bluuebunny/crossref_metadata_2025 huggingface dataset:
Two-Week Topical Treatment with Essaven Gel in Patients with Diabetic Microangiopathy
Authors: Cesarone M.R. , Incandela L. , Belcaro G. , De Sanctis M.T. , Ricci A. , Griffin M.
Published: January 2017

The involvement of the microcirculation in diabetic microangiopathy (DM) causes of severe incapacitation and ulceration. DM is characterized by a diffuse increase in flux, reduction in venoarteriolar response, associated with increased permeability resulting in edema and altered function of microlymphatics. In DM, skin PO2 is decreased and CO2 increased. In this condition capillary exchanges are altered and nutritional alterations eventually lead to skin lesions and ulcers. The aim of this randomized, placebo-controlled study was to evaluate the effect of local (foot) treatment with Essaven gel (EG) in 35 subjects with DM and neuropathy and localized, small (<0.5 cm in maximum diameter) ulcers treated for 2 weeks. Measurements of laser Doppler (LDF) flux, PO 2, and PCO2 in standardized conditions showed positive microcir culatory changes (a significant decrease of the abnormally increased flux and CO2 white PO 2 increased) in the active EG group. Changes in the control group were not significant. In the placebo group variations were limited (mainly associated with skin manipulation and gel appli cation). In conclusion, local treatment for 2 weeks with standardized application of EG acutely improves the microcirculation in subjects with DM and small ulceration.
Chronic Venous Insufficiency: Dysregulation of Collagen Synthesis
Authors: Sansilvestri-Morel Patricia , Rupin Alain , Badier-Commander Cecile , Fabiani Jean-Noël , Verbeuren Tony J.
Published: January 2017

Varicose vein disease is a common condition. Its pathology is not well characterized. A disor ganization of smooth muscle cells and extracellular matrix components in the venous wall have been described. The objective of this paper is to offer an explanation for the abnormal distensibility of varicose veins. The content of hydroxyproline was quantified in control and varicose human saphenous veins. The synthesis of collagen types I, III, and V was quantified in cultured venous smooth muscle cells and dermal fibroblasts of control subjects and patients with varicose veins. The proportion of collagen type III in the heterofibrils composed by collagen types I, III, and V was calculated. The level of hydroxyproline was increased in varicose veins, suggesting an increased content of collagen. This augmentation of collagen in diseased tissues appears to be correlated with an increase of collagen type I since the collagen I mRNA was overexpressed in varicose veins, whereas collagen type III mRNA was not altered. The quan tification of collagen synthesis in cultured cells shows that proportion of collagen type III was significantly decreased in cultured smooth muscle cells and dermal fibroblasts derived from patients with varicose veins. The results indicate a deficiency in collagen type III in patients with varicose veins. Since collagen type III is involved in tissue elasticity, these results offer an explanation for the abnormal distensibility of varicose veins. Moreover, this defect seems to be generalized in different tissues and argues in favor of a genetic alteration of remodeling in these patients.
Temporal Bone Studies of the Human Peripheral Vestibular System
Authors: Velázquez-Villaseñor Luis , Tsuji Kojiro , Wall Conrad , Merchant Saumil N. , Glynn Robert J. , Rauch Steven D.
Published: January 2017

Scarpa's ganglion cell counts were performed in 106 serially sectioned, normal human temporal bones from 75 individuals. Of these 106 bones, 15 were from neonates less than 30 days old, 14 were from infants between the ages of 1 and 12 months, and the remainder were distributed throughout each decade of life, with sample sizes ranging from 4 to 10 per decade. All temporal bones had to meet 2 criteria: no symptoms or signs of inner ear disease except for presbycusis in the medical case history and no abnormality in the inner ear on light microscopy. The total ganglion cell counts declined significantly with age at an average rate of 57 cells per year. The age-related decline was significantly greater in the superior division than in the inferior division. There was also a significant sex effect, independent of age: for any age, the count in men averaged 1,526 cells higher than in women. There was no significant interaural difference. Mathematical models were developed to compute the mean and 95% prediction intervals for Scarpa's ganglion cell counts in terms of age and sex parameters. The counts and models will serve as a normative database against which to compare counts made in temporal bones from subjects with known vestibular disorders.
Temporal Bone Studies of the Human Peripheral Vestibular System
Authors: Tsuji Kojiro , Rauch Steven D. , Wall Conrad , Velázquez-Villaseñor Luis , Glynn Robert J. , Merchant Saumil N.
Published: January 2017

