bluuebunny/crossref_metadata_2025 huggingface dataset:
Congenital Lack of Olfactory Ability
Authors: Leopold Donald A. , Hornung David E. , Schwob James E.
Published: October 2014

Twenty-two patients, all of whom reported never having been able to smell anything, were studied to determine the particular features that distinguish individuals with congenital anosmia. The clinical evaluation on these patients included a thorough medical and chemosensory history, physical examination, nasal endoscopy, chemosensory testing, olfactory biopsies, and imaging studies. There was no evidence to indicate that these patients ever had a sense of smell. The results of olfactory testing suggested that these patients had an inability to detect both olfactory and trigeminal odorants; however, many of the patients in the group seemed to have a slight ability to perceive at least some component of trigeminal odorants. The olfactory epithelium, if it was present at all on biopsy, was abnormal in appearance.
Inspiratory Speech as a Management Option for Spastic Dysphonia
Authors: Harrison Gordon A. , Troughear Richard H. , Davis Pamela J. , Winkworth Alison L.
Published: October 2014

A case study is reported of a subject who has used inspiratory speech (IS) for 6 years as a means of overcoming the communication problems of long-standing adductor spastic dysphonia (ASD). The subject was studied to confirm his use of IS, determine the mechanisms of its production, investigate its effects on ventilatory gas exchange, and confirm that it was perceptually preferable to ASD expiratory speech (ES). Results showed that the production and control of a high laryngeal resistance to airflow were necessary for usable IS. Voice quality was quantitatively and perceptually poor; however, the improved fluency and absence of phonatory spasm made IS the preferred speaking mode for both the listener and the speaker. Transcutaneous measurements of the partial pressures of oxygen and carbon dioxide in the subject's blood were made during extended speaking periods. These measurements indicated that ventilation was unchanged during IS, and that ventilation during ES was similar to the “hyperventilation” state of normal speakers. The reasons for the absence of phonatory spasm during IS are discussed, and the possibility of its use as a noninvasive management option for other ASD sufferers is addressed.
Hearing Loss as a Sequel of Lumbar Puncture
Authors: Michel Olaf , Brusis Tilman
Published: October 2014

Only a few case reports have been published about hearing impairment following lumbar puncture, and not all were thoroughly documented by audiograms. We present nine cases of hearing loss following myelography, lumbar puncture, and spinal anesthesia. We speculate that this rare complication arises only in persons with a wholly or partially patent cochlear aqueduct, and occurs via the release of perilymphatic fluid in the cerebrospinal space. Hearing loss was seen in eight of the nine patients in the lower frequencies, and in six of the nine patients on both sides. Recovery to normal hearing was noticed in six of the nine patients. Transient hearing loss may occur more often than it is generally assumed, and the symptom can remain unnoticed. Since not all of these hearing losses proved to be fully reversible, we suggest informing patients about this complication for medicolegal reasons.
Temporal Bone Findings in Keratitis, Ichthyosis, and Deafness Syndrome
Authors: Tsuzuku Toshihiro , Kaga Kimitaka , Shibata Akihiko , Kanematsu Shuichi , Ohde Schyu
Published: October 2014

In 1981, the term KID syndrome was suggested for patients with congenital ichthyosis associated with deafness and keratitis. We had a chance to examine the temporal bone of an infant with this syndrome. This patient showed no auditory brain stem response in either ear. Temporal bone studies revealed cochleosaccular abnormality. These findings are offered as a possible explanation for the patient's deafness. The pathologic inner ear findings of congenital deafness syndromes associated with ichthyosis have been heretofore reported in Refsum's syndrome and in a case with universal alopecia. In these cases, the temporal bone pathologic findings were a result of cochleosaccular abnormality. From our case and previous reports, it is suggested that the deafness associated with congenital ichthyosis might be the result of cochleosaccular abnormality.
Theoretic Analysis of Middle Ear Gas Composition under Conditions of Nonphysiologic Ventilation
Authors: Ostfeld Ervin J. , Silberberg Alexander
Published: October 2014

As gas flows in and out of the nasopharynx, the pressure in that region fluctuates. It drops below or rises above atmospheric pressure, which is itself not constant but is subject to changes in altitude and weather. Such pressure changes in the nasopharynx produce a pumping of gas into and out of the middle ear. The net amount of middle ear gas transferred from or to the nasopharynx will, component for component, in steady state exactly equal the amount of middle ear gas transferred to or from the microcirculation by means of diffusional absorption by (or release from) the mucosa. In the case of a permanently patulous eustachian tube, a single parameter, characteristic of the rate of ventilation through the open eustachian tube, is found to determine the gas composition in the middle ear, whereas in the case of a middle ear ventilated by tympanostomy, two rate-of-ventilation parameters, one for gas flow through the ventilation tube and one for flow through a periodically open eustachian tube, determine the steady state gas composition. A high rate of ventilation favors absorption of oxygen and venting of carbon dioxide from the middle ear in both cases.
Spontaneous Regression of Juvenile Nasopharyngeal Angiofibroma
Authors: Dohar Joseph E. , Duvall Arndt J.
Published: October 2014

There is debate concerning the natural history of juvenile nasopharyngeal angiofibromas, especially whether or not they can spontaneously regress. Often claimed, spontaneous regression has not been well documented. To our knowledge, this is the first report in which a biopsy-proven juvenile nasopharyngeal angiofibroma spontaneously resolved. A second, less well-documented case is discussed.
Tracheal Agenesis
Authors: Koltai Peter J. , Quiney Robert
Published: October 2014

