bluuebunny/crossref_metadata_2025 huggingface dataset:
Congenital Cholesteatoma of the Ear
Authors: McDonald Thomas J. , Cody D. Thane R. , Ryan Robert E.
Published: October 2014

Congenital cholesteatoma of the ear is a capricious and challenging problem for the otologist. We present 21 cases managed at the Mayo Clinic from 1961 to 1983. In all but one unusual case, the cholesteatoma developed behind an intact tympanic membrane and there was no history of aural infections. Preoperative symptoms and signs were predominantly conductive deafness with either a normal tympanic membrane or an opaque, whitish appearance to the drum. Disease was located in the middle ear or in the middle ear and mastoid, except in one patient who had cholesteatoma extending into the petrous apex. Surgical management depended on the extent of the lesion, and recurrences were unusual, suggesting that congenital cholesteatoma may not be as aggressive as acquired cholesteatoma.
Surgical Obliteration of the Tympanomastoid Compartment and External Auditory Canal
Authors: Schuknecht Harold F. , Chandler J. Ryan
Published: October 2014

The ideal patient for a radical mastoidectomy with total tympanomastoid cavity obliteration is one with chronic granulomatous otomastoiditis without cholesteatoma, profound sensorineural hearing loss, and a normal ear on the opposite side. A meticulous and thorough classical radical mastoidectomy is required. The resultant cavity is eliminated by filling it with pedicled flaps and/or adipose tissue taken from the abdominal wall. Suturing the skin of the anterior and posterior membranous canal walls completes the procedure. Healing is rapid and requires minimal postoperative care. The absence of a cavity eliminates the necessity of additional otologic care. Swimming, diving, and free participation in all other aquatic sports are important additional benefits. This procedure has been performed in 44 patients, 24 by author HFS and 20 by author JRC.
Experiences with Implantable Hearing Devices and a Presentation of a New Device
Authors: Hough Jack , Vernon Jack , Dormer Kenneth , Johnson Bob , Himelick Tom
Published: October 2014

Following animal experiments, anatomic examinations, and histologic studies, an implantable hearing device was developed. This device, the temporal bone stimulator (TBS), uses an inductive coil without percutaneous connection that transmits bone-conducted vibrations to the inner ear. Ten patients have been implanted and followed by the Central Ear Research Institute. The TBS is effective and may have wide application in producing amplification in good sound fidelity when used in patients who have external canal, middle ear, or eustachian tube disease that is poorly corrected by surgery or conventional hearing aids. The utilization of similar principles of electromagnetic transfer of energy directly to the ossicles appears reasonable and is potentially highly rewarding for those who have sensorineural hearing impairments with thresholds greater than 40 dB. The enormous potential benefits derived from the application of these implantable hearing devices is worthy of the greatest effort in future otologic investigation.
Cochlear Implantation: Strategies to Protect the Implanted Cochlea from Middle Ear Infection
Authors: Jackler Robert K. , O'Donoghue Gerard M. , Schindler Robert A.
Published: October 2014

A cochlear implant for use in children must take into account the high incidence of middle ear infection in this age group. A scala tympani electrode that traverses the middle ear and round window will likely act as a conduit by which infection can spread to the inner ear and potentially to the CNS. In this study an attempt was made to reestablish a separation of the cochlea from the middle ear by developing a seal around the implant at the level of the round window. A series of cats were implanted with simulated cochlear prostheses consisting of either a plain Silastic cylinder, a Silastic cylinder wrapped with autogenous fascia, or a Silastic cylinder with a cuff of bioactive ceramic. Middle ear infection was induced, followed by histologic examination. Bioactive ceramic appears to have some merit as a round window sealing material, while fascia was shown to be of no value. Intracochlear infection, when it did occur, was limited to the basal regions of the cochlea.
Effects of Neuropeptides on Mucociliary Activity
Authors: Lindberg Sven , Hybbinette Jan-Christer , Mercke Ulf
Published: October 2014

The effects of four neuropeptides, vasoactive intestinal polypeptide, enkephalin, bombesin, and substance P, on mucociliary activity in the rabbit maxillary sinus were investigated in vivo. The peptides were administered via the feeding artery (arteria maxillaris), and the resulting effects were registered with a noninvasive photoelectric technique. The peptides were tested in the dose range 0.0001 to 10 μg/kg body weight. The following results were observed: 1) vasoactive intestinal polypeptide and enkephalin did not influence mucociliary activity; 2) bombesin had only a slight accelerating effect on the mucociliary activity at doses of 0.1 to 10 μg/kg; and 3) substance P markedly accelerated the mucociliary activity in a dose-dependent manner in the dose range 0.01 to 10 μg/kg, the maximal increase being about 50%. The effect of substance P was atropine-resistant, and probably acted directly on the mucosa.
Pathology Consultation Primary Lymphomas of the Major Salivary Glands
Authors: Batsakis John G.
Published: October 2014

The finding of a lymphoma of the major salivary glands (almost always parotid gland) has two diagnostic implications; it is only part of a known disseminated process, or it may be the first clinical-pathologic evidence of lymphoma. In the latter instance, the disease may be localized or, most often, be a precursory lesion to regional or systemic disease. Patients with Sjögren's or sicca syndrome are at increased risk for the development of lymphoma, and their lymphomas are biologically more aggressive.
Supraglottic Jet Ventilation for Laser Surgery of the Larynx in Children
Authors: Scamman Franklin L. , McCabe Brian F.
Published: October 2014

