bluuebunny/crossref_metadata_2025 huggingface dataset:
Technique of preserving the spinal accessory nerve during radical neck dissection
Authors: Becker Gary D. , Parell G. Joseph
Published: October 2006

Preserving the spinal accessory nerve during radical neck dissection eliminates shoulder disability and does not compromise the incidence of neck recurrence in properly selected cases. The literature and standard textbooks only superficially refer to the method of dissecting this nerve. We describe our technique of preserving the spinal accessory nerve during radical neck dissection.
Nasal tuberculosis: A forgotten entity
Authors: Waldman Steven R. , Levine Howard L. , Sebek Bruce A. , Parker Willard , Tucker Harvey M.
Published: October 2006

Tuberculosis of the nose has become so infrequent that it is virtually a forgotten disease entity among younger practitioners in this country. Nevertheless, it can occur in all segments of our population and may present a confusing diagnostic problem. Two cases of primary nasal tuberculosis have been diagnosed and treated at The Cleveland Clinic Foundation since 1975. The differential diagnosis of nasal granulomatous disease usually includes Wegener's granulomatosis, midline malignant reticulosis, and sarcoidosis. We point out the necessity of including tuberculosis in this differential diagnosis. The definitive work‐up and treatment are also discussed.
Cutaneous aids in the diagnosis of oral ulcers
Authors: Armstrong Robert B.
Published: October 2006

A variety of diseases of diverse etiology may produce oral pathology in a spectrum ranging from blisters through erosion to frank ulcers. The morphologic similarity of such lesions makes precise diagnosis difficult. Some of these diseases also produce cutaneous lesions which suggest or confirm a specific diagnosis. Selected diseases which produce oral ulcers are reviewed with an emphasis on those in which coexisting cutaneous lesions can significantly aid in diagnosis.
The otolaryngologic presentation of botulism
Authors: Shugar Martin A. , Granich Mark S. , Reardon Edward J.
Published: October 2006

Botulism, although an uncommon disease, may nonetheless present to the otolaryngologist. The clinical signs of a severely erythematous, parched tongue, oropharynx, hypopharynx and larynx, especially when associated with bilateral cranial nerve deficits, should arouse suspicion of this disorder. Once the presumptive diagnosis of botulism is made, the otolaryngologist should expeditiously act to ensure appropriate airway control, as respiratory collapse may be imminent.
Clinical and prognostic significance of the T‐B immunological classification of non‐hodgkin's lymphomas
Authors: Ogasawara Hiroshi , Fujitani Tetsuzo , Mizojiri Gentaro , Hattori Hiroshi
Published: October 2006

This study was made to test the clinical significance and the prognostic value of the T‐B immunological classification of non‐Hodgkin's lymphomas.

Thirty‐four patients with adult diffuse lymphomas were studied. Nine patients with T‐cell lymphomas and three patients with non‐T and non‐B lymphomas had poor immunity and poor prognosis. Fifteen patients with B‐cell lymphomas have been found to be associated with a prognosis of intermediate range between that of T‐cell lymphomas and undetermined lymphomas. Seven patients with undertermined lymphomas, which were considered to have lost surface markers of B‐cells, had the best prognosis.

Thus the T‐B immunological classification of this disorder appears to be essential for clinicians, and provides a basis for proper differentiation of treatment for different groups.
Sphenoethmoid approach to the optic nerve
Authors: Sofferman Robert A.
Published: October 2006

Five percent of all head injuries affect some portion of the visual system, and the most common locus of injury is the canalicular segment of the optic nerve. The classic surgical approach to this area is via the transfrontal craniotomy, although the Japanese have utilized an external ethmoidal technique to provide limited extracranial access to the optic canal. Harvey Cushing utilized the transsphenoidal hypophysectomy principally for pituitary tumors causing visual deficits. This paper presents a variation of the transsphenoidal hypophysectomy technique which will allow exposure of the optic nerve from the orbital apex to the optic chiasm through the use of microsurgical instrumentation. A detailed step‐wise description of the surgical methodology is presented, along with drawings to define the approach fully. Four case reports and representative pre and postoperative radiographs illustrate the actual approach in the clinical setting.
Sensorineural hearing loss in the unoperated‐on otosclerotic ear
Authors: Duvall Michael B. , Caparosa Ralph J. , Bailey H. A. Ted
Published: October 2006

Severe sensorineural hearing loss occurs in less than 1% of stapedectomized ears.1−2 This low percentage remains as an irreducible minimum even among the most experienced and competent surgeons. The etiology has been hypothesized; however, the actual cause remains unknown.

The rare occurrence of sensorineural hearing loss of undetermined etiology in the un‐operated‐on side was reported first in 1967 by Armstrong3 who presented a series of three patients. No other references have been found since this initial report.

Recently three unilateral stapedectomized patients who developed sudden severe sensorineural hearing loss in the unoperated‐on ear were studied during the years 1971 through 1979. The hearing loss occurred within 1 week, 6 weeks, and 12 years postoperatively. Although the number is small, a study of this group, in addition to Armstrong's, leads to several interesting considerations:

Is the incidence of sudden sensorineural type hearing loss greater, the same as, or less than that which develops in the non‐otosclerotic general population?

Is there a possibility that the sudden sensorineural hearing loss of undetermined origin would occur at the time of surgery? Would this then be considered as a predisposing if not the actual etiology?