Tracheal agenesis is a catastrophic congenital anomaly that invariably results in death. Forty-seven cases have been previously reported in the literature. We add five additional cases, including two type 1 cases, two type 2 cases, and one type 3 case, based on Floyd's classification scheme. We describe the features of this unusual anomaly at the time of diagnosis. We discuss a rational approach to the management of this difficult problem on an emergent basis that allows for the maintenance of the infant's life until all of the implications of this fatal condition can be assessed. While we do not advocate reconstructive surgery for this anomaly, which has been universally fatal, we discuss the potential rearrangement of the anatomy, which may offer some hope in future cases. The concomitant congenital anomalies associated with these cases are reviewed, and autopsy specimens are presented for their anatomic interest.
Videostroboscopy of Human Vocal Fold Paralysis
Authors: Sercarz Joel A. , Berke Gerald S. , Gerratt Bruce R. , Ming Ye , Natividad Manuel
Published: October 2014

Previous stroboscopic studies of human vocal cord paralysis have been infrequent and have lacked documentation of the site of lesion. In order to study human laryngeal paralysis, the recurrent and superior laryngeal nerves were infiltrated unilaterally with lidocaine hydrochloride in three human volunteers. Vagal paralysis was simulated by combined (superior and recurrent) infiltration in one volunteer. Additionally, 20 patients with untreated laryngeal paralysis were studied from the voice laboratory at UCLA. In addition to videostroboscopic analysis, photoglottography and electroglottography were performed and synchronized with the stroboscopic images. The most significant finding in stroboscopy of the paralyzed larynx was the asymmetry of traveling wave motion. The traveling wave on the normal vocal fold had a faster wave velocity that created a phase difference in the vibration of the two folds. The wave also traversed a greater distance along the vocal fold mucosa on the normal side. No patient or volunteer with untreated laryngeal paralysis had a symmetric traveling wave, either in superior or recurrent laryngeal nerve paralysis. Synchronization with glottography indicated that the differentiated electroglottographic waveform provides useful information about the timing of glottic opening and closure in states of asymmetric laryngeal vibration. Implications for future studies and for the diagnosis of laryngeal paralysis are discussed.
Orbital Complications of Acute Sinusitis: Comparison of Computed Tomography Scan and Surgical Findings
Authors: Clary Randall A. , Cunningham Michael J. , Eavey Roland D.
Published: October 2014

The accuracy of computed tomography (CT) in distinguishing an abscess from cellulitis in children who present with orbital manifestations of paranasal sinus infection remains in question. In this 10-year retrospective study, CT results are compared with surgical findings in 19 patients with orbital complications who underwent surgical exploration within 24 hours of their CT scans. Fifteen of the 19 CT scan interpretations indicated abscesses that were verified intraoperatively. Two patients had negative surgical explorations despite CT interpretations predicting abscesses. An abscess was also surgically documented in 1 of 2 patients whose preoperative scans indicated cellulitis alone. We conclude that the correlation between radiologic and operative findings in 16 of these 19 cases, although not absolute, does substantiate the use of CT scanning as a therapeutic guide in children presenting with orbital disease secondary to paranasal sinusitis.
Planum Semilunatum of the Rat: New Light and Electron Microscopy Observations
Authors: Ten Cate Wouter J. F. , Rarey Kyle E.
Published: October 2014

Planum semilunatum (PSL) cells of the rat ampullae were studied by light, transmission, and scanning electron microscopy. The observed ultrastructure of rat PSL cells was similar to that described in other species, but is in disagreement with earlier reports of rat PSL cells, most probably because of previous divergent definitions of the PSL. Regions of PSL cells were easily distinguished from other nonsensory epithelia at the lateral ends of the crista ampullaris. The PSL region consisted of irregular-shaped columnar to cuboidal pentagonal or hexagonal cells that interdigitated with one another by lateral membrane infoldings. In the PSL region the subepithelial reticular layer appeared thickened and formed wartlike impressions in the basal surface of the PSL cells. These morphological characteristics of the subepithelial reticular layer were unique to the PSL region in the ampulla and may reflect special adaptations of the PSL region to mechanical stress. Furthermore, the thick subepithelial reticular layer may have implications for transport across the PSL region.
Airflow Study of Pathologic Larynges Using a Constant Temperature Anemometer: Further Experience
Authors: Kitajima Kazutomo , Fujita Fumika
Published: October 2014

Phonatory airflow was recorded in 361 laryngeal disease patients and 59 normal subjects by using a constant temperature anemometer to measure Isshiki's proposed parameter, the AC/DC percentage. The pathologic groups displayed AC/DC percentage values smaller than those of the normal group. The value differentials observed among the various diseases suggest that the AC/DC percentage may reflect the vibrational capacity of the vocal cords.
Bovine Temporal Bones as a Source of Inner Ear Antigen
Authors: SanMartin Jose , Rauch Steven D. , Moscicki Richard A.
Published: October 2014