To investigate the efficacy and safety of supraglottic jet ventilation for laser surgery on the larynx, ten studies were performed in seven children scheduled for laser excision of juvenile laryngeal papillomata. The children were anesthetized using halothane, nitrous oxide, fentanyl 3 μg/kg, and a succinylcholine infusion. After the Leonard-Jako laryngoscope was in place, jet ventilation with 70% nitrous oxide in oxygen was begun through a 12-gauge Medicut intravenous cannula inserted in the right-hand light channel of the laryngoscope. Tracheal, inspired, and end-tidal oxygen, nitrous oxide, nitrogen, and carbon dioxide were determined by mass spectrometry simultaneously with arterial blood gases. Oxygen and carbon dioxide levels were always within normal limits, the end-tidal to arterial differences averaging 50 ± 9 and − 2 ± 1 (SEM) mm Hg, respectively. Room air entrainment averaged 32 ± 2%. The end-tidal nitrous oxide averaged 39 ± 2%. The advantages of this technique are that it leaves the larynx completely free for the surgeon and it eliminates the possibility of endotracheal tube ignition. Supraglottic jet ventilation for this surgical procedure was determined to be effective and relatively safe.
Stapedius Reflex to Electrical Stimulation in a Patient with a Cochlear Implant
Authors: Jerger James , Fifer Robert , Jenkins Herman , Mecklenburg Dianne
Published: October 2014

In a patient with a multichannel cochlear implant, it was possible to demonstrate stapedius reflex contraction to intracochlear electrical stimulation. Using a standard immittance measurement technique, characteristics of the electrically evoked reflex were compared to analogous characteristics of the acoustically evoked reflex. Latency-intensity functions were similar for the two modes of excitation, but reflex waveform morphology and amplitude growth functions were different.
Congenital Stapes Ankylosis by Elongation of the Pyramidal Eminence Communication
Authors: Cremers C. W. R. J. , Hoogland G. A.
Published: October 2014

This report confirms the existence of an isolated congenital stapes ankylosis caused by an elongated bony pyramidal eminence. The moderate degree of conductive hearing loss in the patient and the simple surgical procedure needed to produce a normal hearing level are noteworthy.
Acute Mastoiditis: A Review of 69 Cases
Authors: Rosen Arie , Ophir Dov , Marshak Gabriel
Published: October 2014

Sixty-nine cases of acute mastoiditis were managed at the Kaplan Hospital in Israel during a 10–year period. About two thirds (68%) recovered with conservative therapy consisting of wide myringotomy and intravenous antimicrobial therapy, usually ampicillin and cloxacillin. One third (22 patients) were managed surgically by complete mastoidectomy. Indications for surgery were subperiosteal abscess, based on clinical findings in 20 patients; one had septic fever that did not respond to antimicrobial therapy, and one had signs of meningeal irritation. Mastoid radiographs played no role in the decision to operate. Four cases of unsuspected epidural abscess were found, two behind intact tegmental bone. Acute mastoiditis develops mostly in ears that have not been immune to previous infections; thus the mucosal barrier is broken easily and osteitis occurs. Although with the advent of antimicrobial therapy the presentation and course of the disease are milder, the disease is still serious and potentially lethal.
Physical Therapy in the Management of Myofacial Pain Dysfunction Syndrome
Authors: Talaat A. M. , El-Dibany M. M. , El-Garf A.
Published: October 2014

A study of the effectiveness of physical therapy for patients with myofacial pain dysfunction syndrome was performed. Clinical evaluation of 120 patients revealed marked male preponderance, distribution according to age showed a great prevalence of the third decade, and most common chief complaints were pain and muscle tenderness. Patients were classified randomly into three equal groups treated by muscle relaxant drugs, shortwave diathermy, and ultrasonic therapy, respectively. Regular follow-up was carried out for 6 to 12 months to assess patients' responses to different forms of treatment. Evaluation revealed marked relief of symptoms by the use of physical therapy, and the best results were obtained by the use of ultrasonic therapy.
Secondary Immune Response in the Middle Ear: Immunological, Morphological, and Physiological Observations
Authors: Ryan Allen F. , Catanzaro Antonino , Wasserman Stephen I. , Harris Jeffrey P.
Published: October 2014

A model of secondary immune response in the middle ear (ME) was developed in the guinea pig. Animals were immunized intradermally with keyhole limpet hemocyanin (KLH) and challenged with KLH in the ME 8 weeks later. The ME displayed effusion, mucosal hyperplasia, mucosal edema, and leukocytic infiltration. These responses were maximal at 3 days postchallenge, and persisted for 2 to 3 weeks. High levels of antibody were observed in the ME effusions, and serum titers increased significantly. Immunohistochemical localization of antibody indicated that substantial free IgG was present in the submucosa, with much less in the mucosal epithelium. IgA plasma cells were observed in the submucosa at 1 week postchallenge, but no IgM was detected. In contrast to the response observed in sensitized animals, antigen presented to the ME of unimmunized control animals resulted in no effusion, minimal mucosal inflammation, and little or no antibody in either the ME or serum. However, substantial neutrophilic infiltration of the ME cavity was observed. The effusion and inflammation produced by secondary ME immune responses were not affected by tympanostomy tubes. Eustachian tube function as measured by a forced response test was not affected by ME immune response. This suggests that the immunologically induced effusion was not the result of eustachian tube obstruction. We postulate that increased vascular permeability in the ME mucosa, induced by chemical mediators, resulted in the transudation of serum.
Clinical Assessment of Ossicular Mobility by a Ceramic Vibrator Designed for Implantable Hearing AIDS
Authors: Gyo Kiyofumi , Yanagihara Naoaki
Published: October 2014

