recorded stereotaxically through the intact cerebellum with a tungsten microelectrode. The resting activity, response to stimulation, firing pattern, and relationship between spike discharge and nystagmus were the parameters of interest with special attention to the relationship between anatomy and neurophysiology of the vestibular nuclear complex. The results indicate that the superior and medial vestibular nuclei contains a relatively larger number of Type I and II neurons (related to semicircular ducts) and the lateral and inferior vestibular nuclei contains a relatively larger number of Type V neurons (related to otolith organs, spinal cord, etc.) which is in good agreement with anatomical findings. Histologic mapping according to their response type, however, shows no clear topographical arrangement. The average resting frequency was about 30 spikes per second, and the majority of neurons discharge pattern was random. Neuron firing in the nuclei was geared to the slow component of nystagmus. There is considerable crossed inhibitory activity between two sets of the vestibular nuclei.
Multiple Postintubation Complications
Authors: Strome Marshall , Ferguson Charles F.
Published: January 2017

Four cases of multiple postintubation laryngotracheal injuries are presented. They encompass a range of injury including isolated soft tissue damage to total necrosis of the cricotracheal cartilages. The specific precursors were identified and retrospective pitfalls in management outlined. These included difficult intubation, an oversized endotracheal tube, a prolonged duration of intubation, reintubation, and debilitation. Three basic stages of injury were found upon which a treatment regimen was founded: 1) edema alone; 2) infected mucosa alone or with involvement of the internal perichondrium; and 3) true chondritis with or without necrosis. A rational, conservative management protocol based on these histopathological and clinical correlates was formulated.
Normal Limit of the Electrogustometry Test
Authors: Coats Alfred C.
Published: January 2017

Electrical taste thresholds from the right and left anterior parts of the tongue were obtained from 249 normal subjects. Absolute differences between right and left became more variable as the threshold level increased, whereas the variability of relative differences remained more or less constant. The relative difference between right and left electrical taste thresholds was therefore chosen as the measurement of choice for clinical use. It was also found that smoking significantly increased electrogustometry (EGM) test variability, more so in men than in women. Therefore, separate EGM normal limits were defined as follows: nonsmokers, 18%; female smokers, 24%; male smokers, 37%. If the side of the lesion can be predicted, normal limits may be reduced to 15%, 20%, and 32%, respectively. An incidental finding of this study was a correlation between sudden deafness and other “idiopathic,” possibly retrocochlear, lesions and chorda tympani nerve deficits.
Specific Acute Losses of Vestibular Function in Four Patients following Unilateral Section of One or All Components of the Eighth Cranial Nerve
Authors: Miller Earl F. , Pulec Jack L. , Wilcox James G. , Graybiel Ashton
Published: January 2017

Functional tests of the specific auricular organs were administered to four patients who had the common complaint of disabling vertigo and tinnitus. Diagnosis of unilateral inner ear disease or disorder was aided by a relative decrease in right- or left-ear response as recorded by certain techniques, while other methods demonstrated undisturbed function. Partial and complete VIIIth nerve sections completely eliminated the tinnitus and severe symptoms of vertigo in each patient, as well as greatly reduced his extremely high susceptibility to motion sickness, although it caused a short-term increase in instability in walking and standing. Specific auricular organ loss of function was related to the side and extent of the surgical interference. Possible clinical implications are discussed.
Studies of Cochlear Vasculature and Sensory Structures: A Modified Method
Authors: Axelsson A. , Miller J. , Holmquist J.
Published: January 2017

A new “soft surface preparation technique” for detailed studies of all intracochlear structures is presented. The method is a combination of the “hard surface preparation technique” with osmic staining of undecalcified temporal bones and the Prussian blue technique with contrast injection of the cochlear vasculature and subsequent decalcification. Most of the disadvantages of both methods are eliminated by this combination. Large or small pieces of the cochlea can be studied including vascular pattern, vessel details, sensory and supporting structures, and membranes.
Diagnosis and Management of Primary Tumors of the Petrous Apex
Authors: Gacek Richard R.
Published: January 2017