Quantitative assessments of vestibular hair cells and Scarpa's ganglion cells were performed on 17 temporal bones from 10 individuals who had well-documented clinical evidence of aminoglycoside ototoxicity (streptomycin, kanamycin, and neomycin). Assessment of vestibular hair cells was performed by Nomarski (differential interference contrast) microscopy. Hair cell counts were expressed as densities (number of cells per 0.01 mm2 surface area of the sensory epithelium). The results were compared with age-matched normal data. Streptomycin caused a significant loss of both type I and type II hair cells in all 5 vestibular sense organs. In comparing the ototoxic effect on type I versus type II hair cells, there was greater type I hair cell loss for all 3 cristae, but not for the maculae. The vestibular ototoxic effects of kanamycin appeared to be similar to those of streptomycin, but the small sample size precluded definitive conclusions from being made. Neomycin did not cause loss of vestibular hair cells. Within the limits of this study (maximum postototoxicity survival time of 12 months), there was no significant loss of Scarpa's ganglion cells for any of the 3 drugs. The findings have implications in several clinical areas, including the correlation of vestibular test results to pathological findings, the rehabilitation of patients with vestibular ototoxicity, the use of aminoglycosides to treat Meniere's disease, and the development of a vestibular prosthesis.
Controversies in the Medical Management of Persistent and Recurrent Acute Otitis Media Recommendations of a Clinical Advisory Committee
Authors: Pichichero Michael E. , Reiner Seth A. , Yamauchi Terry , Brook Itzhak , Jenkins Stephen G. , Gooch W. Manford , Sher Lawrence
Published: January 2017

Streptococcus pneumoniae is the predominant bacterial pathogen associated with acute otitis media (AOM), causing an estimated 7 million cases annually in the United States. Bacterial resistance should be considered when selecting an antimicrobial agent for otitis media. Significant increases in drug-resistant S pneumoniae are documented worldwide, and less than 50% of S pneumoniae strains are fully susceptible to penicillin in some regions of the United States. Although amoxicillin is recommended for uncomplicated AOM, treatment guidelines should be flexible and adaptable, taking into consideration local and regional susceptibility patterns, the age of the patient, the frequency of prior infections, and the response to prior therapy. Resistant organisms are more prevalent in children younger than 2 years of age and in those who have recurrent or persistent AOM. Overdiagnosing AOM, selecting inappropriate empiric therapy, or both, leads to overuse and misuse of antibiotics and causes increased drug resistance. This article reviews persistent and recurrent AOM and discusses the pitfalls of diagnosis and the practical limitations of current treatment recommendations.
Value of pH Probe Testing in Pediatric Patients with Extraesophageal Manifestations of Gastroesophageal Reflux Disease: A Retrospective Review
Authors: Bauman Nancy M. , Sandler Anthony D. , Bishop Warren P. , Smith Richard J. H.
Published: January 2017

Extended pH probe testing is often performed in patients believed to have extraesophageal symptoms of gastroesophageal reflux disease (GERD), although for this indication its diagnostic value is not well established. A retrospective review of all patients who underwent pH probe testing between 1994 and 1998 was conducted to determine the outcome of antireflux therapy in the subgroup with probable extraesophageal symptoms of GERD. Sixty-eight patients underwent antireflux therapy and had adequate follow-up after pH probe testing to be included in the study. Fifty-eight patients (85%) responded to antireflux therapy (improved, 44%; cured, 41%). The positive predictive value of distal pH probe testing was greater than 90%, but the negative predictive value was less than 50%. The reproducibility of pH probe testing on different study days was poor, but pH probe testing was helpful in assessing the adequacy of antireflux therapy. The presence of gastrointestinal symptoms did not correlate with the response of extraesophageal symptoms to antireflux therapy. Thirteen patients underwent double-probe pH studies. The mean percent time the pH was less than 4 in the upper esophagus was 2.6% (range, 1% to 9.6%). Twelve of these patients were improved or cured with antireflux therapy. Distal pH probe testing is of limited benefit in predicting whether patients with extraesophageal symptoms of GERD will respond to antireflux therapy. If extraesophageal symptoms of GERD are suspected, patients should undergo an empiric trial of antireflux therapy. Distal pH probe testing should be reserved for assessing the adequacy of antireflux therapy if symptoms persist. A prospective, randomized, controlled study will aid in determining the predictive value of double-probe pH studies in pediatric patients with probable extraesophageal symptoms of GERD.
New Clarion Electrode with Positioner: Insertion Studies
Authors: Lenarz Thomas , Kuzma Janusz , Weber Benno Paul , Reuter Günter , Neuburger Jürgen , Battmer Rolf D. , Goldring Jenny E.
Published: January 2017

A new straight thin electrode array (universal electrode) was designed to be used together with a positioner, which will place the electrode array at the medial wall (modiolus) of the cochlea. The study objectives were to demonstrate safety and ease of insertion, tissue trauma, electrode position, and depth for universal and standard electrodes in human temporal bones; to test functional properties in cats; and to determine the surgical procedure and electrophysiological benefits in a clinical study. The cadaver study demonstrated the ease of insertion for the universal electrode and the positioner without tissue damage. An average gain of insertion depth of 180° was achieved with the positioner. Animal studies demonstrated a reduction in threshold of 6 dB for the electrical auditory brain stem response (EABR). Neither additional cochlear damage nor additional connective tissue formation was found. The intraoperative human study findings showed a marked reduction of threshold for both EABR and stapedius reflex thresholds. Impedances were increased. Plain x-rays demonstrated modiolus proximity of the electrode with the positioner. The new Clarion electrode with positioner is a relatively safe design for providing modiolus proximity. The electrophysiological benefits include reduction of threshold and power consumption.
Analysis of the Suprabullar and Retrobullar Recesses for Endoscopic Sinus Surgery
Authors: Bolger William E. , Mawn Christopher B.
Published: January 2017