Ossicular mobility was assessed by direct coupling of a piezoelectric ceramic vibrator to the ossicles during middle ear surgery. The sites excited were 1) body of the incus, 2) head of the stapes, and 3) footplate of the stapes through a hydroxyapatite ceramic strut. The threshold of the vibratory hearing was determined by the patient's response as a minimum audition, and the vibration threshold was obtained by subtracting the preoperative bone conduction threshold from the vibratory hearing threshold. The results were analyzed by the state of hearing after the operation, which revealed that a patient with a good vibration threshold during the operation had a tendency to get good postoperative hearing. This may mean that postoperative hearing can be predicted to some extent during the operation by the measurement of ossicular mobility.
Free Jejunal Grafts for Reconstruction of Pharynx and Cervical Esophagus
Authors: Wang Tian Duo , Sun Yong En , Chen Ying
Published: October 2014

Reconstruction of the pharynx and cervical esophagus continues to pose a challenge to the surgeon. Over the last 2 years the free jejunal graft with microvascular anastomosis has been used to reconstruct pharyngoesophageal defects in ten consecutive cases with failure in only one case, because of a malfunctioning microscope and a temporary pharyngocutaneous fistula. Eight procedures were performed for reconstruction of a pharyngoesophageal defect after an extensive excision of hypopharyngeal carcinoma, one for pharyngoesophageal defect due to cervical trauma in an accident, and another for corrosive atresia. In seven of these cases the unaffected larynx or normal part of the larynx was simultaneously preserved and reconstructed with laryngeal function restored totally in four cases and partially in three cases. The techniques of both pharyngoesophageal and laryngeal reconstruction are presented. In our experience this is a relatively safe and reliable single-staged procedure that provides easier and earlier rehabilitation compared to other methods of reconstruction. Furthermore, the majority of patients may have their larynges rehabilitated simultaneously.
Postnatal Growth of the Human Temporal Bone
Authors: Eby Thomas L. , Nadol Joseph B.
Published: October 2014

Recent interest in cochlear implantation for children has made it important to understand how postnatal growth of the ear will affect such devices. In this study, the postnatal growth of the labyrinth, middle ear, and mastoid was measured in three dimensions using radiographic and temporal bone data. Measurements were made from histologic sections of 48 temporal bones from children and compared to adult temporal bones. Radiographic measurements were made from 253 sets of skull radiographs of children and compared to adult skull series. In the three dimensions measured, there was no postnatal growth of the labyrinth and little variation in size between individuals. Measurements of the middle ear showed greater variation between individuals than measurements of the inner ear, but growth only in the distance from stapes footplate to the tympanic membrane. The mastoid showed growth in all three dimensions: length, width, and depth. The pattern of growth for mastoid length and width appears to follow a double logistic model, with differences between males and females. The growth in mastoid depth is smaller and appears to follow a single exponential curve. The implications for cochlear implantation in children are discussed.
Effect of Changes in Systemic Oxygen Tension on Middle Ear Gas Exchange
Authors: Yee Archie L. , Cantekin Erdem I.
Published: October 2014

The effect of alterations in the systemic oxygen tension on middle ear (ME) gas exchange was studied in three juvenile rhesus monkeys ( Macaca mulatta) using five different inspired oxygen concentrations ranging from 15% to 100%. The anesthetized animals were ventilated for 4 hours, breathing the set of predetermined, constant oxygen-nitrogen gas mixtures. During this period, arterial and venous oxygen and carbon dioxide partial pressures were measured at 30-minute intervals; total ME gas pressure was determined indirectly using tympanometry at 10-minute intervals. Systemic oxygen blood gas tension showed predictable changes which were dependent on the fraction of inspired oxygen. However, fluctuations in the total ME gas pressure were insignificant. Findings suggested that increased systemic oxygen partial pressure does not influence ME gas exchange.
Primary Tracheoesophageal Shunt Operation for Postlaryngectomy Speech with Sphincter Mechanism
Authors: Amatsu Mutsuo , Makino Kunihiko , Tani Mitsutate , Kinishi Minoru , Kokubu Michiyo
Published: October 2014

This paper describes a primary voice restoration technique designed to eliminate the problem of aspiration commonly encountered in rehabilitation procedures following laryngectomy. This technique, utilized in 16 patients, consists of a unique combination of tracheal flap for voice production and bilateral esophageal constrictor muscle flaps to prevent aspiration. Fourteen patients developed satisfactory tracheoesophageal speech; of them 12 had normal deglutition without problems of aspiration. On radiographic examination, the bilateral esophageal muscle flaps, in combination with the dilatation and elevation of the cervical esophagus, provide a sphincter mechanism that prevents tracheal reflux during deglutition.
Pyriform Sinus Fistula: An Unusual Cause of Recurrent Retropharyngeal Abscess and Cellulitis
Authors: DeLozier Howard L. , Sofferman Robert A.
Published: October 2014

