bluuebunny/crossref_metadata_2025 huggingface dataset:
Management of labyrinthine fistulas caused by cholesteatoma
Authors: Parisier Simon C. , Edelstein David R. , Han Jin C. , Weiss Michael H.
Published: November 2015

The surgical management of labyrinthine fistulas caused by cholesteatoma remains controversial. Forty cases (41 ears) of labyrinthine fistulas were reviewed. This represented 10% of our total series of cholesteatomas in adults and children (426 ears). Clinical presentation, extent of disease, results of fistula testing and audiometric studies, and radiographic findings were analyzed. A canal wall‐down procedure was performed in all but one patient. Generally an attempt was made to completely remove the cholesteatoma, to graft the fistulous area, and to reconstruct the middle ear mechanism in one stage. The matrix was preserved in patients with large fistulas where the involved ear was the only hearing one, when the matrix was adherent to the underlying optic duct, and in selected elderly persons. Long‐term followup did not reveal a significant difference in hearing, degree of vertigo, or incidence of recidivism when those patients in whom the matrix was removed were compared with those in whom the matrix was preserved. The importance of recognizing the presence of a labyrinthine fistula preoperatively is stressed, along with the need to be prepared for an unexpected fistula. Operative management is described.
Acoustic‐distortion products: Separation of sensory from neural dysfunction in sensorineural hearing loss in human beings and rabbits
Authors: Ohlms Laurie A. , Lonsbury‐Martin Brenda L. , Martin Glen K.
Published: November 2015

Because distortion‐product otoacoustic emissions (DPOAEs) provide a noninvasive measure of outer hair‐cell (OHC) activity, they should provide a unique and sensitive indicator of the effects of agents that damage hearing. Using DPOAE methods, the present study was designed to assess the relative contributions of the cochlea's outer hair cells to some common sensorineural diseases, including Meniere's disease, acoustic neuroma, and noise‐induced, hereditary, and sudden idiopathic sensorineural hearing loss. Parallel evaluations of DPOAEs were performed under essentially identical conditions in rabbit models of several of the human disorders, including noise‐induced hearing loss, endolymphatic hydrops, and cochlear neurectomy. Animal studies were performed to assess the proficiency of DPOAEs to track a developing sensorineural deficit as well as to compare patterns of DPOAE dysfunction between clinical and experimental forms of peripheral hearing loss. Detailed measures of DPOAEs were collected in the stimulus‐frequency and intensity domains as “audiograms” and response/growth or input/output functions, respectively. The outcome of analyses of both human beings and animals supported the notion that DPOAE testing is sensitive to sensory‐cell disease. Thus, in combination with conventional audiometry, DPOAE measures permit a distinction between the relative contribution sensory and neural components of the cochlea make to hearing deficits.
Otolaryngology problems in the immune compromised patient—An evolving natural history
Authors: Corey Jacquelynne P. , Seligman Ilana
Published: November 2015

As the human immunodeficiency virus is being detected in increasing numbers of asymptomatic individuals at risk, newer earlier patterns of disease have become apparent—including cranial and cervical herpes zoster, oral hairy leukoplakia, and oral candidiasis—thus linking viral and other disease to the development of acquired immunodeficiency disease (AIDS). Many similarities between patients with AIDS and other immunosuppressed patients have emerged. As immunosuppressed patients survive longer, they begin to manifest cancers such as lymphomas and squamous cell cancers in addition to Kaposi's sarcoma. Otolaryngologists can learn to identify and treat otitis and sinusitis in the immunosuppressed patient, to identify predictive early signs such as oral hairy leukoplakia, herpes simplex virus, and oral candidiasis, and to diagnose and treat Koposi's sarcomas of the head and neck, lymphomas, squamous cell cancers, and opportunistic infections as the immunodeficiency disease progresses.
The intracutaneous progressive dilution multi‐food test
Authors: King William P. , Motes James M.
Published: November 2015

Data have been published supporting the view that skin response is more valid and reliable than symptom provocation for interpretation of the intracutaneous provocative food test (IPFT). As such, an intracutaneous progressive dilution food test technique interpreted by skin response is now the standard IPFT technique taught at American Academy of Otolaryngic Allergy‐sponsored courses. While this test technique is less time‐consuming than the 5‐day oral challenge food test of Rinkel, the 15‐ to 90‐minute per test demand still presents a significant deterrant to widespread use. Here we present a time‐efficient, multi‐test technique that allows testing of three to seven foods at one time. The technique is not recommended for use on patients with a history of severe allergic reactions, such as asthma or angioedema, or for testing any food that by history may produce an anaphylactic reaction.
Human papillomavirus DNA sequences in cell lines derived from head and neck squamous cell carcinomas
Authors: Bradford Carol R. , Zacks Susan E. , Androphy Elliott J. , Gregoire Lucie , Lancaster Wayne D. , Carey Thomas E.
Published: November 2015

