bluuebunny/crossref_metadata_2025 huggingface dataset:
Tympanostomy tubes and otic drops
Authors: Meyerhoff William L. , Morizono Tetsuo , Wright Charles G. , Shaddock Lynn Carlisle , Shea Donald A. , Sikora Michael A.
Published: October 2006

Otic drops have been proposed as a form of prophylaxis against the otitis media which follows middle ear contamination by water in patients with tympanostomy tubes. The potential adverse effects of this form of therapy were studied in chinchillas with tympanostomy tubes; 31 chinchillas underwent bilateral tympanostomy tube insertion. Seven animals had a mixture of green dye and Cortisporinotic suspension placed in both external auditory canals 24 hours following the placement of tympanostomy tubes and were sacrificed 30 minutes later for gross examination; 3 of these animals had previous eustachian tube obstruction with Silastic sponge. Twenty‐one animals had Cortisporinotic suspension placed in the right external auditory canal on postoperative days 3, 4, 5, 6 and 7. No otic drops were placed in the left ear. Ten of these 20 animals had VIIIth nerve action potentials measured on postoperative day 17 and the other 11 animals had VIIIth nerve action potentials measured on postoperative day 42 followed by immediate sacrifice for histological examination and scanning electronmicroscopy. The remaining 3 animals had VIIIth nerve action potentials measured 21 days following tympanostomy tube insertion and served as electrophysiological controls.

The 8 ears receiving Cortisporinotic drops mixed with green dye from animals with normal eustachian tubes showed staining of the round window membrane at sacrifice, while the 6 ears receiving Cortisporinotic suspension and green dye from animals with eustachian tube obstruction demonstrated no dye in the middle ear. All animals receiving Cortisporinotic drops in the right ear showed an intra‐aural difference in action potentials with the right ear being attenuated by an average of 10.3 dB at 2,000 Hz, 12 dB at 4,000 Hz, 21 dB and 8,000 Hz, and 26 dB at 12,000 Hz. Morphological study revealed hair cell loss in the hook portion of the cochlea in those animals receiving Cortisporinotic drops. It was concluded from this study that, in patients with patent tympanostomy tubes in place, potentially ototoxic topical agents should be used with caution.
Primary tumors of the facial nerve: Diagnosis and management.
Authors: Pillsbury Harold C. , Price Harvey Craig , Gardiner Linda J.
Published: October 2006

Benign primary tumors of the facial nerve are frequently misdiagnosed because of variable and subtle clinical manifestations. Three such cases of facial nerve neuroma seen in the past 3 years will be presented. Difficulties in patient assessment including the lack of specificity for topographic testing, as well as the capricious behavior of the facial nerve in these patients will be discussed. The efficacy of diagnostic techniques presently available and in use including computerized tomography and electrodiagnostic studies will be discussed. Diagnosis of these tumors might generally be thought to be straightforward and easier with the advent of new diagnostic techniques, but this has, in fact, not been the case. Techniques for removal and repair will be presented. The combined approach utilizing the mastoid and middle fossa will be presented.
Facial nerve grading systems.
Authors: House John W.
Published: October 2006

A comprehensive, accurate, and valid system for reporting results of facial nerve surgery and disease is needed. This study describes and statistically analyzes eight currently available systems for reliability, validity, and ease of use. They are divided into three grading categories: gross scales, regional systems, and specific scales. Botman and Jongkees, May, and Peitersen have proposed five‐point gross scales. Janssen, Smith, Adour and Swanson, and Yanagihara have devised regional systems. Stennert has proposed a specific criteria scale.

Fifteen otologists experienced with facial nerve problems used modifications of the existing scales to evaluate videotapes of 12 patients representing the complete range of facial function. The observers' responses were translated back to the original scales. Observers also ranked patients from least to most severe, to obtain an accurate assessment of facial function for patients in the study. A follow‐up questionnaire examined observers' system preferences.

Validity is measured by correlating responses to different scales and by comparing responses to each scale with observers' rankings. All scales have good validity except the scales of Stennert and Yanagihara.

Consistency of responses is determined by reliability coefficients. Coefficients for all scales are high except for the gross scale, which is moderately reliable, and the Stennert scale, which is unreliable.

Results indicate that all scales succeed in evaluating patients with normal function or total paralysis. The regional scales have the highest reliabilities but they also have wide response ranges. Most also assume a level of precision that is unsubstantiated. Gross scales have smaller ranges, which result in greater agreement of responses but lower reliability. Comparisons to more complex scales show that the simpler gross scales convey similar information about patients.

The study concludes that a gross scale is the best type of system and proposes a new scale for international acceptance. This system has six categories, includes secondary defects, is designed to clearly differentiate between moderate degrees of dysfunction, and should facilitate interpretation and communication of facial nerve results.
Solving ossicular problems in stapedectomy
Authors: Lippy William H. , Schuring Arnold G.
Published: October 2006

Three unusual ossicular problems encountered in stapedectomy are: floating stapes footplate, partial absence of the incus long process, and otosclerosis combined with a fixed malleus. The surgical techniques advocated in solving these problems are: placing a Robinson prosthesis on the floating footplate, utilizing the Lippy modification of the Robinson prosthesis for the problem incus, and performing only a stapedectomy for malleus fixation and otosclerosis. The hearing results in 242 cases were quite satisfactory and no patient had a further sensorineural loss.
The quix test
Authors: Hart Cecil W.
Published: October 2006

Professor Doctor F. H. Quix, of Utrecht, was a keen student of macular function, who published extensively at the beginning of this century. He described many useful tests for otolithic function, and one in particular has continued to be fairly widely used.