Recurrent retropharyngeal cellulitis and recurrent suppurative thyroiditis are rare entities that share a common cause. A congenital fistula from the pyriform sinus apex to the thyroid gland has been identified in approximately 23 cases of suppurative thyroiditis and now has been implicated in a case of retropharyngeal abscess and repeated episodes of cellulitis. Virtually all reported cases have been on the left side, and the fistula is usually identified with a barium swallow study. When the esophagogram fails to demonstrate a fistula, a careful endoscopic search in the area of the left pyriform sinus should be actively pursued. An external surgical approach, which includes resection of the entire tract and involved area of the left thyroid, has been curative in all reported cases subjected to definitive surgical exploration.
Summating Potential and Water Balance in Meniere's Disease
Authors: Dauman René , Aran Jean-Marie , Portmann Michel
Published: October 2014

The summating potentials (SP) to free-field 1-, 2-, 4-, and 8-kHz, 90-dB HL tone bursts were recorded by means of transtympanic electrocochleography in 45 patients divided into three groups: those with Meniere's disease, those whose diagnosis was uncertain, and control subjects. The similarities across frequencies between the human SP (promontory) and the experimental SP (DIF component from basal turn) suggest that the SP recorded in electrocochleography originates mostly from the base of the cochlea; negative values were observed at low frequencies (1 to 2 kHz), positive values at high frequencies (8 kHz). Patients with Meniere's disease showed significantly larger SP values than control subjects. The effect of orally administered glycerol on the SP and action potential amplitudes was evaluated by means of automated recordings repeated every 5 minutes. Summating potential values were remarkably constant in the control group. A decrease in SP absolute amplitude was observed in most patients with Meniere's disease and some subjects with uncertain diagnoses, specifically at low frequencies. These changes were frequently associated with action potential amplitude and auditory threshold improvements at low frequencies. It is assumed that the glycerol-induced SP changes at low frequencies are related to modifications in the low frequency mechanical response of the basilar membrane at the basal turn.
Ototoxicity of Neomycin and its Penetration through the round Window Membrane into the Perilymph
Authors: Harada Takehiko , Nagai Yoshitaka , Iwamori Masao , Nomura Yasuya
Published: October 2014

The ototoxicity of neomycin and its concentration in the perilymph after direct application on the round window membrane were studied. After placing 5 mg of neomycin on the round window membrane of guinea pigs for various time intervals, concentration of the drug in the perilymph was determined by high performance liquid chromatography, and the cochlea was examined by light microscopy. Neomycin penetrated the round window membrane quite easily, and its concentration in the perilymph became extremely high in a short time and then decreased gradually. This indicates that high concentration of neomycin in the perilymph can be attained by application of a small amount of the drug on the round window membrane. Ototoxicity of neomycin was observed after application for 4 hours. Cochlear damage increased as neomycin application time became longer, but no consistent relationship was noted between the concentration of neomycin and the amount of damage. This result is discussed from the point of concentration and persistence of the drug in the inner ear fluids.
Human Endolymphatic Duct: Possible Mechanisms of Endolymph Outflow
Authors: Wackym Phillip A. , Friberg Ulla , Bagger-Sjöbäck Dan , Rask-Andersen Helge
Published: October 2014

The ultrastructure of the normal human endolymphatic duct (ED) was observed by transmission electron microscopy. The role of the epithelium, the various regions of the subepithelial space, and vasculature in the resorption of endolymph was morphologically studied in order to generate testable hypotheses of human ED function. These hypothetical mechanisms of endolymph outflow at the level of the ED are 1) a passive transcellular movement of water across the epithelium, driven by an osmotic gradient created by a subepithelial organic matrix; 2) an active transcellular ion exchange with a passive transepithelial outflow of water, which stresses the importance of the dilated lateral intercellular spaces; and 3) an active transcellular vacuolar endolymph outflow, whereby high molecular weight substances are removed by the ED. These mechanisms may be useful in designing experimental studies of the ED and in interpretation of retrospective light microscopic and transmission electron microscopic studies of patients with Meniere's disease.
Implantable Bone Conduction Hearing Device: Audiant Bone Conductor
Authors: Hough Jack , Himelick Tom , Johnson Bob
Published: October 2014

An implantable hearing device has been developed and has undergone testing by animal experimentation and clinical trials in humans. Recently, the Food and Drug Administration has approved the use of this device in adults who are within the criteria of its utilization, mainly patients with conductive hearing impairments who have good inner ear reception and who are unable to benefit from surgical correction. This update describes observations and experiences we have had during the device's development and defines its limitations as well as its unique thrust into the future relief of hearing impairment. Clinical trials during the investigational period and engineering problems as well as progress are thoroughly discussed.
Comparative Study of Age-Related Cochlear Hair Cell Loss
Authors: Dayal Vijay S. , Bhattacharyya Tapan K.
Published: October 2014

Age-related hair cell loss has been studied in squirrel monkeys using surface preparation of the organ of Corti. Increasing hair cell loss starting at the apex is seen as a function of age. This finding is discussed in the light of our studies in guinea pigs, chinchillas, and rabbits. Reviewed with other human and experimental data, it would appear that many species of animals have age-related histological damage similar to that seen in the human organ of Corti.
Effect of Conductive Hearing Loss and Middle Ear Surgery on Binaural Hearing
Authors: Hall Joseph W. , Derlacki Eugene L.
Published: October 2014