Modern immunologic techniques of immunostaining, immunoblotting, and creation of monoclonal antibodies are gaining wide application in studies of development, function, and pathology of the ear. These techniques require a source of inner ear tissue for production of antigen extract. Human tissue is not readily available, and other mammalian species common in auditory research are small in size. Bovine temporal bones are readily available, and the membranous portions of the inner ear are abundant and easily accessible. Herein we report our technique for acquisition and dissection of bovine temporal bones and preparation and preservation of inner ear antigen.
Consumer Product Aspiration and Ingestion in Children: Analysis of Emergency Room Reports to the National Electronic Injury Surveillance System
Authors: Reilly James S. , Walter Margaret A.
Published: October 2014

Inadvertent aspiration or ingestion of products in children is a reportable problem. The National Electronic Injury Surveillance System (NEISS) monitors 119 hospitals for product (nonfood) hazards through a network of emergency room physicians. Coins (52%) remain the most frequently ingested object (1988–1989). Pins, including nails and bolts, are second in rank. Spheres (eg, balls) are the most common cause of death. Most deaths (97%) occur in the home. Younger children (13.4 versus 22.7 months) are more at risk for death. This analysis suggests that shape, as well as availability, is important in children's injuries and deaths'. Accurate reporting to NEISS of all aspirated objects remains essential so that product safety and the public's health can be improved. Food product injuries, however, are not reported to NEISS.
Distributions of Eustachian Tube Goblet Cells and Glands in Children with and without Otitis Media
Authors: Matsune Shoji , Sando Isamu , Takahashi Haruo
Published: October 2014

The distributions of the goblet cells and submucosal glands in eustachian tubes (ETs) from children with or without otitis media (OM) were studied. From 12 temporal bone—ET specimens obtained from children 1 to 7 years old at death, representative vertically cut histology sections were selected, stained with periodic acid—Schiff–Alcian blue and hematoxylin, and studied by light microscopy. In children without OM, the density of the goblet cells was significantly lower in the roof than in the floor of the ET and was highest in the midcartilaginous portion; glands were most richly distributed near the pharyngeal orifice, and became less densely distributed toward the tympanic portion. In children with OM, the density of the goblet cells was significantly higher both in the roof and floor portions, and the glands were more richly distributed than in the ETs of children without OM. The possibility that the observed increase in ET secretory components in children with OM impairs the passage of air through these tubes is discussed.
Clearance Function of Eustachian Tube and Negative Middle Ear Pressure
Authors: Takahashi Haruo , Hayashi Masahiko , Honjo Iwao , Fujita Akihiko
Published: October 2014

Two experimental studies were performed using 18 cats in order to elucidate the mechanism of the long-lasting course of otitis media with effusion. First, the middle ear (ME) pressure was monitored for 2.5 to 7 hours after filling the whole ME space with saline. On average, −150 mm H2O of negative ME pressure was induced in 3.1 hours. Second, the residual volume of saline with antibiotics, which was put into the ME space 2 to 7 days before, was compared between the side on which tubal ventilatory function was abolished (resection of tensor veli palatini muscle and hamulus pterygoideus) and the opposite, control side. The percentage of the residual volume to the original volume put into the ME was significantly higher on the experimental side (Wilcoxon's ranking test, t = 27.0, p < .05), and in one ear on the experimental side, the ME pressure showed −150 mm H2O just before the bulla was opened 2 to 7 days later. These results seem to indicate that tubal ciliary clearance function can induce negative ME pressure when there is fluid in the ME, and that the negative ME pressure induced by clearance of the ME fluid may disturb further clearance of the ME fluid. This condition may cause the long-lasting course of otitis media with effusion.
Amyloidosis in the Upper Aerodigestive Tracts
Authors: Raymond A. Kevin , Sneige Nour , Batsakis John G.
Published: October 2014

The upper aerodigestive tracts, particularly the larynx, are not uncommon repositories for amyloid. In most instances amyloidosis of the larynx is localized and is not associated with or followed by systemic disease. Oral and nasopharyngeal amyloidoses, on the other hand, are very often manifestations of systemic predisposing disorders. Laryngeal amyloidosis is treated, when indicated, by surgical removal, often repeated because of persistence or multifocal deposits.
Subglottic Ulceration and Healing following Endotracheal Intubation in the Neonate: A Morphometric Study
Authors: Gould Stephen J. , Young Martin
Published: October 2014

In neonates, acquired subglottic stenosis is the most serious long-term complication of endotracheal intubation and is due primarily to posttraumatic fibrosis of the infant larynx. We have examined 78 larynges, 75 of which were intubated, from infants ranging in gestation from 22 to 40 weeks, and who survived from a few hours to up to 300 days. Each larynx was morphometrically assessed for the extent of acute injury, indicated by the percentage of epithelial loss, and healing, indicated by the percentage of a subglottic ulcer covered by metaplastic squamous epithelium. Results show that acute injury is almost invariable, and up to 100% of the subglottic epithelium may be lost within a few hours of intubation, but that progression of injury is relatively short-lived. Ulcer healing starts after a few days, rapidly progresses from day 10, and in the majority of cases is complete after 30 days. This study suggests that long-standing acute injury in the subglottis is the exception rather than the rule, even with the endotracheal tube remaining in place.
Point-Touch Technique of Botulinum Toxin Injection for the Treatment of Spasmodic Dysphonia
Authors: Green David C. , Ward Paul H. , Berke Gerald S. , Gerratt Bruce R.
Published: October 2014

