bluuebunny/crossref_metadata_2025 huggingface dataset:
Selective Killing of Laryngeal Carcinoma Cells by a Monoclonal Immunotoxin
Authors: Zenner Hans-Peter
Published: October 2014

To overcome the lack of selectivity of present anticancer drugs, an alternative approach is described for laryngeal carcinoma cells. An immunotoxin is synthesized containing the toxic chain from ricin coupled to a monoclonal antibody against a laryngeal carcinoma cell line. The newly formed monoclonal immunotoxin selectively kills cells from laryngeal carcinoma cell lines, whereas various normal living cells are not affected. Control experiments rule out the possibility that toxicity can be attributed to contaminating traces of whole ricin toxin. The results indicate that minute amounts of the immunotoxin are selectively cytotoxic for living laryngeal carcinoma cells in vitro.
Aerodynamic Studies of Laryngectomees after the Amatsu Tracheoesophageal Shunt Operation
Authors: Kinishi Minoru , Amatsu Mutsuo
Published: October 2014

Ten speakers with tracheoesophageal shunts were subjected to aerodynamic investigation. Measurements were made of tracheal pressure, airflow rate, and intensity and fundamental frequency of voice. Airway resistance, pulmonary power, acoustic power, and efficiency of voice were calculated from the data. It was found that intensity and airflow rate showed a tendency to augment with increased tracheal pressure, while fundamental frequency remained almost unchanged as tracheal pressure increased. Airway resistance of the tracheoesophageal speakers ranged from about 100 to 1,200 dyne s/cm5 and tracheal pressure ranged from 12 to 80 cm of water, while efficiency of voice ranged from 0.3 × 10−4 to 6.5 × 10−4. These results revealed that compared to the normal larynx, efficiency of voice was approximately the same, although airway resistance and tracheal pressure were substantially greater.
Absence of Later Auditory Brain Stem Response Components, Congenital Horizontal Nystagmus, and Hypotonia in Male Infants
Authors: Kaga Klmitaka , Yokochi Kenji , Kodama Kazuo , Kitazumi Eiji , Marsh Roger
Published: October 2014

Five male infants, all of whom showed findings of wave I or waves I and II only of the auditory brain stem response (ABR), congenital horizontal pendular nystagmus, and hypotonia of head and limbs in the early infantile period with later paresis, are discussed. Their ages ranged from 3 to 13 months at the first examination, at which time neither head control, sitting, nor walking had been attained. Follow-up studies of ABRs revealed persistent abnormalities with neither remission nor progression. In spite of these abnormalities, these infants responded well to voices and other sounds. The congenital nystagmus in each case was demonstrated by electronystagmography to have a frequency of 2 to 3 Hz. The correlation between clinical signs and ABR is uncertain as yet. However, our findings are strongly indicative of nonprogressive inborn abnormalities in the lower brain stem.
Pathology Consultation Carcinomas of the Submandibular and Sublingual Glands
Authors: Batsakis John G.
Published: October 2014

The ratio of benign to malignant tumors changes markedly from parotid to submandibular to sublingual glands. Neoplasms of the submandibular gland are nearly equally distributed between benign and malignant histologic types. Compared to their counterparts in the parotid gland, malignancies in the submandibular gland are more often of a higher histologic grade, more biologically aggressive, metastasize more often, and are more lethal. In the sublingual glands, approximately 80% of the epithelial tumors are malignant.
Predictive Value of Serologic Tests for Syphilis in Otology
Authors: Hughes Gordon B. , Rutherford Isobel
Published: October 2014

Otologic syphilis (luetic inner ear disease) usually is diagnosed by positive serologic tests and by exclusion of other possible causes. Because the FTA-ABS for syphilis is exquisitely sensitive in all but early primary cases, a positive FTA-ABS result and coincident inner ear disease often are thought to be diagnostic of syphilitic inner ear disease. The result is a management dilemma: are there false-positive results in misdiagnosed cases? Over 4 years, the authors performed a prospective study with time-matched controls to determine the predictive value of serologic tests and prevalence of syphilis in otology. Thirty-one cases of otologic syphilis were diagnosed in 5,439 new (different) patients with otologic complaints. In the geographic area studied, this prevalence (570/100,000) was 25-fold greater than that of all reported cases of syphilis in the general population (22.7/100,000). The defined sensitivity of the FTA-ABS (100%) was nearly twofold greater than the measured sensitivity of the rapid plasma reagin (RPR, 55%) in otologic syphilis. Specificities were comparable; therefore, a positive FTA-ABS had higher predictive value than a positive RPR. The prevalence-related predictive value of a positive FTA-ABS (22%) was more than twice that of the RPR (9%) in otology. The predictive value of a positive FTA-ABS in otology was 11-fold greater than that of the FTA-ABS in the general population (2%). Therefore, in suspect cases the FTA-ABS should be used to screen for otologic syphilis in an otologic practice. At a prevalence of 570 cases in 100,000 patients, only 22% of otologic patients with positive FTA-ABS results actually have otologic syphilis. Because disease morbidity can be far worse than treatment morbidity, however, positive results should be considered true-positives to avoid misdiagnosis in potentially infected patients. In suspect cases with positive FTA-ABS, therefore, treatment should be recommended unless specific contraindications exist.
Hormonal Receptor Site Alterations in the Etiopathogenesis of Otosclerosis
Authors: Maurizi M. , Fanò G. , Paludetti G. , Donti E. , Donti G. Venti , Ottaviani F.
Published: October 2014