There is increasing evidence that human papillomaviruses (HPV) have a causal role in some neoplasms in human beings. As examples, DNA of HPV types 16,18, and 31 are frequently present in genital cancers in humans. Recently, oncogenic HPV types have also been identified in neoplasms of the head and neck, including verrucous carcinoma of the larynx, squamous cell carcinomas of the oral cavity and larynx, and inverted papillomas of the nose. These findings and our resource of an extensive panel of head and neck squamous cell carcinoma (HNSCC) cell lines led us to begin to investigate how frequently HPV DNA was present in these tumor cell lines. For initial analysis, twenty‐two HNSCC cell lines derived from 20 patients' tumors were selected as representative of our tumor cell line panel with respect to diversity of primary site, tumor stage, patient age, sex, and clinical course. For Southern analysis, cell line DNA was tested for hybridization with DNA probes for HPV types 6,11,16,18, and 31. Polymerase chain reaction (PCR) analysis was also performed on five tumor cell lines using types 6,11,16,18, and 52 as probes. Southern blot analysis revealed HPV‐specific signals in two of the 22 HNSCC cell lines tested. One of these, UM‐SCC‐23, was HPV 31 positive, which to our knowledge is the first identification of HPV 31 in HNSCC. UM‐SCC‐63, the other HPV‐positive tumor identified by Southern analysis, hybridized with both type 18 and 31. Of the five tumor cell lines tested with PCR, two were HPV positive. One of these was UM‐SCC‐63; the other, UM‐SCC‐19, was previously negative by Southern analysis. Hybridization of the PCR product to HPV 16 and 52 suggests that a novel HPV type may be present. The remaining three cell lines studied by both Southern and PCR analysis were HPV‐negative in both assays. Whether HPV was an etiologic factor or had an effect on prognosis remains to be determined. Further studies are indicated with a larger number of cases to determine the overall frequency and HPV types involved in head and neck cancer, and whether certain HPV types will be associated with prognosis.
Labyrinthitis ossificans: Histopathologic consideration for cochlear implantation
Authors: Green J. Douglas , Marion Mitchell S. , Hinojosa Raül
Published: November 2015

Labyrinthitis ossificans may be a hindrance to cochlear implantation by making electrode insertion difficult. We performed a histopathologic study of 24 temporal bones with labyrinthitis ossificans from multiple causes. The organ of Corti was graphically reconstructed and the degree of obstruction was estimated for each millimeter of the cochlea. Correlations were calculated between the degree of new bone formation and the cause, patient's age and sex, and time from the original temporal bone insult. Our results demonstrate that complete cochlear ossification is rare. The scala tympani in the basal turn of the cochlea is the most frequent area of ossification, regardless of the cause of the labyrinthitis ossificans. Meningogenic labyrinthitis, usually a childhood disease, was associated with the greatest amount of ossification. When ossification resulted from tympanogenic labyrinthitis, the scala tympani was completely ossified near the round window niche in all temporal bones. Neo‐ossification of the basal turn associated with otosclerosis was limited to the proximal 6 mm of the scala tympani in all cases. Three temporal bones had a patent round window niche and basal turn, but significant apical and middle‐turn ossification. Peripheral sensorineural elements were severely degenerated in the region of the ossification in all specimens, and spiral ganglion cell counts were decreased.
Videoendoscopic Evaluation of patients with dysphagia: An adjunct to the modified barium swallow
Authors: Bastian Robert W.
Published: November 2015

The modified barium swallow is currently the most comprehensive, widely available, and easily interpreted technique for the evaluation of patients with dysphagia by the head and neck surgeon. However, it requires the facilities, personnel, and use of a radiology suite, a trained speech pathologist, and exposure of the patient to radiation. If would therefore be helpful to have an adjunctive, physician based, nonradiographic method of examination that could provide information similar to and possibly even more complete than that supplied by the modified barium swallow. Such an adjunctive method could help otolaryngologist‐head and neck surgeons confronted by a new patient with swallowing difficulties to orient themselves to the nature and severity of the problem while waiting for the modified barium swallow to be scheduled, performed, and reviewed. It could also be a helpful tool for management of patients with cancer of the head and neck, whose swallowing function may change rapidly in the early postoperative period. In such cases, intervals between modified barium swallow examinations (dictated by concern over radiation exposure) may be too far apart to allow up‐to‐the‐minute decisions on case management. Finally, some patients who may be too ill to travel to the radiology suite might benefit from a bedside procedure that would yield information about swallowing function similar to that provided by the modified barium swallow. Videoendoscopic evaluation of dysphagia (VEED) is a protocol I developed and have used regularly since 1984. Experience with this method of dysphagia evaluation has shown that it answers the needs outlined above. Its usefulness also goes beyond that of the modified barium swallow by providing a more detailed understanding of the component anatomic and functional deficits that comprise a given patient's swallowing problem, information about upper aerodigestive tract sensory deficits, and a means for visual feedback training of pharyngeal and laryngeal musculature. The protocol is reviewed here. Case reports illustrating the clinical usefulness of VEED as an adjunct to the modified barium swallow are also presented, and the relative strengths and weaknesses of VEED and the modified barium swallow are compared.
Primary spontaneous cerebrospinal fluid rhinorrhea
Authors: Beckhardt Russell N. , Setzen Michael , Carras Robert
Published: November 2015