Intralaryngeal injections of botulinum toxin (Botox), under electromyographic guidance, have emerged as an effective treatment for adductor spasmodic dysphonia. To remain effective, these injections must be repeated every 3 to 9 months as the symptoms recur. One drawback to the current method is the need for electromyographic confirmation of needle placement into the thyroarytenoid muscle. This report describes an anatomic approach to Botox injection that requires only flexible nasopharyngeal endoscopy and careful evaluation of the anatomic landmarks. This technique has been used successfully on 13 patients, and objective pretreatment and posttreatment measures are reported.
Quantitative Mapping of the Effect of Botulinum Toxin Injections in the Thyroarytenoid Muscle
Authors: George Elaina F. , Zimbler Marc , Biller Hugh F. , Wu Bei-Lian , Sanders Ira
Published: October 2014

Spasmodic dysphonia has been successfully treated by thyroarytenoid muscle injections of botulinum toxin (Botox) with dosages ranging from 0.625 to 25 U. In some patients, excessive paralysis with resulting breathiness and aspiration have been noted. In order to maximize the efficiency of Botox injections, the histologic effects of various Botox dosages were examined in the dog. Nine canine thyroarytenoid muscles were injected with 0.5 to 12.5 U of Botox. After 24 hours, the recurrent laryngeal nerve to the injected muscle was electrically stimulated in order to deplete the glycogen within the muscle fibers. Frozen sections of this muscle were then stained for glycogen. Those fibers that retained their glycogen were presumed paralyzed by the Botox injection. The extent of paralysis was found to be dose-related from 1.0 to 7.5 U. At 10 U and above the muscle was completely paralyzed. Spread of the toxin to the lateral cricoarytenoid muscle was seen at doses as low as 1.0 U. Clearly, doses less than 10 U appear sufficient for clinical paralysis.
Immunohistochemical Analysis of the Cytokeratin Expression in Middle Ear Cholesteatoma and Related Epithelial Tissues
Authors: Broekaert Daniel , Leperque Sabine , Boedts Dirk , Ramaekers Frans , Leigh Irene , Coucke Paul , Van Muijen Goos , Lane Birgitte
Published: October 2014

Immunohistochemical investigations were carried out to determine the pattern of cytokeratin (CK) expression in middle ear cholesteatoma and related epithelia. Using monoclonal antibodies specific for CK chains and the indirect immunoperoxidase technique, we examined 10 CK polypeptides for expression. The external stratified squamous epithelium of the tympanic membrane generally expressed CKs 5, 10, and 14. In addition, basal keratinocytes in the annular region of the pars tensa expressed CK 19 (a simple epithelium marker), while suprabasally the hyperproliferative marker CK 16 was expressed. These data reflect the unusual proliferative nature of this region. The unexpected appearance of CK 16 (known to have a limited distribution in healthy epidermis) clearly relates to its expression in the neighboring deep meatus. The medial simple epithelium of the eardrum revealed mucosal CKs 7, 8, 14, 18, and 19. Acquired cholesteatoma lesions, besides CKs 5, 10, and 14, consistently expressed CK 16 in suprabasal layers. These results constitute the first direct molecular evidence for the hyperproliferative nature of the cholesteatoma matrix. Overall, our CK data suggest that aural cholesteatoma lesions and epidermal tissue in this area are related. However, they do not explain the mechanism(s) by which the eardrum or meatal epithelia might invade the middle ear cavity. Congenital cholesteatomas expressed CKs 5, 10, 14, and 16 equally. These CK data do not support the idea of a metaplastic origin from middle ear mucosa; instead, they suggest activation of an ectodermal rest in the middle ear cavity.
Syndrome of Inappropriate Secretion of Arginine Vasopressin in Patients with Cancer of the Head and Neck
Authors: Talmi Yoav P. , Hoffman Henry T. , McCabe Brian F.
Published: October 2014

The syndrome of inappropriate secretion of arginine vasopressin (AVP) known as the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) is associated with a variety of malignant and nonmalignant diseases. Only 17 cases of SIADH have been reported in the literature in association with cancer isolated to the head and neck. A retrospective review of 1,436 patients with head and neck malignancy excluding skin cancer through The University of Iowa Tumor Registry revealed 60 patients with the diagnosis of either SIADH or hyposmolality. A chart review for each of these patients was then done to establish the diagnosis of SIADH through relevant laboratory values and by excluding other causes of hyposmolality and hyponatremia. In 43 of these patients (3%), SIADH was found to be associated only with the cancer of the head and neck. We conclude that the incidence of SIADH in patients with cancer of the head and neck is much higher than previously recognized. As elevated serum AVP levels may not be clinically apparent unless associated with excessive water ingestion, it is possible that an even higher percentage of patients may have increased serum AVP levels.
Substance P and Vasoactive Intestinal Peptide in Nasal Secretions and Plasma from Patients with Nasal Allergy
Authors: Chaen Tokuo , Watanabe Noritake , Mori Kazuo , Mogi Goro , Takeyama Masaharu
Published: October 2014