The authors have studied calcium 45 uptake and cAMP intracellular levels in normal and otosclerotic bone cell cultures after stimulation with calcitonin in the presence or absence of propranolol. The results seem to demonstrate that poststimulatory 45Ca incorporation is slightly different in normal and otosclerotic cell cultures, being slower but longer lasting in the latter. Propranolol administration markedly inhibits 45Ca uptake in normal cells, while in otosclerotic cells a massive intracellular penetration becomes evident after an initial inhibitory phase. Also cAMP intracellular levels behave differently; a marked increase, followed by a rapid decrease, can be detected in normal cells after stimulation with calcitonin, while in otosclerotic cells, the increase is slower and followed by a long lasting reduction. Adding propranolol reduces cAMP levels in normal cells, while it increases levels in otosclerotic cells. The different behavior of calcium metabolism and cAMP levels after stimulation with calcitonin, depending upon the presence or absence of propranolol, seems to indicate an alteration of the transducing mechanism between stimulus, receptor, and cellular effector in otosclerotic cells.
Dipyridamole-Induced Epistaxis
Authors: Mittelman Moshe , Lewinski Uri , Ogarten Ursula , Djaldetti Meir
Published: October 2014

The case history of a patient treated with dipyridamole who developed severe epistaxis, accompanied by alteration of the platelet aggregation tests, is presented. The bleeding did not respond to local therapy and stopped only after discontinuation of the drug and normalization of the platelet aggregation. Hemorrhage, especially in elderly patients, should be considered as a possible complication of dipyridamole administration.
Ultrastructural Characteristics of Capillaries Entering and Leaving the Stria Vascularis
Authors: Watanabe Kensuke
Published: October 2014

Capillaries entering and leaving the stria vascularis were surrounded by layers of basal cells and fibrocytes. The entering capillaries were surrounded by one or two thin basal cells, while the leaving capillaries were surrounded by four or five thicker and interdigitated basal cell layers. Moreover, the layers surrounding the leaving capillaries persisted further into the spiral ligament. Two kinds of filaments were observed in the basal cells, one thin and the other thick. Capillaries were observed to leak horseradish peroxidase before they entered and after they left the stria vascularis. Although the reaction product of horseradish peroxidase was observed in all perivascular spaces of leaving capillaries, very little or no reaction product was observed around some entering capillaries. It is speculated that the layers of basal cells and fibrocytes around entering and leaving capillaries control the vascular flow out of the stria vascularis, although the layers around leaving capillaries may be more contractile than those around entering capillaries.
Histopathology of the Inner Ear in Usher's Syndrome as Observed by Light and Electron Microscopy
Authors: Shinkawa Hideichi , Nadol Joseph B.
Published: October 2014

A case of Usher's syndrome, type 3, is described. Histologic study of the inner ear of the patient demonstrated hair cell loss in the basal turn, severe loss of spiral ganglion cells, widespread neural degeneration in the cochlea, and discrete collections of degenerating supporting cells in the organ of Corti. The pattern of neural degeneration bore some similarity to abnormalities in the retina in retinitis pigmentosa. However, the findings in the supporting cells had no obvious parallel to the findings in the retina in this disorder. The histopathology of Usher's syndrome has been equated with the Scheibe, or cochleosaccular, pattern of degeneration. However, the findings in the present case and a critical analysis of published data did not support this concept.
Infantile Subglottic Hemangiomas an Update
Authors: Shikhani Alain H. , Marsh Bernard R. , Jones Mark M. , Holliday Michael J.
Published: October 2014

Between 1913 and 1985, 323 cases of infantile subglottic hemangiomas have been reported in the English language literature. The purpose of this study is to review these cases, to report The Johns Hopkins Hospital experience with ten additional cases, and to compare the various methods of treatment in an attempt to identify the regimens associated with the best outcome. The majority of the patients presented before the age of 6 months with respiratory distress, most commonly inspiratory stridor. There was a 2:1 female to male preponderance. The diagnosis was established by endoscopy in the majority and confirmed by biopsy in one third, without serious bleeding complications. A plethora of treatment methods have been described, including the following: corticosteroids, tracheotomy, radiation therapy, radioactive implant therapy, surgical excision, cryotherapy, and carbon dioxide laser. These methods were reviewed and their results compared to our own. We conclude that several methods are effective, each having its advantages and disadvantages. We believe that immediate tracheotomy should be performed in cases with severe airway obstruction. Smaller lesions may be vaporized with the carbon dioxide laser without tracheotomy if postoperative care is provided in a pediatric intensive care unit. Corticosteroids may be used alone or in combination with other modalities. External radiation therapy and injection of sclerosing agents are not advised.
Branchio-OTO-Renal Dysplasia in Three Families
Authors: Gimsing Steen , Dyrmose Jørgen
Published: October 2014