The present series of six cases is so small that a conclusion is not possible and inference is only conjecture. It is hoped, however, that this may stimulate past, present, and future search for this unusual occurrence. This may help determine whether or not there is a causal or merely a coincidental relationship.
Spontaneous return of facial motion following seventh cranial nerve resection
Authors: Norris C. W. , Proud G. O.
Published: October 2006

Four patients who had undergone operative procedures, wherein substantial segments of the VIIth cranial nerve had been resected, experienced some degree of reanimation of the muscles of expression despite the fact that no restitutive measures were employed. The site of insult was in the face in two; the temporal bone in one; and the fourth occurred in the cerebellopontine angle.

Teeth‐clenching and grimacing were practiced before a mirror by each subject, and one wonders if “re‐education” of dormant trigeminal nerve fibers might have facilitated the rehabilitation which was achieved.
Panel dicussion: The management of advanced laryngotracheal stenosis. Composite nasal septal graft in the management of advanced laryngotracheal stenosis
Authors: Toohill Robert J.
Published: October 2006

Reconstruction of the larynx and trachea is most often needed after conventional methods of repair have failed. The advanced stenotic lesion can be adequately corrected with a composite nasal septal graft in a one stage procedure. Severe glottic stenosis from crush injuries or following partial laryngectomy, subglottic stenosis, and high tracheal stenosis are most amenable to this type of reconstruction. The surgical technique is presented, and six cases of clinical utilization are reviewed.
Biochemical and cytogenetic techniques for the study of communication disorders
Authors: Kimberling William J. , Brookhouser Patrick E.
Published: October 2006

At least 30 to 40% of all childhood communication disorders are thought to be genetic in etiology. These range from well‐defined entities such as the Treacher Collins and Waardenburg syndromes to such a poorly delineated problem as reading disability. Genetics, in the past, has proved to be a powerful tool in predicting families at risk for having a child with a serious disorder. New techniques in biochemical and cytogenetics are now making feasible the early detection of individuals at high risk for developing certain disorders with the implied potential for prevention or amelioration of the resultant disability through early intervention.
Aerobic and anaerobic bacteriology of cholesteatoma
Authors: Brook Itzhak
Published: October 2006

Cholesteatoma specimens were obtained from 28 patients undergoing surgery for chronic otitis media and cholesteatoma. All specimens were cultured for aerobic and anaerobic organisms. Bacterial growth was present in specimens of 24 of the 28 patients. A total of 74 bacterial isolates were present (40 aerobes and 34 anaerobes). Aerobes alone were isolated from 8 (33.3%) of culture positive patients, 4 patients (26.7%) yielded only anaerobes, and 12 (50%) had both aerobic and anaerobic bacteria. Fifty isolates (27 aerobes and 23 anaerobes) were present in a concentration > 100 CFU/gm. The most commonly isolated aerobic organisms were P. aeruginosa (9), Proteus sp. (7), K. pneumoniae (5), S. aureus (5), and E. coli (4). The anaerobic bacteria most commonly isolated were gram‐positive anaerobic cocci (12), Bacteroides sp. (12, including 5 B. fragilis group), Clostridium sp. (3), and Bifidobacterium sp. (3). The above findings indicate the polymicrobial aerobic and anaerobic bacteriology of cholesteatoma.
Auditory brain stem responses in cerebellopontine angle tumors
Authors: Shanon Eliahu , Gold Shlomit , Himelfarb Mordechai Z.
Published: October 2006

The characteristic features of auditory brain stem responses (ABSR) are described in seven cases of cerebellopontine angle tumors: five acoustic neuromas, one congenital cholesteatoma, and one meningioma.

An attempt is made to correlate the N1 response with the degree of auditory nerve involvement, to gain information about the presence of brain stem displacement, and to evaluate the cranial extension of the lesion by recording responses to contralateral stimuli. The empirical nature of deductions based on crossed stimulation is emphasized.

In tumors originating from the VIIIth nerve, the ABSR pattern is characterized by a well‐defined N1 complex, indistinct or absent additional responses, and prolonged brain stem conduction time (BSCT) on the affected side whenever its assessment is feasible. Recording from the affected side on stimulation of the contralateral side may show normal responses from stations central to the auditory nerve in cases of small‐sized tumors. Medium or large tumors may be accompanied by abnormal N2 and/or N3 responses suggesting involvement of these stations.
Posterior packs and the nasopulmonary reflex
Authors: Jacobs John R. , Levine Laurence A. , Davis Harmon , Lefrak Stephen S. , Druck Norman S. , Ogura Joseph H.
Published: October 2006

Increased mortality and arterial hypoxemia have long been associated with posterior nasal packs placed for control of severe epistaxis. Several authors have postulated a nasopulmonary reflex to partially explain this clinically observed phenomenon. In ten young, healthy subjects, using a multiparameter pulmonary evaluation, posterior nasal packs were placed and no significant changes were observed in lung volumes, flow, and alveolar gas exchange, especially oxygenation. These findings suggest that aspiration, sedation, and degeneration of pulmonary function with age, not a nasopulmonary reflex, have not been adequately emphasized in previously performed studies.
Nasopharyngeal carcinoma: An evaluation of 209 patients
Authors: Dickson Robert I.
Published: October 2006

A unique racially balanced North American series of 209 Patients with nasopharyngeal carcinoma will be presented. The patients were 49% Chinese and 51% non‐Chinese (predominantly Caucasian). Whereas Chinese born in China had a 117.9 times greater incidence of the disease. North American born Chinese showed only a 7.3 times greater incidence than Caucasians. Five year absolute (NED) survival was 25.6% for Chinese and 32% for non‐Chinese. Other racial differences are also discussed.