To clarify the role of substance P (SP) and vasoactive intestinal peptide (VIP) in nasal allergy, we measured their concentrations in the nasal secretions and plasma of normal subjects and patients with nasal allergy to house dust and Japanese cedar pollen by competitive enzyme-linked immunoassay. The mean levels of SP (224 pmol/L) and VIP (41.6 pmol/L) in the nasal secretions of normal subjects were significantly higher than those in plasma (SP 3.04 pmol/L and VIP 1.04 pmol/L; p < .01). The mean levels of SP and VIP in the nasal secretions of the pollinosis group were significantly higher than those of the control group (p < .05 and p < .01), while the levels of the house dust allergy group were not higher than those of the control group. Intranasal allergen challenge significantly reduced SP levels in the nasal secretions of the allergy groups, while it did not influence VIP levels in the nasal secretions. These findings suggest that SP and VIP are actively secreted into the nose and may play an important role in the allergic reaction on the surface of the human nasal mucosa.
Extraction of Inner Ear Antigens for Studies in Inner Ear Autoimmunity
Authors: Yamanobe Shigeharu , Harris Jeffrey P.
Published: October 2014

The search for a diagnostic assay in patients with autoimmune inner ear disease has led to the preparation of antigens from the inner ear, a presumed target in this disorder. In order to standardize the antigen preparations currently being used in the Western blot immunoassay, we have examined several distinct extraction procedures that employ well-known solutions and detergents. Results of this investigation clearly show that antigens of interest (68 kd, 33 to 35 kd, and 32 kd) are optimally extracted with a detergent (0.5% sodium dodecyl sulfate) and that bovine serum albumin, a potential contaminant, can be removed in the water-soluble fractions. Purification of inner ear antigens by these methods will lead to more reproducible results in immunoblotting, as well as a greater opportunity to identify the mechanisms involved in autoimmune inner ear disease.
Cell Kinetics Study of Upper Aerodigestive Tract Squamous Cell Carcinoma Using Bromodeoxyuridine
Authors: Hirano Toshikazu , Zitsch Robert P. , Gluckman Jack L.
Published: October 2014

Thirty patients treated for squamous cell carcinoma of the upper aerodigestive tract were reviewed for a cell kinetics study using bromodeoxyuridine (BrdU). Fresh specimens were obtained from the primary site of the tumors and incubated in Dulbecco's modified Eagle's medium containing BrdU to label S-phase tumor cells. The tumor specimens were stained immunohistochemically with monoclonal antibody against BrdU. The results demonstrated that the BrdU labeling index (BrdU LI) in these cases (470.3 ± 118.2) was greater than the BrdU LI in normal mucosa (162 ± 52.4). In a comparison of the clinical data and histopathologic features, the BrdU LI showed an inverse correlation with patient age (r = −.558; p < .01) and a direct correlation with the frequency of mitoses (r = .411; p < .05). Although the significance of the BrdU LI as a prognostic factor cannot be determined at present, this technique provides a simple in vitro test that avoids the potential hazards of in vivo labeling or the use of radioactive materials.
Mucosal Folds in Human Eustachian Tube: A Hypothesis regarding Functional Localization in the Tube
Authors: Sando Isamu , Aoki Hajime , Takahashi Haruo , Matsune Shoji
Published: October 2014

Differences in the extent of mucosal folding in the superior versus the inferior half of the human eustachian tube (ET) lumen were studied by measuring, as it appeared in histologic cross section, the length of the mucosal margin in the pharyngeal portion, the midcartilaginous portion, the isthmus portion, and the osseous portion of each half of the ET in 16 normal ET temporal bone specimens from 16 individuals 12 to 70 years of age. The mucosal margin of the ET was significantly longer in the inferior half than in the superior half in all four portions (paired t test: pharyngeal portion t[15] = 3.59, p < .01; midcartilaginous portion t[15] = 3.52, p < .01; isthmus portion t[15] = 4.15, p < .01; osseous portion t[15] = 2.24, p < .05). These results indicate that the inferior half of the ET mucosa has more folds than the superior half, and that the surface area of the inferior half of the ET is larger than that of the superior half. This, together with the finding previously reported that secretory components of the ET such as glands and goblet cells are more richly distributed in the inferior (floor) portion than in the superior (roof) portion of the ET, may be related to the fact that the floor of the ET has an active role in clearance function. A hypothesis regarding localization of the ventilatory and clearance functions within the ET is proposed.
Measurement of Mucosal Wave Propagation and Vertical Phase Difference in Vocal Fold Vibration
Authors: Titze Ingo R. , Jiang Jack J. , Hsiao Tzu-Yu
Published: October 2014

Examination of the surface wave properties of the vocal fold mucosa is becoming an important part of assessment of vocal function. A key wave property is propagation velocity, which determines the phase delay between the upper and lower margins of the vocal folds. Excised canine larynges were used to measure this phase delay, and therewith propagation velocity. The motion of two flesh points was tracked stroboscopically. Differential displacements between the flesh points were matched to displacements of a model. A least-squared fit of the data to the model provided the numeric values of propagation velocity, which varied from 0.5 m/s to about 2.0 m/s, depending on fundamental frequency. The corresponding phase delay along the medial surface of the vocal folds varied from about 60°/mm to 30°/mm.
Laser Surgery for Epithelial Hyperplasia of the Vocal Fold
Authors: Hirano Minoru , Sato Kiminori
Published: October 2014

