bluuebunny/crossref_metadata_2025 huggingface dataset:
Airflow Study of Pathologic Larynges Using a Hot Wire Flowmeter
Authors: Kitajima Kazutomo
Published: January 2017

Two aspects of laryngeal airflow, constant flow rate (DC) and alternating flow rate (AC), were examined in patients with vocal cord paralysis, acute laryngitis, and vocal cord polyps using the hot wire flowmeter. Vocal cord paralysis was characterized by a large DC with a small AC/DC percentage, and acute laryngitis showed a normal DC in spite of a small AC/DC percentage. No consistent finding was observed for the laryngeal polyp. Simultaneous measurement of both parameters was thought to better define the physiologic correlates of hoarseness in various laryngeal disorders.
Hodgkin's Disease: Contemporary Classification and Correlates
Authors: Howard Donald R. , Batsakis John G.
Published: January 2017

The current histologic classification of Hodgkin's disease into lymphocyte predominance, nodular sclerosis, mixed cellularity, and lymphocyte depletion forms is practical, reproducible by pathologists, and correlates with extent and course of disease. Such a classification, however, is only a step toward complete understanding of this often enigmatic disease.
Foregut Cysts Presenting as Neck Masses
Authors: Cohen Seymour R. , Thompson Jerome W. , Brennan L. Patrick
Published: January 2017

This paper is a retrospective study of three patients with foregut cysts in the neck who were admitted for diagnosis and treatment. Foregut cysts are uncommon congenital defects of the developing airway and gut. They may occur from the mouth to the anus, and are rare in the neck. Two of the children presented with neck masses, the other with severe airway obstruction and subglottic and upper tracheal stenosis requiring a tracheotomy. The patients are presented in detail, and the histopathology and differential diagnosis are discussed. Surgical treatment is necessary to prevent airway compromise. Surgical extirpation of the cyst should be uncomplicated and curative.
Anterior Cricoid Split: A “Simple” Surgical Procedure and a Potentially Complicated Care Problem
Authors: Grundfast Kenneth M. , Coffman Avon C. , Milmoe Gregory
Published: January 2017

The anterior cricoid split (ACS) has been described as an alternative to tracheotomy in management of the premature infant who develops upper airway compromise after extubation. Sixteen patients at the Children's Hospital National Medical Center (CHNMC) and ten patients at four other hospitals had the ACS operation. For the patients at the CHNMC, average gestational age was 29 weeks, birth weight was 1,264 g, and length of time intubated was 6.2 weeks. Overall success in achieving extubation after the ACS was 69% at the CHNMC and 40% for the group of other hospitals. However, a success rate in achieving extubation after ACS was 75% for both the CHNMC and the group of other hospitals in patients who had become stable enough to have been previously discharged from a neonatal intensive care unit. Problems encountered following the ACS include malposition of tip of the endotracheal tube, increased need for assisted ventilation, myocardial infarction, subcutaneous emphysema, and unexplained inability to ventilate. Analysis of results suggests that the ACS is a valuable operative procedure that can avoid need for tracheotomy in infants with adequate pulmonary function who have narrowing within the airway at the subglottic level. Postoperative care may be problematic and the infant having had the ACS is best managed by an experienced team of experts who are familiar with care of the infant with respiratory insufficiency.
Effects of N-Acetylcysteine on Experimentally Induced Esophageal Lye Injury
Authors: Liu Alfred J. , Richardson Mark A.
Published: January 2017

The effects of N-acetylcysteine (NAC) in the treatment of caustic alkaline injury to the esophagus is examined. Caustic esophageal burns were produced in rats by irrigation with NaOH. Stricture formation was less frequent in animals concurrently treated with either steroids (48%) or NAC (48%) than in control animals that received only the alkaline injury (74%). In addition, the severity of stenosis was less in drug-treated rats. Thirty percent of strictures in control animals were severe (3 +) compared to 6% in the NAC group and 7 % in the steroid group. Both NAC and steroids would seem to ameliorate the tissue reaction to chemical injury as well as temper the degree of stenosis formation. Possibility of synergistic effects warrants future investigation.
High Frequency Ventilation through a Small Catheter for Laser Surgery of Laryngotracheal and Bronchial Disorders
Authors: El-Baz Nabil M. , Caldarelli David D. , Holinger Lauren D. , Faber L. Penfield , Ivankovich Anthony D.
Published: January 2017

One-lung and two-lung high frequency ventilation (HFV) through a 2-mm internal diameter catheter was evaluated in 22 patients during endoscopic laser excision of stenotic lesions of larynx, trachea, and bronchi. High frequency ventilation at 80 to 250 breaths per minute using air during two-lung HFV and using air-oxygen at an inspired oxygen concentration of 25 % during one-lung HFV maintained adequate alveolar ventilation and oxygenation in all patients. The use of HFV through a catheter allowed continuous control of ventilation and provided maximal surgical exposure for endoscopic laser surgery. The continuous outflow of HFV gases through the endoscope also prevented lung contamination with blood and debris. The potential of HFV polyvinylchloride catheter ignition by laser was also evaluated in the laboratory during continuous flow of air-oxygen and oxygen-nitrous oxide. The laser ignited polyvinylchloride tubes in all the mixtures of oxygen and nitrous oxide within 3 to 7 seconds. Oxygen at 30% mixed with nitrogen 70% was safe and all such tubes were not ignited by the laser. The ability of HFV to provide adequate oxygenation during endoscopic laser surgery using air-oxygen at an FiO2 below 30% also avoids the hazard of catheter and airway fire.
Delayed Aerodigestive Tract Complications following Combined Therapy for Thyroid Cancer
Authors: Grossman Thomas W. , Wilson J. Frank , Toohill Robert J.
Published: January 2017