Spontaneous cerebrospinal fluid (CSF) rhinorrhea constitutes only 3% to 4% of CSF fistulas. Nontraumatic, normal pressure CSF fistulas with resultant rhinorrhea, in which no cause can be identified, or primary spontaneous CSF rhinorrhea, is considerably rarer. Presented here are two cases of CSF rhinorrhea of this nature, including the diagnostic workup and treatment. Reviews of literature support laboratory quantitative glucose determination as the most effective and least morbid method for confirming the presence of CSF. Iodine‐contrast (metrizamide/lohexol) computerized tomographic cisternography has been shown to be the most effective and least morbid method for localizing the fistula. For inactive, intermittent, small, or questionable CSF leaks, radionuclide cisternography has been shown to be more effective in identifying the presence of these leaks, although not necessarily the location. Numerous reports provide evidence to support the use of an extracranial rhinologic approach for surgical repair of the leak, as a more successful yet less morbid procedure than a craniotomy when used appropriately.
Effect of Superior Laryngeal Nerve on Vocal Fold Function: An in Vivo Canine Model
Authors: Slavit David H. , Mccaffrey Thomas V. , Yanagi Eriko
Published: November 2015

Assessment of laryngeal framework surgery requires an awareness of the effect of vocal fold mass, stiffness, and position on voice production. The vibratory pattern of the vocal folds during phonation depends on the subglottic pressure as well as the mass and stiffness of the folds. To assess the effect of variations in vocal fold tension with contraction of the cricothyroid muscle on phonation, eight mongrel dog larynges were studied in vivo. Photoglottography, electroglottography, and subglottic pressure were simultaneously recorded as airflow rate and superior laryngeal nerve (SLN) stimulation were varied. Stimulation of the SLN was modified by varying the frequency and voltage of the stimulating electrical signal. Multiple regression analysis of the data revealed a direct relationship between the voltage of SLN stimulation and frequency of vibration (P < 0.001) at constant subglottic pressure. Increases in the stimulating voltage to the SLN also led to an increase in open quotient (p < 0.001), but no statistically significant change in speed quotient, subglottic pressure, or sound intensity. Changing the frequency of SLN stimulation had only a modest effect on the frequency of vibration. These results are consistent with the reported findings of an increase in frequency and open quotient with increased tension in an in vitro canine model. The glottographic measurement open quotient appears to be an estimator of cricothyroid contraction and longitudinal vocal fold tension, and may be clinically applicable to the assessment of superior laryngeal nerve injuries and laryngeal framework procedures.
Clinical Significance of Type 5 Patterns in Platform Posturography
Authors: Dickins John R. E. , Cyr David G. , Graham Sharon S. , Winston Michael E. , Sanford Millie
Published: November 2015

Several abnormal patterns have been identified on the sensory portion of the computerized dynamic posturography test. The vestibular deficit pattern, also known as the “5–6” pattern, is frequently seen in patients with either uncompensated unilateral vestibular lesions, severe bilateral peripheral vestibular loss, or dysfunction involving the vestibular pathways in the brain stem and/or cerebellum. In both sensory conditions 5 and 6, the patient's balance/equilibrium is determined primarily by the vestibular system. A subgroup of the vestibular deficit pattern has been identified, in which only sensory condition 5 is abnormal. This article presents findings in several cases identified with the 5 pattern. Implications for diagnosis and for monitoring the recovery phase after treatment are discussed.
Infraorbital Nerve Dehiscence: The Anatomic Cause of Maxillary Sinus “Vacuum Headache”?
Authors: Whittet H. B.
Published: November 2015

Vacuum disorders of the paranasal sinuses are well described. Patients with facial pain in the distribution of the infraorbital nerve are often labelled as suffering from a “vacuum maxillary sinusitis” and empirically treated by intranasal antrostomy. A varie of mechanisms have been postulated for the production of symptoms in this condition, but all ignore the fact that the maxillary sinus is a relatively insensitive structure. This article introduces a dehiscence of the bony infraorbital nerve canal within the antrum as an anatomic variant and suggests that it may provide the anatomic basis for vacuum sinusitis in the presence of a small natural ostium. Definitive diagnosis is made by outpatient antroscopy, and surgical treatment takes the form of a middle or inferior meatal antrostomy. Persistent symptoms may benefit from an infraorbital neuropexy to provide added protection to the exposed nerve.
Complications of Lumbar Spinal Fluid Drainage
Authors: Roland Peter S. , Marple Brad F. , Meyerhoff William L. , Mickey Bruce
Published: November 2015

Cerebrospinal fluid fistula is an unfortunate, yet well‐recognized, complication of basilar skull fracture, skull base surgery, and neurotologic procedures. Treatment commonly involves the use of continuous lumbar drainage. A retrospective chart review of 32 consecutive patients who required placement of lumbar drain by the otorhinolaryngology and neurosurgical services from March 1988 through July 1991 was undertaken to assess possible complications. The complications found were readily separated into minor and major categories on the basis of the possibility of permanent morbidity or mortality. Minor complications, including subjective complaints of headache, nausea, vomiting, etc., were noted in 59% of patients. Major complications were observed in four of 32 patients (12.5%), including unilateral occlusion of the posterior cerebral artery and unilateral true vocal cord paralysis. Alleviation of all complications was achieved by cessation of lumbar drainage. These cases are presented with discussion of pathogenesis. These findings demonstrate the possibility of potentially serious complications that mandate close monitoring of patients who require continuous lumbar drainage.
Risk Factors of Cancer of the Larynx: Results of the Heidelberg Case—Control Study
Authors: Maier Heinz , Gewelke Ulrike , Dietz Andreas , Heller Wolf‐Dieter
Published: November 2015