A total of 88 patients with epithelial hyperplasia of the vocal fold were treated with endolaryngeal microscopic carbon dioxide laser surgery during the period from 1978 to 1990. The majority of the patients were male smokers. During the follow-up period ranging from 12 to 156 months, 15 patients developed recurrence(s). The recurrent lesion was benign epithelial hyperplasia in 8 patients and invasive carcinoma in 7 patients. The recurrences occurred only in preoperative smokers. Discontinuation of smoking following laser surgery did not affect the incidence of recurrence. The incidence of development of carcinoma did not differ between two histologic types: simple hyperplasia without cellular atypia and dysplasia associated with cellular atypia. The incidence of cancer development for dysplasia cases in the present series (6%) was lower than that in previous reports in which the carbon dioxide laser was not employed for the treatment. Postoperative improvement of vocal function was manifested in an increase of the maximum phonation time, a decrease of the mean airflow rate, and an increase in vibratory amplitude and mucosal wave.
Compliance of the Patulous Eustachian Tube
Authors: Sakakihara Junji , Honjo Iwao , Kurata Kyosuke , Fujita Akihiko , Takahashi Haruo
Published: October 2014

The compliance and ventilatory functions of the eustachian tube (ET) of 17 ears with patulous ETs were examined and compared to those of 16 ears with traumatic perforation of the eardrum (controls) by means of the tubal compliance test, the inflation-deflation test, and the forced response test. The tubal compliance was significantly lower in the patulous ETs than in the controls. An excessive patency of the ET was confirmed among the patients with patulous ETs by a low opening pressure during the inflation test and a low passive resistance on the forced response test. Active ventilatory dysfunction was also found to be significantly more common in the patulous ETs by the deflation test and the measure of dilation efficiency. These results indicated that the ET appeared to be rather rigid and less moveable when patulous than when normal.
Laser-Doppler Measurements and Electrocochleography during Ischemia of the Guinea Pig Cochlea: Implications for Hearing Preservation in Acoustic Neuroma Surgery
Authors: Levine Robert Aaron , Bu-Saba Nicolas , Brown M. Christian
Published: October 2014

Interruption of cochlear blood flow has been implicated as one of the causes of the sensorineural hearing loss that may occur during acoustic neuroma surgery. With the guinea pig as an animal model for cerebellopontine angle surgery, laser-Doppler measurements were used to estimate the cochlear blood flow changes caused by compression of the eighth nerve complex. With compression, the laser-Doppler measurements decreased abruptly; somewhat later, the electrocochleographic potentials declined. When compression was released, laser-Doppler measurements usually returned immediately, followed later by return of the electrical potentials. Some of these potentials, including the compound action potential of the auditory nerve, often became transiently larger than their precompression values. Interposing bone between the laser-Doppler probe and the otic capsule, so that the total bone thickness approximated the thickness of the human otic capsule, decreased the laser-Doppler measurement, but changes caused by compression were still apparent. Thus, although the human otic capsule is much thicker than the guinea pig capsule, it may still be possible to make laser-Doppler estimates of human cochlear blood flow. Laser-Doppler monitoring during acoustic neuroma surgery may be beneficial, because it could give earlier warning of ischemia than is currently available from electrocochleographic monitoring, thereby enabling earlier corrective action. Electrocochleography complements laser-Doppler measurements by indicating the physiologic state of the cochlea.
Vocal Cord Paralysis Caused by Esophageal Cancer Surgery
Authors: Hirano Minoru , Fujita Machiko , Tanaka Shinzo , Fujita Hiromasa
Published: October 2014

Esophageal cancer surgery was the cause of paralysis in 111 (16.7%) of 664 patients with vocal cord paralysis seen from 1981 to 1990 at Kurume University Hospital. Eighty-six patients had unilateral paralysis, whereas 25 had bilateral lesions. Of the 111, 95 (86%) had hoarseness and 59 (53%) had aspiration. The crude survival rate was 63% for 1-year, 32% for 3-year, and 22% for 5-year follow-up. The average life expectancy was short. The general condition was poor in many patients. Thirty-four of the 136 paralytic vocal cords (25%) recovered mobility. An intracordal silicone injection was done in 30 patients, and a medialization procedure was performed in 1. The vocal function was improved in the majority of cases. In 4 patients, severe aspiration persisted following intracordal injection. Of the 4, 1 had cricopharyngeal myotomy and laryngeal suspension and 2 underwent total laryngectomy. The fourth patient died of aspiration pneumonia. The results of the review of the 111 patients have led us to the following treatment policy for patients with vocal cord paralysis caused by esophageal cancer surgery. When the patient has aspiration, vocal cord medialization should be performed as early as possible. If severe aspiration persists even after the medialization procedure, some additional intervention, including cricopharyngeal myotomy, laryngeal suspension, laryngotracheal separation, or total laryngectomy, should be considered. When hoarseness is the only major problem, the prognosis of vocal cord paralysis should be determined on the basis of the state of the recurrent laryngeal nerve and, if available, electromyography findings. Vocal cord medialization is indicated for patients with a poor prognosis for paralysis, and also for those patients whose life expectancy is short.
Congenital Oral Synechiae
Authors: Gartlan Michael G. , Davies Jack , Smith Richard J. H.
Published: October 2014