The so‐called “Quix Test” is performed with the patient standing, feet slightly apart, arms outstretched, index fingers extended, and the examiner assumes a similar mirror‐image posture, such that the fingertips almost touch. The patient is then requested to close his eyes, and the index fingers are observed for drift. The lateralizing value of this sign of vestibular disease is discussed.
Congenital hypoplasia of the depressor anguli oris muscle in the differential diagnosis of facial paralysis
Authors: Millen Steven J. , Baruah J. K.
Published: October 2006

Facial paralysis presents an interesting diagnostic challenge. Etiologies ranging from facial nerve neuromas and CPA tumors to inflammatory disease and traumatic injuries need be considered and evaluated. However, an asymmetric facial appearance may result from abnormalities of facial musculature as well as facial innervation. Two cases of congenital hypoplasia of the depressor anguli oris muscle, a child and an adult, are reviewed to examine its presentation and diagnostic differentiation from other forms of facial paralysis. Photographs presenting the facial deformity and electrodiagnostic studies will be reviewed.
Expansion hyoidplasty: A potential surgical procedure designed for selected patients with obstructive sleep apnea syndrome. Experimental canine results
Authors: Patton Timothy J. , Thawley Stanley E. , Waters Robert C. , Vandermeer Peter J. , Ogura Joseph H.
Published: October 2006

Some patients with “idiopathic” obstructive sleep apnea syndrome have an inspiratory, circumferential, passive collapse of the hypopharyngeal lumen as the mechanism of airway obstruction. Permanent tracheotomy has offered documented dramatic resolution of the airway obstruction with reversal of the associated cardiopulmonary sequelae. Tracheotomy is not, however, without psychological and physical complications detracting from its use. In hope of developing a surgical alternative, the expansion hyoidplasty was conceived. The hyoid bone is transected just medial to each lesser cornu. The trisected hyoid bone is then held in an expanded position by a permanent stainless steel brace. The greater cornua with attached middle constrictor and hyoglossus are moved laterally, while the body of the hyoid with attached geniohyoid and genioglossus shift the base of tongue anteriorly. The procedure is potentially reversible. Twenty dogs were studied pre and posthyoid expansion. Superior hypopharyngeal pressure‐volume and closing pressures were obtained on 10 dogs. The pressure‐volume studies demonstrate a consistent expansion of the superior hypopharynx. The average drop in pressure varied from 2.9 to 12.4 cm H2O in different animals. All posthyoid expansion dogs showed an average increase in closing pressure ranging from −4.4 to −28.3 cm H2O. Deglutition and laryngeal competence were not grossly effected. These results support the continued experimentation towards implementation of the expansion hyoidplasty in humans.
Significance of apparent intratympanic meningiomas
Authors: Rietz Daniel R. , Ford Charles N. , Kurtycz Daniel F. , Brandenburg James H. , Hafez Gholam R.
Published: October 2006

Meningioma is the most common tumor of the central nervous system, but it has only been reported in 79 patients to involve the temporal bone. The 4 cases presented here show striking clinical similarity to a subgroup of 20 meningiomas reported to be entirely intratympanic; however, in each instance the extent, origin, and potential of the disease was not initially evident.

Precise histopathologic diagnosis may be aided by electron microscopy. Current concepts of embryology lend credence to the possible role of arachnoid endothelial cells in the pathogenesis of intratympanic meningioma.

An advanced intracranial meningioma may be overshadowed by the hearing loss, tinnitus, and otalgia calling attention to an intratympanic component. The clinician should remain suspicious of intracranial disease even after excision of an apparently well circumscribed intratemporal lesion. Progessive sensorineural hearing loss and persistent otalgia portend recurrent or intracranial disease. Follow‐up for at least 10 years with judicious use of CT scans is suggested.
Endolymphatic mastoid shunt for treatment of meniere's disease: A five year study
Authors: Goldenberg Robert A. , Justus Molly A.
Published: October 2006

The endolymphatic mastoid shunt seems to be an effective treatment for those patients whose Meniere's disease is refractory to medical and/or supportive treatment. This series is composed of 48 patients who were followed for up to 5 years postoperatively, with 1 year being the minimum follow‐up period; 81% of these patients obtained a satisfactdory relief of their vertigo. The morbidity of the procedure is low with no severe or total hearing loss reported in this series. Surgery should not be recommended until the symptoms have caused severe incapacitation; however, this delay must be tempered by the desire to operate while the hearing is still fluctuating. One of the most important factors in the surgical success may be the exact identification and exposure of the sac at the time of surgery, regardless of the specific shunt technique used. Shorter duration of symptoms and lack of fluctuant hearing loss may be preoperative factors which predict a less satisfactory surgical result. While the endolymphatic shunt procedure is effective in the majority of cases, the patient should be prepared for a secondary procedure if necessary.
Tracheoesophageal speech: Vocal rehabilitation after total laryngectomy
Authors: Singer Mark I.
Published: October 2006

Treatment of laryngeal cancer has evolved over nearly 100 years and includes many methods to conserve the function of speech. It was understood from the inception of total laryngectomy that diversion of exhaled pulmonary air into the pharynx or esophagus would produce satisfactory speech. The effect on safe deglutition of the phonatory fistulae limited the wide applicability of these techniques.

