bluuebunny/crossref_metadata_2025 huggingface dataset:
Predicting Surgical Outcomes in Pediatric Cervicofacial Nontuberculous Mycobacterial Lymphadenitis
Authors: Parker Noah P. , Scott Andrew R. , Finkelstein Marsha , Tibesar Robert J. , Lander Timothy A. , Rimell Frank L. , Sidman James D.
Published: October 2014

Objectives:

We examined surgical outcomes in children with cervicofacial nontuberculous mycobacterial lymphadenitis and attempted to identify predictors of complications.

Methods:

A retrospective chart review from 2 tertiary pediatric centers was used to identify 11 presentation or operative variables (age at surgery, gender, symptom duration, pain, violaceous skin changes, skin breakdown, fluctuance, purified protein derivative positivity, operative procedure, use of nerve integrity monitoring, and use of skin flap advancement) and to compare these to 5 postoperative complications (facial nerve dysfunction [paresis or paralysis], poor scarring, recurrence, wound infection, and wound dehiscence without infection).

Results:

The 45 patients analyzed for presentation or operative variables (28 female, 17 male; average age, 31.2 months) typically presented with painless masses averaging 8.2 weeks in duration, along with violaceous skin changes in 29 of the 45 cases (64%) and skin breakdown in 9 cases (20%). The surgical procedures included parotidectomy with or without selective lymphadenectomy in 38 of the 45 cases (84%) and lymphadenectomy alone in 7 cases (16%). Skin resection and cervicofacial advancement flap reconstruction was performed in 20 cases (44%). Nerve integrity monitoring was utilized in 32 cases (71%). In the 44 patients analyzed for postoperative complications, we found facial nerve paresis in 14 (31.8%), poor scarring in 9 (20.5%), wound infection in 6 (13.6%), recurrence in 4 (9.1%), and facial nerve paralysis in 2 (4.5%). Nine of the 14 cases (64.3%) of initial facial nerve paresis resolved. At final follow-up, facial nerve paresis persisted in 5 of the 14 children (35.7%) with initial postoperative paresis and in 1 of the 2 children (50.0%) with initial postoperative paralysis. Facial nerve paralysis persisted in the other child with initial postoperative paralysis. Overall, 6 of these 7 patients (85.7%) with persistent facial nerve dysfunction had follow-up of less than 1 month. All transient and permanent facial nerve dysfunction was in the distribution of the marginal mandibular nerve only. No statistically significant predictors of complications were identified.

Conclusions:

We report acceptable but not insignificant rates of marginal mandibular distribution facial nerve injury, poor scarring, wound infection, and recurrence following resection of cervicofacial nontuberculous mycobacterial lymphade nitis in children that must be discussed with patients and parents before operation. No presentation or operative variables predicted the complications.
Tonsillectomy Healing
Authors: Isaacson Glenn
Published: October 2014

Objectives:

We performed a prospective observation study in an outpatient surgical and office setting to compare human post-tonsillectomy healing to human cutaneous wound healing and to established animal models of oral healing.

Methods:

Fourteen teenaged patients underwent planned tonsillectomy. Intraoral digital photographs were collected at the time of tonsillectomy, during the management of complications, and at postoperative office visits. Serial intraoral photographs of one patient were taken at 48-hour intervals from the time of surgery until postoperative day 17.

Results:

Intraoral photographs from the days after tonsillectomy revealed a pattern of inflammation and healing that closely paralleled that in human skin and in canine and porcine oral wound models.

Conclusions:

Edema and pain are greatest immediately after surgery, probably as a result of thermal effects and expression of inflammatory mediators that stimulate pharyngeal nociceptors. Pain gradually decreases over time, with an increase in analog pain measures on postoperative days 3 to 5 corresponding to the maximal wound inflammation documented in experimental models. Epithelial ingrowth beneath a fibrin clot begins shortly after wounding. Separation of the fibrin clot about 7 days after surgery exposes vascular stroma. Involution of the vascular stroma and completion of epithelial coverage correlate with decreased pain levels and a lessened risk of bleeding.
High-Force Simulated Intubation Fails to Dislocate Cricoarytenoid Joint in Ex Vivo Human Larynges
Authors: Friedman Aaron D. , Kobler James B. , Landau-Zemer Tali , Barbu Anca M. , Burns James A.
Published: October 2014

Objectives:

We assessed the likelihood of arytenoid dislocation during intubation through the application of controlled force.

Methods:

Six cadaveric human larynges were mounted in an apparatus for simulating forcible collision with the arytenoid complexes. An endotracheal tube tip probe (ETTP) was used to push one arytenoid complex, and a non-slip probe (NSP) was tested on the other. Increasing pressure was applied until the probes either slipped or reached 5 kg of force. Dissection was then performed to assess the integrity of the cricoarytenoid ligament. The forces obtained by pushing an endotracheal tube against an electronic balance were measured to estimate the maximal possible intubating force.

Results:

None of the ETTP or NSP trials disrupted the cricoarytenoid joint ligaments, and the joint never appeared to be dislocated. The mean maximal forces were 1.8 kg for the ETTP (after which, slippage consistently occurred) and 4.7 kg for the NSP. The mean maximal forces from an endotracheal tube pushed against a scale were 1.5 kg (without stylet) and 4.6 kg (with stylet).