Squamous cell carcinoma of the larynx is a multifactorial disease. It is firmly linked to several environmental risk factors. In the meanwhile, a considerable amount of epidemiologic evidence has been built up to implicate chronic consumption of alcohol and tobacco, occupation, diet, and social status in the etiology of the laryngeal cancer. Herein is a report from the first case‐control study on the role of these risk factors conducted in a German population of patients with laryngeal cancer.
Repair of Chronic Tympanic Membrane Perforations Using Epidermal Growth Factor
Authors: Amoils C. Philip , Jackler Robert K. , Lustig Lawrence R.
Published: November 2015

Perforation of the tympanic membrane (TM) is a frequent cause of conductive hearing loss. Persistent TM perforations often require surgical repair with an autologous tissue graft to restore hearing and prevent recurrent infection. While highly efficacious, this method of closure requires a relatively complex and expensive microsurgical procedure. We have recently developed a chronic TM perforation model in the chinchilla for use in the exploration of novel methods of TM repair.
Radiographic Imaging of Sinusitis in HIV Infection
Authors: Armstrong Michael , McArthur Justin C. , Zinreich S. James
Published: November 2015

Magnetic resonance images (MRI) of the brain from 75 homosexual men were reviewed to evaluate the frequency and severity of incidental sinus disease associated with human immunodeficiency virus (HIV). All scans had been performed for reasons other than a history of sinus disease. The opacification of each sinus cavity was scored such that 0 = normal, 1 = < 25%, 2 = 25% to 75%, and 3 = > 75% opacification. Subjects were then stratified by clinical status into four groups: HIV‐, HIV+ without HIV‐related symptoms, AIDS‐related complex (ARC), or AIDS. Grade 1 mucosal thickening was present in 52% to 55% of HIV‐ and HIV+ subjects alike. Moderate disease (grade 2 or 3) was seen in seven of 52 HIV+ subjects, but none of the 23 HIV‐ controls. The incidence of maxillary sinus thickening was 69% in men with AIDS, compared to 30% in HIV‐ men (x2 = 4.1, p < 0.05). Mean maxillary sinus scores were 1.25 ± 0.29 in those with AIDS compared to 0.43 ± 0.15 in HIV‐ men (f = 5.11, p < 0.05). Our results suggest that maxillary sinus disease is more common and more severe in patients who have AIDS.
Surgical Glove Perforations in Otolaryngology: Prevention with Cut‐Resistant Gloves
Authors: Kelly Kevin E. , Lee Kelvin C. , Tami Thomas A.
Published: November 2015

This study examines the role of cut‐resistant, “orthopedic‐type” gloves in prevention of exposure of surgical personnel to infectious body fluids through surgical glove perforation. The incidence of glove perforations in 12 consecutive cases of intermaxillary fixation (IMF) was studied. Surgeons were double‐gloved with standard latex gloves and wore cut‐resistant gloves between the outer and inner gloves. As controls, six cadaver heads were wired into IMF with surgeons double‐gloving without the cut‐resistant glove. The rates of latex glove perforation were then compared between the two groups. Fifty‐three percent (32 of 60) of outer latex gloves, but no inner latex gloves (0 of 50) were perforated when surgeons wore cut‐resistant gloves. In the control group, 45% of outer gloves (9 of 20) and 15% of inner gloves (3 of 20) were perforated. The difference of inner glove perforations—hence cutaneous exposure—between these two groups was statistically significant (p nlt; 0.01). The use of cut‐resistant gloves in addition to double‐gloving with latex surgical gloves is recommended for facial plastic and reconstructive procedures with metal implants and major head and neck surgery, because these operations have a high rate of glove perforation. Because some loss of dexterity is noted when cut‐resistant gloves are worn, the risk of glove perforation must be weighted against the need for optimal dexterity.
An External Reference to Identify the Internal Auditory Canal in Middle Fossa Surgery
Authors: Catalano Peter J. , Eden Avrim R.
Published: November 2015

Traditional middle fossa landmarks, such as the facial hiatus and arcuate eminence, are often unreliable. This study was performed to establish an external reference from which to identify precisely the surgical anatomy of the middle fossa. The head of the malleus was identified from the middle fossa in the temporal bones of 20 adults. The lateral cortex of the temporal squamosa at the zygomatic root was used as the external plane of reference. The head of the malleus was consistenty located 18 mm medial to the outer cortex on a line perpendicular to the reference plane. Medial extension of this line through the malleus head bisected the internal auditory canal. We recommend this method to precisely locate the malleus head as the first landmark in the middle fossa. Other structures, such as the geniculate ganglion, internal auditory canal, and superior semicircular canal can then be safely identified. We also present our results using this technique in six consecutive patients undergoing middle fossa surgery during the past 12 months.
Intraoperative Facial Nerve Monitoring in Posterior Fossa Acoustic Neuroma Surgery
Authors: Uziel Alain , Benezech Jacques , Frerebeau Philippe
Published: November 2015