The introduction of a silicone bivalve device for use in a tracheoesophageal tunnel permits large numbers of laryngectomees to use tracheoesophageal speech. Acoustic, intelligibility, and aerodynamic studies arc described for four laryngectomees and reveal that this method more nearly approximates normal laryngeal speech than conventional esophageal speech. The criteria for contemporary treatment of laryngeal carcinoma are not altered by this rehabilitative method, and expected survival rates are not likely to be affected. The findings and analysis of this method of alaryngeal speech rehabilitation may have important implications for future therapy of laryngeal carcinoma.
Selective application of ct in the management of laryngeal trauma
Authors: Schaefer Steven D. , Brown Orval E.
Published: October 2006

The clinical course of five patients with varying degrees of laryngeal trauma are presented to illustrate the predictive value of computed tomography (CT) in the management of laryngeal trauma. Computed tomography visualizes well the laryngeal skeleton, soft tissues and airway in the injured larynx. Cost effectiveness of CT scanning is an important consideration, and the authors have chosen their case examples to restrict this examination to selected patients.
Histologic findings in a larynx reconstructed by a nasoseptal autograft after partial laryngectomy
Authors: Laurian N. , Zohar Y. , Turani H.
Published: October 2006

In the course of a 5‐year follow‐up of 16 patients who underwent plastic reconstruction of the larynx by a nasoseptal graft after extended frontal and frontolateral laryngectomies, one of them developed local recurrence of squamous cell carcinoma and was totally laryngectomized.

Histological studies were made of the grafted cartilage and its mucosal lining. The microscopic findings are reported.
Endoscopic laser repair of posterior glottic, subglottic and tracheal stenosis by division or micro‐trapdoor flap
Authors: Dedo Herbert H. , Sooy C. Daniel
Published: October 2006

Laryngeal and tracheal stenosis have been refractory to a wide variety of treatments including dilation, stents, or have required major open operation, e.g., laryngofissure with and without skin or mucosal grafts and segmental resection with larynx release. Adequate airway even when achieved was frequently at the expense of voice quality and significant morbidity or mortality.

A new highly successful endoscopic technique is described for the treatment of posterior glottic stenosis (apparent bilateral vocal cord paralysis), subglottic stenosis, and tracheal stenosis up to 1 cm thick. The procedure involves the endoscopic use of the CO2 laser, and a micro‐trapdoor mucosal flap. Ninety percent of the patients in the group studied obtained an adequate airway with good voice quality and no tracheotomy was required in those patients not already having one. In 19 patients there was no mortality and essentially no morbidity.
Retropharyngeal abscess – a ten‐year experience
Authors: Barratt George E. , Koopmann Charles F. , Coulthard Stanley W.
Published: October 2006

The authors present an extensive review of current literature as well as their ten‐year experience in management of patients with retropharyngeal abscesses. Emphasis is placed upon age, sex, type and duration of symptoms, bacteriology, methods of diagnosis, therapy, and complications. The author's series reveals that retropharyngeal abscesses are found in adults, there is a wide spectrum of bacteriological organisms represented, and with appropriate antibiotic and surgical management the majority of patients survive without major residual sequelae.
Role of the mastoid in tympanic membrane reconstruction
Authors: Jackler Robert K. , Schindler Robert A.
Published: October 2006

Otologists have long debated the importance of the mastoid in determining the success or failure of tympanic membrane reconstruction. The pneumatic spaces within the mastoid represent an “air reservoir” which can be drawn upon during periods of eustachian tube dysfunction and buffer the middle ear against the development of detrimental negative pressures. Mastoid inflammatory disease, if untreated, may result in recurrent suppuration and graft failure. Small mastoid volume, aside from its well known association with chronic infectious middle ear disease, has been shown to effect adversely graft survival following myringoplasty. In 48 patients undergoing myringoplasty with simple mastoidectomy, neither small mastoid size nor inflammatory mastoid disease significantly decreased the rate of graft healing. This suggests that simple mastoidectomy is an effective means of repneumatizing the mastoid and eradicating mastoid sources of infection. The successful surgical creation of a pneumatized mastoid cavity in communication with the middle ear was confirmed by postoperative computerized tomographic (CT) scans. In failed cases, CT scanning predictably identified residual mastoid disease. Simple mastoidectomy is considered to be a safe and useful adjunct to myringoplasty in selected cases of chronic otitis media with perforation.
Autoimmunity and inner ear disorders: An immune‐complex mediated sensorineural hearing loss
Authors: Veldman Jan E. , Roord John J. , O'connor Alec F. , Shea John J.
Published: October 2006

An immune‐complex mediated form of autoimmune disease is described with the inner ear as one of its target organs. Around 40 dB bilateral sensorineural hearing loss improved on short‐term corticosteroid therapy to normal levels. This case report is presented against the background of a general survey on autoimmunity and inner ear diseases. Cellular and humoral immune reactions may be etiologic moments in an audiovestibular dysfunction of autoimmune character.
Otosclerosis And Otospongiosis: Clinical and histological comparisons
Authors: Parahy Christian , Linthicum Fred H.
Published: October 2006

The simultaneous ocurrence of otosclerosis and otospongiosis in the same lesion is well documented. The logical sequence of events would seem to be softening and destruction of the bone by the otospongiotic lesion, which is subsequently converted to otosclerosis. Examination of 46 temporal bones had led us to further classify the lession as: 1. an active lession, both otospongiotic and otosclerotic, 2. an inactive lesion, also both otosclerotic and otospongiotic, or 3. a fibrous lession.