Two four‐year‐old patients with definite nasopharyngeal carcinoma, the youngest in the literature, are included in the study.

Survival and prognosis of nasopharyngeal carcinoma depends on tumor histology, initial stage of disease, dose of radiation and pre‐irradiation node biopsy.

Five year absolute survivals for different histologies were; lymphoepithelioma 52.4%, non‐keratinizing squamous cell 31.5% and keratinizing squamous cell 16.3%. The overall 5 year absolute survival for the series was 29%. When initial primary disease was localized to the nasopharynx (T0, T1, T2) with or without mobile nodes (N0, N1, N2) the survival rose to 41%. Cases treated with 6000 rads or more primarily had the best survival results. Pre‐irradiation node biopsy consistently resulted in poorer survival. When the nodes were mobile (N1, N2) the survival rate was 46.9% 5 year NED in the non‐biopsied group and 25% 5 year NED when nodes were excised prior to primary irradiation therapy.
Long custom‐made plastic tracheostomy tube in severe tracheomalacia
Authors: Shapiro Robert S. , Martin W. Maurice
Published: October 2006

Tracheomalacia occasionally occurs after repair of esophageal atresia and distal tracheoesophageal fistula. It is usually mild, and tracheostomy is rarely necessary. In severe cases of tracheomalacia after repair of esophageal atresia and distal tracheoesophageal fistula, the tracheomalacia may extend below the tip of a regular plastic tracheostomy tube. A patient with just such a problem is presented. A custom‐made long plastic tracheostomy tube was designed. A method of gluing the upper portion of a standard plastic tracheostomy tube to an uncuffed thin‐walled polyvinyl chloride endotracheal tube was discovered and the technique is described in detail. The literature is reviewed concerning custom‐made long plastic tracheostomy tubes, and tracheomalacia in relation to esophageal atresia and distal tracheoesophageal fistula.
Acoustic neurinoma in a population of noise exposed workers
Authors: Miller Maurice H. , Doyle Thomas J. , Geier Susan R.
Published: October 2006

Regulations from the Occupational Safety and Health Administration require the performance of audiometric tests on workers exposed to potentially hazardous noise levels. These tests are frequently performed by Occupational Hearing Conservationists who have taken a 20‐hour course based on recommendations of the Council for Accreditation in Occupational Hearing Conservation.

Unless audiograms performed by such personnel are promptly reviewed and appropriate referral to specialists made, significant and potentially life‐threatening otic disease may go undetected. This paper reports a series of workers with acoustic tumors initially detected by an Occupational Hearing Conservation Program. It is dangerous to assume that the hearing loss and tinnitus reported by noise‐exposed workers is necessarily the result of workplace noise exposure.
Recurrent laryngeal nerve damage following formalin infiltration of ductus arteriosus
Authors: Seibert Robert W. , Seibert Joanna J. , Norton J. B. , Williams Doyne
Published: October 2006

Formalin infiltration of the ductus arteriosus, a recent palliative procedure in neonates with certain congenital cardiac defects, has been shown to result in delayed left recurrent laryngeal nerve paralysis. Implication for the airway and later management are discussed.
Local immune system in the developing fetal larynx
Authors: Nakashima Tadashi , Makishima Kazumi , Komiyama Sohtaro , Takeda Kazuo , Hiroto Ikuichiro
Published: October 2006

Using histopathological and immunofluorescent techniques, we investigated the development of the glandular system of the larynx from 12 human fetuses. Glandular buds were first observed at the fourth month of gestation and glandular distribution became evident from the fifth month in the larynx. Ciliated or nonciliated epithelium covered the cavity of the larynx, with the exception of the true vocal cord. Immunofluorescent examination revealed the presence of IgG in the fetal larynx, but there was little fluorescence for IgA, IgM and IgE. Secretory component (SC) synthesis, on the other hand, was found in each serous‐type glandular epithelium or acinus from the fourth month on. Our observations suggest that the local immune system by SC, which binds to IgA as SIgA in human laryngeal mucosa, is inherently acquired in the fetal larynx.
Autoimmune thrombocytopenic purpura‐like syndrome in a patient with head and neck cancer
Authors: Jubelirer Steven J. , Goodloe‐Greens Lynn , Deykin Daniel
Published: October 2006

We report a case of presumed autoimmune thrombocytopenic purpura in a patient with squamous cell carcinoma of the neck. A review of the literature on the association of autoimmune thrombocytopenic purpura and solid tumors is presented. Autoimmune‐like thrombocytopenia should be considered when patients with head and neck carcinoma present with an acute hemorrhagic diathesis.
Hereditary angioedema: Association with IgA deficiency and otolaryngologic disorders
Authors: Bond William R. , Herrod Henry G. , Duberstein Larry E.
Published: October 2006