Five patients with primary tumors of the petrous apex were diagnosed and treated between the years 1968 to 1974; two had congenital epidermoids, two had chondromyxosarcomas and one had neurofibroma. The embryological development of the foramen lacerum and the pattern of expansion of these primary tumors support the contention that these three categories of tumors arise in the foramen lacerum. Knowledge of the structures surrounding the foramen lacerum can provide a guide to early diagnosis of petrous apex tumors. Since these tumors cannot be completely removed, the goal of surgery is to obtain histological diagnosis and to produce permanent fistulization of the petrous apex. Although there are several recommended surgical approaches to the petrous apex, the transmastoid-translabyrinthine procedure was used in this series.
Paget's Disease of the Temporal Bone
Authors: Nager George T.
Published: January 2017

Osteitis deformans Paget is a fairly common, heritable, sometimes progressive disease of bone which affects primarily the axial skeleton and may lead to deformity and weakness. It affects 3% of the population over forty years of age and males more frequently than females. The skull and temporal bones become involved in about two-thirds of the patients. Progressive involvement of the temporal bones may lead to alteration of position, increase in size and change of architecture of the petrous pyramid, external canal, middle ear and inner ear capsule. These changes in turn may produce impairment of hearing (about 30–50% of cases) and vestibular function (20–25%). The clinical, radiological, and pathological manifestations of Paget's disease of the temporal bone are discussed in detail and explained with photomicrographs. Examples of tumor formations and vascular changes are presented.
Temporal Bone Histopathological Findings in Trisomy 13 Syndrome
Authors: Sando Isamu , Leiberman Alberto , Bergstrom LaVonne , Izumi Soji , Wood Raymond P.
Published: January 2017

This study reports the histopathological findings of 14 temporal bones from infants with trisomy 13 syndrome. The most primitive anomalies in the structures of the inner and middle ears in the present series are those of the semicircular canals, particularly of the horizontal canals: flattened horizontal canal cristae, absence or opening of the utricular endolymphatic valve, small facial nerve, and obtuse angle of the geniculate area of the facial nerve. Each ear demonstrated more than one of those anomalies. The anomalies present features similar to those found in the structures of the normal six to ten-week fetus. Many other mild anomalies observed appear to demonstrate features similar to those seen in the same structures in later fetal life. Reviewing these findings, most of the anomalies that were found in the inner and middle ears appear to be the result of poor development of the structures for reasons which are now unclear. In addition, middle ear infection was found in all cases.
Middle Ear Effusions: Definitions and Terminology
Authors: Paparella Michael M.
Published: January 2017

There are many confusing terms which presently apply to the group of clinical problems accompanied by middle ear effusion manifestations. Out of this chaos there is a need for logic and simplicity. All of the middle ear effusions are examples of the broadly descriptive categorical term “otitis media” meaning “inflammation” of the middle ear which includes examples of frank “infection” as well. Based upon clinical and laboratory observations there are essentially four types of intrinsically occurring middle ear fluid which, along with clinical findings, provide the means of identifying the clinically descriptive term which should be used: 1) serous fluid (serous otitis media); 2) mucoid fluid (mucoid otitis media, secretory otitis media, glue ear); 3) bloody fluid (barotrauma, aerotitis); 4) purulent fluid (purulent or suppurative otitis media); and 5) any combination of the above four ( e.g., seropurulent otitis media, serosanguineous otitis media, mucopurulent otitis media, etc.).
Classification of Middle Ear Effusions
Authors: Senturia Ben H.
Published: January 2017

Proper use of terminology and classification of various categories of effusion throughout the world is necessary if we are to obtain dissemination of pertinent scientific and clinical information and to make progress in understanding and eradicating this widespread group of diseases. The general term, middle ear effusion, and the categories serous, mucoid, and purulent are suggested to describe collections of fluid in the middle ear; the use of other descriptive terms should be influenced by the nature of the clinical, cytologic, bacteriologic, histopathologic and chemical findings in the fluid and lining membrane of the middle ear.
Pediatrician's View of Middle Ear Effusions: More Questions than Answers
Authors: Paradise Jack L.
Published: January 2017

Although middle ear effusion is the most common of the chronic conditions encountered in pediatric practice, it frequently goes unrecognized, and relatively little is known about its epidemiology or its natural history. More importantly, the impact of middle ear effusion on the overall well-being of infants and children, and on their cognitive and language development, remains essentially unexplored. In part because of these gaps in our knowledge, and also because prospective, controlled treatment trials have not been reported, uncertainty and controversy exist concerning: 1) the necessity, in many instances, of treating middle ear effusion; 2) the choice of various treatment methods; and 3) the timing of those treatments that are undertaken. Finally, the widespread use of adenoidectomy to prevent middle ear inflammation is seriously lacking in supporting evidence. A few reported studies bear on some of these questions, but both their scope and the information they provide are limited. In order to resolve important prognostic and treatment issues concerning middle ear effusion during infancy and childhood, carefully designed epidemiologic and clinical studies of types not hitherto reported are urgently needed.
Atelectasis and Secretory Otitis Media
Authors: Sadé J. , Berco E.
Published: January 2017