Hyalinization of the spiral ligament only occure adjacent to active otospongiotic or very large otosclerotic lesions. If the lesion adjacnet to the spiral ligament is inactive, there is no hyalinization. It seems illogical that a hyalinized spiral ligament will return to normal when the lesion changes from active otospongiosis to inactive otosclerosis.

Otospongiotic and otosclerotic lesions are found side by side at the periphery of lesions, and both are adjacent to normal bone. These findings have implications concerning the mode of action of sodium fluoride and other medications that are under evaluation for the control of the sensorineural hearing loss due to otosclerosis.
Injectable collagen in laryngeal rehabilitation
Authors: Ford Charles N. , Martin Douglas W. , Warner Thomas F.
Published: October 2006

Glottic insufficiency has been successfully managed by Teflonr̀ augmentation of paretic vocal cords over the past two decades. Collagen fulfills the criteria for a suitable bioimplant and is an attractive alternative as it is a normal constituent of the extracellular protein matrix. This study explores the use of modified bovine collagen injected into the canine larynx. Clinical situations are simulated by creating lesions and injecting collagen at different sites. The technique permits precise placement and quantification. Histologic study of the collagen implant fails to show evidence of significant foreign body reaction. The injected collagen appears similar to viable connective tissue and is colonized by host fibroblasts and nourishing capillaries.
Total en bloc resection of the temporal bone and carotid artery for malignant tumors of the ear and temporal bone
Authors: Graham Malcolm D. , Sataloff Robert T. , Kemink John L. , Wolf Gregory T. , Mcgillicuddy John E.
Published: October 2006

A technique for single stage totalen blocresection of the temporal bone and infratemporal carotid artery with immediate reconstruction has been described. This formidable procedure requires the collaborative efforts of neurotologic skull base surgeons, neurosurgeons, and head and neck surgeons.

Two patients have undergone this procedure; one with squamous cell carcinoma and one with extensive basal cell carcinoma. The quality of life following this procedure is adequate and the cosmetic deformity can be minimized. Longer follow‐up is necessary to determine the value and overall impact of this approach to cancer of the temporal bone on disease free interval and patient survival. Further experience with the technical aspects of this procedure should reduce the operating time, blood loss, and resultant morbidity.
One day VS. two days of prophylactic antibiotics in patients undergoing major head and neck surgery
Authors: Fee Willard E. , Glenn Michael , Handen Cynthia , Hopp Martin L.
Published: October 2006

Thirty patients undergoing major head and neck sugery were prospectively randomized to receive moxalactam (30 mg/kg) before surgery and for either 3 or 6 doses total postoperatively. Wound infection criteria were carefully specified and serum drug levels were monitored. Overall infection rate was 3%; the single infection occurred in a patient randomized to the 3 dose protocol. There was no statistically significant difference in infection rates between the two groups. Drug serum levels between the groups did not differ and none of the patients developed significant drug side effects.

We conclude that short course prophylaxis is equally effective as more prolonged therapy. Our wound infection rate compares favorably with previous studies and supports the use of moxalactam as a prophylactive antibiotic in major head and neck surgery.
Cervical epidural anesthesia for head and neck surgery
Authors: Wittch Donald J. , Berny James J. , Davis R. Kim
Published: October 2006

Patients with head and neck cancer frequently suffer from chronic obstructive pulmonary disease and arteriosclerotic cardiovascular disease, making them poor risks for anesthesia. Arrhythmogenic inhalation anesthetics along with assisted ventilation used in general anesthesia further complicate the intraoperative, as well as the postoperative, course.

Cervical epidural anesthesia has been employed in a number of cases of breast and upper thoracic surgery at Walter Reed Army Medical Center with remarkable success. It has also been used in chronic pain control. We described the use of cervical epidural anesthesia for a neck dissection. The technique of placing 0.5% Marcaine® at the level of C7‐T1 is described.

