bluuebunny/crossref_metadata_2025 huggingface dataset:
Down's syndrome: A modern otorhinolaryngological perspective
Authors: Strome Marshall
Published: October 2006

The incidence of Down's syndrome is estimated at 1.5 per 1000 births, or 7,000 newborns annually in this country. Mounting financial considerations in the delivery of medical care, as well as humanitarian considerations, fostered this in‐depth prospective, multidisciplinary study. One hundred and seven patients comprised the initial group, and 83 met the criteria established for documentation of otorhinolaryngological parameters. All patients were home based and given scheduled, routine pediatric care. Otolaryngology care, when indicated, was by consultation. The uniqueness of this study exists in the fact that children were followed from the first year of life, in what must be considered an enhanced environmental setting for Down's syndrome patients.

Otologic, rhinologic and laryngologic parameters were explored in‐depth with the following resultant data. Patients with stenotic ear canals had a markedly increased incidence of associated middle ear effusion. In addition, patients with an increased frequency of upper respiratory tract infections in association with stenotic canals had an even greater incidence of effusion. When stenotic canals were present, the diagnosis of fluid proved difficult for the primary care physician. The total incidence of conductive middle ear pathology was shown to be significantly lower than in most reported studies. Equally important was the fact that at the time of data computation, none of the children had active, chronic middle ear pathology and cholesteatoma had not been identified.

Adenoidectomy was shown clinically to have little apparent effect on the course of otologic pathology, nasal respiration or rhinorrhea in Down's syndrome. Previously unreported surgical correlates of the nasopharyngeal anatomy were related to upper respiratory obstructive symptoms manifest by many of these children. Apparent, spontaneous resolution of the latter, in most instances with age, correlated well with anticipated changes in the growth of the involved structures. Low dose antibiotic therapy was shown to be of benefit in controlling early rhinorrhea.

Isolated congenital abnormalities of the lower respiratory tract were discussed with the findings that symptoms related to the respiratory tract must not be assumed to be inherent to the syndrome until other potential etiologies have been thoroughly considered.

Factors relating to intelligence in Down's syndrome were explored with the conclusion that a direct and favorable comparison could be made in this study between improved hearing and improved intellect.
An holistic approach to Meniere's disease. Medical and surgical management
Authors: Wiet Richard J. , Kazan Robert , Shambaugh George E.
Published: October 2006

A review of the medical and surgical management of 195 patients with Meniere's disease is presented. In order to avoid a piecemeal approach to the problem of Meniere's disease, the “whole” patient must be treated. Psychological counseling, medical management, and when indicated selective surgical management is advocated. The diagnosis of Meniere's must be confirmed through careful history, physical, neurotological evaluation and selective testing.

The majority of patients can be controlled medically; however, in this study 52 (26%) patients underwent surgical therapy. Twenty‐eight patients underwent some type of saccus surgery for Meniere's disease with overall relief of 71%; however, better relief of vertigo was seen with labyrinthectomy and nerve section. The most common indication for surgery was disabling vertigo. However, fluctuating progressive sensorineural loss, may be an important reason to advise surgery.

Surgical techniques for Meniere's disease continue to evolve. A graduated approach is preferred, starting with endolymphatic‐mastoid shunt, proceeding to middle fossa vestibular nerve section when medical status and hearing are adequate. When hearing is socially inadequate, labyrinthectomy with or without yestibular nerve section is preferred. A good working relationship with a neurosurgeon is advised for otolaryngologists performing middle fossa surgery.
Recovery nystagmus in ménière's disease
Authors: Mcclure Joseph A. , Copp John C. , Lycett Paul
Published: October 2006

Spontaneous nystagmus occurs during a Ménière's attack although the literature indicates that the direction can be variable. Previous observations made during the acute and recovery stages of a Ménière's attack suggested that the direction of the spontaneous nystagmus was consistent with the primary‐secondary sequence of nystagmus that occurs with relatively prolonged stimulation of the normal vestibulo‐oculomotor system. To evaluate this nystagmus pattern further, spontaneous nystagmus was monitored in eight patients using DC electronystagmography during an acute Ménière's attack. All showed an initial contralateral nystagmus during the acute phase of the attack with reversal to an ipsilateral (or recovery) nystagmus, as the acute symptoms subsided. Such a pattern of nystagmus occurring over a few hours is a helpful diagnostic aid, and when surgery is being considered, it provides objective evidence of the ear with active disease.
Stapedectomy: Incus bypass procedures. A report of 203 operations
Authors: Sheehy James L.
Published: October 2006

The records of 203 stapedectomy operations in which we used a prosthesis from the malleus handle or a columella from the tympanic membrane were reviewed; 63 operations were primary stapedectomies, and 85% had a postoperative conductive deficit of 15 dB or less. The most common single indication for an incus bypass procedure was idiopathic malleus head fixation.