Radical surgery for papillary adenocarcinoma of the thyroid has been associated with a significant incidence of complications. In some instances, postoperative irradiation is given when there is some suspicion of persistent or occult disease, although thyroid suppression and ablative radioiodine therapy have proved to be very effective adjuvants to surgery. Three patients with papillary adenocarcinoma of the thyroid developed severe, delayed complications 25, 7, and 2 years, respectively, after treatment with primary radical surgery and postoperative irradiation. The degree of injury to the aerodigestive tract as a result of the surgery and irradiation therapy makes treatment difficult regardless of the modality. The possible mechanisms that cause these complications, along with proposed methods of treatment, are discussed.
Effect of Gastric Acid on the Pathogenesis of Subglottic Stenosis
Authors: Little Frank B. , Kohut Robert I. , Koufman James A. , Marshall Richard B.
Published: January 2017

A case of subglottic stenosis, recalcitrant to conventional therapy, was associated with asymptomatic aspiration of gastric acid into the larynx. Once the reflux was controlled by use of an antacid regimen and an H2 blocker, the subglottic stenosis resolved and the patient could be decannulated. This case led to the use of an experimental canine model of subglottic stenosis to examine gastric acid as a pathogenic factor in the development of subglottic stenosis. In control animals, mucosal lesions healed without development of stenosis. In experimental animals with mucosal lesions painted with gastric acid, subglottic stenosis developed. When perichondrium and cartilage were violated and gastric acid applied, stenosis was even more severe and developed more rapidly.
Prognostic Determinants and a New View of Staging for Patients with Nasopharyngeal Carcinoma
Authors: Neel H. Bryan , Taylor William F. , Pearson Gary R.
Published: January 2017

There is no agreement on the single best staging system for patients with nasopharyngeal carcinoma. We have evaluated prospectively several staging systems and have assessed the predictive value of many variables on survival and found that the most important are extensive tumor within the nasopharynx or regional extension, nodes in the lower portion of the neck, and cranial nerve involvement. Other variables that have not been used in traditional extent of disease staging systems but that have an adverse bearing on survival have been studied by multiple regression techniques in the Cox proportional hazards model. Two prognostic scores, which can be used for classifying patients into survival groups, ranging from excellent survival (low score) to poor survival (high score), have also been presented. With these schemes, patients who are at high risk for recurrence after conventional therapy can be reliably selected.
Vocal Cord Granulomas
Authors: Benjamin Bruce , Croxson Glen
Published: January 2017

A series of 16 vocal cord granulomas in adults and children were studied; of these, seven occurred postintubation. All granulomas were removed at least once and the recurrence rate was high. On average, there were three removals, and some patients are still under observation. The recurrence rate did not seem to be related to removal by surgical excision or by laser. We postulate, contrary to conventional teaching, that vocal ulcer and vocal cord granuloma should be regarded as separate entities which occur at the same anatomical site.
Strangulation: A Full Spectrum of Blunt Neck Trauma
Authors: Line Warren S. , Stanley Robert B. , Choi Joseph H.
Published: January 2017

Strangulation accounts for up to 10% of violent or criminally related deaths in the United States annually. Strangulation techniques include hanging, throttling, garrotting, and chokeholds. These methods are thought to cause unconsciousness or death by compression of either the airway or the major vessels of the neck. A review of the records of 112 nonsurvivors and 59 survivors of strangulation revealed that hyoid bone and laryngotracheal fractures occurred in both groups, particularly in throttling victims. The laryngeal injuries themselves could not be implicated as the cause of death, and survivors usually presented without airway compromise. However, failure to appreciate such injuries in survivors may lead to permanent voice complications. A full understanding of the spectrum of strangulation is also required if the otolaryngologist is called to testify as an expert witness in such cases.
Neuroendocrine Markers in Paragangliomas of the Head and Neck
Authors: Warren W. H. , Caldarelli D. D. , Lee I. , Javid H. , Gould V. E.
Published: January 2017

Eighteen paragangliomas of the head and neck (11 carotid body tumors, four glomus tympanicum tumors, three glomus jugulare tumors) were studied retrospectively. Tissue from each of these tumors was immunostained for the presence of serotonin, a variety of neuropeptide hormones, and the enzyme neuron-specific enolase (NSE). Seven tumors were studied by electron microscopy. The clinical and laboratory records were reviewed for evidence of endocrine activity or metabolic imbalance. All tumors displayed diffuse and intense immunostaining for NSE. In addition, a wide variety of hormonal substances could be identified. Those most frequently demonstrated were serotonin and leu-enkephalin. Ten of the 11 carotid body tumors demonstrated immunoreactivity for multiple hormones. By electron microscopy all tumors contained a heterogeneous population of membrane-bound neurosecretory granules. None of these tumors was associated with a clinically apparent endocrine syndrome. We conclude that paragangliomas of the head and neck are neuroendocrine tumors that are capable of synthesizing a variety of hormonal substances. These hormonal substances rarely elicit a clinically apparent endocrine or metabolic imbalance. All of the tumors demonstrated immunostaining for NSE. Future studies on serum levels of NSE may provide useful diagnostic and follow-up data.
Effect of β Blockade on Singing Performance
Authors: Gates George A. , Johnson Leonard , Saegert Joel , Shepherd Alexander , Wilson Neil , Erwin M. Hearne
Published: January 2017