Hereditary angioedema (HAE) is an autosomal dominant disorder characterized by recurrent edema of the oropharynx, the extremities, and by abdominal pain This disorder is caused by a defect in the C1 esterase inhibitor (C1 INH) which inhibits the first component of complement (C1). Four generations of a family are described and laboratory data of five individuals of this family are given as these individuals presented for general otolaryngologic procedures. The mortality of acute laryngeal edema is described to vary from 6% to 54% and may necessitate a tracheotomy as a life saving measure A deficiency of IgA is also noted in this family, and to our knowledge, this is the first time this has been shown in association with HAE. Present therapy consists of long utilization of danazol, an attenuated androgen. Recently a partially purified C1 INH has been reported for acute episodes of HAE, and preliminary results are promising.
Computerized axial tomography with air contrast of the cerebellopontine angle and internal auditory canal.
Authors: Anderson Robert , Diehl Jan , Maravilla Kenneth , Fancher James , Schaefer Steven
Published: October 2006

The introduction of computerized axial tomography (C.T.) in 1973 completely changed the diagnostic evaluation of acoustic neuromas. Seventy to eighty percent of all acoustic neuromas can be diagnosed with intravenous enhanced C.T. scan. Acoustic tumors with a diameter of less than 1.5 cm., however, are not consistently seen on C.T. scan. Twenty‐six consecutive patients were evaluated by C.T. scan with air contrast posterior fossa myelography (C.T. air cisternography). Nineteen studies were normal, with complete air filling of the internal auditory canal. Surgically verified acoustic neuromas were demonstrated in four patients. Two studies were inconclusive and there was one false positive. Other than headaches, there is no morbidity associated with this technique. C.T. air cisternography should be considered as the definitive study for evaluating patients for acoustic neuromas who have normal intravenous contrast enhanced C.T. scans. This study reports the first intracanalicular tumor diagnosed with this technique.
Recurrent cementifying fibroma of the jaws.
Authors: Sweet Robert M. , Bryarly Richard C. , Kornblut Alan D. , Corio Russell L.
Published: October 2006

The cementifying fibroma is a benign fibro‐osseous tumor of the jaws, and is generally believed to originate from the periodontal ligament. The tumor commonly presents as an asymptomatic mass lesion, and is usually well‐circumscribed clinically so that conservative excisions have been the treatment of choice.

From 1970‐1980, 94 cases of cementifying fibromas involving either the maxilla or the mandible were accessioned by the Tumor Registry of the Armed Forces Institute of Pathology. Recurrences were found in 11 of these cases, of which 6 involved the mandible. Experiences with these cases are described, as well as experiences with two patients who were managed at the National Naval Medical Center and National Institutes of Health.

Conclusions indicate that preferred management for most recurrent cementifying fibromas involves conservative removals which attempt to preserve form and function of the affected site. Residual disease when unavoidable often remains quiescent for extended periods of time without compromise to the patient involved.
Otomastoid cholesteatomas with intact eardrum.
Authors: Cross J. Parker
Published: October 2006

Eight patients presented with otomastoid cholesteatomas behind intact eardrums. All except one were operated on. Two patients fulfilled contemporary criteria for congenital cholesteatomas and the others were acquired. The detailed consideration of these patients suggests orderly steps in management.
Treatment of carcinoma of the vocal cord a review of 20 years experience.
Authors: Woodhouse Robert J. , Quivey Jeanne M. , Fu Karen K. , Sien Peter S. , Dedo Herbert H. , Phillips Theodore L.
Published: October 2006

At the University of California, San Francisco, 323 patients were treated for carcinoma of the vocal cord between January 1956 and December 1975. Patients with early T1 or T2 lesions were treated with radiotherapy or conservative surgery. Patients with T3 or T4 lesions were treated with total laryngectomy, radiation alone, or combined therapy. Of the 247 patients treated with definitive radiotherapy, initial control of the primary lesion was achieved in 100% of T1S, 80% of T1, 52% of T2, and 50% of T3 and T4 lesions. Surgical salvage of radiation failures was 86%, giving ultimate control rates in this group of 100% for T1S, 97% for T1, 91% for T2 and 64% for T3 and T4. Involvement of the anterior commissure did not significantly affect local control or survival rates of the irradiated patients. Voice quality was satisfactory in 95% of controlled patients. Surgery alone was used as the primary treatment modality in 63 patients, with ultimate local control achieved in 75% of T1S, 83% of T1, 85% of T2, 81% of T3 and T4 lesions. Planned combined therapy was successful in 9/13 patients in whom it was used. The overall 3 and 5 year actuarial survival rates were 84% and 77% respectively; corresponding determinate survival rates were 90% and 86%.
Necrotizing sialometaplasia
Authors: Gavron Joseph P. , Ardito Joseph A. , Curtis Arthur W.
Published: October 2006

Necrotizing sialometaplasia of salivary gland tissue is a benign, self‐limiting disease usually confined to the minor salivary glands. To date only 49 cases have been reported. The clinical and histologic appearance may simulate squamous cell carcinoma, and unnecessary mutilating surgery may be performed if an erroneous diagnosis is made. The otolaryngologist must recognize this disease entity since it heals spontaneously and requires no treatment. Necrotizing sialometaplasia has no known premalignant potential.
Improved survival for patients with advanced carcinoma of the head and neck treated with methotrexate‐leucovorin prior to definitive radiotherapy or surgery.
Authors: Ervin Thomas J. , Kirkwood John , Weichselbaum Ralph R. , Miller Daniel , Pitman Susan W. , Frei Emil
Published: October 2006