Indications, limitations, complications, and the potential uses of cervical epidural anesthesia in head and neck cancer patients are discussed.
Phaeohyphomycosis of the maxilloethmoid sinus caused by drechslera spicifera: A new fungal pathogen
Authors: Sobol Steven M. , Love Rick G. , Stutman Harris R. , Pysher Theodore J.
Published: October 2006

“Phaeohyphomycosis” refers to soft tissue and systemic infections caused by dematiacious septate fungi. Drechslera spicifera, a dematiacious fungus, rarely pathogenic in humans was found to cause maxilloethmoid sinus disease in two immunocompetent children. The clinical presentation was similar to noninvasive aspergillosis. Intracavitary surgical excision without adjuvant chemotherapy resulted in apparent cure. The microbiologic and clinicopathologic aspects of this mycotic sinus disease are reviewed and discussed in relation to the entire spectrum of human disease reported which has been attributed to this organism.
Corticosteroid management of airway hemangiomas: Long‐term follow‐up
Authors: Hawkins Donald B. , Crockett Dennis M. , Kahlstrom Emily J. , Maclaughlin Eithne F.
Published: October 2006

Nine children with airway obstructing hemangiomas were managed with corticosteroid therapy for durations of 6 weeks to 17 months. One patient required a tracheotomy. Steroid therapy improved the airways of the other 8 patients. Therapy was continued for 8 months or longer in 6 patients, none of whom developed life‐threatening infections. Examinations 1½ to 7½ years after therapy revealed all of the patients to be within normal range for height and weight, but 3 of the 6 patients treated for 8 months or longer were in the lower range of normal. Steroid therapy is an effective method of protecting the airway in some patients with hemangiomas. Its disadvantage is that therapy may be necessary for several months. The risk of infections and growth suppression is minimized by using small maintenance dosage and alternate day therapy.
Post‐traumatic cholesteatoma of the external auditory canal
Authors: Brookes Gerald B. , Graham Malcolm D.
Published: October 2006

Post‐traumatic cholesteatoma of the external auditory canal is a rare condition which is not mentioned in any of the American or British otological reference works. Three cases are described, and the pathogenesis, management, and medico‐legal implications discussed.
Surgical management of meniere's disease with endolymphatic sac decompression by wide bony decompression of the posterior fossa dura: Technique and results
Authors: Graham Malcolm D. , Kemink John L.
Published: October 2006

The results of wide bony decompression of the posterior fossa in 49 consecutive individuals with idiopathic unilateral Meniere's disease are reported. These results are similar to many previously published series, 71% of individuals are free of vertigo and 86% have unchanged or improved hearing. Utilizing the classification proposed by the American Academy of Ophthalmology and Otolaryngology, 73% fell into Class A, B, or C with relief of vertigo.

These results together with the low complication rate encourages us to consider surgery at an earlier date, hoping to stabilize hearing at a more useful level and to relieve vertigo.
Laryngeal carcinoma in childhood. Report of a case and review of the literature
Authors: Laurian N. , Sadov R. , Strauss M. , Kessler E.
Published: October 2006

A rare cose of an 8½ year old boy with a stage III well differentiated squamous cell carcinoma of the larynx, which responded to chemotherapy and irradiation, is reported. It is the 56th cose in children up to 15 years of age and the 20th case in children 10 years old or younger reported since 1868.

Carcinoma of the larynx in children has similar clinicopathological features to those of adult laryngeal carcinoma, but markedly differs as concerning sex incidence ratio. The main differential diagnosis is juvenile papillomatosis and the principal risk factor is previous cervical irradiation. Delayed diagnosis is frequent since clinical manifestations might be attributed to the normal laryngeal maturation process or to a common respiratory infection. Treatment is problematic, for special effort must be made to preserve laryngeal anatomy and function and to avoid complications. Prognosis of childhood laryngeal cancer is unclear since the reported survival rates are not tumor stage related.
Evaluation of speech of laryngectomees after the amatsu tracheoesophageal shunt operation
Authors: Amatsu Mutsuo , Kinishi Minoru , Jamir Joselito C.
Published: October 2006

Fourteen patients were evaluated by a number of tests to analyze the voice produced following the senior author's surgical technique for speech rehabilitation.

The parameters used were sustained duration of the prolonged vowel, counting per breath, syllables per breath, words per breath, and words per minute for quantitative determination. The qualitative parameters used were pronunciation accuracy, level of intelligibility and adequacy. The results obtained were better than those of esophageal speakers and approximate laryngeal voice.

A comparison of relative advantage over other rehabilitative procedures is presented.
Internal carotid artery thrombosis following soft palate injuries: A case report and review of 16 cases
Authors: Hengerer Arthur S. , Degroot Terry R. , Rivers Robert J. , Pettee Daniel S.
Published: October 2006

Sixteen cases with soft palate lacerations and neurologic sequelae secondary to internal carotid artery injury are presented and reviewed. In all 16 cases, it is probable that blunt trauma to the internal carotid artery produced an intimal tear causing an intraluminal thrombus to form. Within 48 hours of injury all patients demonstrated varying degrees of neurologic deficit with 5 deaths.

This article recommends the following treatment protocol for these cases: 1. admission for 48 hours observation; 2. early ultrasound or angiography at first sign of neurologic changes; 3. immediate anticoagulation if internal carotid artery occlusion is discovered; 4. surgery is usually inappropriate as the thrombus presents in the inaccessible skull base or may embolize during attempted removal.