Presently, the basic structures and spaces of the paranasal sinuses are more clearly understood by otolaryngologists than ever before. Yet, the more subtle and complex ethmoid features, especially of the ethmoidal pre-recesses and recesses, still elude many otolaryngologists. One of the most nebulous, elusive, and difficult-to-understand recesses is the sinus lateralis, or as it is more correctly called, the retrobullar and suprabullar recesses. The primary purpose of this investigation was to ascertain the prevalence of the sinus lateralis in humans. The secondary purpose was to better characterize this subtle feature of ethmoid anatomy. Human cadaver sinonasal complexes were meticulously dissected by both gross and endoscopic techniques. The hiatus semilunaris superior and sinus lateralis were present in all specimens. A separate and discrete retrobullar recess was present in 93.8%. Typically, a crestlike projection from the basal lamella to the lamina papyracea was noted within the posterior aspect of the retrobullar recess. A single, discrete, well-developed suprabullar recess was present in 70.9%, and a rudimentary suprabullar recess was present in 22.9%. In 7.2%, a single large cleft collectively excavated the retrobullar and suprabullar recess areas; separate retrobullar and suprabullar tracts were not present in this subgroup. Typically, the suprabullar recess was separate from and did not communicate with the frontal recess. The data from this investigation indicate that the separate terms retrobullar recess and suprabullar recess more accurately designate the anatomy and are recommended over the term sinus lateralis.
Assessment of Hearing in Infants with Moderate to Profound Impairment: The Melbourne Experience with Auditory Steady-State Evoked Potential Testing
Authors: Rance Gary , Briggs Robert J. S.
Published: January 2017

Auditory steady-state evoked potential (ASSEP) testing has been used in the assessment of hearing in infants at the University of Melbourne School of Audiology Clinic during the past 10 years. This study examines the evoked potential and behavioral hearing test findings for 200 children in whom permanent, moderate to profound hearing loss was diagnosed with the ASSEP procedure. The ASSEP audiograms were obtained with amplitude and frequency modulated tones at octave frequencies (500 to 4,000 Hz). In 184 infants, the hearing loss appeared to be of sensorineural origin. For these children, there was a strong correlation between ASSEP findings and behavioral thresholds, with Pearson r coefficients ranging from 0.81 to 0.93 with test frequency. As such, the ASSEP findings obtained in the first months of life were accurate enough to form a basis for fitting amplification and early intervention. For the 16 children whose hearing loss appeared to be the result of auditory neuropathy, however, ASSEP thresholds showed little or no relationship to the behavioral audiogram.
Pediatric Outcomes with the Nucleus 24 Contour: North American Clinical Trial
Authors: Staller Steve , Arcaroli Jennifer , Parkinson Aaron , Arndt Patti
Published: January 2017

The Nucleus 24 Contour is a new cochlear implant that has recently undergone clinical trials in adults and children. The Contour uses the same electronics as the previous-generation Nucleus 24 (CI24M) but incorporates a downsized receiver-stimulator and a perimodiolar electrode array. The indications for use were expanded to include children as young as 12 months of age and children 24 months of age and older with severe to profound hearing loss who had open-set word recognition up to 30%. The Contour was successfully implanted in 256 children. The mean level of postoperative speech perception with the Contour was significantly better than the preoperative baseline with hearing aids on all measures. Children who had open-set speech perception in an audition-only condition before surgery demonstrated higher levels of postoperative performance with the Contour than children with no open-set speech perception before surgery.
Postimplantation Audition and Educational Attainment in Children with Prelingually Acquired Profound Deafness
Authors: Boothroyd Arthur , Boothroyd-Turner Dorothy
Published: January 2017

Language and educational attainment were evaluated over a 4-year period in 8 profoundly deaf, orally trained child users of the Nucleus multichannel implant with the spectral peak (SPEAK) processor. The average age at implantation was 5.8 years. In terms of audition and language, these children resembled severely deaf children, with unaided hearing losses in the region of 70 to 75 dB, who use hearing aids. In tests of educational attainment and literacy, average performance lagged behind grade placement by an amount that increased with increasing language demand of the task. The benefits of implantation are considerable; nevertheless, auditory limitations, combined with language deficits already present at the time of implantation, present a continuing educational challenge. Earlier implantation, when the auditory system is more plastic and language delays are automatically minimized, may well produce better outcomes, but this advantage remains to be demonstrated.
Diagnosis of Chronic Rhinosinusitis
Authors: Lanza Donald C.
Published: January 2017

Chronic rhinosinusitis is a multifactorial disease defined as inflammation of the nasal cavity and paranasal sinuses with a history of at least 12 weeks in duration. The major symptoms include facial pressure or pain, nasal obstruction, discharge or purulence, and hyposmia or anosmia. The minor symptoms include fever, halitosis, fatigue, and dental pain. Microorganisms play a significant role in the persistence and origination of the inflammatory process, although the exact role of these organisms in the pathogenesis of chronic rhinosinusitis is unclear. The clinical diagnosis relies heavily on the patient history and physical examination, which may include nasal endoscopy and computed tomography. Diagnostic techniques are here reviewed.
Biopsy and Specimen Collection in Chronic Rhinosinusitis
Authors: Orlandi Richard R.
Published: January 2017