Conclusions:

Arytenoid dislocation did not happen, and gross disruption of the joint capsule or ligament did not occur, even when the testing approximated the maximum force achievable under extreme conditions. Endotracheal tube insertion thus seems unlikely to cause arytenoid dislocation.
Vocal Fold Stem Cells and Their Niche in the Human Vocal Fold
Authors: Sato Kiminori , Umeno Hirohito , Nakashima Tadashi
Published: October 2014

Objectives:

Vocal fold stellate cells (VFSCs) in the maculae flavae have many morphological differences from conventional fibroblasts in the human vocal fold mucosa. It is uncertain whether the VFSCs are derived from the same embryonic source as conventional fibroblasts. The purpose of this study was to investigate the stemness of the VFSCs and whether the pericellular matrices in the maculae flavae are a hyaluronan-rich matrix, which is required for a stem cell niche.

Methods:

Paraffin-embedded specimens were stained with Alcian blue (pH 2.5) for a hyaluronidase digestion study. Immunoreactivity to antibodies directed to CD44, CD133, Oct-4, Ki67, and telomerase was investigated in 5 human adult vocal fold mucosae.

Results:

The VFSCs were resting cells (G0-phase) and expressed a mesenchymal stem cell marker. The VFSCs did not express hematopoietic or embryonic stem cell markers. Telomerase resided in the VFSCs. The hyaluronan concentration in the maculae flavae was high and the VFSCs expressed hyaluronan receptors, indicating that maculae flavae are characterized by a certain criterion of hyaluronan-rich matrix.

Conclusions:

There is growing evidence that the VFSCs in the human maculae flavae are somatic (mesenchymal) stem cells of the vocal fold, and that the maculae flavae may be a candidate for a stem cell niche that is a microenvironment nurturing a pool of VFSCs.
Tracheotomy Tubes with Suction above the Cuff Reduce the Rate of Ventilator-Associated Pneumonia in Intensive Care Unit Patients
Authors: Ledgerwood Levi G. , Salgado Moses D. , Black Hugh , Yoneda Ken , Sievers Ann , Belafsky Peter C.
Published: October 2014

Objectives:

We evaluated the effect of tracheotomy tubes that enable suction immediately above the cuff on the development of ventilator-associated pneumonia (VAP).

Methods:

Patients without preexisting pneumonia who required tracheotomy were randomly assigned to receive a tracheotomy tube with or without above-the-cuff suction. The suction tube provided 10 mm Hg of continuous wall suction while the tracheotomy tube cuff was inflated. Data regarding the development of VAP, time on the ventilator, and length of stay in the intensive care unit (ICU) were recorded and compared between groups.

Results:

Eighteen patients were randomized and prospectively evaluated. Nine patients received standard tracheotomy tubes, and 9 received suction-above-the-cuff tracheotomy tubes. The prevalences of VAP were 56% in the control group and 11% in the suction tracheotomy group (p = 0.02). The mean times on the ventilator were 18 ± 14 days in the control group and 11 ± 11 days in the suction group (p = 0.12). The mean lengths of ICU stay were 26 ± 15 days in the control group and 18 ± 15 days in the suction group (p = 0.14).

Conclusions:

Use of suction-above-the-cuff tracheotomy tubes significantly decreases the incidence of VAP in ICU patients. There were trends toward decreased time on the ventilator and decreased length of stay in the ICU.
Outcomes and Complications of Endoscopic Approaches for Malignancies of the Paranasal Sinuses and Anterior Skull Base
Authors: Suh Jeffrey D. , Ramakrishnan Vijay R. , Chi John J. , Palmer James N. , Chiu Alexander G.
Published: October 2014

Objectives:

Malignant tumors of the paranasal sinuses are traditionally approached by a variety of external incisions. Recent advances in endoscopic endonasal surgery have allowed for some of these tumors to be treated endoscopically. The purpose of this study was to assess the outcomes and complications of the endoscopic approach in a series of patients with paranasal sinus malignancies.

Methods:

A retrospective chart review was performed of patients with sinonasal or skull base malignancies treated with endoscopic or endoscopic-assisted resections at a tertiary care institution from 2002 to 2010. Patient data were collected on symptoms, tumor type, operative technique, and postoperative course. Baseline risk factors, overall and disease-free survival data, and surgical outcomes were compared between the two groups.

Results:

Of the total 49 patients, 36 (73%) underwent an endoscopic approach and 13 (27%) underwent endoscopicassisted approaches. Sarcomas (9 cases) were the most common tumor type, followed by squamous cell carcinoma (8), adenocarcinoma (8), and melanoma (7). The mean follow-up time for all patients was 3.58 years (range, 1.1 to 8.8 years). Surgical complications were more frequent with open approaches than with endoscopic approaches (23.1% versus 5.6%; p = 0.11). Medical complications were significantly more common with open approaches (38.5% versus 8.3%; p = 0.02). The disease-specific mortality rate was 8% (4 of 49). The local tumor recurrence rate was 16% (8 of 49). The 3-year disease-free survival rates were 86.8% in the endoscopic group and 67.7% in the open group (p = 0.047); however, the patients in the endoscopic group had lower T stages (p = 0.0068) and lower ASA scores (p = 0.03).