Major congenital synechiae of the oral cavity constitute a clinically confusing spectrum of abnormalities. On the basis of clinical data, we propose two categories: 1) abnormalities secondary to persistence of the buccopharyngeal membrane and 2) abnormalities secondary to formation of ectopic membranes. An ectopic membrane results from abnormal fusion and can be subclassified as a subglossopalatal membrane, glossopalatal ankylosis, or syngnathia. This classification is supported by embryologic studies and is used to reclassify all cases reported since 1900. Distinct differences, such as the presence of associated limb anomalies, emerge; these are reviewed and add support to the proposed classification.
Vestibular and Balance Rehabilitation Therapy
Authors: Shepard Neil T. , Smith-Wheelock Michael , Telian Steven A. , Raj Anil
Published: October 2014

A prospective observational study of the performance of patients enrolled in an individually customized program of habituation and balance rehabilitation physical therapy was conducted from January 1988 to January 1990. Patients ranged in age from 20 to 89 years, with a wide variety of diagnoses. Two global outcome measures — posttherapy symptom response score and pretherapy and posttherapy disability score — were developed and used to judge overall patient performance. In addition, two specific indicators — one for balance performance (dynamic posturography) and one for sensitivity to rapid head movements (motion sensitivity quotient) — were used to measure performance in these two areas. Results indicate statistically significant changes before versus after therapy for both specific measures, and 80% to 85% of the patients showed a reduction in symptoms and disability score following therapy. Analysis of variance and multiple regression analysis indicate that nature of symptoms, pretherapy disability level, history of head injury, and results on dynamic posturography were the variables most predictive of therapy outcome, while age and duration of symptoms made no difference. Other variables, such as medications and site of lesion, were found to affect the length of therapy but not the outcome.
Efficacy of Ceftibuten for Acute Otitis Media Caused by Hemophilus Influenzae: an Animal Study
Authors: Rosenfeld Richard M. , Doyle William J. , Seroky James , Swarts J. Douglas , Greene Israel
Published: October 2014

Ceftibuten is a new oral cephalosporin with an unusual stability to β-lactamases that can hydrolyze other extended-spectrum cephalosporins. Using the chinchilla animal model, we compared the efficacy of ceftibuten (n = 33) with that of saline (n = 34), ampicillin (n = 32), and cefixime (n = 31) for the treatment of acute otitis media caused by β-lactamase—producing nontypeable Hemophilus influenzae. Ceftibuten was superior to ampicillin regarding the time necessary to sterilize the middle ear (p < .001) and eliminate effusion (p < .001). The mean days of therapy required for bacteriologic cure were 2.57 for ceftibuten, 2.95 for cefixime, 7.95 for ampicillin, and 8.16 for saline. At the conclusion of therapy, chinchillas treated with ceftibuten had a significantly lower prevalence of positive cultures and middle ear effusion than did animals treated with ampicillin. No significant differences were observed between ceftibuten and cefixime. The results of this randomized, investigator-blinded experiment warrant further consideration of ceftibuten as a second-line agent for acute otitis media caused by ampicillin-resistant H influenzae.
Hyalinizing Trabecular Adenoma of the Thyroid Gland
Authors: Hicks M. John , Batsakis John G.
Published: October 2014

Hyalinizing trabecular adenoma is a follicular-derived tumor of the thyroid gland with a strong predilection for women. In the reported cases, the biologic course has been benign and without recurrences. The most important histologic differential diagnosis is medullary carcinoma, particularly the encapsulated form of that neoplasm.
Teflon Injection: Pointers and Pitfalls
Authors: Lewy Robert B.
Published: October 2014

Our objective is to clarify the procedure used in a series of 335 cases of injection of paralyzed vocal cords. Over 29 years, questions have arisen about the procedure, mostly from trainees. They relate to timing, indications, method, and follow-up. Results of the procedure, when properly performed, have been highly successful. Where indications are appropriate, injection is usually uncomplicated, relatively safe, and done with minimum instrumentation. This is our response, in a question-and-answer format, to the most frequent queries.
Comparison of Functional Endoscopic Sinus Surgery under Local and General Anesthesia
Authors: Gittelman Paul D. , Jacobs Joseph B. , Skorina Jane
Published: October 2014

We present a retrospective comparison of intravenous sedation and general anesthesia techniques employed at New York University—Bellevue Medical Center for functional endoscopic sinus surgery. Some authors have stressed the use of local anesthesia with intravenous sedation in order to avoid complications and reduce blood loss. We have reviewed 232 patients who underwent 401 consecutive ethmoidectomies and maxillary antrostomies. Local anesthesia, employed in 64% of patients, carried an estimated blood loss of 23 mL per side. General anesthesia was associated with an average blood loss of 58 mL per side. The rate of operative complications for local anesthesia was 8.7% per patient, with a 1.6% rate of major complications per side. General anesthesia carried an overall complication rate of 2.4% per patient, with no major complications. General anesthesia is a relatively safe and viable option for endoscopic sinus surgery that in selected cases may be preferable to local anesthesia.
Angiolymphoid Hyperplasia with Eosinophilia (Histiocytoid Hemangioma): Evaluation of Treatment Options
Authors: Cheney Mack L. , Bhatt Samir , Googe Paul , Hibberd Patricia L.
Published: October 2014

Angiolymphoid hyperplasia with eosinophilia is an uncommon benign vascular proliferative lesion of unknown cause. In this report, a case is presented of a patient who was confirmed to be positive for human immunodeficiency virus and in whom the lesion had shown rapid accelerated growth. The case is used to illustrate a variety of therapeutic techniques and to evaluate the effectiveness of the various alternatives in the treatment of this unusual clinical problem. Long-term follow-up after radical excision of the tumor mass is presented.
Conversion Deafness
Authors: Wolf Michael , Shoshan Jossef Ben , Birger Moshe , Kronenberg Jona
Published: October 2014