Branchio-oto-renal dysplasia, often called the BOR syndrome, in its full expression consists of 1) hearing loss of conductive, sensorineural, or mixed type; 2) preauricular pits; 3) auricular deformities; 4) lateral cervical sinuses, cysts, or fistulas; and 5) renal malformations. The condition is inherited in an autosomal dominant mode. The findings in three affected families are described, and pertinent genetic and clinical aspects are discussed. The potential seriousness of the renal and aural malformations stresses the importance of early recognition of this syndrome.
Change in the Capillary Permeability of the Stria Vascularis by Different Methods of Death and Fixation
Authors: Watanabe Kensuke
Published: October 2014

The permeability of the stria vascularis to horseradish peroxidase (HRP) was examined. Ten minutes after an intravenous injection of HRP, 15 guinea pigs were killed and fixed by four different methods: 1) cochleas fixed 3 minutes after decapitation, 2) administration of an overdose of pentobarbital, 3) cochleas fixed for 5 minutes before decapitation, and 4) cochleas fixed immediately after decapitation. In the animals in group 1, HRP leakage was observed in almost all strial vessels (86%), and blood sludging and amorphous HRP reaction product in 98% of strial capillaries. In the animals in group 2, strial capillaries were observed both with noticeable HRP leakage and with no evidence of leakage. Blood sludging was associated with amorphous HRP reaction product, while no blood sludging was associated with granular HRP reaction product. In group 3 animals, only faint or no HRP reaction product was observed in the perivascular spaces. Only 3% of the capillaries had blood sludging. In the animals in group 4, blood sludging but no HRP leakage was observed in almost all capillaries (82%). It is speculated that HRP does not normally leak from the strial capillaries, although many researchers have reported to the contrary. It appears that HRP leaks from the strial capillaries only when acute anoxia or hypotension continues for a few minutes. These conditions induce blood sludging and are followed by the appearance of many marginal folds in these capillaries.
Heterotopic and Accessory Salivary Tissues
Authors: Batsakis John G.
Published: October 2014

Heterotopic salivary tissue is found where salivary glands are not normally placed or expected. Sites of predilection are in the neck, where the heterotopias appear to bear a relationship to the branchial apparatus, and within the mandible. Neoplastic transformation is unusual, especially so for the extraosseous heterotopias. This contrasts with accessory salivary tissue, which consists of detachments from a major salivary gland occurring along the external duct systems. Accessory salivary tissue is heir to all the diseases of the parent glands.
An Endoscopic Method of Tympanic Membrane Fluorescein Angiography
Authors: Applebaum Edward L. , Deutsch Elise C.
Published: October 2014

Fluorescein angiography is a recently developed method of studying the tympanic membrane's dynamic vasculature. Our preliminary studies using an ophthalmic fundus camera and aural speculum did not always permit visualization of the entire tympanic membrane, and the electronic flash unit used in our initial studies did not cycle fast enough to visualize effectively the rapid arterial phase of blood flow. In this report, we describe an endoscopic method of tympanic membrane fluorescein angiography that uses a continuous xenon light source. A representative angiogram from a normal subject is described. The mallear artery apparently is the major blood supply to the posterior half of the tympanic membrane, which is consistently better perfused than the anterior half. Branches from the annular ring of blood vessels supply the anterior half of the tympanic membrane. Preliminary studies of two temporalis fascia tympanoplasty patients indicate that the graft becomes revascularized 2 to 4 weeks after surgery and that posterior grafts may revascularize earlier than anterior grafts.
Auditory and Temporal Bone Abnormalities in Charge Association
Authors: Wright Charles G. , Meyerhoff William L. , Brown O. E. , Rutledge J. C.
Published: October 2014

CHARGE association is a recently described cluster of congenital defects including ocular coloboma, heart disease, choanal atresia, retarded development and/or CNS abnormalities, genital hypoplasia, and ear anomalies. Although congenital hearing loss has been reported in CHARGE association, no information regarding the underlying temporal bone disease is available in the literature to date. The authors evaluated four patients with multiple anomalies consistent with CHARGE syndrome. Two surviving patients have bilateral severe hearing loss on auditory brain stem response testing. Two patients did not survive, and their temporal bones were obtained at autopsy for histologic examination. All four temporal bones showed severe middle ear defects including ossicular deformities, absence of the stapedius muscle, absence of the oval window, aberrant course of the facial nerve, and dehiscence of the facial nerve canal. In the more severely affected case, a Mondini-type malformation of the cochlea was present, together with multiple anomalies of the vestibular apparatus. Vestibular defects also occurred in the other case; however, the cochleae were found to be normally developed.
External Auditory Canal Stenosis and Partial Atresia without Associated Anomalies
Authors: Grundfast Kenneth M. , Camilon Felizardo
Published: October 2014

Unilateral or bilateral ear canal stenosis or atresia occurring without microtia or associated anomalies may go undetected during early childhood. Summaries of ten cases illustrate difficulties in making early diagnoses. An unusual case of inherited isolated bilateral external canal atresia occurring in a mother and daughter is included. Potential pitfalls in diagnosis and management are discussed.
Malleus Grip Prosthesis
Authors: Schuknecht Harold F. , Bartley Mary L.
Published: October 2014

The malleus grip prosthesis is designed for ears with conductive hearing loss caused by pathologic conditions of the stapes in association with pathologic conditions of the malleus or incus. The malleus grip procedure was performed on 220 ears, and follow-up studies are available on 203. Mild to profound sensorineural hearing losses occurred in 16 (8.37%). The remaining 187, on the first postoperative test, had an average air-bone gap of 14 dB, and subsequent examinations on 100 of them showed no significant change with the passage of time. The procedure is technically more difficult than stapes surgery for otosclerosis, and success is highly dependent upon selection of appropriate cases and meticulous implantation of the prosthesis.
Twelfth Daniel C. Baker, Jr, Memorial Lecture Victor Negus: 57 Years Later
Authors: Harrison Donald F. N.
Published: October 2014