Conclusions:

Endoscopic approaches to the sinuses and skull base have become progressively more sophisticated with advances in skull base reconstruction, advances in surgical technique, and improvements in technology. This study demonstrates the relative safety and utility of the endoscopic approach for sinonasal and skull base malignancies. In carefully selected patients, endoscopic approaches demonstrate survival rates comparable to those of traditional surgery, and fewer perioperative complications. With appropriate planning and careful surgical decision-making, endoscopic surgery shows promise as a minimally invasive alternative in the treatment of sinonasal malignancies. Recent advances in endoscopic endonasal surgery have allowed for some of these tumors to be treated endoscopically. The purpose of this study was to assess the outcomes and complications of the endoscopic approach in a series of patients with paranasal sinus malignancies.
Malleus and Incus: Correlates of Size
Authors: Todd N. Wendell , Creighton Francis X.
Published: October 2014

Objectives:

Wide ranges of dimensions of the malleus and incus have been reported for various human populations. Unaddressed are concordance of malleus and incus sizes, bilateral symmetry, whether ossicle size correlates with otitis media, and whether second-branchial arch derivatives have more variability than first-arch derivatives. We sought to quantitatively describe the malleus and incus in a population not heretofore reported, with the following hypotheses in mind: 1) an ear's malleus and incus sizes are concordant; 2) a cranium's malleus and incus sizes have bilateral symmetry; 3) the sizes of the malleus and incus are unrelated to the mastoid-size indicator of childhood otitis media; and 4) second-branchial arch derivatives have more variability than do first-arch derivatives.

Methods:

We performed a postmortem material analysis of 41 adult crania without clinical otitis.

Results:

The sizes of clinically normal mallei (eg, 21.2 to 30.7 mg) and incudes (eg, 24.4 to 37.4 mg) were varied. Concordance of malleus mass and incus mass was found. However, no relation of malleus and incus sizes with mastoid size was found. The variability of first-arch derivatives was similar to that of second-arch derivatives.

Conclusions:

Clinically normal mallei and incudes had masses and dimensions that varied even more than previously reported. Nevertheless, bilateral symmetry was exhibited, as was concordance of masses.
Expression of Autoantibodies in Patients with Sudden Sensorineural Hearing Loss
Authors: Cho Chang Hyun , Jung Byoung Seo , Jung Joo Hyun , Lee Jung Ho , Lee Ju Hyoung
Published: October 2014

Objectives:

The aim of this study was to establish the expression rate of autoimmunity in patients with sudden sensorineural hearing loss and to determine whether a positive marker is associated with a higher rate of hearing recovery after steroid treatment.

Methods:

A prospective study was performed on 137 patients who experienced sudden sensorineural hearing loss and underwent immunoserologic investigations. Autoantibodies evaluated on the day of admission included anti-double-stranded DNA, rheumatoid factor, antiphospholipid immunoglobulins G and M, antinuclear antibody, and complements C3 and C4.

Results:

Of 137 patients, 75 were male and 62 were female (mean age, 45.1 years). Hearing loss was found on the left side in 61 patients and on the right side in 76 patients. Elevation of at least 1 autoantibody or abnormal complement levels were found in 80 patients (58%), and abnormalities of 2 or more antibodies were found in 28 (20%). There were no statistically significant correlations between autoantibody abnormalities and age, initial hearing level, or positive treatment response.

Conclusions:

There is no clear evidence of a correlation between autoimmunity and hearing improvement in patients with autoantibody abnormalities. A high (but not significant) expression rate of autoantibody abnormality and complement level was seen in patients with sudden sensorineural hearing loss.
Congenital Middle Ear Cholesteatoma: Experience from 26 Surgical Cases
Authors: Yamatodani Takashi , Mizuta Kunihiro , Hosokawa Kumiko , Takizawa Yoshinori , Sugiyama Kenichi , Nakanishi Hiroshi , Mineta Hiroyuki
Published: October 2014

Objectives:

We analyzed the clinical features and surgical techniques used in cases of childhood congenital cholesteatoma of the middle ear.

Methods:

We studied 26 patients (26 ears) who underwent surgery for congenital cholesteatoma between January 1998 and December 2009, focusing on the location and type of cholesteatoma, the surgical procedures involved, and the results obtained. Patients with prior otologic procedures were excluded. A 4-stage system was used to grade the cholesteatomas.

Results:

The frequency of posterior-quadrant involvement and open-type cholesteatomas increased in the more advanced stages. Second-look operations were performed in 60% of stage III and 75% of stage IV cases; and residual cholesteatomas were found in 20% of stage III and 75% of stage IV cases. Of the cases evaluated both before and after the operation, 100% of stage I and II cases, 86% of stage III cases, and 50% of stage IV cases showed improvement in hearing function.

Conclusions:

The staging system is relatively simple, while accurately reflecting clinical results. However, there are many differences between the anterior and posterior types of congenital cholesteatomas in surgical approach and postoperative progression that are not reflected in the classification systems and require further study. In addition, we reviewed the surgical procedures involved in anterior-quadrant cases, and propose a modified surgical procedure.
Tongue Strength as a Predictor of Functional Outcomes and Quality of Life after Tongue Cancer Surgery
Authors: Lazarus Cathy L. , Husaini Hasan , Anand Sumeet M. , Jacobson Adam S. , Mojica Jackie K. , Buchbinder Daniel , Urken Mark L.
Published: October 2014

Objectives:

Surgical resection of oral cancer can result in altered speech, swallowing, and quality of life (QOL). To date, the oral outcome variables of tongue strength, tongue and jaw range of motion, and saliva production have not been extensively assessed. This pilot study was done to assess tongue strength along with other oral outcomes and their relationship to performance status for speech, swallowing, and QOL after partial glossectomy. Our aim was to create a norm for what should be considered a normal tongue strength value in this population. We hypothesized that patients with tongue strength of 30 kPa or greater would perform better on the performance status scale and various QOL measures than do patients with tongue strength of less than 30 kPa.