Intraoperative facial nerve monitoring has become an indispensable tool during cerebellopontine angle surgery. Ninety‐seven patients underwent surgical removal of an acoustic neurinoma with the use of a pneumatic sensor monitoring between January 1, 1986, and December 31, 1990. In the early postoperative period, a normal or near‐normal facial function (grades I and II) was achieved in 86% of the patients, a moderate dysfunction (grade III) was present in 7%, and a total or severe dysfunction (grades V or VI) was present in 6%. Normal function at 1 year was achieved in 90.5% of the patients, 4% were grade II, a moderate dysfunction (grade III) was present in 2%, and 3% showed a total or severe dysfunction (grade V and VI). The incidence of normal function decreased with tumor size, with an occurrence rate of 100%, 94%, and 91% in small, medium, and large tumors, respectively. In eight consecutive patients, all responses detected by the monitoring during the operation were collected and analyzed according to intraoperative events. Analysis of the results indicate that 95% of the 316 mechanically induced stimulations were of small or extremely small amplitude, and only 5% were of moderate amplitude. A medial‐to‐lateral strategy of dissection, preservation of the arachnoid veil over the facial nerve, a control by the monitoring of the amount of traction, and a more widespread use of sharp dissection were the major approaches to reduce surgical trauma during dissection.
Crystalline Preparation of Botulinum Toxin Type a (Botox): Degradation in Potency with Storage
Authors: Gartlan Michael G. , Hoffman Henry T.
Published: November 2015

Laryngeal injection of botulinum toxin type A is currently the most effective method of treating spasmodic dysphonia. Botox, a crystalline preparation of botulinum toxin type A, is the only toxin approved for clinical use in the United States and is packaged in vials of 100 mouse units (MU). One MU corresponds to the calculated median lethal intraperitoneal dose (LD50) injected in mice. The logistic problems arising from the need for repeated injections of small amounts of Botox have been addressed by several investigators by refreezing unused Botox for use at a later time. Although FDA labeling recommends that Botox not used within 4 hours of reconstitution be discarded, data regarding degradation in potency after reconstitution and refreezing are not currently available. Using the LD50 Swiss‐Webster mouse bioassay and statistical analysis by the Probit procedure, a 69.8% loss in potency was found when Botox was reconstituted, immediately frozen, and then assayed 2 weeks later (p < 0.0001). Statistically significant degradation in potency was seen after refrigerator storage for 12 hours (p = 0.007), but not for 6 hours (p = 0.16). Clinical implications regarding the dilution, use, and storage of Botox are discussed.
Is Cis‐Platinum Vestibulotoxic?
Authors: Myers Steven F. , Blakley Brian W. , Schwan Sabina
Published: November 2015

Serial vestibular testing was performed on 34 patients undergoing cis‐platinum chemotherapy and 12 age‐matched normal subjects. Vestibular testing comprised caloric and low‐frequency, sinusoidal rotational testing (0.01 to 0.16 Hz). Test‐retest variability in the caloric and rotational vestibular assessment of the normal subjects formed the basis for evaluation of subclinical loss of vestibular function within our patient population. In spite of high‐dose cis‐platinum chemotherapy (100 mg/m2) with cumulative dosages to 1600 mg, no clear evidence of vestibular toxicity was found.
Sinonasal Undifferentiated Carcinoma: A Ray of Hope
Authors: Deutsch Brian D. , Levine Paul A. , Stewart F. Marc , Frierson Henry F. , Cantrell Robert W.
Published: November 2015

In 1987, we published a case series of a newly‐described, highly malignant neoplasm, termed sinonasal undifferentiated carcinoma, in which treatment results were poor. In this updated study, we report the followup for the original three surviving patients and for six additional cases whose tumors were diagnosed between January 1987 and October 1991. These data suggest that the prognosis for patients with localized disease may be better than originally described.
Analysis of DNA Content in Supraglottic Epidermoid Carcinoma
Authors: de Guzman Rafael Barona , Martorell M. A. , Basterra J. , Armengot M. , Montoro A. , Montoro J.
Published: November 2015

DNA analysis by flow cytometry is considered to be of prognostic value in epidermoid carcinoma of the head and neck. However, few and contradictory studies have been made on laryngeal carcinomas. We studied 48 epidermoid carcinomas in patients subjected to horizontal supraglottic laryngectomy with a 5‐year‐ followup. The technique described by Hedley for fixated and paraffin‐embedded tumors was used. Thirteen tumors were excluded on the grounds of presenting variation coefficients in excess of 10. Of the 35 cases analyzed, 28 (80%) were diploid and seven (20%) aneuploid. No correlation was observed between tumor ploldy and patient survival, recurrence, or any of the histopathological variables studied.
Adult supraglottitis
Authors: Barrow Howard N. , Vastola A. Paul , Wang Robert C.
Published: November 2015

Airway management of supraglottitis in the adult is controversial as regards the choice between observation and acute intervention. This study was undertaken to determine whether factors exist that place patients at higher risk of airway obstruction and to review conservative treatment outcome. Of 46 cases during an 8‐year period, seven required tracheostomy and 39 were observed. Odynophagia and fever were present in all patients. Yearly clusters of up to six cases in 1 month were detected. White blood cell count and heart rate were significantly more elevated in those who underwent tracheostomy. A symptom duration of less than 24 hours was associated (p < 0.05, χ2 analysis) with airway compromise as well. There was no associated morbidity or mortality, and mean hospital stay was 5.2 days for those observed and 7.9 days for those who underwent tracheostomy. (OTOLARYNGOL HEAD NECK SURG 1993;109:474‐7.
A comparison of growth rates of acoustic neuromas: Nonsurgical patients vs. subtotal resection
Authors: Rosenberg Seth I. , Silverstein Herbert , Gordon Michael A. , Flanzer John M. , Willcox Thomas O. , Silverstein Julie
Published: November 2015