Biopsy, aspiration, swab, and irrigation of the nose and sinuses are methods used in specimen collection and culture when chronic rhinosinusitis is suspected. Biopsy may be indicated to identify the presence of fungal elements in the mucus or tissues, suspected neoplasm, or inflamed bone. Aspiration directly from the maxillary sinus is considered to be the gold standard for culture, but it is painful. Direct endoscopic-guided culture of the middle meatus appears to be a viable substitute, with swab and suction methods having similar rates of microbiological contamination. Topical delivery methods for irrigating sinus cavities may utilize spray bottles, nebulizers, or a bulb syringe; these have various degrees of efficacy in dispersing materials to the sinuses. Use of the bulb syringe appears to offer broad distribution with limited risk of sample contamination. Specimens must be handled carefully to avoid loss of fungal elements. Advantages and indications of various methods are reviewed.
Sinonasal Mucociliary Clearance in Health and Disease
Authors: Cohen Noam A.
Published: January 2017

Although much has been elucidated in the past 170 years concerning the precise mechanism of ciliary function in the healthy or diseased human respiratory system, significant questions remain. The first description of ciliary action is credited to Sharpey in 1835. However, the importance of mucosal function was not apparent until Hilding's investigations of the postsurgical canine sinus demonstrated scar formation and disruption of mucociliary clearance. Subsequently, several techniques for mucosal coverage of exposed bone, most notably by Sewall and Boyden, were reported. The underlying physiology explaining the importance of the mucosa and the concept of mucosal preservation became apparent with the description of the sinonasal mucociliary flow patterns by Messerklinger; and thus the restoration of natural sinus physiology, ie, mucociliary clearance, became the goal of both medical and surgical treatment of sinonasal inflammatory disease. Clearance of benign and pathological substances in the mucus is governed by the propulsive force of the beating cilia and the physical characteristics of the overlying mucus. The respiratory cilia continually beat in a coordinated fashion, and in times of stress (eg, exercise, infection, or fever) ciliary beat frequency increases to accelerate mucus clearance. Thus, upper airway ciliary motility is under dynamic modulation. Multiple investigations incontrovertibly demonstrate a marked decrease in sinonasal mucociliary clearance in patients with chronic rhinosinusitis. Possible explanations for this finding are 1) a reduced basal ciliary beat frequency, 2) an alteration of the viscoelastic properties of airway secretions, and/or 3) a blunted dynamic response of sinonasal cilia to environmental stimuli. Studies of the first two explanations yield conflicting results, and to date, the third possibility remains uninvestigated. A review of the current understanding of the cellular regulation of respiratory ciliary activity and its contribution to chronic rhinosinusitis is presented.
Transnasal Endoscopy-Assisted Skull Base Surgery
Authors: Stamm Aldo M.
Published: January 2017

Skull base surgery (SBS), which originated in the 19th century, became refined in the 20th century in parallel with technological advancements and is now in the midst of further refinements largely driven by advances in endoscopic sinus surgery. With the development of modern SBS, lesions that were once inoperable and potentially fatal can now be eradicated successfully by means of endoscopy-assisted procedures that reduce or completely eliminate intracranial trauma, minimize postsurgical morbidity, and make full recovery possible. It is absolutely mandatory to have the appropriate instrumentation for endoscopy-assisted SBS. Among the new technologies available are advanced endoscopes, high-speed suction irrigation drills, digital video cameras, computed tomography and magnetic resonance imaging, and systems for 3-dimensional computer-assisted image-guided surgical navigation. An experienced endoscopic surgeon working with multidisciplinary teams, and using new instrumentation and techniques, can bring SBS to new levels of success in the 21 st century.
Quantification of the “In Vitro” Development of the Mouse Embryo Inner Ear
Authors: Van De Water Thomas
Published: January 2017

The development of sensory structures in organ cultures of the twelfth and thirteenth gestation day mouse otocysts has been quantified and the expected “in vitro” development may be predicted. The scoring system may be applied to the “in vitro” analysis of congenitally malformed ears in mutant strains of mice.
The Early Development of the Larynx in Staged Human Embryos
Authors: Tucker John A.
Published: January 2017

More than 15 serially sectioned human embryos from stage 8 to stage 15 were examined, together with relevant reconstructions and photographs. Their lengths ranged from 1 to 7 mm, and their ages from 18 to 33 postovulatory days. The necessity of employing a recognized staging system is stressed. The foregut appears either late in stage 8 or during stage 9. The median pharyngeal groove that appears during stage 9 presages the first indication of the respiratory system and includes the future larynx. The laryngotracheal sulcus begins to be circumscribed at stage 10 and a caudal expansion represents the pulmonary primordium. The tracheoesophageal septum appears at stage 12. The right and left lung buds become definite by stage 13. The hypopharyngeal eminence, arytenoid swellings, and epithelial lamina of the larynx are detectable at stage 14. Vestibulotracheal and pharyngotracheal canals are distinguishable at stage 15. Hence, from the first appearance of the foregut at about 19 days, the larynx has developed into a recognizable organ two weeks later, namely, by 33 days.
Visible Laryngeal Changes during Voice Therapy
Authors: Brewer David W. , McCall Gerald
Published: January 2017