The symptoms associated with performance anxiety, or the so-called stage fright syndrome, are similar to those of α and β adrenergic stimulation. Suppression of symptoms and improvement in instrumentalist's performance after β blockade suggest that this modality would be of benefit for singers as well. To evaluate the dose-effect relationship of β blockade upon singing performance and the possible effect of these agents upon performance maturation, we studied 34 singing students during end of semester juries, using a double-blind crossover paradigm. Students performed once with either placebo, 20, 40, or 80 mg of nadolol, and again 48 hours later, with placebo. There was a significant dose-related, limiting effect upon intraperformance cardiac rate. A small, but statistically significant, dichotomous effect upon performance rating was noted: low-dose nadolol tended to enhance performance, whereas larger doses impaired performance. We conclude that the effects of low dose β blockade upon singing are minimally helpful and high doses may detract from performance ability.
Management of Chronic Aspiration by Subtotal and Submucosal Cricoid Resection
Authors: Krespi Yosef P. , Pelzer Harold J. , Sisson George A.
Published: January 2017

Modern techniques of conservation surgery of the laryngopharynx often result in narrowing, immobility, and decreased sensation of the hypopharynx. These procedures also compromise the most vital function of the larynx — protection of the airway. Permanen tracheostomy is always necessary for protection of the airway. Teflon injection, cartilage implant to the larynx, and extended pharyngeal myotomy can provide only temporary relief. Swallowing studies under fluoroscopy as well as laryngopharyngoscopy verify a narrowed pharyngeal inlet with the pharynx trapped between the cricoid and the cervical spine. Extrapharyngeal, subtotal, submucosa resection or the posterior cricoid ring results in a flaccid posterior laryngeal wall and enlarged hypopharyngeal inlet. At the same time the laryngeal inlet is narrowed, reducing aspiration and still preserving the voice.
Electromyographic Findings in Focal Laryngeal Dystonia (Spastic Dysphonia)
Authors: Blitzer Andrew , Lovelace Robert E. , Fahn Stanley , Brin Mitchell F. , Fink Matthew E.
Published: January 2017

Spastic dysphonia is a clinical speech disorder characterized by spasms of the laryngeal muscles during phonation, producing a broken pattern of speech sometimes termed laryngeal stuttering. Fourteen patients with the diagnosis of spastic dysphonia based on voice quality were referred for evaluation; detailed clinical and electrophysiologic evaluations were performed. Laryngeal electromyographic (EMG) testing failed to demonstrate any spontaneous activity in the 14 patients tested. Seven patients (50 %) had normal number and amplitude of motor unit potentials. Four of these had disparate amplitudes when compared with the other side, and two had complex motor unit potentials. The other seven patients (50 %) had abnormal findings, including three patients with abnormally increased amplitude. Two patients had asynchronous activity characteristic of a tremor disorder. One patient had synchronous bursts of activity also affecting the diaphragm, later diagnosed as pyramidal and extrapyramidal disease. One patient had bursts of activity, and later presented with diffuse myoclonus. Laryngeal EMG therefore seemed to be a more precise way of evaluating patients presenting with a tremulous voice pattern termed spastic dysphonia. Clinical observation and EMG data demonstrated that spastic dysphonia is not a “spastic” disease. We identified patients with tremor (2), pyramidal and extrapyramidal disease (1), and myoclonic disorders (1). The remainder of the patients had clinical and EMG findings consistent with dystonia, a neurologic disorder characterized by abnormal, often action-induced, involuntary movements or uncontrolled spasms. We classify these patients as having “focal laryngeal dystonia” when the disorder occurs in isolation. It may also present as a component of a generalized dystonic syndrome.
The Human Larynx at the End of the Embryonic Period Proper
Authors: Müller Fabiola , O'Rahilly Ronan , Tucker John A.
Published: January 2017

The laryngeal cavity was studied in eight serially sectioned embryos of stage 23 and in three early fetuses, and graphic reconstructions were prepared. After the isolation of the tracheal from the pharyngeal cavity during stages 16 through 22, a communication (not necessarily the pharyngotracheal duct) appears again during stage 23. At this time (8 postovulatory weeks) the laryngeal cavity comprises 1) the coronal and parts of the sagittal clefts of the vestibule (uniting later at the laryngeal inlet); 2) the ventricles, which are not yet completely formed; and 3) the subglottic cavity, which appeared already in earlier stages. The characteristic events of stage 23 are the dissolution of the epithelial lamina and the development of the ventricles. The disruption of the epithelial lamina is an active process that comprises rearrangement and growth, but not loss of cells. The ventricles, which begin as solid outgrowths in stage 20, do not represent fifth pharyngeal pouches. They now point toward the middle of the still paired thyroid laminae and are not at the level of the future glottis, which lies more caudally. In the absence of the median part of the soft palate, the nasopharynx communicates widely with the oral cavity. The epithelium of the respiratory tube, including the larynx, resembles that of the pharynx and esophagus in being pseudostratified columnar and showing a clear basement membrane. It is ciliated over that part of the epiglottis that surmounts the arytenoid swellings, and also over the tip and back of the latter. The transitional area between the laryngopharynx and the esophagus is already innervated by the recurrent laryngeal nerve. Nerve fibers have not yet reached the epithelium of the coronal cleft and the ventricles, but fibers are present near the sagittal cleft of the vestibule. The sensory innervation of the pharynx and larynx has been followed and plotted for the first time in an embryo, and previously unrecorded silver-impregnated receptors have been observed.
Cleft Larynx with Airway Obstruction
Authors: Holinger Lauren D. , Tansek Karin M. , Tucker Gabriel F.
Published: January 2017