A conservative approach to the management of acoustic neuromas in elderly patients has been used since 1971. Elderly patients without symptoms of brain stem compression are initially treated by observation and yearly radiographic imaging. A translabyrinthine radical‐subtotal resection is performed if brain stem compression is present or if tumor is growing rapidly. Twenty‐three patients, ages 65 to 86 years, had initial nonsurgical management of their tumors. Growth rates could be determined for 16 patients. Thirteen patients not requiring surgery had an average tumor growth rate of 0.6 mm/yr. Three patients with an average growth rate of 6.8 mm/yr eventually required surgery. No patient whose tumor was < 15 mm at initial evaluation has experienced brain stem symptoms or demonstrated rapid tumor growth. Twenty‐four patients ages 65 to 86 years underwent planned subtotal tumor excision. Eighteen patients followed postoperatively for more than 1 year demonstrated an average rate of regrowth of tumor of 0.7 mm/yr. (OTOLARYNGOL HEAD NECK SURG 1993;109:482‐7.)
Pediatric sinusitis and subperiosteal orbital abscess formation: Diagnosis and treatment
Authors: Arjmand Ellis M. , Lusk Rodney P. , Muntz Harlan R.
Published: November 2015

Twenty‐two children with subperiosteal orbital abscesses were treated at St. Louis Children's Hospital between 1983 and 1992. Eighteen patients were otherwise in good health; four patients had cystic fibrosis, mucoceles, or were immunocompromised. All patients were treated with intravenous antibiotics and abscess drainage. CT scans were obtained preoperatively in each case. Ten patients were treated with endoscopic ethmoidectomy and abscess drainage, and 11 were treated with external ethmoidectomy and abscess drainage. One child was initially treated with abscess drainage and an elective endoscopic ethmoidectomy was performed later. There were no cases of permanent visual loss or neurologic sequelae. Culture results were positive in 14 cases and mixed infections were common. Complications included recurrent abscess, cerebritis, and empyema. We recommend combined medical and surgical treatment for all children with subperiosteal orbital abscess. We feel that endoscopic ethmoidectomy and abscess drainage offers some advantages over external ethmoidectomy and abscess drainage.
Clinical application of otoacoustic emissions: What do we know about factors influencing measurement and analysis?
Authors: Hall James W. , Baer Jane E. , Chase Patricia A. , Schwaber Mitchell K.
Published: November 2015

Three electrophysiologic audiologic procedures‐aural immittance measurement, auditory brainstem response (ABR), and otoacoustic emissions (OAE) — were first described in the 1970's. Immittance measurement and ABR have contributed importantly for years to the assessment of auditory function in children and adults, whereas OAEs have not yet been incorporated into the everyday audiology test battery. In this article, we argue that the transition from OAE measurement by hearing scientists in laboratory settings to routine application by audiologists in the clinic will be greatly facilitated by (1) comprehensive, large‐scale studies of the effects of subject characteristics, such as gender and age (from infancy to advancing adulthood), on both transient evoked (TEOAE) and distortion product (DPOAE) otoacoustic emissions; (2) clinical investigations of TEOAE and DPOAE in sizeable patient populations with specific neurotologic diagnoses; (3) guidelines for OAE test protocols in clinical environments; and (4) clear criteria for OAE analysis in clinical populations.
The effect of surfactant on eustachian tube function in a gerbil model of otitis media with effusion
Authors: Fornadley John A. , Burns J. Kevin
Published: November 2015

The relationship of eustachian tube surfactant and otitis media with effusion on eustachian tube opening pressure was studied in a gerbil model. Injection of killed Streptococcus pneumoniae bacteria created a serous effusion that increased eustachian tube opening pressure. The introduction of exogenous surfactant to this system resulted in a dramatic decrease in eustachian tube opening pressure in both normal ears and those with effusion. Identifying means to increase surfactant in the eustachian tube could be beneficial in reducing persistent otitis media with effusion.
Epistaxis, medical history, and the nasopulmonary reflex: What is clinically relevant?
Authors: Loftus Bernadette C. , Blitzer Andrew , Cozine Katherine
Published: November 2015

Posterior epistaxis and its management are associated with increased morbidity and sudden death. A “nasopulmonary reflex,” changes in pulmonary function induced by packing, has been postulated to cause hypoxia and lead to the reported morbidities. However, no study has followed patients prospectively to associate complications with oxygen status. Continuous pulse oximetry monitoring of 19 patients hospitalized with posterior packing was undertaken to document the Incidence and extent of oxygen desaturation, and to correlate complications with O2 status and historical factors. A further aim was to clarify the clinical relevance of the nasopulmonary reflex. In 1200 hours of monitoring, desaturations to less than 90% were observed on only two occasions: one self‐limited episode in an actively bleeding patient and one major hypoxic event with respiratory arrest in an alcoholic patient under sedation for delerium tremens. Complications, while uncommon, were more appropriately ascribed to rebleedlng or underlying medical problems than to primary O2 status. The nasopulmonary reflex, as previously described in terms of a primary drop in O2, therefore seems clinically irrelevant. Early surgery for posterior epistaxis is not warranted on the basis of maintenance of adequate oxygenation alone.
Immunotherapy in patients undergoing functional endoscopic sinus surgery
Authors: Nishioka Gary J. , Cook Paul R. , Davis William E. , McKinsey Joel P.
Published: November 2015