Patients presenting with Stage III‐IV squamous carcinoma of the head and neck often relapse following aggressive surgery and/or radiotherapy. In an attempt to increase survival in this high risk group of patients, HD‐MTX, 3 gm./m2/dose, given weekly, was administered to 21 inoperable patients with Stage III/IV squamous carcinoma of head and neck prior to, and for 1 month after, definitive surgery and/or radiotherapy. Six of 11 patients (55%) who showed a significant response (> 50% reduction in tumor volume) to HD‐MTX are alive and free of tumor >38 months following treatment (p = 0.6) (Fisher Exact Test). Responder median survival is > 38 months while non‐responder median survival is 15 months (p =.02) (Log Rank Test). For the entire treatment group, at a mean duration of 44.2 months following initiation of therapy, 7 patients (33%) remain alive and free of tumor. Patients responding to induction MTX‐LCV more often become eligible for combined modality approach than did the non‐responder group. This “downstaging” of the tumor prior to aggressive surgery or radiotherapy may be responsible for the increased survival rate seen in those patients who responded to MTX‐LCV.
Peritonsillar abscesses in children
Authors: Richard Holt G. , Plez Tinsley P.
Published: October 2006

A follow‐up retrospective study was performed on 41 children who presented with peritonsillar abscesses from 1970–1980. The ages ranged from 3 to 16 years, with the mean age of 10 years. There were 26 females and 15 males. The abscesses were predominantly left‐sided (28 vs. 13 right‐sided) and the mean duration of symptoms was 3 days. Of the patients, 39% had been treated with antibiotics prior to the abscess development. Only 15% of the patients had a documented past history of exudative tonsillitis. Of the 41, 1 patient was lost to follow‐up, and 11 underwent tonsillectomy for the abscess. Thus, 29 patients were reviewed who received no surgical therapy for their peritonsillar abscess other than incision and drainage. These patients were contacted for an interval history with a period of follow‐up ranging from 6 months to 10 years.

Only 2 of the 29 patients (7%) had recurrent abscesses. Two other patients (7%) had further recurrent bouts of exudative tonsillitis but not abscesses. These 4 children were in an initial group of 6 who had a prior history of documented tonsillitis. The incidence of recurrent peritonsillar abscesses reported in the literature has ranged from 7.6 to 16% in series which were comprised mainly of adults. The low incidence of recurrent abscesses (7%) in this series would indicate a need to reevaluate the indication for tonsillectomy for peritonsillar abscess in the pediatric age group. The authors recommend that tonsillectomy be performed in those children who present with a pervious history of documented tonsillitis or suffer a complication at the time of the first abscess (neck abscess or airway compromise).
Failures in surgery for stapedial otosclerosis
Authors: Freeman Joseph
Published: October 2006

The causes for failure in surgery for stapedial otosclerosis are many. Most of these occur in the early postoperative period. Failures occurring later are due to either a breakdown of the reconstructed transformer system or to a labyrinthitis due to failure of the vestibular seal. The role of cochlear otospongiosis in producing late failures has not been sufficiently emphasized. This clinical review of 105 surgical failures examined consecutively during the years of 1975 through 1979 will demonstrate the importance of cochlear otospongiosis in this consideration. The fate of the unoperated‐on ear in unilateral surgical failures will be demonstrated. Control of the progressive sensorineural hearing loss in these instances can be gained by the use of sodium fluoride therapy.
Management of canal stenosis with a transposition flap
Authors: Adkins Warren Y. , David Osguthorpe J.
Published: October 2006

Stenosis of the of the external auditory canal is difficult to manage. Numerous surgical prodecures have been advocated for its correction and all function to varying degrees, but repeat stenosis remains a problem. Our experience, with the use of a superiorly based preauricular transposition flap in combination with an endaural and postauricular approach in 5 patients, 8 ears, is presented. In 3 patients, 5 ears, the stenosis was congenital; in 1 patient, 1 ear, traumatic; and in 1 patient, 2 ears, secondary to chronic external otitis. With a follow‐up of 1 to 9 years, the functional and cosmetic results have been satisfactory in all cases.
The positive pressure of cholesterol granuloma idiopathic blue eardrum. Differential diagnosis
Authors: Farrior Brown , Kampsen Edward , Farrior Jay B.
Published: October 2006

The purpose of this presentation is to demonstrate the positive middle ear pressure in cholesterol granuloma, the so‐called idiopathic blue drum or chocolate ear. Because of this positive middle ear pressure the patients with idiopathic blue eardrum do not tend to develop the retraction pockets or subsequent cholesteatoma and therefore this is rarely a destructive disease. Since the symptoms are minimal and there is no destruction, probably the best treatment of the idiopathic blue eardrum is no treatment at all.

In cholesterol granuloma, chronic secretory otitis media, and chronic serous mastoiditis the results of surgery are dubious because the entire air cell system of the temporal bone, including the petrous apex, cannot be completely exenterated and therefore these cells continue to secrete and exert the positive pressure.