This study investigated whether conductive hearing loss reduces normal binaural hearing advantages and whether binaural hearing advantages are normal in patients who have had hearing thresholds improved by middle ear surgery. Binaural hearing was assessed at a test frequency of 500 Hz using the masking level difference and interaural time discrimination thresholds. Results indicated that binaural hearing is often poor in conductive lesion patients and that the reduction in binaural hearing is not always consistent with a simple attenuation of the acoustic signal. Poor binaural hearing sometimes occurs even when middle ear surgery has resulted in bilaterally normal hearing thresholds. Our preliminary results are consistent with the interpretation that auditory deprivation due to conductive hearing loss may result in poor binaural auditory processing.
Cochlear and Retrocochlear Immune-Mediated Inner Ear Disorders
Authors: Veldman Jan E.
Published: October 2014

Three different forms of immune-mediated sensorineural hearing loss are described. The pathogeneses of these three cases with severe audiovestibular deficits are completely different. To make an appropriate diagnosis remains a dilemma. Autoimmunity plays a certain role, but is not always present. Vascular and neural tissue can become involved. Immune-mediated forms of sensorineural hearing loss can be of cochlear or retrocochlear origin.
Anesthetic Management for Tracheobronchial Laser Surgery
Authors: Rontal Michael , Wenokur Milford E. , Rontal Eugene , Elson Lawrence
Published: October 2014

The use of the laser has become a well-recognized means of treating obstructing lesions of the tracheobronchial tree. Patients with lower airway compromise are in a precarious state of equilibrium. Everything done by the endoscopy-anesthesiology team tends to change this balance. Cooperation and coordination of this well-disciplined team is needed for efficient treatment of difficult cases. This paper outlines our surgical techniques, which have been tempered and modified to an anesthetic technique that provides the greatest safety with comfort. We detail the basic anesthetic methods for drug usage, pulmonary ventilation, and patient monitoring that we now use. A careful analysis of our results is presented to show that this technique does provide relatively safe anesthesia in this difficult setting.
Staged Repair of Extensive Tracheal and Laryngotracheal Stenoses
Authors: Biller Hugh F. , Lawson William , Weisberg Verne
Published: October 2014

The usual operative procedures (primary tracheal anastomosis, cricotracheal anastomosis, skin grafting and stenting, pedicle cartilage grafts, or free rib grafts) used to correct stenoses of great length involving the trachea or laryngotrachea have a high incidence of failure. An alternative method of reconstruction is the open technique, which requires three stages. The initial stage creates a trough after resection of the stenotic area, followed by subcutaneous embedding of a rigid material adjacent to the trough, and finally closure of the trough by reformation of the anterior wall. This staged procedure has been used in adult patients with tracheal stenoses greater than 4 cm, in patients with tracheal stenoses involving the cricoid, and in patients whose primary corrective operative procedures have failed. This paper critically assesses 30 patients who have had a staged reconstruction with a minimum follow-up of 12 months. The indications, number of procedures performed, time required for decannulation, complications, and analysis of failures are presented. The incidence of success in this series of patients is 76% (23/30).
Hyperbaric Oxygen Therapy for Laryngeal Radionecrosis
Authors: Ferguson B. J. , Hudson William R. , Farmer Joseph C.
Published: October 2014

Radionecrosis of the larynx is a debilitating disease associated with pain, dysphagia, respiratory obstruction, and, in some cases, the need for laryngectomy. Persistent poor wound healing can lead to death. A series of eight patients with advanced (grades III and IV, Chandler classification) radionecrosis of the larynx treated with adjunctive hyperbaric oxygen therapy is presented. Signs and symptoms of radionecrosis were dramatically ameliorated in seven of eight patients, while one patient, despite subjective improvement, eventually required laryngectomy. There were no deaths. These results are compared to previous series on radionecrosis of the larynx in which hyperbaric oxygen was not used. This series indicates that hyperbaric oxygen therapy is a useful and effective adjunctive treatment modality in the management of laryngeal radionecrosis.
Immediate Free Gastro-Omental Flap Reconstruction of the Mouth and Throat
Authors: Panje William R. , Little Alex G. , Ferguson Mark K. , Moran William J. , Scher Natan
Published: October 2014

a portion of the greater curve of the stomach with its attached omentum was transplanted to reconstruct the pharynx and oral cavity after ablation of upper aerodigestive tract cancer. The tissue characteristics of the transplanted material were similar to those of the removed oropharyngeal tissue. The gastro-omental free flap produced a moist mucosal surface that was self-cleaning and distensible. The free gastro-omental flap was successful in five of seven patients. Because of excessive flap secretions during the early postoperative period, all patients had tracheotomies to protect the lower airway from aspiration.
Tracheal Bronchogenic Cyst: A New Clinical Entity?
Authors: Wenig Barry L. , Abramson Allan L.
Published: October 2014

Bronchogenic cysts arise as congenital anomalies of the primitive foregut. Although bronchogenic cysts arising from and partially occluding the trachea have been reported in adults, this entity has not as yet been documented in children. We report a case of an infant with respiratory distress resulting from an intratracheal bronchogenic cyst. In view of its ability to create airway compromise, the pathogenesis, preoperative evaluation, and surgical management of this rare lesion will be discussed.
Dysphagia Due to Cervical Spine Surgery
Authors: Welsh Louis W. , Welsh John J. , Chinnici Joanne C.
Published: October 2014