The three-dimensional morphology of the mammalian larynx was studied for 15 years. Using specimens obtained from a wide variety of sources, efforts were made to correlate structure with function and thus explain the variations in size and morphology seen in over 150 families of mammals.
Experience with Partial Cricoid Resection and Thyrotracheal Anastomosis
Authors: Pearson F. G. , Brito-Filomeno L. , Cooper J. D.
Published: October 2014

Since 1973, 28 patients have undergone tracheal and subglottic resection with reconstruction by primary laryngotracheal anastomosis. Nine patients had postintubation stricture, eight had blunt trauma with cricotracheal disruption, seven had a neoplasm, two had an inhalation burn, and two had idiopathic stenosis. In all cases, the anterior cricoid arch was completely resected and a submucosal segment of the posterior cricoid plate was partially resected. A posterior shell of cricoid plate was preserved in 21 patients with intact laryngeal nerve function. Postoperatively, a Montgomery T-tube was used to stent the anastomosis and subglottic area in ten patients, all of whom had residual injury or disease at or immediately below the level of the cords. The proximal arm of the T-tube was positioned above the vocal cords. The tube was removed within 1 month in eight patients and remained for 3 and 18 months in the other two. The extent of resection varied from 2.5 to 7 cm. Tension-relieving procedures were added in 13 cases. Fourteen patients have been followed longer than 5 years, and five patients for more than 10 years. A widely patent anastomosis was maintained in 26 patients. In two patients, a partial restenosis resulted in some limitations of exercise tolerance. Voice and exercise tolerance have not deteriorated with the passage of time. Recurrent laryngeal nerve function was completely preserved in 20 of the 21 patients whose nerve function was intact before operation.
Demonstration of Human Papillomavirus Capsid Antigen in Carcinoma in Situ of the Larynx
Authors: Kashima Haskins , Kuhajda Francis , Mounts Phoebe , Loury Mark
Published: October 2014

We have undertaken a retrospective study to investigate the role of human papillomavirus (HPV) in the development of laryngeal carcinoma in situ (CIS). Sixty paraffin-embedded tissue specimens, collected from 20 patients with a history of laryngeal CIS, were examined for the presence of HPV capsid antigen. All but four individuals were men, with an average age at diagnosis of 64 years. An immunoperoxidase technique showed that 20 specimens from 14 patients contained detectable HPV capsid antigen. An independent evaluation for histopathologic features characteristic of HPV infection identified viral changes in the 14 patients as well as an additional two. No correlation was found between clinical course, as determined by histologic severity of vocal cord lesions, and presence of HPV. These results suggest that HPV should be considered an etiologic agent in the development of laryngeal CIS.
Deglutition following Supraglottic Horizontal Laryngectomy
Authors: Hirano Minoru , Tateishi Morio , Kurita Shigejiro , Matsuoka Hidetaka
Published: October 2014

In order to determine factors that may contribute to deglutition problems following supraglottic horizontal laryngectomy or its modified techniques, clinical records of 38 patients were studied. Contribution of the following factors was investigated: Age; sex; tumor classification; radical neck dissection; extent of and symmetry in removal of the aryepiglottic folds, arytenoid cartilages, and false folds; removal of the base of the tongue, hyoid bone, and a part of the vocal folds; extent of removal of the epiglottis and thyroid cartilage; cricopharyngeal myotomy; and some complications and concomitant diseases. The results suggest that removal of the arytenoid cartilage and asymmetrical removal of the false folds contribute to deglutition problems. We conclude that the standard supraglottic horizontal laryngectomy associated with surgical approximation of the larynx to the base of the tongue and cricopharyngeal myotomy does not usually cause serious deglutition problems. When the arytenoid cartilage is removed, reconstruction of the structure is required for the prevention of severe aspiration.
Carcinoid Tumor of the Larynx: The Role of Conservative Therapy
Authors: Patterson Susan D. , Yarington C. Thomas
Published: October 2014

Carcinoid tumors of the larynx are an extremely rare condition, universally malignant, and unresponsive to radiation and chemotherapy. Just over 20 cases have been reported in the literature to date. Treatment is adequate surgical excision. The number of these tumors reported should increase due to the use of electron microscopy and immunohistologic techniques in making the diagnosis. This paper illustrates the role of conservative laryngeal surgery, when appropriate, as an effective form of therapy. The basic pathologic diagnostic criteria are illustrated.
Management of Difficult Airway Problems with Percutaneous Transtracheal Ventilation
Authors: Weymuller Ernest A. , Paugh Donald , Pavlin Edward G. , Cummings Charles W.
Published: October 2014