Methods:

We used a cross-sectional design in this study. The postoperative assessment included 1) Performance Status Scale and Karnofsky Performance Status Scale; 2) oral outcome variables of tongue strength, jaw range of motion, and saliva production; and 3) patient-rated QOL ratings via Eating Assessment Tool, M. D. Anderson Dysphagia Inventory, EORTC-H&N35, and Speech Handicap Index.

Results:

Patients with tongue strength of at least 30 kPa performed better on the performance status scales and various QOL measures. The cutoff score of 30 kPa for tongue strength measures revealed a trend in predicting performance on the scales and QOL measures.

Conclusions:

The oral outcome variables correlated with performance status for speech, swallowing, and QOL. We propose a norm for tongue strength in this population, based on the trend seen in this group of patients, as none previously existed. Future studies are under way that incorporate a larger sample size to further validate this norm. Future studies will also examine oral functional outcome measures in a larger population by including other oral and oropharyngeal sites to help predict speech and swallow performance status and QOL.
Globus Pharyngeus: Effectiveness of Treatment with Proton Pump Inhibitors and Gabapentin
Authors: Kirch Suzanne , Gegg Ryan , Johns Michael M. , Rubin Adam D.
Published: October 2014

Objectives:

This study was performed to investigate the effectiveness of treatment of globus pharyngeus with proton pump inhibitors, gabapentin, or both.

Methods:

The subjects all presented with globus pharyngeus during the years 2006 to 2011. The inclusion criteria included a chief (primary) complaint of globus pharyngeus; a trial of proton pump inhibitor therapy for at least 2 months and/or a trial of gabapentin for at least 2 weeks; and at least 1 follow-up visit. We reviewed 331 charts; 87 patients met the criteria. The response to treatment was graded as none, partial, or complete.

Results:

Seventy-seven percent of all patients had improvement. Sixty-seven percent of patients had a partial or complete response from aggressive reflux management. Sixty-six percent of patients who had a trial of gabapentin reported improvement. Eight of 14 patients who did not improve with aggressive reflux management improved with gabapentin.

Conclusions:

A majority of patients with globus pharyngeus can be helped by treating reflux or neuralgia. A trial of gabapentin should be considered for patients who do not respond or only partially respond to reflux management.
Measurement of Phonation Threshold Power in Normal and Disordered Voice Production
Authors: Zhuang Peiyun , Swinarska Joanna T. , Robieux Camille F. , Hoffman Matthew R. , Lin Shengzhi , Jiang Jack J.
Published: October 2014

Objectives:

Phonation threshold pressure (PTP) and phonation threshold flow (PTF) are useful aerodynamic parameters, but each is sensitive to different disorders. A single comprehensive aerodynamic parameter sensitive to a variety of disorders might be beneficial in quantitative voice assessment. We performed the first study of phonation threshold power (PTW) in human subjects.

Methods:

PTP and PTF were measured in 100 normal subjects, 19 subjects with vocal fold immobility, and 94 subjects with a benign mass lesion. PTW was calculated from these two parameters. In 41 subjects with a polyp, measurements were obtained before and after excision. Receiver operating characteristic (ROC) analysis was used to determine the ability of the three parameters to distinguish between controls and disordered groups.

Results:

The PTW (p < 0.001), PTP (p < 0.001), and PTF (p < 0.001) were different among the three groups. All parameters decreased after polyp excision. PTW had the highest area under the ROC curve for all analyses.

Conclusions:

PTW is sensitive to the presence of mass lesions and vocal fold mobility disorders. Additionally, changes in PTW can be observed after excision of mass lesions. PTW could be a useful parameter to describe the aerodynamic inputs to voice production.
Bone-Anchored Hearing Devices in Children with Unilateral Conductive Hearing Loss: A Patient-Carer Perspective
Authors: Banga Rupan , Doshi Jayesh , Child Anne , Pendleton Elizabeth , Reid Andrew , McDermott Ann-Louise
Published: October 2014

Objectives:

We sought to determine the outcome of implantation of a bone-anchored hearing device in children with unilateral conductive hearing loss.

Methods:

A retrospective case note analysis was used in a tertiary referral pediatric hospital to study 17 consecutive cases of pediatric patients with unilateral conductive hearing loss who were fitted with a bone-anchored hearing device between 2005 and 2010.

Results:

The average age of the patients at the time of bone-anchored hearing device fitting was 10 years 6 months (range, 6 years 3 months to 16 years). Qualitative subjective outcome measures demonstrated benefit. The vast majority of patients reported improved social and physical functioning and improved quality of life. All 17 patients are currently using their bone-anchored hearing device on a daily basis after a follow-up of 6 months.