The present case represents the result of this formulated treatment protocol.
Pulsatile tinnitus: A dehiscent jugular vein
Authors: Rouillard Roger , Leclerc Jacques , Savary Paul
Published: October 2006

A case is reported of n female patient with subjective tinnitus synchronous with her pulse, in the left ear. A dehiscent high seated jugular vein was found in the middle ear. A surgical technique is presented using a septal cartilage homogrnft to cover the dehiscent vein.
Sino‐Orbital aspergillosis associated with total ophthalmoplegia
Authors: Yumoto Eiji , Kitani Shinji , Okamura Hlroshi , Yanagihara Naoaki
Published: October 2006

Invasive aspcrgillosis of the paranasal sinuses involving the orbit is termed sino‐orbital aspergillosis. Prognosis of sino‐orbital aspergillosis, complicated by impaired visual acuity and neurological signs, is disastrous and usually fatal. We herein report two patients with sino‐orbital aspergillosis associated with total ophthalmoplegia. One patient was successfully treated with surgical eradication including orbital exenteration. In contrast, the other died of cerebral infarction, probably due to fungal thrombosis of the middle cerebral artery, despite repeated local debridement followed by orbital exenteration and administration of antifungal agents. Experience with these cases strongly indicates the necessity of prompt surgical eradication, including orbital exenteration if necessary, in the treatment of sino‐orbital aspergillosis.
Histopathology of the temporal bone in osteogenesis imperfecta congenita: A report of 5 cases
Authors: Berger Gilead , Hawke Michael , Johnson Alan , Proops David
Published: October 2006

The histopathologic findings in 8 temporal bones from 5 patients with osteogenesis imperfecta congenita are reported. The otic capsule, bony walls of middle ear, and ossicles showed evidence of both deficient and abnormal ossification. Microfractures were found in the otic capsule and in the anterior process and handle of the malleus, in addition to their common location at the crurn of the stapes. The cochlear and vestibular end‐organs appeared normal. Pathologic changes compatible with otosclerosis were not seen. The possible implication of these changes on hearing and balance is discussed.
Measurement of auditory brain stem potentials in bell's palsy
Authors: Shanon Eliahu , Himelfarb Mordechai Z. , Zikk Daniel
Published: October 2006

Auditory brain stem potentials (ABP) were recorded in 27 patients with Bell's palsy during the early phase of the disease and 1‐3 months later. Pathological findings were observed in 6 patients, the dominant features being prolonged brain stem transmission time and diminished amplitude of the second wave. The extension of the pathological process in the so called idiopathic peripheral facial paralysis appears to vary. The observation of brain stem involvement in some patients with Bell's palsy may have important clinical implications.
The ucsf/storz multichannel cochlear implant: patient results
Authors: Schindler Robert A. , Kessler Dorcas K. , Rebscher Stephen J. , Yanda Jennie L. , Jackler Robert K.
Published: October 2006

Using the four channel cochlear implant system with a vocoder‐based processor developed at UCSF over an extensive period of research, clinical trials of the UCSF/Storz device were initiated in February 1985, under the sponsorship of Storz Instrument Company. To date, 13 patients have been implanted with this device, nine of whom have been fitted with their external processor and transmitter and have received at least their initial postoperative evaluation. Patient results have been extremely promising, with eight of the nine patients obtaining some open‐set auditory only speech understanding. Most patients have demonstrated improvement over time and all patients have attained an enhancement in lipreading ability with the use of the UCSF/Storz device.
Toxic shock syndrome following septoplasty using plastic septal splints
Authors: Wagner Richard , Toback Jeffrey M.
Published: October 2006

Toxic Shock Syndrome (TSS) is an acute multisystem disease that has been recognized to occur in a variety of clinical settings. Postoperative TSS has been described following nasal surgery associated with the use of postoperative nasal packing. We report a case of classic TSS following septoplasty where intranasal splints without nasal packing were used. Recommendations for prevention of TSS associated with nasal surgery are presented.
Mucosal melanoma of the head and neck
Authors: Blatchford Steven J. , Koopmann Charles F. , Coulthard Stanley W.
Published: October 2006

Nine cases of primary malignant melanoma of the upper respiratory tract treated at the University Hospital over the past 10 years are presented. Of the 9 cases, 6 had primary lesions located in the nasal cavity with the remaining 3 presenting in the nasopharynx, hard palate, and larynx, respectively. The authors review presenting symptoms, diagnostic evaluation, current therapeutic modalities, and clinical course in these cases. Specific cases are discussed to emphasize items of clinical or therapeutic importance.
Tumefactive fibroinflammatory lesions of the head and neck
Authors: Olsen Kerry D. , DeSanto Lawrence W. , Wold Lester E. , Weiland Louis H.
Published: October 2006

We use the term “tumefactive fibroinflammatory lesion” to describe an unusual

Although the biologic behavior and the surgical findings suggest that this lesion is an invasive, aggressive malignancy, the histologic appearance is a benign lesion consisting of an admixture of fibrous tissue and inflammatory cells. Treatment has included
Vocal restorative surgery: Why wait?
Authors: Trudeau Michael D. , Hirsch Steven M. , Schuller David E.
Published: October 2006

The case histories of 36 laryngectomees with vocal restorative surgery from the Department of Otolaryngology were reviewed to determine the patient's current mode of speech and number and type of complications to recovery and rehabilitation. The patients comprised two groups: 21 with tracheoesophageal fistula (tef) at the time of laryngectomy (primary) and 15 with tef subsequent to laryngectomy (secondary). Results of the review indicated that while approximately 10% fewer patients in the primary group were using a surgically restored voice, none of the surviving primary group remained aphonic. In contrast, 27% of the surviving secondary group failed to develop some form of verbal communication. When the complication rate is identified, vocal restorative surgery at the time of laryngectomy appeared to be very successful in initiating the rehabilitation process without
Silent otitis media: Clinical applications
Authors: Paparella Michael M. , Goycoolea Marcos , Bassiouni Mokhtar , Koutroupas Steven
Published: October 2006