Dubious surgical results in patients with positive pressure of cholesterol granuloma are illustrated by cases with open cavities and incomplete mastoid surgery, intact canal wall techniques with complete surgery and ablation, extensive radical mastoid surgery with closure of the canal and retention blue domed cysts forming in the cavities of modified radical, and fenestrations of the horizontal semicircular canal.
Small fenestra stapedectomy. A preliminary report
Authors: Ted Bailey H. A. , Pappas James J. , Graham Sharon S.
Published: October 2006

The small fenestra stapedectomy is based on a rationale of creating a more effective acoustical mechanical transmission system, while reducing potential labyrinthine disturbance. Surgical technique for the small fenestra stapedectomy is described, including the creation of the fenestra and the use of a McGee stainless steel piston prosthesis with loose areolar tissue around the piston. Postoperative results are compared in a series of 100 cases, 50 having the small fenestra technique, SFT, and 50 having partial or total footplate removal procedure. Vestibular results demonstrate a noticeable reduction in postoperative complaints of balance disorders in the SFT patients. Hearing results, when compared between the two groups, show a statistically significant advantage for the SFT patients in postoperative high frequency threshold sensitivity and speech discrimination scores. Technical difficulties in creating the fenestra without fracturing the entire footplate are discussed and suggestions made for their avoidance. The advantages of lowered risk, based on reduced trauma to and contamination of the labyrinth, as well as improved high frequency hearing sensitivity and speech discrimination, support the use of this procedure and call for further investigation and development of its clinical potential.
Facial neurilemmomas
Authors: Horn Karl L. , Crumley Roger L. , Schindler Robert A.
Published: October 2006

Benign facial nerve neurilemmomas are frequently misdiagnosed tumors due to subtle and variable clinical presentation. Three cases treated recently at the University of California — San Francisco are presented to demonstrate the clinical features, diagnostic evaluation, and surgical treatment.
Artificial larynges: A review and development of a prototype self‐contained intra‐oral artificial larynx
Authors: Lowry Louis D.
Published: October 2006

New means of speaking after laryngectomy or loss of continuity of the airway have consisted of: 1. Pharyngostome with artificial larynx (artificial mechanism connecting the trachea to the pharynx). 2. Artificial sound to nose or mouth (e.g., bellows, grammaphone). 3. A reed device from tracheostome to the mouth or the nose. 4. Tracheoesophageal fistula with or without a communicating connecting device. 5. Transcervical sound source which is used by placing a sound source on the external neck transmitting the sound into the pharynx. 6. The implanted sound source, or 7. Intra‐oral sound source.

This paper will review devices used to aid in artificial speech production provided in the past. No attempt will be made at reviewing the surgical literature on voice conservation procedures.

Four sections are presented: 1. Early History of Laryngectomy and Review of Historical Artificial Larynges, 2. History of Alaryngeal Speech Production Without an Artificial Device, 3. Studies of Speech Production, Comparisons of Esophageal and Artificial Laryngeal Speech, and 4. Development of the Prototype Self‐Contained Intra‐Oral Artificial Larynx; synopsis of references reviewed in the first three sections; and a presentation of our new device in the fourth section.

Each review is presented in chronological order with dates provided. Each of the first three sections is independent but relates to the common problem of alaryngeal speech.

At the onset of design the self‐contained intra‐oral artificial larynx was thought to be only for persons after laryngectomy who for some reason could not attain esophageal speech. Later it became apparent that there are others, such as quadriplegics with tra‐cheostomies, who could also benefit from an artificial larynx which is orally controlled. The artificial larynx being tested at present in our lab is fitted into a dental plate or dental shim with a hearing aid speaker and a built‐in exponential horn which opens posteriorly. This artificial larynx is in its third revision and, at present, is externally wired during the testing phases. In its final form the power supply, electronic circuits, off‐on switch, speaker and exponential horn will be completely contained in the dental prosthesis. Modifications are being made to obtain appropriate loudness with a decreased voltage requiring fewer batteries fitted into the prosthesis. The circuits will be placed on a microcomputer chip after the best circuits have been obtained by testing externally placed hard wired circuits on several objects.
Congenital cricoid stenosis
Authors: Morimitsu Tamotsu , Matsumoto Ichiro , Okada Shuichi , Takahashi Masami , Kosugi Tadayoshi
Published: October 2006

A case of congenital cricoid stenosis in a 9‐year‐old girl was reported. The stenosis was confirmed by direct laryngoscopy and laryngotracheograms performed through the tracheostoma. The excess cartilaginous tissue was removed under a midline incision of the cricoid cartilage (cricoidplasty). Seventeen cases of cricoid stenosis reported since 1960 were studied and the clinical entity was discussed. On the basis of the embryology of the larynx, the mechanism of origin of this malformation was also discussed.

Although cricoid stenosis was a fatal malformation before 1968, it is now a curable disease using an emergency treacheostomy and a cricoidplasty.
Craniometaphyseal dysplasia: The first successful surgical treatment for associated hearing loss
Authors: Shea John , Gerbe Ronald , Ayani Nobuo
Published: October 2006

Craniometaphyseal dysplasia is a rare bone disorder characterized by various osseus abnormalities of the cranium and long bones. Hearing loss is often the presenting complaint. This is the first reported case of hearing loss due to craniometaphyseal dysplasia successfully corrected by operation.
Lymphoreticular neoplasia in the nose
Authors: Kronschnabel E. F.
Published: October 2006