Conclusions:

This study has shown improved quality of life in children with unilateral hearing loss after implantation of their bone-anchored hearing device. There was a high degree of patient satisfaction and improvement in health status reported by children and/or carers. Bone-anchored hearing devices have an important role in the management of children with symptomatic unilateral hearing loss. Perhaps earlier consideration of a bone-anchored hearing device would be appropriate in selected cases.
I. A syndrome of Ear and Sinus Symptoms Dependent upon Disturbed function of the Temporomandibular Joint
Authors: Costen James B.
Published: October 2014

Headache and ear symptoms directly dependent upon disturbed function of the mandibular joint frequently occur in cases showing sufficient pathology about the sinuses to otherwise account for them. There are so many medical, rhinologic and ophthalmologic reasons for headache distributed about the ears, vertex and occiput; and there are so many nasal changes to account for eustachian tube obstruction, that evulsion of the condyle of the mandible from overbite is not considered.

Hearing tests show a mild type of catarrhal otitis with eustachian tube involvement, usually simple obstruction. This is due to pressure on its anterior membranous wall, transmitted through soft tissue from the relaxation of pterygoid muscles and associated sphenomandibular ligaments during overbite.

The promptness with which the ears improve seems to controvert the idea that the ear condition is due to trauma or concussion of the labyrinth or tympanic structures from the condyle of the mandible. Cases of shock to the labyrinth from a blow on the chin are not within the scope of this paper.

Attacks of dizziness in these cases are obviously due to changes in intratympanic pressure affecting the labyrinth. The effect is transient and recurrent, relieved by inflation of the eustachian tube, and not the picture seen in toxic labyrinthitis.

The areas involved in the headache cases are typical of headache of posterior sinus origin and are easily taken for such. Persistence of the headache after indicated sinus surgery is sometimes due to mandibular joint pathology.

The symptoms arise as a result of overaction of the joint at first, and later adds the regional effect of a loose, pathologic joint, produced by absorption of the meniscus, condyles and surrounding bone.

The prognosis in a given case depends on these factors: (a) the accuracy with which refitted dentures relieve abnormal pressure on the joint; (b) the extent of injury to the tube and to the condyle, the meniscus, and the joint capsule.

The mechanics of occlusion and dental problems are not included here. Only sufficient reference to the anatomy of the mandible and joint is made to clarify the ear or sinus diagnosis.

Anatomic reasons are advanced to account for abnormal conditions of the eustachian tube, and for the distribution of pain toward the vertex, occiput, pharynx and tongue. It is barely possible that mandibular joint pathology may be an etiologic factor in glossopharyngeal neuralgia, the association of chorda tympani and auriculotemporal nerves with the ninth occurring via sensory connections to the otic ganglion.
Concentration of Antibiotics in Sinus Secretions
Authors: Axelsson A. , Brorson J.-E.
Published: October 2014

Patients with acute maxillary sinusitis with secretion were treated by doxycycline and spiramycin. Doxycycline was given for nine days, 200 mg initially followed by a single daily dose of 100 mg. Spiramycin was given for 10 days, 1.5 g twice a day. The concentration of the antibiotics was determined in 149 samples of sinus secretion, aspirated or irrigated, from 58 patients by means of the bacterium inhibitory capacity of the antibiotic. The concentrations of the antibiotics were measured biologically on blood agar plates of standardized thickness, seeded with appropriate bacterial strains. The concentration in general was well above the MIC for the bacteria found. There was a statistically significant increase in spiramycin concentration with duration of therapy. However, the concentration in general showed very varying values for both antibiotics without any correlation to such parameters as age, radiological finding, appearance of the sinus content and interval from the last antibiotic dose. The reason for this is discussed.
Idiopathic Facial Palsy and Pregnancy
Authors: Mair Iain W. S. , Elverland Hans H. , Johannessen Thor A.
Published: October 2014

Idiopathic peripheral facial paralysis is a common clinical condition, but the etiology and preferred mode of treatment are still undecided. The currently popular etiological theory centers around disturbances of microvascular circulation. The literature contains conflicting statements on the incidence of this condition in pregnancy. Six cases are reported, one bilateral, in all of which the paralysis developed within six weeks of delivery. The incidence of facial paralysis was not significantly different in our pregnant and nonpregnant populations of similar age groups. A battery of tests failed to reveal any specific etiologic factors. None of the patients had toxemia, therefore, hypertension is not a causative factor. Comparison with the Melkersson-Rosenthal syndrome would indicate that tissue edema is not involved in the pathogenesis of the idiopathic paralysis of pregnancy. Both idiopathic sudden deafness and idiopathic facial paralysis occur preferentially in the later stages of pregnancy and the early puerperium. Further research into the pathophysiology of this stage of pregnancy may clarify some of the etiological problems of these two conditions.
Humidification of Respired Gas by Nasal Mucosa
Authors: Liese W. , Joshi R. , Cumming G.
Published: October 2014

End tidal water vapor tension of the expirate after nasal and then after oral inspiration was measured at the lips of seven normal subjects using a mass spectrometer. At a mean inspired air temperature of 23°C and Ph.o of 14.7 mmHg, the mean end tidal Ph.o was was 40.57 mmHg after nasal and 37.15 mmHg after oral inspiration. The difference was statistically significant. The evidence for complete saturation of expired gas is discussed. Assuming a 100% saturation of expired gas the average contribution of the nasal mucosa to the water content of the respired air in this experiment was 3 gm/m3 or approximately 10% of the total water contributed by the respiraory tract.
Surgical Anatomy of the Sinus Epitympani
Authors: Wigand M. E. , Trillsch K.
Published: October 2014