Silent (masked) otitis media refers to usually chronic pathological conditions behind an intact tympanic membrane which may be clinically “undetected” or “undetectable.” Correlations are described for pathological changes in temporal bones and clinical considerations for 1. silent otitis media associated with Hemophilus influenzae meningitis in infants, 2. silent otitis media — the continuum, 3. silent otitis media — sequelae, and 4. chronic silent otitis media.
Congenital vascular lesions of the head and neck
Authors: Persky Mark S.
Published: October 2006

There is no universally acceptable classification method of treating congenital vascular lesions of the head and neck. An historical perspective, the hemodynamics of arteriovenous fistulas, and the various modalities of treatment are presented. The importance of superselective angiography in studying these lesions is emphasized. Embolization represents a major advance in the treatment of these patients and cooperation between head and neck surgeon and the vascular radiologist is encouraged. The evaluation and treatment of 66 patients with congenital head and neck vascular lesions are presented. The rationale for various types of treatment is reviewed.
Malignant external otitis with optic neuritis
Authors: Holder Clinton D. , Gurucharri Michael , Bartels Loren J. , Colman Marc F.
Published: October 2006

Malignant external otitis(MEO) is a progressive necrotizing infection which spreads to the skull base. The causative organism is usually Pseudomonas aeruginosa and 90% of the patients are diabetic. The infection gains access to the skull base at the temporal bone. Cranial nerve involvement is common. We present a case of malignant external otitis causing blindness due to optic neuritis. Progressive vascular involvement along the skull base is the pathogenic mechanism that best explains spread from the temporal bone to the orbital apex.
The effects of delay in standard treatment due to induction chemotherapy in two randomized prospective studies
Authors: Toohill Robert J. , Duncavage James A. , Grossmam Thomas W. , Malin Thomas C. , Teplin Robert W. , Wilson J. Frank , Byhardt Roger W. , Haas Judith S. , Cox James D. , Anderson Tom , Holoye Paul Y. , Ritch Paul S. , Haas Charles D. , Libnoch Joseph , Hoffmann Raymond G. , Fischer Mary E.
Published: October 2006

It is often suggested that tumors will respond to induction chemotherapy and result in improved survival for patients with squamous cell carcinoma of the head and neck. Two regimens of induction chemotherapy were studied in separate randomized, prospective trials over the last 6 years. Eighty‐three patients with advanced disease were entered into the first study (43/chemotherapy; 40/control), and 60 into the second (27/chemotherapy; 33/control). Patient randomization was stratified by stage (III/IV) and site (oral cavity, oropharynx, nasopharynx, hypopharynx, larynx, paranasal sinuses). The first study utilized bleomycin, Cytoxan,® methotrexate and 5‐fluorouracil in two cycles (one cycle if no tumor response), followed by standard treatment which consisted of combined irradiation and surgery or, in some instances, primary irradiation alone. The second study utilized cisplatin and 5‐fluorouracil in three cycles prior to standard treatment. An objective tumor response to chemotherapy was observed in 68% in the first study and 85% in the second. The patient survival in both studies @ 24 months in the first; @ 19 in the second) was better in the control than that in the experimental groups (43% to 31%; 69% to 46%). In the second study, the average length of delay of standard treatment was longer than in the first study (95 daysvs.66 days;P<.02). Results combining theP‐values of both studies indicate that the relative risk of having persistent disease was 2.9 times greater for patients who received chemotherapy. While toxicity to chemotherapy was not a factor in survival, the number of patients who withdrew from the studies and those who did not comply with treatment were greater in the chemotherapy groups. Except for new drug regimens of exceptional promise, it is recommended that future studies be designed so that chemotherapy is given concurrent with, or following the completion of standard treatment.
The risk for otolaryngologists who treat patients with aids and aids virus infection: Report of an in‐process study
Authors: Sooy C. Daniel , Gerberding Julie L. , Kaplan Michael J.
Published: October 2006

The risk of contracting acquired immune deficiency syndrome (AIDS) is a concern to otolaryngologists and other health care workers. Failure to appreciate this valid concern is dangerous, but overestimating it may be equally injurious to the delivery of good patient care.

We review the data on antibody titers and recovery of cultured virus in blood, saliva, middle ear fluid, cerumen, tears, and nasal mucous. We also report the initial findings of a prospective study of otolaryngologists at the San Francisco General Hospital.