Surgery upon the cervical vertebrae may produce prolonged dysphagia due to regional damage, hemorrhage, infection, and denervation. Cases illustrating these problems are presented with attention to the progression of the clinical course and the diagnostic modalities of radiology and endoscopy. Methods of prevention are emphasized and the therapeutic plan is outlined.
Developments in Pediatric Neurolaryngology
Authors: Richardson Mark A.
Published: October 2014

Advances in diagnosis through the use of video and still photographs have made the recognition of pediatric laryngeal disorders much more accurate and precise. Open laryngeal surgery in children was felt to possibly impair growth and development. New procedures to correct structural congenital and acquired lesions in children have freed us from many of these reservations. One of the frontiers now being explored is neurogenic abnormalities within the pediatric larynx. At present, no uniform method of evaluation is being used other than observation of laryngeal motion. The use of electromyography in combination with still and motion photography should allow proper evaluation of the results of surgery or observation.
Laryngeal Problems in Children
Authors: Fearon Blair
Published: October 2014

Some diseases of the larynx that now are rare were common in 1950, when the author began the practice of pediatric otolaryngology. These include laryngeal tuberculosis, bulbar poliomyelitis, and acute exanthemata. The management of laryngotracheitis and supraglottitis has altered markedly, with the mortality reduced drastically. The advent of the operating microscope and carbon dioxide laser has broadened the efficacy of laryngeal surgery. Subglottic stenosis continues to be a challenge despite new operations. Laryngeal transplant may be the answer to some intractable diseases.
Reinnervation of Skeletal Muscle: A Comparison of Nerve Implantation with Neuromuscular Pedicle Transfer in an Animal Model
Authors: Meikle David , Trachy Ronald E. , Cummings Charles W.
Published: October 2014

In recent years there has been increased interest in the possibility of reinnervating paralyzed muscles, particularly the muscles of the face and of the larynx. There has been dispute over the relative effectiveness of different approaches. This study was undertaken to compare direct nerve implantation with the transfer of a neuromuscular pedicle using denervated strap muscles in a rabbit model. Reinnervation was carried out both immediately after denervation and after a delay period. Evidence of return of function was obtained by a method of long-term electromyographic monitoring and was confirmed electrically by evoked electromyography and muscle tension measurement and histologically by brain stem uptake of horseradish peroxidase. Both methods of nerve transfer produced consistently functional neuromuscular units, with physiological activity and muscle strength comparable with those in normally innervated controls. Return of function was apparent within 6 weeks of both nerve implantation and neuromuscular transfer; with this model, neither method showed a clear advantage over the other.
N1 Latency Prolongation in the Guinea Pig Cochlea Treated with Nitrogen Mustard-N-Oxide Studied by Narrow Band Analysis
Authors: Ikeda Katsuhisa , Kusakari Jun , Kawamoto Kazutomo
Published: October 2014

The effect of nitrogen mustard-N-oxide (NMO) upon the click and tone burst–evoked N1 latency was examined in 14 albino guinea pigs. In all animals except one, the pseudothresholds of action potentials were elevated, especially in the high tone area. In addition to the amplitude reduction, the N1 latency was prolonged in 12 animals. The narrow band analysis of N1 revealed that the latency was equally prolonged in all frequency areas, although the amount of the amplitude reduction was much larger in the high frequency area. It was concluded that the prolongation of the N1 latency in NMO-treated animals was due to dysfunction of outer hair cells along the entire cochlear partition.
Eustachian Tube Histopathology during Experimental Influenza a Virus Infection in the Chinchilla
Authors: Giebink G. Scott , Ripley Mary Lou , Wright Peter F.
Published: October 2014

The eustachian tubes of 29 influenza a virus–infected chinchillas were examined for histopathologic signs at intervals up to 21 days after inoculation to elucidate the pathologic basis of negative middle ear pressure, which occurs during viral respiratory tract infection in humans. In the animal model, eardrum inflammation and negative middle ear pressure mirrored epithelial damage in the eustachian tube and the accumulation of cellular and mucous debris in the tubal lumen. Epithelial damage was greatest in the proximal two thirds of the tube near the nasopharynx, whereas goblet cell metaplasia and increased secretory activity was greatest in the distal, tympanic one third of the tube. These results provide a morphologic correlate to the development of negative middle ear pressure, and perhaps explain the pathologic basis for purulent otitis media during viral respiratory tract infection.
Prevention of Recurrent Cholesteatoma in Closed Tympanoplasty
Authors: Zini Carlo , Scandellari Roberta , Sanna Mario , Gamoletti Roberto , Russo Alessandra , Delogu Peppina , Taibah Abdel
Published: October 2014