In the course of microsurgical interventions of the middle ear a separate bony niche was frequently encountered in front of the epitympanum, situated between the middle cranial fossa and the compartment of the tensor tympani muscle. It could be identified in 13 of 22 nonselected human temporal bones. Its size and topographical relations were studied by microdissection. The average distances to the following structures were measured: internal auditory canal, anterior semicircular canal, facial and greater superficial petrosal nerves, geniculate ganglion, carotid artery, and basal turn of the cochlea. This niche, for which the term “sinus epitympani” is suggested, deserves interest because of its role as site of hidden pathology, and as a route of approach to preepitympanic structures.
The Translabyrinthine Removal of Acoustic and other Cerebellopontine Angle Tumors
Authors: Glasscock Michael E. , Hays James W.
Published: October 2014

This paper reviews the history of acoustic tumor surgery and sets forth the technique of translabyrinthine surgery. Thirty-five patients with 36 tumors are presented and the results explained in detail. A plea is made for standardization of reporting results and some of the controversy concerning surgical technique is discussed briefly.
The Anterior Commissure Revisited
Authors: Tucker Gabriel F. , Alonso William A. , Cowan Malcolm , Tucker John A. , Druck Norman
Published: October 2014

Reexamination of the anterior commissure from the perspective of semantics, the anatomy of tumor spread, and connective tissue histology and embryology has reaffirmed previously published findings. In addition, this investigation of the convergence of the various structures toward the anterior commissure has led to the hypothesis that the anterior subglottic larynx may have a midline embryological origin. Whether this area should be included in the “anterior commissure” or possibly better considered as an area to which anterior commissure tumors spread is as yet undetermined.
Neural Activity in the Vestibular Nuclei of the Cat
Authors: Ryu J. H. , McCabe B. F.
Published: October 2014

The responses of 600 single neurons in the vestibular nuclei of the cat to a constant angular acceleration (4°/sec2) or ice water caloric stimulation were investigated, and neurons were classified according to their responses. Animals were anesthetized and activity was recorded stereotaxically through the intact cerebellum with a tungsten microelectrode. The resting activity, response to stimulation, firing pattern, and relationship between spike discharge and nystagmus were the parameters of interest with special attention to the relationship between anatomy and neurophysiology of the vestibular nuclear complex. The results indicate that the superior and medial vestibular nuclei contains a relatively larger number of Type I and II neurons (related to semicircular ducts) and the lateral and inferior vestibular nuclei contains a relatively larger number of Type V neurons (related to otolith organs, spinal cord, etc.) which is in good agreement with anatomical findings. Histologic mapping according to their response type, however, shows no clear topographical arrangement. The average resting frequency was about 30 spikes per second, and the majority of neurons discharge pattern was random. Neuron firing in the nuclei was geared to the slow component of nystagmus. There is considerable crossed inhibitory activity between two sets of the vestibular nuclei.
Ethacrynic Acid, Furosemide, and Vestibular Caloric Responses
Authors: Levinson Richard M. , Capps Mary Jayne , Mathog Robert H.
Published: October 2014

Ethacrynic acid and furosemide, saluretic diuretics of high potency, have been shown to be toxic to the auditory system. In the present study, it was found that the depressant effect of ethacrynic acid extends into the vestibular system. Cats, given a 20 mg/kg intravenous bolus of ethacrynic acid, exhibited a 50% greater reduction of the vestibular nystagmus response to a caloric irrigation than control animals receiving normal saline. This was true for all three major parameters of the recorded nystagmus response (degrees of slow phase displacement, frequency of beats and slow phase velocity). This effect was very rapid in onset (present at 30 seconds postinjection), and quite transient (approaching normal by 20 minutes postinjection). Furosemide did not produce the vestibular depression. Nystagmus responses observed after injection of furosemide (at 20 mg/kg) were not significantly different from those of control animals receiving normal saline. Possible mechanisms of action and therapeutic implications of the ethacrynic acid-induced vestibular depression are discussed.
Middle Ear Masses Mimicking Glomus Tumors: Radiographic and Otoscopic Recognition
Authors: Valvassori Galdino E. , Buckingham Richard A.
Published: October 2014

A high jugular bulb, an ectopic carotid artery, and an intratympanic cholesterol granuloma may, at times, mimic a middle ear glomus tumor, otoscopically. The otoscopic and radiographic findings which differentiate these lesions include microscopic otoscopy, tomography, carotid arteriography, and retrograde jugular venography. Examples of otoscopic and radiographic findings and procedures which enable the clinician to differentiate these lesions are presented.
Application of Color Television in Bronchoesophagology
Authors: Rayl John E. , Rourke Donald
Published: October 2014

The educational value of utilizing modern color television studio equipment for endoscopic examinations has improved the efficiency with which the experienced endoscopist can train other physicians. Experience with a color television-endoscopy program has demonstrated the following additional advantages: 1) unlimited audience during real-time viewing; 2) efficient training of endoscopic personnel; 3) endoscopic image magnification; 4) videotape recording; 5) immediate playback; 6) Polaroid photographs of endoscopic lesions from TV monitor for patient's record; 7) patient education; and 8) videotape editing for educational purposes. The basic requirements for a comprehensive color television-endoscopy program including personnel, light sources, endoscopes, cameras, test equipment, synchronization, picture monitors, and videotape recorders are briefly described. This description is related to assist other physicians and associated personnel who wish to implement their own television-endoscopy program.
Nasotracheal Intubation in Management of Delayed Decannulation
Authors: Crysdale William S.
Published: October 2014