That condition where the tympanic membrane is displaced toward the promontory is termed atelectasis. Thirty-seven patients (61 ears) showing various degrees of atelectasis graded from stage 1 to stage 4 were studied. Atelectatic drums are an inflammatory phenomenon occurring in underventilated ears. This conclusion is reached by considering the reversibility of the atelectasis upon ventilation; while the inflammatory factor can be deduced from the history and histopathology of the atelectatic drum, as well as the histology of the necrosed incus, the latter occurs in over a third of our cases. Also pneumatization of the mastoid is almost never present. Twelve (21%) of the ears treated did indeed develop a perforation at one time or another (two had cholesteatomas). Chronic granulating external otitis with specific features occurred in 15% of cases. The characteristics of these ears and their case histories lead us to view atelectatic ears as part of the otitis media syndrome, where their place is somehow transitional between secretory otitis media on the one hand and chronic otitis media on the other.
Immunoglobulin E in Chronic Middle Ear Effusions
Authors: Lim David J. , Liu Yea S. , Schram James , Birck Herbert G.
Published: January 2017

A total of 61 middle ear effusions and matched sera obtained from patients suffering from chronic otitis media with effusions (OME) was examined for IgE and other immunoglobulins to see if a reaginic antibody is involved in OME. The IgE levels were determined by the Phadebas IgE radioimmunoassay test. Excluding one patient who had extremely high IgE as a result of parasitosis, there were only three cases which showed marginally increased serum IgE levels. Elevated IgE levels in sera and/or in effusions were unrelated to a history of allergy. The mucoid effusions had significantly higher effusion levels than the levels in corresponding sera (p <.0005). Fourteen percent of the cases examined showed effusion IgE levels five times or more higher than serum levels. Biopsy specimens of these patients showed numerous degranulating mast cells. Only two specimens showed eosinophilic infiltration. It is suggested that the IgE is produced locally by the mucosa in mucoid-type effusions and may have been involved in mast cell degranulation. However, this study cannot confirm the allergic nature of the OME.
Secretory Otitis Media
Authors: Veltri Robert W. , Sprinkle Philip M.
Published: January 2017

The purpose of our paper is to propose a possible mechanism involving an immune-mediated disease process. A microbiological, biochemical and immunological approach to substantiate such a mechanism is presented.
Eustachian Tube Ventilatory Function in Children
Authors: Cantekin Erdem I. , Bluestone Charles D. , Parkin Leon P.
Published: January 2017

In order to establish a simple stimulus-response characteristic of Eustachian tube physiology in children, the tubal ventilatory function was studied. The parameters of active and passive opening of the tube were measured for three groups of patients with non-intact tympanic membranes. The group with traumatic perforations of the tympanic membrane without any history of middle ear disease had better active equilibration function than the group with chronic otitis media and perforations of the tympanic membrane and the group with tympanostomy tubes in the tympanic membrane. Quantitatively, this could be expressed in terms of residual positive pressures. In the study of repeated inflation of the middle ear, all groups had lower second opening pressures which are attributed to the effect of surface forces.
Autonomic Stimulation, Osmolarity and Prostaglandin Effects in the Eustachian Tube
Authors: Jackson Richard T.
Published: January 2017

Stimulation of the vidian nerve in the dog induced an apparent vasodilation in the mucosa of the Eustachian tube. It is presumed that these parasympathetic fibers course from the greater petrosal nerve through the vidian to the sphenopalatine ganglion. The pharyngeal nerve arises from the ganglion and innervates the mucosa of the tube. Perfusion of the dog's Eustachian tube with solutions of various osmolarities caused a shrinking or swelling of the tube mucosa. Ten percent alterations in the concentration of saline, Ringer's or isotonic KCl produced a hypo- or hypertonic effect. Systemic administration of osmotic diuretics was shown to remove water from normal and edematous tubal mucosa. An agent in human middle ear effusions was found to contract smooth muscle. The behavior of this agent in pharmacological tests suggested the presence of prostaglandins (PG). The effusions were tested for the presence of other inflammatory mediators such as bradykinin, acetylcholine and histamine. These were felt to be absent or present in small amounts. A radioimmune assay of pooled samples of middle ear effusions revealed the presence of several PG, notably PGF2α and PGE2. There appeared to be a higher concentration of PG in mucoid effusions than serous effusions. The inflammatory capabilities of these agents are mentioned.
Clinical Results and Complications of Tympanostomy
Authors: Kokko Eino , Palva Tauno
Published: January 2017