It appears that the risk of transmission of AIDS is low and can be minimized by sound infection control measures similar to those for hepatitis B.
Treatment of hemifacial spasm with transcutaneous electrical stimulation
Authors: Yamamoto Etsuo , Nishimura Hiroko
Published: October 2006

A transcutaneous electrical stimulation method was used to treat hemifacial spasms. This treatment was applied concomitantly with drug therapy to 21 patients, and was found effective in 17 patients (81%). Electrotherapy is considered to be useful in patients with mild spasms and in those with severe spasms for whom surgical treatment is not possible.
Toxic shock syndrome in nasal surgery: A physiochemical and microbiologic evaluation of merocel® and nugauze® nasal packing
Authors: Breda Stephen D. , Jacobs Joseph B. , Lebowitz Arthur S. , Tierno Philip M.
Published: October 2006

A prospective comparison of the microbiologic safety of Merocel® versus NuGauze® nasal packing in 119 surgical patients is presented. Presurgical and postsurgical nasal cultures were obtained, analyzed, and compared. The importance of a preoperative nasal culture isolate of Toxic Shock Syndrome Toxin Number 1 (TSST‐1) producing Staphylococcus aureus in predicting postoperative toxigenic S. aureus isolation and Toxic Shock Syndrome symptomatology is demonstrated. An in vitro comparison of the ability of NuGauze® and Merocel® to amplify TSST‐1 production was performed.
Surgical management of choanal atresia
Authors: Richardson Mark A. , Osguthorpe J. David
Published: October 2006

Our experience with the diagnosis and surgical management of 37 patients with congenital atresia or severe stenosis of both posterior nasal choanae is presented. Twenty‐five were repaired transnasally and 12 were repaired transpalatally. Soft stents were fashioned from Silastic® tubing and used for 6 to 12 weeks postoperatively. In 64% of the transnasal operations and 83% of the transpalatal operations, full patency of both choanae was achieved without the necessity of dilatations. In most of the remaining operations, one lumen remained patent.
Physiologic mucosal changes within the nose and ethmoid sinus: Imaging of the nasal cycle by MRI
Authors: Kennedy David W. , Zinreich S. James , Kumar Ashok J. , Rosenbaum Arthur E. , Johns Michael E.
Published: October 2006

Magnetic resonance studies frequently demonstrate increased T‐weighted signal in the nasal area. To further evaluate this phenomenon, several MRI examinations of the nasal cavity were performed within an 8‐ to 12‐hour period. The study demonstrated that changes alternated from side to side and were interrupted by the administration of topical vasoconstriction, confirming imaging of the normal nasal cycle. Changes were also observed within the ethmoid sinuses. Signal intensity on T‐weighted images during the congested phase was similar to inflammatory mucosa. Occasionally, these changes make interpretation of the extent of pathology difficult in patients with sinus disease, and raise the possibility of inflammatory pathology in asymptomatic patients. Awareness of MRI imaging of nasal cycle should reduce the likelihood of diagnostic errors and provides another method for study of this physiologic phenomenon.
The evolving treatment of necrotizing external otitis
Authors: Kraus Dennis H. , Rehm Susan J. , Kinney Sam E.
Published: October 2006

Necrotizing external otitis, or malignant external otitis, as initially described by Chandler, is a life‐threatening Pseudomonas infection of the external auditory canal and skull base, which occurs most commonly in elderly diabetic patients. Historically, radical surgical intervention was the primary method of treatment. The treatment of choice has shifted during the past 20 years to aggressive systemic antibiotic therapy, with surgery reserved for those patients whose disease is resistant to medical therapy. Using this approach, 19 patients with necrotizing external otitis were treated at the Cleveland Clinic Foundation during the past 8 years. A 90% rate of cure was obtained. The diagnostic approach to patients suspected of having necrotizing external otitis, a classification scheme defining the extent of disease, delivery of systemic antibiotic therapy, indications for surgical intervention, and overall effectiveness of treatment are reviewed.
Peritonsillar and neck abscesses in the pediatric age group
Authors: Dodds Brian , Maniglia Anthony J.
Published: October 2006

A retrospective study was performed on 93 abscesses in children admitted for diagnosis and treatment at Rainbow Babies and Childrens Hospital, University Hospitals of Cleveland, during a 15‐year period from 1972 to 1987. Forty‐five percent were peritonsillar, 20.5% superficial neck, 21.5% submandibular‐submental, 9.6% retropharyngeal, and 3.4% parapharyngeal. All four complications resolved without sequelae. Early diagnosis and adequate treatment were of paramount importance to achieve a low complication rate and a short hospital stay. Bacteriology and antibiotic therapy, as well as surgical treatment, are discussed.
Lipoma and liposarcoma OP the parotid gland: High‐resolution preoperative imaging diagnosis
Authors: Korentager Richard , Noyek Arnold M. , Chapnik Jerry S. , Steinhardt Marvin , Luk Shing C. , Cooter Noel
Published: October 2006

Over the past 7 years, nine fatty tumors within the parotid gland have been managed (eight lipomas, one liposar‐coma). High‐resolution computed tomography examination was carried out in all cases; with correct preoperative diagnosis recorded each time. The computed tomography imaging characteristics of lipoma, liposarcoma, and the differential diagnosis from other fat density lesions, such as a fatty infiltration, appear quite specific.

The liposarcoma and six of the lipomas were resected at formal parotidectomy with facial nerve preservation. Two patients with small intraglandular lipomas have elected to undergo long‐term clinical and imaging observation.

Our experience indicates that high‐resolution, soft‐tissue imaging with computed tomography and magnetic resonance imaging permits consistent preoperative fatty tumor diagnosis. This imaging input facilitates rational treatment decision‐making.