A clinical‐pathological discussion of three lymphoreticular neoplastic diseases is presented, with illustrative case histories. These are 1. malignant rnidline reticulosis; 2. extra‐medullary plasmacytom; 3. histiocytic lymphoma. Responsibility for exact diagnosis rests with the otolaryngologist to provide accurate and representative biopsy material for the pathologist. Because of the rarity of the disorders, the pathologist is entitled to repeat biopsies and consultations as needed. Although treatment is at the hands of others — oncologists and radiation therapists — the examining expertise of the otolaryngologist is essential in the care of these patients.
Vasomotor rhinitis: An update
Authors: Bickmore John T.
Published: October 2006

A comparison of pertinent features of three types of rhinitis, with emphasis on etiology and immunologic factors, is made. Separation of nasal allergy from vasomotor rhinitis and from nasal polyposis is attempted. The ambiguity of terms used by various authors, which has caused confusion in the classification of rhinitis, is noted. It is the author's opinion that allergic rhinitis, vasomotor rhinitis and nasal polyposis are nasal diseases with their own identity in the majority of instances. However, this identity is not always clearly evident. Too often, allergic principles of treatment, particularly immunotherapy, are advised, and not found to be helpful.
Some effects of the respired environment on the nose
Authors: Ballenger John J.
Published: October 2006

There is a dearth of factual information relating to the effect of the external gaseous environment on the mucosa of the upper respiratory tract. This paper is an attempt to gather some factual information in this regard. It is suggested that the mucus transport time is a meaningful index of the ability of the ciliated nasal mucosa to cope with the environmental challenges. Further, it is suggested that a depressed transport time may be one step in nasal disease induction.
Secondary surgical treatment of intranasal deformities of the unilateral cleft palate nose
Authors: Lowenthal Gerson
Published: October 2006

Intranasal as well as external nasal repair is desirable in the total repair of the unilateral cleft palate nose and in many instances can be achieved concurrently. Carefully performed septal reconstruction will correct the nasal obstruction due to the severe septal deviation to the cleft side and the usual caudal dislocation to the uninvolved side. Since a minimal amount of cartilage is removed, good support is Mayntained for the cartilaginous dorsum. Appropriate management of the turbinates, including extraction, infraction, submucous intramural electrocoagulation, or partial submucous resection will improve the functional result. Because of the better positioning of the septum, some of the alar and columellar abnormalities may be cosmetically improved, and repositioning of the ala or columella will enhance the esthetic appearance.
Polytomography in méaniègre's disease: An update
Authors: Austin David F.
Published: October 2006

In a previous article the use of polytomography of the vestibular aqueduct in Ménière's disease was described. The value of this procedure in the prognosis of surgery was evaluated by contrast of results with a non‐radiographically examined population. Since then five more years of experience has been gained through routine radiographic examination of all patients with Ménière's disease.

Within the above epoch, several efforts have been made to effectively separate patients into categories based on therapeutic expectations and prognostic stratifications. In addition X‐ray studies, glycerol tests, hearing levels, frequency of vertigo and other clinical features have been suggested as offering suitable data for prognostic stratification.

This paper updates the radiologic data previously presented, and reviews the efforts to date to accomplish significant prognostic stratification. Several clinical aspects of patients with Meniere's disease which may affect its severity are outlined.
Diagnostic advantages of the torok monothermal differential caloric test
Authors: Kumar Arvind
Published: October 2006

In the Torok monothermal differential caloric test, each ear is irrigated with 10 ml and 100 ml of water at 20$$ C in 5 and 20 sec, respectively. The intensity of the induced nystagmus is expressed in terms of frequency at culmination. The ratio between the weak and strong caloric responses may be normal or disproportionately large or small. When large, the ratio exceeds 3.5 and is called vestibular recruitment, a sign of labyrinthine disease. A ratio of 1.1 or less is called vestibular decruitment, a sign indicative of posterior fossa abnormality. Of 54 patients showing decruitment, a central lesion was confirmed in 51, an identification rate of 94%. The test is thus valuable in differentiating labyrinthine from retrolabyrinthine lesions.
Evaluation of the regional blood circulation of the hindbrain by dynamic computed tomography
Authors: Valvassori Galdino E. , Maffee Mahmood F. , Dobben Glen D.
Published: October 2006

Permanent or transient reduction of blood flow to the hindbrain is often responsible for symptoms of disequilibrium, dizziness and occasionally sensorineural hearing loss. Recent advances in CT technology and the development of continuous rapid rotational CT brain scanning now permit a practical and relatively non‐invasive method for evaluation of regional brain circulation.

It is the purpose of this presentation to review displays of normal CT hindbrain circulation and compare them with displays from patients with hindbrain ischemia. Dynamic CT provides a useful clinical index of brain blood circulation and can be used to detect and differentiate insufficiency due to pathology of the brain, of the artery supplying it, or of the cardiovascular system.

Finally, the quantitative hemodynamic benefit from surgery of the carotid or vertebral arteries can be properly evaluated by this technique.
Cholesteatoma in children
Authors: Glasscock Michael E. , Dickins John R. E. , Wiet Richard
Published: October 2006

The surgical management of cholesteatoma in children reMayns a controversial subject. Many authors hold that the disease itself is more aggressive than that seen in adults. Furthermore, there appears to be a consensus that intact canal wall procedures, if used at all, should be reserved for adults only. The purpose of this paper is to study a group of children and adults who underwent the surgical removal of their cholesteatoma by intact canal wall tympanoplasty at The Otology Group between March 1, 1971 and March 1, 1977. A comparison of the results and complications in the two groups is presented in detail.
Chemotherapy for salivary gland cancer
Authors: Suen James Y. , Johns Michael E.
Published: October 2006

Salivary gland cancers are usually treated with surgery and irradiation; however, some of the aggressive salivary gland cancers recur or metastasize and are not amendable to treatment with further surgery or irradiation. Little is known about chemotherapy for these palliative situations because of the relatively scarcity of these cancers. The data in the literature has provided little clinical information because all salivary gland cancers are usually lumped together and/or multiple different drug combinations are used.