Cleft larynx is a rare congenital anomaly becoming recognized and reported with increasing frequency. While it is most commonly associated with aspiration in newborns, airway obstruction can occur. We report two cases of upper airway obstruction due to a soft tissue mass related to the cleft. Since endoscopic findings of cleft larynx are subtle and easily overlooked, the technique of direct laryngoscopy is extremely important. In addition to recognition of the condition, embryology and treatment are also discussed.
Androgen Stimulation and Laryngeal Development
Authors: Beckford Neal S. , Schaid Dan , Rood Stewart R. , Schanbacher Bruce
Published: January 2017

Androgen-induced changes in laryngeal growth patterns were studied using a sheep animal model. Forty-eight lambs were divided into eight treatment groups. Lambs in seven of the groups were castrated at birth, while lambs in the eighth group served as an intact (non-castrated) control. Six groups were then treated with varying doses of testosterone and dihydrotestosterone, while the seventh served as a castrated, nontreated control. All animals were killed and gross dissections of the larynges were performed. Thirty-four linear and angular measurements were obtained from each larynx. The mean superior thyroid horn separation showed the most dramatic androgen-induced effect (p = 0.023). Laryngeal anterior-posterior diameter, superior thyroid horn height, posterior thyroid cartilage width, thyroid cartilage angle, and vocal process to arytenoid base distances all demonstrated positive dose-response relationships. Hypoandrogenic levels appeared to have an inhibitory effect upon laryngeal growth when compared to castrated controls.
Paravestibular Canaliculus in Meniere's Disease
Authors: Ikeda Minoru , Sando Isamu
Published: January 2017

The paravestibular canaliculus (PVC) and its contents were studied in 27 temporal bones from individuals with Meniere's disease and in the same number of controls. The specimens were examined by the medial view graphic reconstruction method and/or histologically under a light microscope. In most of these bones (88.9% of controls and 85.2% of Meniere's bones) only one PVC was noted; in the remaining bones (11.1% of controls and 14.8% of Meniere's bones) two PVCs were recognized. Most of the PVCs (88.9%) in both control and Meniere's bones were located in the petrous bone anterolateral to the vestibular aqueduct (VA). In one third of both control and Meniere's bones the PVC extended below the inferior margin of the posterior semicircular canal. In 74.1 % of the Meniere's bones the PVCs were noted to exit directly to the posterior cranial fossa, whereas such a course was present in only 40.7% of controls. The difference in this parameter between control and Meniere's disease bones is statistically significant and appears to be related to the size of the VA. The length of the PVC, however, seems to be independent of both the size of the VA and the degree of development (thickness) of the petrous bone surrounding the PVC. In four Meniere's bones a part of the main vein in the PVC was absent; this was never observed in a control bone. We found no other evidence in this study to link the function or anatomy of the PVC to Meniere's disease.
Thread Test of Lacrimation in 110 Cases of Peripheral Facial Paralysis
Authors: Yagi Nobuya
Published: January 2017

The thread test of lacrimation was performed on 110 patients with peripheral facial paralysis, and the changing values during the course of paralysis were observed. In 27.3%, the values stayed within the normal range of 60% to 140% of the intact side throughout the course of illness (normal type). In 14.5%, the value was over 140% before the start of recovery (hypertype 1). High values were seen in 39.1% during recovery from facial paralysis (hypertype 2), and values under 60% (hypotype) in 6.4%. Hyperlacrimation was frequently observed in Hunt's syndrome. Hypertypes, with temporarily increased lacrimation during the course of illness, seemed to reflect the regenerating activities of injured nerves in the early and recovery phases of facial palsy.
Crocodile Tears and Thread Test of Lacrimation
Authors: Yagi Nobuya , Nakatani Hiroaki
Published: January 2017

Patients with incomplete recovery from peripheral facial paralysis often complain of eye-watering while eating (crocodile tears or gustolacrimal reflex). In 55 patients (22 completely recovered from peripheral facial paralysis, 23 incompletely recovered, and ten with hemifacial spasm), lacrimation was monitored by the thread test (a modification of the Schirmer test) during taste stimulation. In the 22 patients with complete recovery, the results of the thread test did not differ before and after a sweet-sour candy was given (taste stimulation). All the patients with incomplete recovery showed either synkinesis or contracture. Lacrimation on the side of the lesion was high even before taste stimulation. After taste stimulation, a rapid and definite increase in lacrimation was observed. The results show that in patients with synkinesis and incomplete recovery after peripheral facial paralysis, the misdirected regeneration of the injured nerve fiber often occurs from the gustatory nerve to the lacrimal nerve, as well as between motor fibers.
Reconstruction of the Ossicular Chain with Hydroxyapatite Implants
Authors: Grote Jan J.
Published: January 2017