Use of a flexible fiber-optic naso-laryngoscope has permitted visualization and identification of laryngeal structures and various abnormalities in patients difficult to examine by mirror laryngoscopy. It has already made possible a fuller appreciation of laryngeal appearances related to both normal and to disturbed physiology. In addition, it has been possible to observe the larynges of three patients during the use of such therapeutic procedures as use of loft register, yawn, sigh, and voice focus; to hear the therapist's requests of the patients; and to observe the patient's immediate laryngeal response as well as listen to his audible response. Such information now makes possible a more definitive treatment plan. As treatment is carried out, documentation of progress and reevaluation is greatly enhanced. The teaching value of this in a field which has had to rely primarily on empirical concepts in the past is noteworthy. Since multiple observers are permitted with the combined laryngoscope video-tape equipment, common bases of image simultaneous with sound, may assist in the development of a workable nomenclature for the many scientific disciplines engaged in research in voice and its major role in the broad field of human communications.
Surgical Correction of Subglottic Stenosis of the Larynx in Infants and Children; Progress Report
Authors: Fearon Blair , Cotton Robin
Published: January 2017

A survey of 25 consecutive cases of severe subglottic stenosis in children and infants, managed conservatively, revealed an unexpectedly high 24% mortality rate. A three year ongoing experimental study in infant primates indicated the feasibility of operative correction of subglottic stenosis without interference with usual laryngeal growth potentials. Initial results in the surgical correction of subglottic stenosis in two patients are very encouraging. For surgical correction of subglottic stenosis we recommend division of the cricoid and upper trachea anteriorly with interposition of autogenous cartilage, without removal of scar tissue, and without internal laryngeal stenting.
Reconstruction of the Tongue
Authors: deFries Hugh O.
Published: January 2017

Total or subtotal glossectomy for carcinomas of the tongue results in severe dysfunction of speech and swallowing. In such cases the larynx is frequently removed to prevent aspiration. In our experience the larynx may be preserved and intelligible speech and swallowing, without aspiration, may be achieved. Two patients were rehabilitated following total glossectomy by means of a tongue prosthesis. In two other patients in whom over one-half of the anterior tongue was removed the tongue was reconstructed by means of a deltopectoral flap.
Laryngotracheal Autograft for Postcricoid Carcinoma; A Reevaluation
Authors: Som Max L.
Published: January 2017

Of 84 surgically treated cases of postcricoid carcinoma, 23 had a pharynxesophageal reconstruction by use of a laryngotracheal autograft. This procedure is most suitable in females with manifestations of the Paterson-Broun-Kelly syndrome. The distal esophagus is not “at risk” because of skip areas or second primary lesions. Failures are due predominantly to inability to control the lymphatic metastasis. Stomal recurrence may be due to ascending metastasis from the tracheoesophageal groove and mediastinum. A routine combined neck dissection is urged in all instances. Mediastinal node extirpation with or without resection of the manubrium may increase survival rate. Adequate surgical exposure with visualization, palpation, and exploration of the extent of the cancer is suggested prior to determination of the method of reconsruction of the pharyngoesophagus. In selected cases without previous radiotherapy the laryngotracheal autograft has proved satisfactory.
Stria Ultrastructure and Vessel Transport in Acoustic Trauma
Authors: Duvall Arndt J. , Ward W. Dixon , Lauhala Kathryn E.
Published: January 2017

One hundred and ten chinchillas were exposed to a 700–2800 Hz noise at 123 dB for 15 minutes. A consistent pattern of ultrastructural pathology within the lateral cochlear wall was found. Significant damage to the stria vascularis was first observed one hour postexposure, reached a peak at 24 hours, and had recovered almost completely by 28 days. Spiral prominence damage was permanent. The pathology included stria widening, temporary disappearance of intermediate cells, alterations of the internal membrane system and abnormal vessel transport. Horseradish peroxidase (HRP) was employed as an indicator of transport from vessels. Transport from the stria vessels was absent when stria ultrastructural abnormality was at a maximum; at other postexposure times, however, abnormally rapid exodus of HRP from the vessels of the stria was observed in animals who had received intravenous injections of HRP 30 seconds prior to sacrifice. On the other hand, no leakage was observed in the animals injected one minute before sacrifice. Theories to explain this transport dichotomy are proposed.
The Present Status of Therapy of Bell's Paralysis: A Critical Evaluation
Authors: Wolferman Adolph
Published: January 2017

The etiology of Bell's paralysis is yet unknown, and is likely to be multiple. The vast majority of patients suffering from Bell's paralysis recover spontaneously, and a certain number do not recover regardless of treatment, nor is there uniformity in the opinion as to what constitutes a full recovery. No investigation has as yet demonstrated beyond a reasonable doubt that any given medical treatment will alter the course of Bell's paralysis under any circumstance or prevent permanent partial or total denervation. At the present time, surgical decompression is the only treatment that deserves serious consideration; however, after a period of great enthusiasm, even surgical decompression is becoming more and more controversial. The evaluation of decompression in Bell's paralysis is as difficult as any other form of treatment. The two formidable problems are: 1) How and when are we able to recognize those cases which will degenerate? 2) How can we determine whether those cases showing evidence of degeneration will not recover spontaneously? The assumption that surgical decompression will prevent denervation has yet to be proven. The nerve excitability test as used in clinical practice is a very crude test and gives only the most rudimentary information of the functional status of the facial nerve. Tests describe a situation at a given moment and have no prognostic significance. Neither the opponents nor the proponents of decompression have been able to prove their point, and the value of decompression remains in doubt. Both a conservative and a more aggressive attitude have justification. Very extensive clinical investigations are required to prove or disprove the value of decompression in Bell's paralysis.
Experimental Results of Autogenous Cancellous Bone Chips Transplanted into the Canine Frontal Sinus Cavity
Authors: Abramson Allan L. , Eason Robert L. , Pryor William H. , Messer Eugene J.
Published: January 2017