Tympanostomy tube treatment was used in 181 patients on 323 ears and a followup study was made as an average three years and two months later. Sixty-five percent of the ears had healed completely and in these the average tube treatment time had been 11.3 months. In 22% the tubes were still in position, the average time for treatment being 24.2 months. Five percent showed purulent discharge and recurrence of the glue ear was noted in 3%. A dry perforation developed in five patients. Cholesteatoma was seen in four ears but in only one of these it may have been related to the location of the tube at the posterior drum margin.
Mastoidectomy and Epitympanotomy
Authors: Proud G. O. , Duff W. E.
Published: January 2017

The procedure of mastoidectomy and epitympanotomy effected a two-year arrest of serous otitis media and correction of a refractory retraction pocket in 12 out of 20 patients with one patient lost to follow-up. Each mastoid and epitympanum was extensively involved with chronically inflamed tissue which surrounded the ossicles and chorda tympani nerve.
Survey of the Development of Laryngeal Epithelium
Authors: Tucker John A. , Tucker Gabriel F. , Vidic Branislav , Stead Jeffrey
Published: January 2017

An overview of the developing laryngeal epithelium has been presented to establish the norm. The sequential relationships of the formation of the protective laryngeal covering, cellular and glandular, have been reviewed. The topographical distribution of the epithelial elements in the human larynx are illustrated in the adult and contrasted in the child. Unique and previously undescribed cellular ultrastructure and transition areas have been identified. Biological integration of form and function is again well illustrated in the epithelium of the human larynx.
Effects of Removal of the Statoacoustic Ganglion Complex upon the Growing Otocyst
Authors: Van De Water Thomas R.
Published: January 2017

An experiment was designed to answer the question as to whether or not the neural elements of the statoacoustic ganglion complex have a trophic effect upon the histodifferentiation of the sensory structures of the embryonic mouse inner ear anlage as it develops in vitro. The embryonic inner ear anlage with associated otic mesenchyme and statoacoustic ganglion complex was excised from 11, 12, and 13-day CBA/C57 mouse embryos. The inner ear explants of each gestational age group were further divided into two groups: the first group “A” (with) statoacoustic ganglion was explanted to the organ culture system without further surgical intervention; the second group “B” (without) statoacoustic ganglion underwent further surgical manipulation during which their statoacoustic ganglion complexes were dissected away prior to explantation to in vitro. The explanted embryonic inner ears were allowed to develop in organ culture until the equivalent of gestation day 21 in vivo was reached for each group; then all cultures were fixed and histologically processed and stained by a nerve fiber stain, in combination with a stain for glucoprotein membranes. Each specimen was code labeled and scored for histodifferentiation of sensory structures. Light microscopic observations confirmed that in group “A” cultures, statoacoustic ganglion neurons and their nerve fibers were present in association with the developed sensory structures; neither ganglion cell neurons nor their nerve fibers were found to be present in the sensory structures that developed in the group “B” organ culture specimens. Quantification revealed no consistent trend of greater occurrence of any sensory structure in the groups of explants analyzed. The presence of such a trend would have signified the probable existence of a trophic effect of the statoacoustic ganglion neural elements upon development of inner ear sensory structures in the group “A” explants of the 11, 12, and 13-day embryo inner ear organ culture specimens when compared to the aganglionic group “B” cultures. Microscopic comparison of the sensory structures and their sensory hair cells that developed in the organ cultures revealed no differences in the quality of the histodifferentiation of either group “A” or group “B” explants. A base to apex pattern of histodifferentiation of the organ of Corti sensory structures, which has been described to occur in vivo, was noted to occur in the in vitro developed cochlear ducts of all of the explanted inner ears without respect to whether neural elements were present (“A”) or absent (“B”) during development. It was concluded from the quantification of histodifferentiation data and the above observation on the pattern of differentiation of Corti's organ that no trophic effect of neural elements of the statoacoustic ganglion complex influencing the histodifferentiation of sensory structures of 11, 12, and 13-gestation day mouse embryo inner ear explants as they differentiate in vitro could be demonstrated.
Electroacoustic Measures of Present Prostheses
Authors: Wolf R. V. , Bilger R. C.
Published: January 2017