Sixty‐six operations were revision stapedectomies; 65% had a postoperative deficit of 15 dB or less. In 50% the bypass indication was necrosis of the incus.

There were 74 stapedectomies in a previously fenestrated ear; 60% had a postoperative deficit of 15 dB or less.

Incus bypass procedures in stapedectomy, when indicated, yield satisfactory hearing results. Otolaryngologists who perform stapedectomy must be familiar with these procedures.
Panel discussion: Pathogenesis of otitis media. Studies on middle ear effusions
Authors: Juhn S. K.
Published: October 2006

The analyses of middle ear effusion (MEE) in otitis media may prove important information for better understanding of etiology, evaluation of inflammatory stages of the middle ear cavity, and evaluation of the efficacy of the treatment. Biochemical composition of serous and mucoid effusion has been characterized in terms of enzymes (lactate dehydrogenase, (LDH), lysozyme, alkaline and acid phosphates), and hexosamine content of MEE. In addition to immunoglobulin (IgA, G, and M) content, several new immunochemical parameters (immune complexes, complements, secretory IgA) and histamines have been determined in various types of MEE. Bacteriological findings of MEE, age of patients, viscosity of MEE, and clinical course (fresh or recurrent) have been correlated with the results of biochemical and immunochemical analyses of MEE. Parallel studies of animal models (serous otitis media by eustachian tube obstruction, purulent otitis media by direct innoculation of pneumococcus) showed sequential changes of mucoperiosteum and alteration of enzyme levels (LDH, lysozyme) at various times after the induction of experimental otitis media. It was found that LDH and lysozyme levels were higher in the purulent otitis media group than in the serous otitis media group and that enzyme levels decreased with clearing of the bacteria along with the resorption of inflammatory changes evidenced by histology. Human MEE studies showed that lysozyme levels were higher in the culture positive group than in the negative group, substantiating the animal findings.

Strong indications have been shown that biochemical and immunochemical characteristics of MEE can reflect the degree of inflammatory changes in the middle ear cavity. Thus, baseline information necessary to specify the factors responsible for chronicity or the tendency of recurrence of otitis media has been established. Further longitudinal studies are necessary to evaluate the efficacy of presently available treatment on the management of the disease process in otitis media.
Paecilomyces fungus infection of the maxillary sinus
Authors: Rowley Steven D. , Strom C. Gordon
Published: October 2006

Paecilomyces is a fungus only recently recognized as a human pathogen. We describe the only known case of sinusitis to date due to such a fungus. The histologic characteristics of paecilomyces are presented, and based on a review of fungal sinusitis and a disease‐free 30 month follow‐up, the treatment of this entity is suggested to be conservative local surgical debridement and aeration.
The cochlear implant — oklahoma group experience to date
Authors: Hough Jack , Mcgee Mike , Dormer K. J. , Richard G. , Guthrey George , Waterfall Kathleen , Engelmann Larry , Shaefer Arlene B.
Published: October 2006

The establishment of a cochlear implant team and the implementation of the Oklahoma City project was for the purpose of monitoring techniques and results reported by other investigators as well as perhaps contributing to the improvement of this method of restoring sound to profoundly deafened individuals. Years of planning and 3 years of actual experience with over 25 patients who have been implanted will be documented. Technical advances in prosthetic attachments and new transformer circuitry as well as better methods of evaluating results will be presented. Our assessment of the value of the cochlear implant and its future will be discussed.
The use of the tidal breathing flow volume loop in laryngotracheal disease of neonates and infants
Authors: Abramson Allan L. , Goldstein Mark N. , Stenzler Alex , Steele Andrew
Published: October 2006

Flow volume loops have been valuable in the diagnosis of upper airway obstruction in adults; however, the use of this technique in neonates has been limited because of their inability to perform a forced exhalation. We have used the tidal breathing flow volume loop (TBFV) to evaluate upper airway function in 100 neonates and infants. Eleven of the neonates and infants tested with this method were found to have laryngotracheal abnormalities such as tracheal stenosis, innominate artery compression, subglottic hemangioma, and unilateral vocal cord paralysis.

Normal neonates and infants demonstrate a round or oval TBFV loop pattern, while those with upper airway obstruction show a flat inspiratory or expiratory curve.