Autogenous marrow-cancellous bone chips were transplanted into 36 canine frontal sinus cavities and studied over variable postoperative periods by radiographic and histologic methods. Cysts lined with frontal sinus mucosa were noted to enlarge progressively between three and 26 weeks. Cysts which originated from the ectoturbinate scroll frequently went on to communicate with the nasofrontal duct (neocavitation). If no cystic formation developed, this loosely packed autograft eventually was transformed into organized cancellous bone, thus obliterating the sinus cavity. When external frontal contour was evaluated, good results were obtained when the cavity was completely filled with cancellous autograft. If partial filling of the sinus cavity was performed, a variable amount of depression was noted.
Mechanics of the Eustachian Tube as it Influences Susceptibility to and Persistence of Middle Ear Effusions in Children
Authors: Bluestone Charles D. , Beery Quinter C. , Andrus W. Scott
Published: January 2017

Middle ear pressures were assessed by tympanometry in a group of 56 children with concurrent or recent middle ear effusions, prior to myringotomy and tympanostomy tube insertion. Following myringotomy, the ventilatory function of the Eustachian tube was studied. Of the 104 ears tested, 76 (73%) had measured premyringotomy middle ear pressure between −100 and −400 mm H2O, or indeterminate middle ear pressure. Following myringotomy, most of the Eustachian tubes of children with prior otitis appeared to be more “floppy,” when compared with tubes of patients with traumatic perforations and an otherwise negative otologic history. Certain hypotheses have been presented regarding the mechanics of the system constituted by the nasal cavity, nasopharynx, Eustachian tube, middle ear and mastoid air cells as they influence susceptibility to, and persistence of, middle ear effusions.
Growth of the Inner Ear in Organ Culture
Authors: Van De Water Thomas , Ruben R. J.
Published: January 2017

An organ culture system is presented for the mammalian inner ear. The development of the inner ear is recorded with time lapse cinematography and conventional histological techniques. The system allows for morphological development of differentiation of the neurosensory structures of the inner ear. The use of the organ culture system as a research tool for the understanding of normal and abnormal development of the inner ear is discussed.
Tucker Retrograde Esophageal Dilatation 1924–1974
Authors: Tucker John A. , Silberman Harvey D. , Turtz Myles L. , Tucker Gabriel F.
Published: January 2017

Emphasis has been placed on a historical review of corrosive ingestion in the last 175 years with particular reference to etiology, diagnostic technique, therapy and sociologic factors. A complete reversal of the medical approach, i.e., from therapy of cicatricial stenosis to prevention of the formation of esophageal stenosis, has occurred. The reasons for and methods of this change have been presented. Tucker retrograde bougienage as a valued technique in the therapy of severe esophageal obstruction has withstood the “test of time.” Its minimal application has to date included many thousands of patients. Current figures from the manufacturer indicate a steady distribution rate of 10 sets/month. Its indication and application has broadened from caustic ingestion to include congenital, acquired, severe esophageal, hypopharyngeal and even cases of laryngeal stenosis. The necessity for the use of Tucker retrograde bougienage has, thankfully, greatly diminished.
Pathogenesis of Middle Ear Effusions
Authors: Paparella Michael M.
Published: January 2017

Detailed morphological and physiological studies are necessary as a basis for understanding normal, near normal and abnormal conditions of the middle ear cleft. Animal and human studies are essential. Animal studies provide a means of controlling and isolating variables. Herein we describe methods of producing acute and chronic middle ear effusions in animals. An animal model has also been developed for purulent otitis media. Corollary comprehensive studies are underway in humans. A multidisciplinary effort including pathology, microbiology, immunology, histochemistry, etc., yields interesting information which helps explain the pathogenesis of these common clinical problems.
Protein and Cellular Pattern of Glue Ear Secretions
Authors: Palva Tauno , Holopainen Eino , Karma Pekka
Published: January 2017

Analysis of glue ear secretions showed that the total protein content was slightly higher than in serum and that in the effusion proteins appeared that were specific to the mucosal secretion. The cellular analysis of samples from 137 ears showed that lymphocytes and neutrophils predominated, and that monocytes and phagocytes appeared in most specimens. Eosinophils and mast cells were rare. Staining of bacteria in the smear was seen in one-third of the slides and the mucus strands were numerous. The cellular picture is in line with an infective etiology.
Immunofluorescent Studies in Experimental Middle Ear Effusions
Authors: Hussl Burkhard , Lim David
Published: January 2017