Recurrent cholesteatoma in a series of 534 staged intact canal wall tympanoplasties performed over a 10-year period has been reviewed for the present study. Overall detected incidence of recurrent cholesteatoma is 5.2% (28 of 534 operated ears). A steady decrease of recurrent cholesteatoma was found, however, in the second period of our surgical experience (1978 to 1982) when prevention techniques were adopted in all operations, resulting in a 1.07% incidence (four of 373 operated ears). Our present policy for prevention of recurrent cholesteatoma in intact canal wall tympanoplasties with mastoidectomy includes 1) the use of plastic sheeting with thick Silastic, 2) the repair of bony sulcus defects with cartilage shavings, 3) staging of the operation with preplanned reexploration of the middle ear and mastoid, and 4) transtympanic ventilation tube insertion in cases of refractory tubal insufficiency.
Auditory Brain Stem Evoked Response Characteristics in Developing Infants
Authors: Zimmerman Marilyn C. , Morgan Donald E. , Dubno Judy R.
Published: October 2014

The auditory brain stem response (ABR) of a single group of developing normal infants was examined longitudinally, from newborn through 6 months of age. A sufficiently broad range of stimulus variables was included to ensure that the auditory system was adequately sampled in order to demonstrate developmental principles. Findings indicate that there are no differences in wave V latency-intensity functions between infants and adults. For waves I, III, and V, absolute and interwave latency–repetition rate functions differ between infants and adults and undergo systematic changes throughout the first 6 months of life. The most dramatic ABR changes (between any two sequential test sessions in infants) occurred between the ages of newborn and 2 weeks, with less pronounced ABR changes beyond 2 weeks of age. The pattern of latency change for wave I was different from that for waves III and V. After 2 weeks of age, wave I latency was the same as the adult value at all repetition rates. In contrast, waves III and V were characterized by decreasing latency throughout the follow-up period. A curvilinear developmental model provided a satisfactory fit to ABR latency data.
Radiographic Imaging for the Cochlear Implant
Authors: Rosenberg Richard A. , Cohen Noel L. , Reede Deborah L.
Published: October 2014

Imaging plays an essential role in evaluating the cochlear implant candidate and the results of implantation. Eighteen candidates for cochlear implantation were reviewed for this study. Fourteen received implants; all but one, intracochlear devices. Based on the trial use of multiple techniques, a protocol has been established for the use of radiography in implant studies. The protocol suggests preoperative high resolution semiaxial computed tomographic scanning, intraoperative anteroposterior transorbital plain films if there is doubt concerning the electrode placement, and postoperative plain films in cases of unexpected poor device performance. In cases with complications, postoperative CT scanning may be required.
Nystagmus of Paroxysmal Positional Vertigo: Some New Insights
Authors: Katsarkas A.
Published: October 2014

In most of our patients with paroxysmal positional vertigo, the paroxysm was usually short (< 25 or 30 seconds). With the eyes deviated toward the lowermost ear, the observed nystagmus was rotatory-linear and the fast phases beat toward this ear. When the eyes were deviated to the opposite side, the fast phase of nystagmus was mainly upward linear-oblique. In a small number of patients, however, some unusual findings were observed: 1) the nystagmus was the usual rotatory-linear, but the duration was much longer; or 2) the nystagmus was purely horizontal; or 3) the nystagmus was rotatory-linear, but the fast phases were in opposite direction to that usually observed. These data suggest that: 1) the observed paroxysmal nystagmus seems compatible with excitation of the posterior or horizontal semicircular canal of the lowermost ear, or the superior canal of the uppermost ear; and 2) singular nerve section is an appropriate treatment only if the observed paroxysmal nystagmus is compatible with excitation of a posterior semicircular canal.
Electron Microscopic Study of the Inner Ear following Anaphylaxis
Authors: Ohashi Yoshihiro , Nakai Yoshiaki , Kato Motoaki
Published: October 2014

Although very little is known about the role of immunologic responses in disorders of the inner ear, including sensorineural hearing loss, data lending support to the possibility of their involvement have recently been published. The present experimental study was undertaken to obtain a better understanding of the fine structures of the inner ear following systemic immune responses. In guinea pigs sensitized with egg albumin, antigen challenge not only evoked bronchospasms, but also induced some pathologic changes in the inner ear, especially in the stria vascularis. These findings lead to the inference that the inner ear may be affected by systemic immune responses in sensitized animals.
Asymptomatic Laryngocele: Incidence and Association with Laryngeal Cancer
Authors: Close Lanny Garth , Merkel Marie , Burns Dennis K. , Deaton C. William , Schaefer Steven D.
Published: October 2014

Since laryngoceles are usually asymptomatic, their incidence is probably higher than the literature suggests. With the advent of computed tomography, the incidence and significance of the asymptomatic laryngocele in a general head and neck practice can be addressed. To this end, 304 consecutive patients with a variety of otolaryngic diagnoses were studied prospectively by computed tomography of the neck from January 1983 to February 1985. Thirty-eight (12.5%) of the patients had asymptomatic laryngoceles, defined as air-containing structures in the supraglottic region extending more than 5 mm above the superior border of the thyroid cartilage during normal breathing. The incidence of laryngoceles associated with laryngeal cancer (29%) was higher than that for laryngoceles associated with other diseases (9%). No patient with an asymptomatic laryngocele not associated with laryngeal cancer showed evidence of a subsequent laryngeal neoplasm during close follow-up of 10 to 36 months.
Thyroid Cancer in Patients 70 Years of Age or Older
Authors: Har-El Gady , Sidi Jack , Kahan Ernesto , Segal Karl , Abraham Aristide
Published: October 2014