This paper describes the clinical results of the application of dense hydroxyapatite assembly prostheses. A study of 60 patients with hydroxyapatite incus prostheses revealed an air-bone gap closure within 20 dB in 86.6% of the cases, and an air-bone gap closure of less than 10 dB in 60.6%. No improvement was seen in 5% of the patients. The follow-up period varied from 1 to 4 years with an average of 2 years, and the hearing gain remained constant during this period. Hydroxyapatite may be considered a useful material for reconstructive middle ear surgery.
Manual for Use of Montgomery® Laryngeal, Tracheal, and Esophageal Prostheses
Authors: Montgomery William W. , Montgomery Stuart K.
Published: January 2017

This manual is designed to instruct the surgeon, nurse, and, directly or indirectly, the patient on the updated usage of prostheses involved with reconstructive surgery of the larynx, trachea, and esophagus. The silicone tracheal T-tube has been modified in an attempt to prevent its being displaced posteriorly into the trachea. The silicone tracheal cannula can be used in place of a tracheotomy tube unless there is aspiration or positive pressure breathing is required. Its success with sleep apnea has been especially gratifying. The salivary bypass tube and the esophageal tube continue to be of use when treating esophageal fistulas, strictures, and reconstruction of the cervical esophagus. The laryngeal keel and stent are described and illustrated for use with reconstructive laryngeal surgery.
House 3M Cochlear Implant: Surgical Considerations
Authors: Luxford W. M. , House W. F.
Published: January 2017

The cochlear implant is now available widely as a treatment alternative for carefully selected patients with profound sensorineural deafness for whom other treatments or prostheses have been unsuccessful. This paper discusses the surgical techniques for implantation of the House 3M cochlear implant. There have been no serious surgical complications and only a few postoperative problems that were remedied satisfactorily. The surgical procedure allows replacement of a failed device or upgrading of the device as improvements become available in the future.
Current Distributions Produced by the Banded Electrode Array: An Experimental Study Conducted with a Tank Model
Authors: Lukies P. M. , Tong Y. C. , Clark G. M.
Published: January 2017

The tank model consisted of a 22-band electrode array lying in a homogeneous normal saline solution in the base of a tube 5 mm in diameter and 4 cm in length. The current distribution was obtained by measuring vector potentials along the longitudinal direction at a given radial distance from the electrode array. The results indicate that when only one pair of electrodes is stimulated, the current distribution is bell shaped. When two pairs are simultaneously stimulated by two isolated current sources, the results demonstrate a vector summation of current density throughout the system.
Cochlear Pathology of Sensorineural Deafness in Cats: Coadministration of Kanamycin and Aminooxyacetic Acid
Authors: Leake P. A. , Snyder R. L. , Schreiner C. E.
Published: January 2017

The coadministration of kanamycin (400 mg/kg body weight, s.c.) and aminooxyacetic acid (25 mg/kg body weight, s.c.) results in rapid, total destruction of cochlear hair cells in cats. This drug combination is safer and the time course of hearing losses is less variable than with administration of aminoglycosides alone. Uniform survival of spiral ganglion neurons at 2 and 4 weeks after drug administration suggests a time course similar to that previously observed in neomycin-deafened cats, but more data with longer survival periods are needed to verify these preliminary observations.
Information Extraction from Speech
Authors: Murphy A. J. , Ratcliffe N. W. , Johnson D. A. H. , Dewhurst D. J.
Published: January 2017

As an approach to the separation of the information in speech from speaker-specific attributes, we have used a modified cepstral analysis followed by a peak-tracking process in the cepstral domain. The resulting tracks show a high degree of similarity between different male speakers saying the same words and is a basis for speaker-independent word recognition. The method does not involve pitch frequency determination.
Signal-Processing Hearing Aids for the Totally and Profoundly Deaf
Authors: Walliker J. R. , Fourcin A. J.
Published: January 2017

We have developed a family of single-channel signal-processing aids for the profoundly and totally deaf. Common to them all are the analysis of speech into the components most important to the deaf lipreader; the synthesis of stimuli which make the best use of the patient's sensory abilities; and facilities to ensure accurate matching of the aid to the patient. The totally deaf are electrically stimulated by electrodes on the promontory or on the round window of the cochlea using charge-balanced controlled current square waves automatically adjusted to be at a comfortable level. Many potential candidates for electrocochlear stimulation have significant low frequency residual hearing, but do not find conventional hearing aids to be useful. We have found that they can often make very effective use of the voice fundamental frequency presented as an acoustic sinusoid. Our approach to these patients avoids the need for implant surgery but preserves that option should total loss of hearing occur in the future. Both electrocochlear and acoustic methods of signal presentation are implemented with similar hardware. The speech signal from a microphone or other source is analyzed by a voice fundamental frequency extractor and a voiceless sound detector. Their outputs are processed by a single chip microcomputer that synthesizes the output waveform. In both devices the aid is tailored to the patient using a desktop computer that stores amplitude-frequency characteristics and frequency mapping tables into a read-only memory.
Results for Chinese and English in a Multichannel Cochlear Implant Patient
Authors: Xu S. A. , Dowell R. C. , Clark G. M.
Published: January 2017