Immunological phenomena occurring in the mucosa of the middle ear and Eustachian tube were investigated following tubal obstruction in squirrel monkeys which produced middle ear effusions. Although there are many variations among specimens, in general all classes of immunoglobulin producing plasma cells have shown an increase in number and/or an increase in intensity of fluorescence. IgG and IgA-producing plasma cells were more prominent than those producing other immunoglobulins. These findings support the concept that the middle ear and Eustachian tube in monkeys as in humans is protected by an immunodefense system.
Isolation of Viruses and Mycoplasmas from Middle Ear Effusions: A Review
Authors: Klein Jerome O. , Teele David W.
Published: January 2017

Reports of studies of middle ear effusions (MEE) obtained by needle aspiration are reviewed in this paper; viruses were isolated from 29 of 663 patients (4.4%) and respiratory syncytial virus was isolated most frequently (22 patients); only one mycoplasma, M. pneumoniae, was recovered from the MEE of 771 patients. Viruses were also sought from the throat or nasopharynx of 249 patients with MEE; 59 patients (23.7%) had a respiratory virus present. M. pneumoniae was isolated from the throat or nasopharynx in three of 116 patients. Although these results indicate that viruses and mycoplasmas are uncommonly found in effusions associated with acute or chronic otitis media, few studies have been attempted in recent years. The discovery of additional respiratory viruses and development of new techniques for isolation and identification of viruses indicate that the present results may be incomplete.
Antimicrobial Factors and Bacterial Correlation in Chronic Otitis Media with Effusion
Authors: Lang Raymond W. , Lim David J. , Liu Yea S. , Birck Herbert G.
Published: January 2017

Analyses of effusions and sera from patients with otitis media with effusion demonstrated local production in the middle ear of lysozyme, IgA and IgG. The effusion IgM was markedly elevated in some patients, also indicating local production. Complement C3 with rare exception was significantly lower in effusions than sera, suggesting utilization of complement in the middle ear, perhaps in conjunction with antibodies. The presence of high levels of lysozyme and immunoglobulins in effusions correlates with the low isolation rate of microorganisms in culture and may influence survival of organisms in the middle ear.
Tympanometry: Application and Interpretation
Authors: Feldman Alan S.
Published: January 2017

The poor relationship between hearing loss and ear disease minimizes the effectiveness of audiometry as a technique for the identification of middle ear disorders. Tympanometry has been shown to be a highly sensitive technique for the identification of and differentiation between middle ear disorders. It is particularly useful in a pediatric population where ear disease is so frequently encountered. The interpretation of tympanometry on the basis of a descriptive analysis of tympanograms is proposed as opposed to a coded typing system. Descriptive analysis views the pathological effects of middle ear diseases on pressure peaks, amplitude and shape of tympanograms.
Tympanometry Revealing Middle Ear Pathology
Authors: Renvall Ulf , Holmquist Jörgen
Published: January 2017

In order to evaluate the usefulness of impedance audiometry as a screening method for school children, two different pilot studies were performed. The results indicated that impedance audiometry (tympanometry and stapedius reflex test) was more efficient than otoscopy and pure tone screening in the detection of ears with secretory otitis media (SOM). In order to gain some more experience, an extended study of 800 7-year-olds was performed. The results from this investigation showed 6.5% pathological values with pure tone screening, 13.5% pathological values with tympanometry and 32% elevated or nonelicitable stapedius reflexes. Analysis of our observations indicates that the stapedius reflex may be too sensitive a test to be used as a screening method. Tympanometry, however, is recommended as a complement to pure tone screening in screening of children. A 6–12 months follow-up was also performed on 357 ears in which an initial study had shown a middle ear pressure of ≤ −100 mm H2O. At the repeated test 20% had pathological pure tone screening, 40% had a middle ear pressure of ≤ −100 mm H2O, 57% had elevated or nonelicitable stapedius reflexes, and 14% had middle ear effusion. The high frequency of persisting abnormal middle ear pressure and effusion in these 357 ears suggests that a middle ear pressure of ≤ −100 mm H2O can be a predisposing factor for SOM. In an experimental study on human temporal bones it was demonstrated that the tympanogram preserves its original appearance when the water level is low in the middle ear, while a higher level gives rise to a pathological tympanogram. It is also demonstrated that there is a discrepancy between the tympanometrically, indirectly recorded middle ear pressure and the middle ear pressure as measured manometrically, directly from the middle ear.
Otitis Media in the Newborn Infant
Authors: Shurin Paul A. , Pelton Stephen I. , Klein Jerome O.
Published: January 2017

Otitis media occurs frequently in newborn infants and often is associated with systemic infection. Patients studied at the Boston City Hospital have provided preliminary data on the otoscopic findings, tympanometric patterns and etiologic agents characteristic of otitis in this age group.
School Screening for Middle Ear Effusions
Authors: Brooks Denzil N.
Published: January 2017

Early detection of middle ear effusions is highly desirable not only from a medical standpoint, but also educationally, psychologically and socially. Present methods do not appear to be adequate and the proposal has been made that impedance measurement may be of greater effectiveness in detecting abnormalities of middle ear function. Eighty children have been studied over a period of six to seven years during which time the middle ear function has been monitored by means of an impedance meter. Approximately one-half of the children have not indicated any variation in middle ear function over the period of observation. About one-third of the children have had isolated episodes of effusion from which they have recovered spontaneously and without adverse effects. The remaining one-sixth have had repeated episodes of effusion or persistent middle ear malfunction for substantial periods of time. Observation of the middle ear muscle reflexes at suitably chosen time intervals appears to have promise as a method of early detection of effusion in the middle ear.
Cytologic and Immunologic Response Revealed in Middle Ear Effusions
Authors: Bryan Marian P. , Bryan William T. K.
Published: January 2017