Percutaneous transtracheal jet ventilation was used in the management of 13 cases of upper airway obstruction. Cases are subdivided according to the nature of the presenting airway problem. The first group had stable upper airway abnormalities; the second group presented as emergencies with rapidly evolving upper airway obstruction. This technique has two major advantages: 1) it provides rapid access to the airway during acute emergencies; and 2) it provides control of the airway where tissue distortion from head and neck trauma or tumor surgery makes standard anesthetic techniques difficult. Complications including catheter displacement, total expiratory obstruction, pneumothorax, and subcutaneous emphysema have been encountered. The authors conclude that percutaneous transtracheal jet ventilation is effective. However, potential problems exist and an in-depth understanding of the technique is necessary for its appropriate application and successful use.
Transcutaneous Electrical Stimulation of the Recurrent Laryngeal Nerve in Monkeys
Authors: Sanders Ira , Aviv Jonathan , Racenstein Michael M. , Kraus Warren M. , Biller Hugh F.
Published: October 2014

The recurrent laryngeal nerve (RLN) of four anesthetized adult Macaca fascicularis monkeys was stimulated by applying current with blunt electrodes placed unilaterally and bilaterally on the intact neck skin along the tracheoesophageal groove. The stimulus consisted of 2.5- to 4.0-mA cathodal pulses, each of 1-ms duration, beginning at a frequency of 10 Hz and increasing by 10-Hz increments to 100 Hz. Unilateral stimulation from 10 to 30 Hz resulted in a graded vocal cord abduction, with the maximal glottic aperture occurring at 30 Hz. Stimulation above 30 Hz produced a graded cord adduction, with nearly complete glottic closure at 100 Hz; bilateral stimulation yielded similar results, with total glottic closure at 100 Hz. Confirmation of the RLN as mediator of this frequency-dependent cord motion was achieved by surgically isolating it and attaining identical results with direct stimulation. No cardiopulmonary alterations were observed in any trial. Transcutaneous electrical stimulation of the RLN seems to be a relatively safe, reliable, and noninvasive method of controlling vocal cord position and thereby the glottic airway in monkeys.
Pitfalls to Laser Correction of Choanal Atresia
Authors: Muntz Harlan R.
Published: October 2014

Many methods have been used over the years to correct choanal atresia, a cause of neonatal respiratory distress. The precise, relatively bloodless incisions of the carbon dioxide laser have made it an effective tool for laser surgery using a transnasal approach. In spite of its utility, certain conditions impede laser surgery. These conditions include septal deviation, enlarged inferior turbinates, high arched hard palate, and other craniofacial disorders. Prolonged duration of stenting appears to reduce the success rate.
Management of Infants with Prenatal Ultrasound Diagnosis of Airway Obstruction by Teratoma
Authors: Holinger Lauren D. , Birnholz Jason C.
Published: October 2014

We report a case of a cervical teratoma that was diagnosed prenatally. In anticipation of potential upper airway obstruction, resources were mobilized to the operating room at the time of planned cesarean section. The neonate developed respiratory distress, and her airway was secured. There was no evidence of cerebral anoxia initially, and she is currently thriving with no central or peripheral neurologic defects. As prenatal diagnosis by ultrasound becomes more refined, the otolaryngologist will play an increasing role in perinatal decision-making and anticipated emergencies at the time of delivery. Airway obstruction of various causes will be the most urgent problem.
Bronchial Casts in Children
Authors: Werkhaven Jay , Holinger Lauren D.
Published: October 2014

Bronchial casts were found in four children during a 2-year period at the Children's Memorial Hospital. These four children represent 0.2% of the 1,943 endoscopic cases during that time. Thirty other cases of bronchial casts have been reported previously in children 9 years of age or younger, only 12 of which were not associated with cystic fibrosis. Casts may be a complication of many diseases; cystic fibrosis, asthma, bronchitis, allergic bronchopulmonary aspergillosis, and bronchocentric granulomatosis are the most common. With the exception of cystic fibrosis, these diseases may all have an allergic pulmonary reaction as the underlying cause. In all four cases reported here, the diagnosis was made at endoscopy because the clinical picture is not dissimilar from that of bronchial foreign bodies. Management includes endoscopic removal of the cast, chest physical therapy with nebulized acetylcysteine, and an evaluation to determine the underlying condition.
Variants of Möbius' Syndrome and Central Neurologic Impairment
Authors: Cohen Seymour R. , Thompson Jerome W.
Published: October 2014

Möbius' syndrome is a complex neurologic disorder; its etiology and characterization have eluded clinicians for over a century. The pure Möbius' syndrome is rare, and the involvement of the sixth and seventh nerves has been found to have a host of associated defects. These include 1) limb and shoulder abnormalities; 2) multiple cranial nerve defects; 3) occasional mental retardation; 4) external, middle, and inner ear abnormalities; 5) laryngeal neurologic defects that cause stridor, obstruction, and aspiration; and 6) severe dysphagia and associated aspiration with life-threatening pneumonias. The children with severe neurologic dysfunction from central nuclear deficiencies were in many respects so similar in their clinical course that they are included in this paper. All of the patients required a tracheotomy to support the airway and to permit tracheobronchial toilet. A feeding gastrostomy was necessary in all but one patient. To counter life-threatening aspiration in the patients with multiple CNS defects, the Lindeman laryngeal diversion was considered the procedure of choice and proved very effective. The details and problems of this procedure are discussed. The aural defects and laryngeal findings in this series of patients are described in detail.
Pathogenesis of Subglottic Stenosis from Endotracheal Intubation
Authors: Hawkins Donald B.
Published: October 2014