This report presents our experience with 50 thyroid cancer patients 70 years of age or older, out of 606 patients of all ages. Comparing this series to those describing thyroid cancer patients of all ages, we found that thyroid carcinoma in the 70 + age group presents at a more advanced clinical stage, behaves more aggressively, and has a higher death rate. These findings are attributed mainly to the higher incidence of undifferentiated carcinoma and the more aggressive course of the differentiated types of carcinoma in the older age group. If suspected thyroid nodules are managed by initial radical treatment, carcinoma can be diagnosed earlier and patients will survive longer.
Osteogenic and Chondrogenic Sarcomas of the Jaws
Authors: Batsakis John G.
Published: October 2014

Osteosarcomas and chondrosarcomas are the most common malignancies of the jaw bones, in which the incidence is approximately 10% of their total distribution. The mandible is the bone of predilection for osteogenic sarcoma, the maxilla for chondrosarcoma. Both sarcomas are preponderantly locally invasive lesions that resist control, with 5-year cure rates less than 50% for either sarcoma.
Phonatory Effects of Thyroid Cartilage Fractures
Authors: Stanley Robert B. , Cooper Donald S. , Florman Steven H.
Published: October 2014

Blunt trauma can cause a wide range of injuries to the cartilaginous framework of the larynx. The severity of injury that is required to cause a permanent disorder of vocal function if left untreated has not been defined. A study using excised canine and human larynges was undertaken to identify the effects of minimal displacement or malalignment in simulated thyroid cartilage fractures on selected voice production measurements. These fractures were found to cause changes in glottal configuration sufficient to affect glottal resistance as well as amplitude and noise content of the voice signal produced by each larynx. Therefore, relatively minor injuries of the thyroid cartilage may cause potentially serious disorders of phonation.
Monoclonal Antibodies: The Coming Revolution in Diagnosis and Treatment of Human Disease
Authors: Price Brandon J.
Published: October 2014

Hybridoma technology has revolutionized the diagnosis of human disease. Owing to the unique specificity of monoclonal antibodies (MABs) of murine origin, hundreds of highly sensitive, accurate in vitro diagnostic tests have been developed for clinical laboratory and athome use. Major research efforts are now underway to exploit this specificity for direct therapeutic purposes: MABs are being used by themselves in treating lymphomas, and in conjugated form with radionuclides, toxins, and chemotherapeutic drugs to treat a variety of tumors. Human MABs now are being tested in tumor imaging and for treatment of infectious diseases. New technologies have been developed to alter the genetic structure of MABs (eg, chimeric antibodies) to increase their treatment efficacy. As development of therapeutic uses for these reagents continues and, especially, as they receive approval for general clinical use, hundreds of kilograms per year will have to be produced. This paper reviews some of the recent developments in this area and describes two novel technologies that have been developed for large-scale cultivation of hybridoma cells.
Congenital Laryngeal Anomalies Associated with Tracheal Agenesis
Authors: Holinger Lauren D. , Volk Mark S. , Tucker Gabriel F.
Published: October 2014

Forty-eight cases of tracheal agenesis have been reported to date. Previous authors have studied gross postmortem laryngeal specimens. Of 37 cases wherein laryngeal findings were mentioned, only 14 were reported to be abnormal. This report details two more cases of tracheal agenesis and includes a detailed histopathologic study of the laryngeal anomalies by serial horizontal section. Although one of these specimens appeared normal at autopsy, both were found to have several abnormalities when studied microscopically in horizontal section. Both have an elliptical cricoid cartilage, an abnormality originally discovered by one of us (G.F.T.) using the same technique.
Telescopic Endolaryngeal Surgery
Authors: Loré John M.
Published: October 2014

Magnification for endolaryngeal visualization, biopsy, and removal of benign lesions and carcinoma in situ is achieved using a telescope inserted in stripping type forceps. The combined telescope and forceps are passed easily through any standard laryngoscope with a holder. Excellent visualization is achieved through the telescope, which can be provided with 0°, 30°, or 70° optics. In most circumstances, these instruments obviate the use of the operating microscope, being simpler and just as exact. The field of vision, however, is smaller. The instruments are also ideal for cervical tracheoscopy and mediastinoscopy.
Phonatory Airflow Analysis in Patients with Laryngeal Disease
Authors: Woo Peak , Colton Raymond H. , Shangold Lee
Published: October 2014

Phonatory airflow was recorded in 150 patients with various laryngeal diseases and in 60 persons with normal voices. All subjects produced several sustained vowels at different loudness levels. Disturbances of voice due to laryngeal disease may be manifested as variations of mean flow (DC), alternating flow (AC), or as a variation in the amplitude of the frequency components of the airflow signal (frequency spectra). The quantification of airflow characteristics is important if the clinician is to have a better understanding of laryngeal disease. Furthermore, preoperative and postoperative analysis can serve to document therapeutic effectiveness.
Management of Patients with Long-Term Tracheotomies and Aspiration
Authors: Gilbert Ralph W. , McIlwain Jeff C. , Bryce Douglas P. , Ross Ian R.
Published: October 2014

The purpose of this study was to develop a management protocol for patients with long-term tracheotomies and aspiration, in order to develop clinical criteria for extubation and reduction of aspiration-related complications. We studied 39 patients with tracheotomies in place for over 3 months, 28 of whom completed management. Patients were classified according to degree of impairment and managed with the aims of avoiding aspiration and performing extubation whenever feasible. Criteria for choosing various management strategies are presented.