To determine the electrical nature of the signals delivered to the electrode implanted in scala tympani, extensive electroacoustic measures were made on a House-Urban stimulator, both in a closed, acoustic system (hearing-aid box) and in the sound field. For these measures, the external coil was separated from the internal coil by plexiglass, and the internal coil was loaded resistively. Illustrations of the signal delivered to the electrode are provided.
Hearing Performance with the Auditory Prosthesis
Authors: Bilger R. C. , Hopkinson N. T.
Published: January 2017

With their prostheses activated 12 of 13 subjects were able to respond to sound (bands of noise) at intensities (35–65 dB SPL) that typically arise in the normal acoustic environment. While this “hearing” did allow them to be aware of speech, it did not permit them to understand speech. On the other hand, this “hearing” does seem to help them with identification of common environmental sounds and with lipreading, within the context that those abilities were tested here.
A State-of-the-Art Review
Authors: Tonndorf Juergen
Published: January 2017

Work on cochlear prostheses for the auditory rehabilitation of the profoundly deaf represents a challenging problem. Some early, but perhaps premature, surgical attempts have helped to bring the entire issue into focus. Systemic studies are now under way in many different places. Although the purely engineering problems as well as the surgical ones appear solvable at this time, the remaining unsolved problems lie in two areas: 1) the bioengineering interfacing, i.e., the search for methods needed to connect an engineering (electronic) device to the neural auditory system in an efficient manner; and 2) clinical tests for the assessment of the functional state of the cochlear nerve.
Study of Spastic Dysphonia Using Videofiberoptic Laryngoscopy
Authors: Parnes Steven M. , Lavorato Alfred S. , Myers Eugene N.
Published: January 2017

— Spastic dysphonia is a speech disorder, characterized by a “strangled voice quality,” irregularly occurring phonatory arrests, and a jerky pattern of speech. This is often extremely disruptive to the patient's ability to communicate. Two cases are presented in which a new technique, videofiberoptic laryngoscopy, was employed in the study of these patients. The characteristic laryngeal behavior of this disorder is documented and recorded, particularly noting the increase in supraglottic activity and how different vocal maneuvers alter this activity.
Vocal Cord Paralysis and Thyroid Surgery
Authors: Kratz Robert C.
Published: January 2017

— A technique used to identify the recurrent and superior laryngeal nerves using a flexible fiberoptic bronchoscope is presented. The author has used this technique in 12 cases and found it superior to other techniques that he has tried.
Dysplastic Epithelial Changes in Nasal Polyps
Authors: Busuttil A.
Published: January 2017

— In 33 patients undergoing nasal polypectomy, severely dysplastic or intraepithelial malignancy was observed focally in the surface Lining of these polyps. Follow-up on 29 of these patients showed that the changes did not recur or progress to invasive tumor, and that local excision was curative. Investigations as to the possible causation of such changes failed to provide any answers. Other hypotheses in relation to the pathogenesis and significance of these changes are put forward.
Human Tympanic Membrane — Malleus Attachment Preliminary Study
Authors: Graham M. D. , Reams Carl , Perkins Rodney
Published: January 2017

— The relationship between the malleus handle and the tympanic membrane in humans has been studied with primary attention being directed to the fibrous layer of the tympanic membrane and its method of attachment to the malleus. This attachment is most intimate at the level of the umbo and becomes progressively more tenuous as the short process is approached. The long process of the malleus, comprised of a bony core, has a definite sleeve of cartilage surrounding its entire length. This cartilage is surrounded by a perichondrial layer which has previously been termed a periosteum. In the lower third, the fibrous lamina propria appears to split equally and the fibers then blend imperceptively with those of the perichondrial layer surrounding the manubrium. At high levels, the attachment is less intimate, most of the fibers appearing to pass lateral to the malleus handle. The embryologic development of the tympanic membrane-malleus junction has been considered and the anatomical features of this area have been considered in relation to functional requirements.