A total of 283 consecutive patients with chronic sinusitis underwent functional endoscopic sinus surgery. There were 72 allergic patients and 211 nonallergic patients. Data were collected on the effect of immunotherapy on middle meatotomy patency, synechiae formation, and recurrent polyps in allergic patients. Data supported the following conclusions: (1) Immunotherapy given either before or after surgery does not statistically influence middle meatotomy patency, synechiae formation, or recurrence of polyps after functional endoscopic sinus surgery. However, the data do suggest, for all three outcome parameters, that allergic patients who undergo immunotherapy do better than those who do not undergo immunotherapy and, with the exception of recurrent polyps, do as well as nonallergic patients. (2) The prevalence of preoperative polyps is the same for allergic and nonallergic patients in this study, but polyp recurrence is higher in allergic patients. (3) Approximately 40% of allergic patients who began preoperative immunotherapy stopped immunotherapy after surgery because their allergic symptoms resolved or were minimal. A comment regarding this observation is provided.
Ultrastructural changes in the cochlea of the guinea pig after fast neutron irradiation
Authors: Schwartz Ilsa , Kim Chong‐Sun , Shin See‐Ok
Published: November 2015

Guinea pigs were irradiated with fast neutrons. After a single dose of 2, 6, 10, or 15 Gy was applied, scanning and transmission electron microscopy of the temporal bone was performed to assess the effect of fast neutron irradiation on the cochlea. Outer hair cell damage appeared with neutron irradiation of more than 10 Gy, and Inner hair cell damage with neutron Irradiation of more than 15 Gy. Outer hair cells were more severely damaged than Inner hair cells. No statistically significant differences were found in damage of basal, middle, and apical turns. The second and third rows of outer hair cells were more severely damaged than the first row of outer hair cells. The most significant findings in transmission electron microscopy were clumping of chromatin and extension of the heterochromatin in the nuclei of hair cells. The cytoplasmic changes were sequestration of cytoplasm, various changes of mitochondria, formation of vacuoles, and irregularly arranged stereocilia. The morphologic change in stria vascularis was intercellular and perivascular fluid accumulation. It appeared to be a reversible process.
Environmental Tobacco Smoke and Otitis Media
Authors: Gulya A. Julianna
Published: November 2015

Environmental tobacco smoke (secondhand smoke) is a health hazard experienced by one half to two thirds of the nation's children younger than 5 years of age. Although the role of environmental tobacco smoke in the genesis of pulmonary disease in children has been increasingly recognized, somewhat less attention has been paid to the role of environmental tobacco smoke in the development of childhood otitis. This presentation will review current data regarding environmental tobacco smoke, with a particular emphasis on its effects on the ears and eustachian tube. Current American Academy of Otolaryngology‐Head and Neck Surgery Foundation, Inc. education efforts will also be discussed.
Accumulation of Interferon Gamma‐Producing TH1 Helper T Cells in Nasal Polyps
Authors: Miller Chase H. , Pudiak Deborah R. , Hatem Fadi , Looney Richard J.
Published: November 2015

We investigated the mechanisms involved in the formation of nasal polyps by examining T‐cell clones and their production of soluble mediators in nasal polyps. Recently, the allergic origin of nasal polyps has been challenged. To study this question we characterized T cells from polyp tissue of allergic individuals in terms of their cytokine pattern. Nasal polyp T cells were cloned from allergic individuals undergoing polypectomy. Polyp tissue was dispersed enzymatically, and T cells were stimulated with mitogen and interleukin‐2. Control T cells were obtained from peripheral blood of nonallergic donors. Cytokine production of interleukin‐4 and interferon was then determined by indirect enzyme‐linked immunosorbent assay tests. Polyp T‐cell clones were found to produce high interferon but low interleukin‐4 levels that were not significantly different from control peripheral blood T‐cell clones. In addition, immunoglobulin production by dispersed polyp tissue was investigated. Immunoglobulin levels were higher in polyp tissues than in serum with immunoglobulin A predominating. These results suggest that the inflammatory reaction in nasal polyps is different than that seen in a typical type I hypersensitivity response.
Performance of the Internal Jugular Vein after Functional Neck Dissection
Authors: Lake Gary M. , Dinardo Laurence J. , Demeo Jonathan H.
Published: November 2015

The objective of this study was to assess internal jugular vein performance after functional neck dissection in routine and extended head and neck surgical procedures, including bilateral neck dissections, treatment of radiation failures, and those combined with microvascular free grafts. Because the indications for functional neck dissection in our practice have increased, it is important to assess the use of the procedure in these circumstances. Although previous work has suggested the patency of the internal jugular vein after functional neck dissection, actual flow rates have not been investigated. The function of the dissected internal jugular vein was analyzed with duplex ultrasound at least 4 weeks after treatment. Maximal venous flow rates were evaluated. The results of this study will be presented and discussed.
Rhinologic Headaches
Authors: Chow James M.
Published: November 2015