The cellular patterns of middle ear effusions which reveal lymphocytic transformation and macrophage activity, help to explain the basic pathologic condition. This appears to be a typical delayed-type hypersensitivity reaction. The nasal cytogram often contributes to the understanding of the aural pathology. The treatment must be individualized with an effort to find the source of antigenic stimulation causing the response, and, in turn, support the systemic immune system of the patient in definitive ways, as have been suggested.
Microorganisms in Chronic Otitis Media with Effusion
Authors: Liu Yea Sang , Lim David J. , Lang Raymond , Birck Herbert G.
Published: January 2017

A total of 175 effusions obtained from 172 patients suffering from chronic otitis media with effusions was examined for bacterial smear and culture. Eighty percent showed positive bacterial smear, but only 49% yielded positive bacterial culture. The mucoid effusions had positive cultures in only 37%, whereas the bacterial culture rate was higher in serous (59%) and leukocytic (64%) types. The isolation of common pathogens accounted for about 50% of the isolates, and nonpathogens accounted for the remaining 50%. The high incidence of microorganisms in the middle ear effusions in the present series raises the possibility of bacterial contribution in many cases of OME.
Antibacterial Therapy and Middle Ear Effusions
Authors: Shurin Paul A.
Published: January 2017

Antimicrobial drugs chosen for their activity against the causative pathogens of otitis media provide effective treatment for acute attacks. Prolonged administration of some of these agents has recently been shown to be of value in the prevention of symptomatic otitis. The role of drug therapy in the management of chronic or recurrent middle ear effusion is unknown at present.
Allergic Factors in Management of Middle Ear Effusions
Authors: Clemis Jack D.
Published: January 2017

There is no single specific therapy for the treatment of middle ear effusions and, therefore, a holistic approach to management is necessary. Current management involves multiple therapeutic modalities of which we believe tube and allergy are most efficient.
Myringostomy for Middle Ear Effusions
Authors: Birck Herbert G. , Mravec Joseph J.
Published: January 2017

From 1972 to 1974, 736 children had tympanostomy tubes inserted for chronic serous otitis media resistant to medical therapy. The total number of ears involved was 2,237. The cleft palate patients constituted 8.8% of the total and had 15.4% of all procedures. Patients with allergy comprised 19% of the total population and had a higher incidence of otitis media following tube insertion. Adenoidectomy was performed in 44% of all patients and 35* of these required further tube insertions, suggesting that adenoidectomy in combination with tube insertion is not necessarily the primary treatment of choice. Children under six made up 78.5% of the total. The most common complication, a draining ear with an incidence of 15.1% was treated successfully with aqueous Merthiolate® irrigations. There were 14 tympanic membrane perforations.
Management of Middle Ear Effusions in Infants with Cleft Palate
Authors: Paradise Jack L.
Published: January 2017

Middle ear effusion is now generally recognized as a virtually universal complication in infants with cleft palate. Such infants may therefore be assumed to experience conductive hearing loss of some degree or other throughout infancy. Hoping to prevent not only deficits in intellectual and language development, but also permanent otic and auditory handicaps, we have routinely treated such infants as early as practicable with myringotomy and tympanostomy tube insertion. Subsequently, we have repeated the operation whenever blockage or extrusion of the tubes resulted in recurrence of persistent effusion. In this manner we have been able to maintain most infants in satisfactory middle ear status most of the time. Otorrhea, however, has been a frequent complication. Preliminary findings suggest that infants managed according to this regimen may eventually develop better language function than those not receiving such management. A current study is designed to test the advantages and disadvantages that might result from deferring the initial routine myringotomy until somewhat later in infancy.
Twenty-Five Years of Tympanoplasty
Authors: Wolferman Adolph
Published: January 2017

Twenty-five years of experience with tympanoplasty have demonstrated that the operation is not as safe as it is generally thought. Serious complications do occur. Many problems of middle ear reconstruction remain unsolved and more often than not results have not withstood the test of time. This paper attempts to answer the following questions. 1) What are the hazards in tympanoplasty surgery? 2) What are the complications of tympanoplasty? 3) What can tympanoplasty do for the welfare of the patient with reasonable certainty? 4) What has tympanoplasty been unable to do in spite of continued attempts and experimentation? 5) Why is tympanoplasty successful or unsuccessful in seemingly similar cases?
Electrical Stimulation of the Auditory Nerve and Auditory Prostheses: A Review of the Literature
Authors: Bilger R. C.
Published: January 2017

The literature dealing with implanted auditory prostheses is reviewed in terms of experimental studies in men and animals.
Research Plan for Evaluating Subjects Presently Fitted with Implanted Auditory Prostheses
Authors: Bilger R. C. , Black F. O. , Hopkinson N. T.
Published: January 2017

The basic research plan for this evaluation is presented here along with a description of the logistics of transporting the subjects from their homes to the laboratory for evaluation.