Subglottic stenosis is more likely to develop secondary to endotracheal intubation if one or more trauma-related risk factors are involved. Ulcerations occur most often in the posterior-lateral cricoid ring. They vary in size and may involve the entire circumference of the subglottic area. The ulcerations heal with fibrous scarring which, if extensive enough, results in subglottic stenosis.
Bipolar Cautery for the Fiberoptic Bronchoscope
Authors: Marsh Bernard R.
Published: October 2014

a bipolar electrocautery probe for use through the fiberbronchoscope has been designed and has proven useful in treating small endobronchial lesions and bleeding sites.
Melanotic Neuroectodermal Tumor of Infancy
Authors: Batsakis John G.
Published: October 2014

The melanotic neuroectodermal tumor of infancy is a usually benign neuroectodermally derived tumor with a predilection for the anterior maxilla of children who are less than 1 year of age. The lesion is considered to be readily treated by conservative excision, but it should be regarded as potentially malignant, even though there is infrequent expression of such malignancy.
Staging of Maxillary Cancer
Authors: Willatt D. J. , McCormick M. S. , Morton R. P. , Stell P. M.
Published: October 2014

Of the many proposed classifications for staging maxillary sinus cancer, none has been adopted universally and none is known to be superior to the others. This study identified the best of six currently used classifications using data from 53 previously untreated patients with squamous cell carcinoma of the maxillary sinus. Analysis of each classification's ability to stage the majority of patients, produce a balanced distribution of T stages, and correlate T stage with treatment and prognosis revealed Harrison's classification to be the best. Harrison's classification should be adopted worldwide as the classification of choice for staging squamous cell carcinoma of the maxillary sinus.
Three-Year Experience of Treating Recurrent Respiratory Papilloma with Interferon
Authors: Lusk Rodney P. , McCabe Brian F. , Mixon Janis H.
Published: October 2014

This paper presents the 3-year follow-up of the original 19 patients with recurrent respiratory papilloma treated with exogenous alpha human leukocyte interferon (α-IFN) at the University of Iowa. Two patients were dropped from the study because of poor patient compliance, and one was lost to follow-up. After approximately 1 year of α-IFN treatment, five patients were clear, and the rest continued to have disease: Seven mild, two moderate, and two severe. A second course of α-IFN was administered to eight patients, all of whom had a decrease in the volume of the papilloma. The reduction in anatomic distribution was variable. During the observation period all patients either cleared (50%), improved (25%), or continued with severe disease (25%). In summary, the response of recurrent respiratory papilloma to α-IFN therapy is dramatic in some patients and slight in others.
Sternomastoid Myoperiosteal Flap for Reconstruction of the Subglottic Larynx
Authors: Friedman Michael , Grybauskas Vytenis , Skolnik Emanuel , Toriumi Dean M. , Chilis Thomas
Published: October 2014

Reconstruction of the subglottis is usually required after resection of cricoid cartilage or tracheal tissue in cases of trauma, subglottic stenosis, or invasive thyroid carcinoma. There are multiple techniques available for reconstruction of the subglottic larynx, but most of them have a high rate of complications or graft failure. We have found the sternocleidomastoid myoperiosteal flap to be an ideal means of reconstruction. In an experimental study, we performed subglottic reconstruction using the sternomastoid myoperiosteal flap on 15 mongrel dogs to determine the presence of bone formation versus calcified fibrous scar. Radiologic studies suggested apparent metaplastic bone formation at the graft site, and histologic studies confirmed this. Functionally, 12 dogs had stable airways without stridor or subglottic narrowing. Three dogs died of complications. With successful reconstruction of large defects in the canine subglottis, attempts to repair large subglottic and tracheal defects in the human are feasible.
Perceptual-Physiologic Approach to Evaluation and Treatment of Dysphonia
Authors: D'Antonio Linda , Lotz Wendy , Chait David , Netsell Ronald
Published: October 2014

The value of a perceptual-physiologic approach to both the evaluation and treatment of voice disorders is described and illustrated with an example of a patient with ventricular fold phonation. Objective measures are obtained to facilitate the understanding of the underlying pathophysiology and to document change over time. Evaluation data are recorded and interpreted collectively by a speech-otolaryngology team and may be valuable for medicolegal cases. Finally, the evaluation methods, particularly videolaryngoscopy, may be used for biofeedback purposes to facilitate voice therapy.
Pneumosinus Dilatans
Authors: Smith I. M. , Maran A. G. D. , von Haacke N. P.
Published: October 2014

Pneumosinus dilatans is an extremely rare condition in which facial deformity is caused by gross enlargement of apparently normal paranasal sinuses. To our knowledge, this is the first case to be reported in the English literature.
Supracricoid Hemilaryngopharyngectomy
Authors: Laccourreye H. , St Guily J. Lacau , Fabre A. , Brasnu D. , Menard M.
Published: October 2014

The supracricoid hemilaryngopharyngectomy consists of resection of the supracricoid hemilarynx and ipsilateral pyriform sinus. Two hundred forty patients underwent this procedure from 1964 through 1983. Two hundred twenty-two patients had no airway impairment, and 204 recovered normal deglutition. The local recurrence rate was 5.2%. Indications for the procedure are carcinoma of the supracricoid upper part of the pyriform sinus and carcinoma of the lateral laryngeal margin with normal vocal cord mobility.
Effects of Staphylococcus Aureus on the Ciliary Activity of the Middle Ear Lining
Authors: Ohashi Yoshihiro , Kihara Shoko , Nakai Yoshiaki , Ikeoka Hiroshi
Published: October 2014