From January 1, 1991, to June 30, 1992, 18 patients were identified as having rhinologic sources for their primary symptom of facial pain or headache. These 18 patients satisfied certain inclusion and exclusion criteria to identify the site of origin of the headaches or facial pains as coming from the nasal cavities or paranasal sinuses. The majority of these patients (12 patients) were determined to have a septal spur causing the facial pain or headache. Other identified causes included retention cysts (3 patients), mucosal contact points (2 patients), and a dehiscent infraorbital nerve (1 patient). Fifteen of these 18 patients (83%) were significantly improved or cured of their facial pain or headache after medical or surgical therapy. The 3 patients who had either a minimal improvement or no improvement in their facial pains or headaches included 1 patient with an area of mucosal contact between the middle turbinate and the bulla ethmoidalis and 2 patients with septal spurs. In summary, medical or surgical therapy can be beneficial in the treatment of patients with headaches or facial pains of rhinologic origin.
Congenital Perilymphatic Fistula: Computed Tomography Appearance of Middle Ear and Inner Ear Anomalies
Authors: Weissman Jane L. , Weber Peter C. , Bluestone Charles D.
Published: November 2015

Congenital perilymphatic fistula is an abnormal communication between the inner ear and middle ear. Inner ear anomalies have been described on computed tomography scans. Middle ear anomalies have been found at surgery; the most frequent are anomalies of the stapes and round window. This retrospective study describes the appearance of the inner and middle ear on computed tomography scans, and of the middle ear at surgery, in 10 patients (15 ears) in whom perilymphatic fistula was found at surgery. Twelve of 15 stapes were abnormal at surgery; 4 of these 12 (33%) could be seen on computed tomography scans. Two stapes normal at surgery were normal on computed tomography. Three round windows were abnormal at surgery; none of these was seen on computed tomography scans. There were also four dysplastic cochleas, four dysplastic vestibules, and three dilated vestibular aqueducts. Computed tomography scans identified an abnormal inner ear, middle ear, or both in 8 (53%) of the 15 ears with perilymphatic fistula. An inner ear or middle ear anomaly on computed tomography may heighten clinical suspicion of congenital perilymphatic fistula.
Multi-sectoral strategies as dead ends of policy integration: Lessons to be learned from sustainable development
Authors: Nordbeck Ralf , Steurer Reinhard
Published: November 2015

Until the mid-2000s, the rise of a “new pattern of strategy formation” in the context of sustainable development (SD) appeared to be a promising shift from mostly ineffective one-off-planning to iterative governance processes. The present paper revisits this once promising governance approach critically. Based on studies, evaluations and peer reviews, it synthesizes how national SD strategies have failed as policy documents and as governance processes in better integrating policies across sectors and levels of government. Based on the conclusion that comprehensive policy integration cannot be achieved through a single multi-sectoral strategy, we argue that it is time to either abandon an approach that has obviously failed to deliver or to recalibrate SD strategies towards the more realistic end of effectively communicating a long-term vision. Although the political relevance of SD strategies has declined in recent years, our findings are relevant to implementing other multi-sectoral strategies and the post-2015 United Nations Sustainable Development Goals. While the former replicate already the governance failures analyzed here, the implementation of the latter runs a considerable risk of doing so in the near future.
An Investigation of General Practitioner Referrals to Palliative Care Services
Authors: Pugh Elizabeth MG
Published: November 2015

A cross-sectional interview study designed to elicit general practitioners' reasons for referral to palliative care services was conducted. Three groups of general practitioners (GPs) were sampled: frequent referrers, non-referrers and nurse referrers. Fifteen GPs from each group were interviewed. A structured interview was carried out either face-to-face or over the telephone. The results showed significant differences between groups of GPs relating to why they did and did not refer patients to palliative care services. The main difference was that the GPs who frequently referred did so most often for ‘nursing support’, while those in the non-referring group most commonly mentioned ‘symptom control’. Fifty-three per cent of both frequent and non-referring GPs gave ‘the carers coping well’ as the commonest reason for not referring patients. Significant differences were also shown in what the GPs perceived was the most important thing they could offer cancer patients, with 60% of the GPs who had referred no patients answering ‘my time’. The results also provided evidence that the majority of the GPs characterised a ‘good death’ as being ‘pain free’, and that they perceived themselves to have an important role in providing palliative care for their terminally ill patients
Revisiting the Scope of Victimology — How Broad a Discipline Should it Be?
Authors: Garkawe Sam
Published: November 2015

Should there be any limitations on who is defined as a ‘victim’ for the purposes of the discipline of victimology? Does the discipline extend beyond the traditional study of victims of crime, to include, for example, the study of victims of natural disasters, poverty, HIV/AIDS, and all forms of repression and discrimination? While this issue was frequently discussed in the earlier years of modern victimology, since the agreement of the UN General Assembly to the 1985 UN Declaration of Basic Principles of Justice for Victims of Crime and Abuse of Power (the ‘Declaration’), debate on this issue seemed to have subsided. The title of the Declaration suggests that a consensus emerged that victimology should only include victims of crime and victims of abuse of power, each of these terms having specific definitions as found in the Declaration.

However, it appears that many victimologists do not necessarily accept the definitions and limitations of the Declaration. They argue that victimology ought to be concerned with all forms of human suffering, regardless of their origin. This article aims critically to assess the arguments and counter-arguments to this perspective. It concludes that there is no strong justifiable reason to limit the scope of the discipline, although for practical reasons it will often be necessary for particular research projects, victim advocacy and courses to establish clear parameters around which types of victims they will be concerned.