A multichannel cochlear prosthesis was implanted in a Chinese patient who suffered from profound sensory hearing loss. The preoperative Minimal Auditory Capabilities (MAC) battery tests in English, as well as an open set bisyllable word test, an open set sentence test, and speech tracking in Chinese indicated significant improvement of speech perception for both English and Chinese after the operation. Substantial understanding of running speech was possible in both languages without the help of lipreading.
Clinical Results for Postlingually Deaf Patients Implanted with Multichannel Cochlear Prostheses
Authors: Brown A. M. , Dowell R. C. , Clark G. M.
Published: January 2017

Clinical results for 24 patients using the Nucleus 22-channel cochlear prosthesis have shown the device to be successful in presenting amplitude, fundamental frequency, and second formant information to patients with acquired hearing loss. For all patients, this has meant a significant improvement in their communication ability when using lipreading and some ability to understand unknown speech without lipreading or contextual cues. Approximately 40% of patients are able to understand running speech in a limited fashion without lipreading, and this ability has been evaluated using the speech-tracking technique for a number of patients. Many patients are able to have limited conversations on the telephone without using a special code. Although the prosthesis has been designed with the presentation of speech signals in mind, recognition and discrimination of environmental sounds has also been very encouraging with patients scoring 70% to 80% correct for closed set environmental sound testing. Follow-up testing has indicated that the ability to understand open set speech without lipreading continues to improve up to at least 12 months postoperatively. Open set sentence test results improved from an average of 20% at 3 months to 40% at 12 months.
Finnish Approach to the Treatment of Acute Otitis Media Report of the Finnish Consensus Conference
Authors: Karma P. , Kouvalainen K. , Prinssi V-P. , Palva T. , Kärjä J. , Ruuskanen O. , Mäkelä P. H. , Launiala K.
Published: January 2017

The theme of the first consensus conference to be held in Finland was the treatment of acute otitis media. The statements and recommendations accepted by the conference, which was organized according to the National Institutes of Health model, are presented in this report. On the basis of scientific knowledge, clinical experience, and conditions in Finland, the conference delegates concluded that penicillin V, in large doses, is still the drug of first choice in this disease. The importance of surgical drainage of the middle ear was stressed, as was the necessity of careful follow-up of the patient until the condition is completely healed. Decongestants were considered rather useless. In the prevention of recurrent attacks, adenoidectomy but not tonsillectomy was regarded as being of help, tympanostomy of probable benefit, antimicrobial (sulfonamide) prophylaxis worth considering in selected cases, but the effect of pneumococcal vaccination poor. The conference delegates agreed that uncomplicated acute otitis media should, as before, usually be treated by physicians taking care of children at the primary health care level.
Pathology of Chronic Suppurative Otitis Media
Authors: Meyerhoff William L.
Published: January 2017

Chronic suppurative otitis media is associated with irreversible tissue disease. This tissue disease includes bony changes (osteitis osteogenesis, bone destruction), fibrosis of the mucoperiosteum, granulation tissue, subepithelial glandular formation, tympanosclerosis TM perforation, polyp formation, cholesteatoma, and cholesterin granuloma.
Experiences with the Nucleus Multichannel Cochlear Implant in Three Young Children
Authors: Luxford William M. , Tonokawa Lisa L. , House William F. , Berliner Karen I. , Hough Jack V. D. , Martin Elizabeth
Published: January 2017

Clinical trials for the Nucleus multichannel cochlear implant in children 2 through 9 years of age have been ongoing for approximately 1 year. We describe three children who have used the device for at least 8 months. Based on these three cases, we discuss some factors that might affect the outcome of the Nucleus implant in young children: age at implantation, age at onset of deafness, and duration of profound deafness before implantation. Surgical and rehabilitation issues, including educational settings, are reviewed.
Topodiagnosis of Lesions in Bell's Palsy
Authors: Yanagihara Naoaki , Kitani Shinji , Gyo Kiyofumi
Published: January 2017

Combined measurements of reflexive lacrimation, stapedial reflex, and electrically induced taste give an indication of the site and extent of infratemporal lesions of the facial nerve. Using refined test batteries, we established the presence of intratemporal lesions in Bell's palsy in 80 patients with facial paralysis. In the acute stage of Bell's palsy, suprastapedial lesions predominated and the occurrence of a suprageniculate lesion was not rare. In the subacute stage, the lesions proximal to the stapedial nerve tended to subside and infrastapedial lesions increased. In 60% of 53 patients with denervation verified by electrodiagnostic examinations, the suprastapedial lesion was responsible for degeneration of the nerve. In the other 40%, degeneration involved the infrastapedial segment.
In Search of Pathologic Correlates for Hearing Loss and Vertigo in Pagets Disease
Authors: Khetarpal Umang , Schuknecht Harold F.
Published: January 2017