Conversion deafness is very rarely encountered among adults. This report will illustrate two cases of this somatoform disorder following different traumatic experiences. It emphasizes the difficulties in establishing the diagnosis and reviews various aspects of treatment.
Composition of the Otosclerotic Stapes: Electron Microprobe Analyses
Authors: Rosenberg Gary D. , Tubergen Laverne B.
Published: October 2014

For the first time, otosclerotic stapes have been distinguished from unafflicted controls at a high level of significance by using a spectrum of elements measured by energy-dispersive spectrometer-electron probe microanalyses (EDS/EPMA). Discriminant analyses of the maximum concentration of 13 elements measured at several sites within each of 32 stapes differentiated otosclerotic from unafflicted individuals well above the 95% confidence level. Eight of the 9 control (unafflicted) and 21 of the 23 afflicted stapes were correctly classified. In descending order of contribution to the discriminant function, the elements are Zn > Cr > K > Ca > Si > Mn > Na > Al > Mg > P > Fe > S > Ti. Zinc and chromium account for much of the difference, but discriminant analyses excluding them still distinguish the two groups at the 95% confidence level. These results are consistent with previous reports of high levels of alkaline phosphatase, a zinc-containing enzyme, in afflicted stapes. But the broad spectrum of elements capable of distinguishing otosclerotic stapes warrants study of additional zinc-containing and other metal-containing or metal-activated moieties.
Tall Cell Carcinoma of the Thyroid Gland
Authors: Hicks M. John , Batsakis John G.
Published: October 2014

Tall cell carcinoma of the thyroid gland is an aggressive variant of papillary carcinoma with a respectable 20% to 25% lethality. Its histologic features are characterized by a basal orientation of nuclei, abundant eosinophilic or oxyphilic cytoplasm, and a cellular height-width ratio greater than 2:1. These distinguish it from another aggressive variant, columnar cell carcinoma, which has a stratification of its nuclei and scant cellular cytoplasm.
Cochlear Wall Titanium Implants for Auditory Nerve Stimulation
Authors: Niparko John K. , Kileny Paul R. , Pfingst Bryan E. , Kemink John L. , Johansson Carina , Tjellström Anders
Published: October 2014

Genetically deaf dalmatian dogs and ototoxically deafened macaque monkeys were implanted with electrodes housed in cochlear wall titanium implants to assess long-term stability, tolerance, and performance. Short-term human implantation, followed by trials of stimulation, was performed in 4 unilaterally deaf patients. In the dog experiments, cochlear wall electrode stimulation produced consistent electrophysiologic thresholds that were higher, by approximately 6 dB, than those obtained with bipolar scala tympani stimulation. Clinical testing revealed electrically evoked middle latency response, auditory brain stem response, and/or behavioral detection responses in 3 of 4 patients, at levels below those for facial nerve activation and pain sensation. Electrode place discrimination studies, with controls for loudness cues, revealed near-perfect discrimination in a monkey subject. Eleven of the 12 animal implants were found to be rigidly fixed in the cochlear bone, with direct contact between bone and implant over 8% to 23% of the implant surface for the 6 implants examined in detail. These results suggest that long-term fixation of titanium cochlear wall implants occurs by virtue of intimate implant-bone contact in restricted areas. This approach to prosthetic stimulation demonstrates encouraging performance characteristics in achieving auditory activation.
The Hayek Oscillator: A New Method of Ventilation in Microlaryngeal Surgery
Authors: Dilkes Michael G. , Hill Adam C. , McKelvie Peter , McNeill Jane M. , Monks Paul S. , Hollamby Robert G.
Published: October 2014

The Hayek oscillator is an externally (body) mounted cuirass ventilator used in the intensive care unit. We have used it to ventilate patients undergoing microlaryngeal surgery. It was found to be a relatively safe method of ventilation in these cases, with the advantage of dispensing with any form of endolaryngeal or endotracheal intubation.
Failed Extubation in the Neonatal Intensive Care Unit
Authors: Walker Paul , Forte Vito
Published: October 2014

One of the roles of the pediatric otolaryngologist in the neonatal intensive care unit (NICU) is the assessment and management of the neonate who fails a trial of extubation. This paper reviews the recent 5-year institutional experience at The Hospital for Sick Children, Toronto, with neonates who failed extubation and who subsequently underwent diagnostic endoscopy. One hundred twenty-eight neonates from the NICU underwent diagnostic endoscopy. Of these, 58 neonates underwent diagnostic endoscopy for failure to extubate. Nine neonates were extubated after diagnostic endoscopy and retrial (16% of the series). Eleven neonates were extubated after additional endoscopic procedures (19% of the series). Twenty-four neonates underwent anterior cricoid split, of whom 20 or 83% (34% of the series) were eventually successfully extubated with no further airway intervention required during the study period (minimum 6 months' follow-up). Eleven neonates underwent tracheotomy (19% of the series). Four neonates underwent another external procedure to allow extubation (7% of the series). Three neonates died while still intubated (5% of the series). Our management of the neonate who fails a trial of extubation is discussed.