Our previous investigation using normal guinea pigs disclosed that, like respiratory mucosa, the middle ear lining has ciliary activity, and that this ciliary activity becomes more active as the location becomes more distal to the eustachian tube. In this experimental study, the effects of Staphylococcus aureus on the middle ear lining was examined from functional and morphological viewpoints. In conclusion, the ciliary activity at the entrance to the eustachian tube and that more distal to the tube present a similar pattern of reaction to S aureus in an in vitro system. On the other hand, the ciliary activity of the middle ear lining displays a varying pattern of reaction according to the locations within the tympanic cavity.
Sensorineural Hearing Loss in Children with Sickle Cell Anemia
Authors: Odetoyinbo Olujimi , Adekile Adekunle
Published: October 2014

Various degrees of hearing loss have been associated with sickle cell anemia. Fifty-six Nigerian children 6 to 15 years old were investigated for presence, type, and degree of hearing loss. Sensorineural hearing loss ≥ 25 dB in two or more frequencies was found in 12 of 56 patients (21.4%). Tympanometry was normal in all patients, but acoustic reflex was elevated or absent in seven of 12 patients with hearing loss. Analysis of the data revealed 1) a significant association between sensorineural hearing loss and the homozygous sickle cell disease, and 2) a significant association between hearing loss and early occurrence of vaso-occlusive crisis. This latter finding suggests that the microvasculature of the cochlea in young infants may be more susceptible to occlusion during sickle cell crisis.
Hanhart's Syndrome with Special Reference to Temporal Bone Findings
Authors: Sekhar H. K. Chandra , Sachs M. , Siverls V. C.
Published: October 2014

We report two cases of Hanhart's syndrome. The first patient was a male who died in the neonatal period, and whose temporal bones were removed, processed, and histologically examined; the findings are presented in this article. The second case concerns a living patient with the typical characteristics of the syndrome. An attempt is made to show that a gross first and second branchial arch anomaly exists in this syndrome and not just the micrognathia that is obvious to the onlooker. Possible causes and classifications of facial dysmorphia are discussed.
Carcinoid (Neuroendocrine Carcinoma) of the Larynx
Authors: Baugh Reginald F. , Wolf Gregory T. , McClatchey Kenneth D. , Lloyd Ricardo V. , Evans David A.
Published: October 2014

Carcinoid of the larynx is a rare aggressive malignancy with few long-term survivors. Three cases of laryngeal carcinoid treated at the University of Michigan and 23 cases reported previously are reviewed. The clinical behavior, patterns of metastasis, and response to therapy were analyzed to determine optimal therapeutic evaluation and treatment strategies. Patient survival did not correlate with clinically evident regional adenopathy, length of symptoms, extent of laryngeal surgery, or retrospective staging according to American Joint Committee guidelines on cancer of the larynx (AJC-1980). Distant metastatic spread occurred frequently and was the most common cause of death. Surgical therapy is currently the only effective treatment for primary or recurrent disease. Future treatment regimens must address distant spread of tumor.
Speaking Fundamental Frequency of Postlingually Profoundly Deaf Adult Men
Authors: Leder Steven B. , Spitzer Jaclyn B. , Kirchner J. Cameron
Published: October 2014

We investigated the speaking fundamental frequency (F0) of 21 postlingually profoundly sensorineurally deaf men. Results indicated that speaking F0 was significantly higher for the deaf group than for normal-hearing, age-matched men. Neither duration of profound deafness nor hearing aid usage affected speaking F0 values significantly. The findings of the present study provide a baseline for determining the effects of rehabilitation.
Lymphoepithelial Lesion and Sjögren's Syndrome
Authors: Batsakis John G.
Published: October 2014

The lymphoepithelial lesion of salivary glands, which begins with a focal, periductal lymphoreticular reaction and progresses to partial or total replacement of functioning acinar parenchyma, is associated with several clinical disorders. The lesion may be solely a salivary gland disease without systemic manifestations or may be a tissue manifestation of autoimmune disease — Primary or secondary Sjögren's syndrome. Besides its own morbidity, the lesion is associated with the development of lymphomas.
Recovery and Probable Persistence of Cytomegalovirus in Human Inner Ear Fluid without Cochlear Damage
Authors: Davis Larry E. , Rarey Kyle E. , Stewart John A. , McLaren Leroy C.
Published: October 2014

Cytomegalovirus (CMV) was recovered from a 5-month-old infant with probable congenital infection. In life, no hearing impairment had been observed. Auditory brain stem evoked responses were bilaterally intact. At necropsy, both temporal bones were morphologically normal, as demonstrated by light and electron microscopy. Sensory hair cells of the organ of Corti appeared intact. Cytomegalovirus was recovered from a mixture of perilymph and endolymph, but not the brain, CSF, or vitreous humor. This appears to be the first report of an individual with an inner ear CMV infection in which neither structural nor functional alterations of the inner ear were apparent. This case also suggests that CMV can persist within the inner ear for prolonged periods following congenital infection.
Drug Permeability of the Endolymphatic SAC
Authors: Yamane Hideo , Nakai Yoshiaki , Sugiyama Masao , Konishi Kazuo , Takahashi Kenichi , Okada Tadashi
Published: October 2014