Mixed sensorineural and conductive hearing loss is a common clinical manifestation of Paget's disease of the temporal bone, and while there are numerous clinical and pathologic reports on the condition, none have identified a consistent pathologic explanation for the hearing loss. We performed histologic studies on 26 temporal bones exhibiting Paget's disease from 16 persons, of whom 7 had audiometric testing performed. Contrary to common opinion, the conductive hearing loss is not caused by ossicular fixation; in fact, no cause could be found in the seven ears with documented conductive hearing losses. While the sensorineural hearing losses were greater than normal for age, we could not identify cochlear disorders that could be attributed to Paget's disease. It is concluded that the hearing losses in Paget's disease are caused by changes in bone density, mass, and form that serve to dampen the finely tuned motion mechanics of the middle and inner ears.
Distortion Product Emissions in Humans
Authors: Martin Glen K. , Ohlms Laurie A. , Harris Frances P. , Franklin Daniel J. , Lonsbury-Martin Brenda L.
Published: January 2017

The realization that otoacoustic emissions are sensitive to cochlear disorders has resulted in the speculation that they may have considerable clinical potential as objective measures of hearing. To assess the clinical utility of one type of emission, the distortion product emission (DPE), a study was undertaken in individuals with hearing impairments representing a number of common otologic disorders. The results of this investigation provided evidence that tests of DPEs promise to satisfy a number of requirements important to clinical testing, including objectivity of measurement procedures, test-retest reliability, simple subject preparation, readily available instrumentation, and relatively brief examination periods. The fine resolution of DPEs within the stimulus frequency and level domains also permits an accurate confirmation of the pattern of hearing loss. For example, tests of DPEs detected a 20-dB hearing level impairment at a single frequency in an ear exhibiting early signs of noise-induced hearing loss, and a 10-dB improvement in sensitivity following ingestion of the hyperosmotic agent glycerol in an ear displaying a mild to moderate hearing loss due to Meniere's disease. Finally, the application of DPEs to the objective testing of otologic disorders suggests that the ability of these responses to assess the sensory component of a sensorineural disorder may contribute to the eventual understanding of the complicated pathogenesis of many cochlear diseases. When all the positive features of DPE testing are realized, the potential contribution that these measures can make in a clinical setting becomes apparent.
Otopathologic Correlates of the Continuum of Otitis Media
Authors: Paparella Michael M. , Abdelhammid Mohamed M. , Schachern Patricia A. , Sahni Rana , Yoon Tae H. , da Costa Sady S.
Published: January 2017

It has been our hypothesis that different types of middle ear effusions and the clinical manifestations with which they are associated represent the typical inflammatory response. Employing an animal model under controlled conditions, we present statistical evidence that change in the mucosa of the middle ear in otitis media can occur along a continuum, with early forms regressing to more chronic stages of the disease. We also demonstrate an increase in the thickness and a decrease in the permeability of the round window membrane in a longitudinal study of otitis media in the same animal model. Histopathologic changes in human temporal bones with otitis media with effusion or chronic otitis media are similar to the changes in the animal models. These results support a concept that all categories of otitis media (serous, purulent, mucoid, and chronic) represent different stages in a continuum of events.
Ankyloglossia with Deviation of the Epiglottis and Larynx
Authors: Mukai Susumu , Mukai Chikako , Asaoka Kazuyuki
Published: January 2017

We observed ankyloglossia to be usually accompanied by displacement of the epiglottis and larynx. Infants with this disease developed dyspnea and skin and hair abnormalities. In addition, they had other symptoms, such as a dark forehead, a frowning expression, a dark color around the lips, scanty eyebrows, swelling around the palpebrae, harsh respiratory sounds, hard crying, snoring, and frequent yawning. In spite of these abnormalities, they had been considered to be healthy by their pediatricians. Arterial oxygen percent saturation (SaO2) was measured while the infants were asleep, suckling, and awake, The results revealed that their SaO2 was unstable and slightly low. The symptoms and signs of this disease were very similar to those observed in victims of sudden infant death syndrome before their death. Correction of the ankyloglossia and deviation of the epiglottis and larynx resulted in great improvement of these signs as well as a stabilization and increase of SaO2.
Antibiotic Prophylaxis in Clean-Contaminated Head and Neck Oncologic Surgery
Authors: Weber Randal S. , Callender David L.
Published: January 2017

The use of antibiotic prophylaxis in head and neck oncologic surgery has greatly reduced the risk of postoperative wound infection and the corresponding increase in morbidity and health care costs. Conversely, inappropriate perioperative use of antibiotics increases costs and risks to patients. Antibiotic prophylaxis is beneficial only in clean-contaminated head and neck surgery; targets are the bacterial flora that commonly inhabit the skin and upper aerodigestive tract, with antibiotics effective against gram-positive aerobic organisms and anaerobic organisms providing the best coverage. Maximum efficacy is achieved with immediate preoperative and short-term (< 48 hours) postoperative antimicrobial administration in adequate doses. Optimum benefit from prophylaxis in head and neck oncologic surgery depends on appropriate selection and administration of antibiotics in combination with sound, established surgical principles.
Adenoidectomy and Otitis Media
Authors: Gates George A. , Muntz Harlan R. , Gaylis Brendan
Published: January 2017