Nasotracheal intubation was used in the attempted decannulation in eight cases of delayed decannulation. Radiological and endoscopic evaluation indicated that posterior displacement of the anterior tracheal wall above the tracheal stoma was the cause of the delay. In all cases, the tracheotomy cannula was removed under anesthesia and a nasotracheal tube was inserted temporarily. Good communication between surgical and anesthetic staff and the facilities of an intensive care unit were indispensable. Decannulation was achieved in six cases. Temporary nasotracheal intubation in patients with posterior displacement of the anterior tracheal wall will splint the wall until extubation is feasible.
Some Aspects of Fetal Laryngeal Development
Authors: Tucker John A. , Tucker Gabriel F.
Published: October 2014

Some aspects of morphological and physiological development of the fetal larynx are presented. Histochemical confirmation and determinations of fetal glandular activity are needed. Anomalous development of the larynx is still conjecture, but congenital cytsic formation with glandular development appears possible after the fifth month of human fetal life.
Viral Labyrinthitis — An Experimental Study
Authors: Karmody Collin S.
Published: October 2014

An attempt was made to produce viral labyrinthitis in the rhesus monkey. Rhesus monkeys are susceptible to the mumps virus. Nine animals were used. After removal of the stapes, the left oval windows were plugged with Gelfoam® soaked in a culture of live mumps virus; right oval windows were plugged with Gelfoam® soaked in killed cultures. Animals were sacrificed at different time intervals, postinfection. In eight of the nine animals there was seroconversion from negative to positive; however, none of the animals developed the histologic changes of viral labyrinthitis.
Follicular Carcinoma of Hürthle Cell Type as Cause of Hemoptysis
Authors: Cummings Charles W. , Weymuller Ernest , Goodman Max L.
Published: October 2014

A patient with follicular carcinoma, Hürthle cell type, who developed subglottic extension and uncontrollable hemoptysis is presented. In consideration of the patient's age a conservative therapeutic program was instituted with a definite response to I131 therapy despite poor radioactive iodine (RAI) uptake by the tumor. Laryngectomy and thyroidectomy were eventually required to control hemoptysis; the patient remains socially functional and asymptomatic after a 30-month period. The two-year period of weekly office visits and temporizing treatment as occurred in this patient cannot be recommended. It seems appropriate to advocate surgical treatment including laryngectomy for follicular carcinoma, Hürthle cell type, localized to the laryngotracheal area without regard for the age of the patient.
Positional Nystagmus in Association with Macroglobulinemia
Authors: Keim Robert J. , Sachs George B.
Published: October 2014

Waldenstrom's macroglobulinemia is a malignant lymphoproliferative disease associated with a monoclonal macroglobulinemia. Most explanations of the cochlear and vestibular symptoms in this disease have dealt with vascular thrombotic or hemorrhagic phenomena. Five patients currently being treated for macroglobulinemia have been reviewed. Three patients gave a history of periodic dizziness and underwent extensive neuro-otologic examination. The results suggested an alternate mechanism for the pathophysiology of the vestibular disturbance in macroglobulinemia. Vestibular examination by use of electronystagmography provided information which suggests that the cupulae may be altered by the macroglobulins to act as gravity receptors.
Present Status and Future Development of the Cochlear Prosthesis
Authors: Michelson Robin P. , Merzenich Michael M. , Schindler Robert A. , Schindler David N.
Published: October 2014

Presently devised single channel devices generate relatively primitive sensation of hearing. They provide some enhancement of communication skills for the totally deaf. Definite psychological advantages for the totally deaf have been observed. Pitch discrimination is by the mechanism of “periodicity pitch.” No “place” pitch encoding is possible. The recognition of complex sounds is not possible. Multiple segments of auditory nerve must be stimulated in a manner which will simulate the complex patterns of neural activity necessary for speech discrimination. Electrodes can be optimized and the pathophysiological consequences of electrical stimulation can be determined in experimental animals. The perceptual consequences of electrical stimulation, however, can best be determined in man himself. How much we will have to rely on known and future methods of aural rehabilitation will depend upon how well perceptual speech patterns can be generated by electrical stimulation of the auditory nerve.
Reconstruction of the Open Mastoidectomy Ear: A Six Year Progress Report
Authors: Smith Mansfield F. W.
Published: October 2014

This report deals with 61 mastoid cavities which were revised or reconstructed using homograft techniques over a six-year period. Discussed are the variety of homograft procurement techniques and surgical homograft techniques which have been abandoned and included in a review of 16 consecutive mastoid revisions performed from 1973–1974 utilizing a standard surgical technique.
Nontraumatic, Nonneoplastic Subglottic Stenosis
Authors: Djalilian Mohsen , McDonald Thomas J. , Devine Kenneth D. , Weiland Louis H.
Published: October 2014

During a 20-year period, 12 patients with nontraumatic, nonneoplastic subglottic stenosis were seen at the Mayo Clinic. The etiologic factors were relapsing polychondritis, amyloidosis, sarcoidosis, and Wegener's granulomatosis. Because of the diverse initial presentation of the disease, the clinician should consider that the stenosis is a manifestation of a systemic disorder and carry out an otolaryngologic and physical examination with the appropriate roentgenograms and blood and urine tests. Treatment, if a systemic disease is proved, consists of appropriate medication. Surgery may be necessary, depending on the nature of the lesion. Small strictures may not need to be treated.
Injuries to the Neonatal Larynx from Long-Term Endotracheal Tube Intubation and Suggested Tube Modification for Prevention
Authors: Hengerer Arthur S. , Strome Marshall , Jaffe Burton F.
Published: October 2014