Intravenously injected kanamycin sulfate (KM) was located in the endolymphatic sac (ES) of guinea pigs by an immunohistologic method. Kanamycin sulfate had passed through the capillaries in the subepithelial layer and reached the epithelial layer as early as 1 minute after injection. The amount of KM in the epithelial layer gradually increased with time (until 30 minutes after injection). The KM also accumulated in floating cells in the ES. These results tend to indicate that the ES is rather easily permeable to systemically administered drugs, which readily get into the regional endolymph. In conclusion, much more attention should be paid to the ES and drug ototoxicity associated with drug therapy in the management of patients with inner ear disturbances.
Acoustic Schwannoma Presenting as a Tumor of the External Auditory Canal
Authors: Tran Ba Huy Patrice , Hassan Jean Michel , Wassef Michel , Mikol Jacqueline , Thurel Claude
Published: October 2014

An acoustic neurinoma involving the internal auditory canal, the vestibule, the cochlea, the middle ear, and extending into the cerebellopontine angle and the external auditory canal, is described in a 56-year-old woman. An initial episode of vertigo was followed by a 27-year history of progressive unilateral hearing loss leading to complete deafness and areflexia with central compensation. The tumor was removed by a two-step surgical procedure, and the histologic features were those of a schwannoma.
Silicone Tracheal Cannula Update
Authors: Lavelle William G. , Montgomery William W. , Jacobs Edward E.
Published: October 2014

The Montgomery® silicone tracheal cannula is a current alternative to the standard tracheotomy tube. This paper extends the 1986 report to include unusual indications for its use, complications and their management, and further recommendations on its use gathered from recent experience.
Ultrastructural Findings in a Case of Meniere's Disease
Authors: Nadol Joseph B. , Thornton Aaron R.
Published: October 2014

The temporal bones of an individual with documented unilateral Meniere's disease were prepared for light and electron microscopy. a morphometric analysis was performed on hair cells, spiral ganglion cells, dendritic fibers in the osseous spiral lamina, afferent and efferent endings, and afferent synaptic contacts. In the ear with Meniere's disease, we found hair cell damage, including disruption of the cuticular bodies and basalward displacement of some outer hair cells. There was no significant difference in the number of hair cells or spiral ganglion cells on the two sides. There was a significant decrease, however, in the number of afferent nerve endings and afferent synapses at the base of both inner and outer hair cells in the ear with Meniere's disease as compared to the contralateral ear.
Histochemical Study of Posterior Cricoarytenoid Muscle Reinnervation by a Nerve-Muscle Pedicle in the Cat
Authors: Fata Joseph J. , Malmgren Leslie T. , Dum Richard , Gacek Richard R. , Woo Peak
Published: October 2014

Reinnervation of the posterior cricoarytenoid (PCA) muscle with a nerve-muscle pedicle (NMP) has been proposed for patients with bilateral abductor vocal cord paralysis. Since its success has been controversial, a glycogen depletion histochemical technique was used to examine reinnervation. An ansa cervicalis NMP was implanted into the denervated PCA in nine cats. Eight months later, vocal cord activity was evaluated. The NMP nerve was stimulated extensively in seven cats (experimental group). Optical densities of NMP-supphed PCA muscle fibers from experimental and control groups were compared to detect differences in glycogen content. The results demonstrated quantitative evidence of reinnervation in two experimental animals. Electrical stimulation of the NMP produced abduction in one of these two animals, but was never observed during spontaneous respiration or airway occlusion. These observations indicate that reinnervation can occur but abduction requires electrical stimulation. The NMP technique may be more successful with an electrical pacer.
Acquired Subglottic Stenosis in Children
Authors: Catlin Francis I. , Smith Richard J. H.
Published: October 2014

Subglottic stenosis is a disorder characterized by narrowing of the airway below the glottis or apposing edges of the true vocal cords. In a broad definition, the term may be used to describe airway compromise in the regions of the larynx or the trachea or both. In children, the stenosis is usually due to scar formation secondary to prolonged airway intubation, rather than to external trauma. The location and extent of the stenosis are highly variable; consequently, corrective measures need to be selected to suit the individual problem. In the present series of children, conservative treatment was adequate for lesser degrees of stenosis; those with more severe scarring required external laryngeal surgery. The preoperative evaluation and treatment plans are reviewed.
Laser Resection for Early Oral Cavity Cancer
Authors: Nagorsky Matthew J. , Sessions Donald G.
Published: October 2014

Laser excision of early selected cancers of the oral cavity and pharynx is a well accepted and reported treatment. Postoperative radiation therapy is employed in patients with unfavorable pathologic findings and in patients expected to have a high recurrence and metastatic rate. In most patients the combination of laser excision and postoperative radiation therapy is well tolerated and results in satisfactory healing, excellent tumor control, and high-level posttreatment function. This report discusses the treatment and results in 28 patients treated for early cancer of the oral cavity and pharynx. The local control rate of 77% compares favorably with the reported results following either conventional or laser excision of these lesions. The overall complication rate was 39%, with a 25% rate for patients not receiving postoperative radiation therapy, and a 58% complication rate for patients treated with postoperative radiation.