Adenoid enlargement has traditionally been considered a factor in otitis media; adenoid size, however, does not appear to be correlated with otitis media occurrence. Presence of pathogenic bacteria in the adenoids of children with otitis media has been shown, and adenoidectomy appears to affect the middle ear primarily by removal of the source of infection in the nasopharynx. Three recent randomized, controlled studies showed the efficacy of adenoidectomy in the treatment of chronic secretory otitis media. In one study comparing no treatment, adenoidectomy, and adenotonsillectomy, a significant benefit was seen with adenoidectomy that was not enhanced by tonsillectomy. Another study that compared adenoidectomy, tympanostomy tubes, and a combination of the two showed a significant reduction in effusion time and less surgical retreatment over 2 years in the two adenoidectomy groups. The third study demonstrated the effect of adenoidectomy in children with recurrent chronic otitis media with effusion after failure of tympanostomy tube insertion. All three studies showed that the effect of adenoidectomy was independent of adenoid size. This review discusses current concepts of adenoid physiology and pathology, the major adenoidectomy studies, and indications for the procedure.
Surgical Management of Sinus Disease in Children
Authors: Manning Scott C.
Published: January 2017

In the past few years, interest in pediatric sinus surgery has increased in response to the introduction of new endoscopic techniques and to mounting societal pressure to resolve the problem of persistent rhinosinusitis in the day-care setting. As yet, there are no prospective controlled studies demonstrating efficacy of sinus surgery in children with uncomplicated acute or recurrent acute sinusitis, and medical management overwhelmingly remains the treatment of choice for these patients. Sinus surgery may be indicated, however, for three groups of pediatric patients: those with true chronic disease, those with serious underlying disease states aggravated by recurrent sinusitis, and those with suppurative complications of sinusitis.
Current Indications for Tonsillectomy and Adenoidectomy
Authors: Bluestone Charles D.
Published: January 2017

Tonsillectomy and adenoidectomy are currently the most common pediatric surgical procedures performed in the United States. Tonsillectomy may be effective in recurrent acute throat infection (acute tonsillitis), chronic tonsillitis, tonsillar hypertrophy, and peritonsillar abscess. Antimicrobial therapy may also be beneficial. Clinical trials evaluating children with obstructive adenoids are currently being evaluated; anecdotal evidence points to improvement in development and quality of life after surgery. The efficacy of adenoidectomy in paranasal sinusitis has not been evaluated in clinical trials; antimicrobial therapy or the possibility of upper respiratory tract allergy should be considered in such cases. For acute otitis media, recommendations range from no treatment in cases that will abate with time, to antimicrobial prophylaxis, to myringotomy with tympanostomy tube insertion, adenoidectomy with or without tonsillectomy, or a combination of adenoidectomy with myringotomy and/or tympanostomy tubes. The decision for or against otic and/or pharyngeal surgery should be individualized on the basis of severity, duration, and frequency of illness; previous treatment; and risk.
Inhibition of Nasopharyngeal Colonization of Hemophilus Influenzae by Oral Immunization
Authors: Kurono Yuichi , Shimamura Koichiro , Mogi Goro
Published: January 2017

Nontypeable Hemophilus influenzae organisms were inoculated into the nasopharynx of BALB/c mice immunized by oral administration of formalin-killed bacteria. Salivary antibodies and the colonization of H influenzae in the nasopharynx were investigated in order to clarify the effect of oral immunization. Salivary immunoglobulin A antibody titers against H influenzae were significantly increased by oral immunization, but salivary immunoglobulin G antibody titers were not. The bacteria inoculated into the nasopharynx were more rapidly eliminated in immunized mice than in control mice. The results suggest that oral immunization might be useful in preventing otitis media with effusion by inhibiting the colonization of the nasopharynx by pathogenic bacteria.
Endolymphatic Hydrops Induced by Immune Response of the Endolymphatic Sac: Relation to Perilymph Antibody Levels
Authors: Tomiyama Shun-Ichi
Published: January 2017

This study investigated the effect of a secondary immune response in the endolymphatic sac on the development of endolymphatic hydrops in guinea pigs. Following secondary keyhole limpet hemocyanin (KLH) challenge directly to the sac in systemically presensitized animals, hydrops rapidly developed within 1 week, then gradually reduced by 4 weeks. After 5 weeks, hydrops gradually recurred and developed again. Mean perilymph anti-KLH antibody levels rose from day 1 to 4 weeks and then decreased. The elevation of perilymph anti-KLH antibody levels on day 2 was due to an increased vascular permeability and there was a local regeneration by the challenge of the sac after day 7. The development of hydrops correlated well with mean perilymph anti-KLH antibody levels in the period from day 1 to day 7. After 2 weeks, there was no correlation between them. These results suggest that an immune response of the sac may induce an excess secretion of endolymph in the initial stage and may further lead to irreversible dysfunction of the sac at a later stage.
Spiral Modiolar Vein: Its Importance in Viral Load of the Inner Ear
Authors: Fukuda Satoshi , Harris Jeffrey P. , Keithley Elizabeth M. , Ishikawa Kazuo , Küçük Babür , Inuyama Yukio
Published: January 2017

Guinea pig—specific cytomegalovirus and Sendai virus were inoculated into the cochleas of seronegative guinea pigs to study the route of entry of cells participating in inner ear inflammation. Inflammatory cells accumulated around the spiral modiolar vein and appeared to be streaming from this vein into the scala tympani via a collecting venule. Inactivated virus inoculated into the cochlea and normal control cochlea failed to show inflammatory cell infiltrates. The spiral modiolar vein appears to play an important role in the movement of cells from the systemic circulation into the inner ear as part of the host's normal defense against invading pathogens such as viruses.