In an effort to arrive at a rational basis for recommending specific drug regimens for specific histologic types of salivary gland cancers, a two‐part study was undertaken to determine which chemotherapy drugs seem to be effective or ineffective. One part was a literature review, and the second part was a survey of numerous institutions' experiences, including our own.

A total of 85 cases of salivary gland cancers treated with chemotherapy were felt to be evaluable for this study. The overall response rate (complete and partial) was 42%. Although disease responded whether it was local, regional, or distant disease, there was a higher response rate in local‐regional disease compared to distant metastases.

Salivary gland cancers are definitely sensitive to chemotherapy drugs. This study reveals which drugs seem to be effective and provides some rational basis for future chemotherapy trials for salivary gland cancers.
Panel discussion: Pathogenesis of otitis media. Pathology and microbiology of otitis media
Authors: Meyerhoff William L. , Giebink G. Scott
Published: October 2006

Otitis media (OM) can be subdivided into purulent, serous, mucoid, and chronic forms. It may occur in the absence of tympanic membrane changes and involve the inner ear. Purulent otitis media is characterized early by edema, hyperemia, and polymorphonuclear leukocyte infiltration in the subepithelial space (SES) and later by mucosal metaplasia, granulation tissue, and osteitis. S. pneumoniae and H. influenza are most commonly identified. Serous and mucoid OM frequently develop from eustachian tube dysfunction. Serous transudate from vessels in the SES passes to the middle ear (serous otitis media). Basal cells differentiate into goblet cells and subepithelial glandular formation occurs. This secretory activity, coupled with fluid reabsorption, results in a mucoid effusion. Bacteria can be cultured from about 30% of these effusions. Chronic otitis media denotes irreversible tissue pathology. It may be sterile although S. aureus and coliform bacteria are frequently isolated.
Applications of the biomechanical behavior of cartilage to nasal septoplastic surgery
Authors: Murakami Wilson T. , Wong Louis W. , Davidson Terence M.
Published: October 2006

The biomechnnics of septal cartilage as they apply to septoplasty are studied. The original investigations on septal cartilage are reviewed and summarized. Biomechanical principles of the behavior of cartilage are reviewed and applied to the principles of septoplasty surgery. Using pigs' ears, theoretical predictions are investigated and verified. Incorporating this information, an approach to septoplastic surgery is described.
Amino acid profiles in inner ear fluids and cerebrospinal fluid
Authors: Thalmann R. , Comegys T. H. , Thalmann I.
Published: October 2006

The levels of 19 amino acids in utricular endolymph, vestibular and cochlear perilymph, and cerebrospinal fluid of guinea pigs were determined using gradient elution reverse phase high performance liquid chromatography of the o‐phthaldialdehyde‐ethanethiol adducts with fluorescence detection. Aspartate and glutamate were significantly higher in endolymph than in perilymph, in agreement with earlier results on cochlear fluids based on enzymatic fluorometric techniques. All other amino acids tested were significantly lower in the endolymph, in most cases by an order of magnitude. Vestibular perilymph and perilymph of scala vestibuli are virtually identical. Amino acid levels were all higher in perilymph of scala vestibuli than in cerebrospinal fluid; two by an order of magnitude. All differences were statistically significant, with the exception of aspartate. Amino acid levels in perilymph of scala tympani were highly variable, dependent upon sampling technique, and no definite values are therefore presented. Comparisons with results from other laboratories, technical pitfalls, and possible implications and interpretations of the results are presented.
Surgical management of dural and temporal lobe herniation into the radical mastoid cavity
Authors: Graham Malcolm D.
Published: October 2006

The possible underlying causes of temporal lobe herniation into the radical mastoid cavity are discussed, and the surgical principles and operative techniques for its correction are detailed and illustrated. The method herein described has been found to be effective and reliable in permanently correcting the dura and tegmen bone defect. A representative case history is presented.
Spectral analysis of tuning fork generated tones
Authors: Reiter David
Published: October 2006

Tuning forks have been used as clinical pure tone generators since the middle of the nineteenth century. The development of electronic signal sources has fostered innumerable advances in audiologic diagnosis, yet the tuning fork remains in daily use by thousands of physicians, for rapid and reliable screening of auditory acuity.

This study examines tuning forks as oscillators, determining harmonic distortion with real‐time spectral analysis. Various methods of striking the instrument are compared, with regard to harmonic distortion and sound pressure level generated. Tuning forks are, thus, compared to their electronic counterparts for the first time in the literature.

Gentle striking of a steel, 256 Hz. fork on the thenar eminence produces tones comparable in purity to those generated by ANSI‐calibrated audiometers.

Similar results were obtained with forks of higher frequency; however, careful use of light aluminum alloy forks may produce equally satisfactory results.