Since the early 1960's nasotracheal tubes have been used for neonates with primary respiratory diseases which necessitated positive pressure ventilation. This therapy may be required for extended periods of weeks to months meaning prolonged trauma to the neonatal larynx. The initial injury and long-term effects of the endotracheal tube in this age group have not been adequately investigated. The acute findings can be arytenoid and posterior commissure ulcerations and, in some cases, cartilage erosion. Long-term follow-up in these children to age 3.5 years showed a persistent arytenoid defect with chronic hoarseness. The consideration of a change in the structure of the endotracheal tube is suggested as a possible means of avoiding these injuries.
Tracheal Incision as a Contributing Factor to Tracheal Stenosis: An Experimental Study
Authors: Lulenski Gary C. , Batsakis John G.
Published: October 2014

Tracheostomies were performed on 25 mongrel dogs, employing either a vertical or inverted U flap incision in the trachea. Following cannulation for 14 days, the animals were maintained for three months and endolarygeal photographs were taken. At the time of autopsy, comparisons of the gross specimens were carried out, as well as histological sectioning through the tracheal stomal area. Both endolaryngeal examination and study of the gross specimens at autopsy revealed less distortion of the tracheal lumen following the flap versus vertical tracheostomy, especially in those animals having the flap of cartilage resewn to the trachea at the time of decannulation. Measurements of the cross sectional area at the tracheal stoma were also made. In animals having a flap tracheostomy, the stomal lumen was preserved, regardless of resuturing the flap. However, animals having a vertical tracheostomy lost an average of 18% of the tracheal area when compared with those having a flap incision. Histological examination revealed cartilaginous growth across the tracheostomy incision only in animals having the flap tracheostomy. Support for the flap tracheostomy is provided from animal experimentation.
Incidence, Predisposing Factors and Outcome of Pharyngocutaneous Fistulas Complicating Head and Neck Cancer Surgery
Authors: Dedo Douglas D. , Alonso William A. , Ogura Joseph H.
Published: October 2014

A major complication of head and neck cancer surgery following radiation and extensive resection is pharyngocutaneous fistula. A retrospective analysis of 36 fistula patients out of 376 major head and neck procedures between January 1971 and July 1973 revealed certain guidelines for improved clinical management. Since a large discrepancy existed in the incidence of fistulas between the different surgical procedures, each operative group was examined separately. The incidence, predisposing factors, and methods of treatment for this complication following composite jaw-neck resections and various laryngeal procedures are analyzed and discussed.
The Peripheral Hearing Mechanism: A Biochemical and Biological Approach
Authors: Naftalin Lionel
Published: October 2014

A new approach is described to the problem of hearing at energy levels near threshold. Models depending on the macro-physics of levers are rejected. Instead, evidence is presented for frequency analysis, signal placement and energy transduction by the properties (known or experimentally determined) of the cochlea and of the structures within the scala media. The hypothesis developed rests on the established theorems of Gabor and Brillouin, and at the same time is based on the data of enzymology. Care is taken not only that the hypothesis does not conflict but that it is actually consonant with recent solid state physics. The cochlea by virtue of its internal geometry and contained column of fluid is considered to perform a Fourier analysis to a first approximation. This crude “placement” of the acoustic signal is refined by the semi-solid-state lattice of the tectorial membrane which far from permitting dissipation of the signal energy actually “concentrates” the energy at the membrane surface of the hair processes of a hair cell. Here biochemical transduction, akin to the processes known for other sensory cells, transforms acoustic energy through an ion-shuttling mechanism to the form of energy characteristic of living cells, viz. enzyme conformational changes.
Caloric and Optokinetic Nystagmus in Cerebellar Patients
Authors: Stroud Malcolm H. , Rauchbach Erol
Published: October 2014

In certain cerebellar lesions, optokinetic tracking is deficient, especially on tracking or following to the ipsilateral side. However, in many cases optokinetic nystagmus can occur, and apparently in better degree than would be expected from a study of pendulum tracking. This may be due to the patient leading into the stimulus and picking it up as soon as it is presented in far lateral gaze (in the direction of the fast component) and allowing the drift caused by the tone deficit to assist the tracking. An added vestibular tone can eliminate such a pseudo reflex. Induced vestibular nystagmus is enhanced and assumes a more dominant role so that optokinetic nystagmus is overcome, not only on gaze to the side of the tracking, but also on straight ahead gaze and even on some deviation of the eyes in the opposite direction.
Schwannoma of the Jugular Foramen
Authors: Gacek Richard R.
Published: October 2014

Two cases of schwannoma limited to the jugular foramen are described. This entity may clinically and radiologically resemble glomus jugulare tumors so closely, that only careful histological examination of an adequate surgical tumor specimen can provide a definitive diagnosis. Since documentation of this form of neurogenic tumor is lacking in the literature, it suggests that the entity is very rare or that such tumors may be erroneously classified as glomus jugulare tumors. The two cases in this study were managed surgically by subtotal removal via a wide transmastoid approach.