Tidal breathing flow volume loops offer a new, rapid and noninvasive method for evaluating the upper airway function in neonates and infants, and may play an important role in diagnosing upper airway dysfunction and evaluating the need for therapeutic intervention.
Scrofula — the dangerous masquerader
Authors: Levin‐Epstein Allan A. , Lucente Frank E.
Published: October 2006

Mycobacterial cervical lymphadenitis or scrofula continues to puzzle the clinician. Its propensity for mimicking other diseases delays treatment and increases the risk to the general public and hospital personnel. Historical data, physical findings and laboratory tests are often unreliable, thus delaying diagnosis and treatment. Sixteen patients with scrofula were treated from 1975 to 1980. Most patients were from India, Pakistan, or Latin‐America. Only 3/16 gave a positive history of TB contact, 6/16 had constitutional symptoms, 8/16 had matted nodes, 9/16 had nodes in the posterior triangle, and only 1/16 had a positive chest x‐ray. AFB stain was negative in 9/16 patients; culture was negative in 8/16. Skin testing and histologic analysis were more reliable, with 13/16 and 13/14 positive respectively. Our experience confirms both the importance of attempting excisional biopsy, where feasible, and the increased morbidity associated with incisional biopsy in the scrofula patient. All patients in our series responded well to treatment with combination standard antitubercular medications including isoniazid, ethambutol, pyridoxine and rifampin.
A method of predicting the length of intubation in Trauma‐Induced respiratory insufficiency.
Authors: Kaplan Jory , Weymuller Ernest
Published: October 2006

A retrospective study of patients intubated for more than 24 hours was undertaken to assess the possibility of predicting the length of intubation. Patients requiring intubation for injuries secondary to motor vehicle accidents were scored according to a well‐documented grading system which enables a numerical assessment of the severity of injury.

There appears to be a significant relationship between this score and the length of intubation. It also appears possible to estimate the duration of intubation within the first 24 hours after injury in this group of patients.

This information could provide an objective criterion for the clinician who must choose between prolonged intubation or tracheotomy in the management of severely injured patients.
Modified supraglottic laryngectomy and resection of lesions of the base of tongue
Authors: Weisberger Edward C. , Lingeman Raleigh E.
Published: October 2006

Extensive malignant tumors involving the base of tongue and adjacent pharyngeal walls usually require surgical resection combined with radiation therapy and sometimes chemotherapy. Often it is elected to perform a concomitant laryngectomy to prevent chronic aspiration, but not because of tumor extension to the larynx.

A new technique allowing preservation of glottic function is described. This involved preservation of the false vocal folds and their surgical closure. The interarytenoid mucosa is preserved. This provides a fistula with a sphincteric function in the interarytenoid area. A permanent tracheostoma is created.

This procedure has been used in the treatment of eight patients from April of 1979 to April of 1982. One patient died of sepsis in the early postoperative period. Of the seven evaluable patients, only one experienced significant aspiration postoperatively. All patients achieved adequate phonntion. Four patients developed good speech. The remaining three patients have some speech, but are limited in their articulation because of resection of a significant portion of the oral tongue. Three patients are alive and have developed a recurrence. Two patients are alive with recurrent disease and two patients died of their disease.

This procedure appears to allow adequate surgical resection of extensive oropharyngeal neoplasms with preservation of the laryngeal functions of phonation and protection of the lower tracheal‐bronchial tree.
Lateral laryngeal suspension: A new procedure to minimize swallowing disorders following tongue base resection
Authors: Hillel Allen D. , Goode Richard L.
Published: October 2006

Fourteen patients who underwent composite resections for oropharynx and tongue base cancers had lateral laryngeal suspensions in order to improve postoperative swallowing ability, minimize the surgical defect, and decrease shifting of the mandible after composite resection. Eleven of these patients had significant base of tongue resections (30–90%) and 3 had oropharyngeal resections. Thirteen (93%) were able to eat by mouth, 14 patients (100%) had a normal airway, and 14 (100%) had intelligible speech.
The site and function of the nasal valve
Authors: Haight James S. J. , Cole Philip
Published: October 2006

Previous observers have suggested that the main site of respiratory airflow resistance is localized to the vestibular region of the nose. This resistive segment of the airway was investigated using a “head‐out” body plethysmograph in subjects with anatomically normal noses (a) untreated, (b) congested and (c) decongested. In all three conditions, 2/3 of the total nasal airflow resistance was found within the bony cavum in the vicinity of the pyriform aperture and about 1/3, in the cartilaginous vestibule. As might be expected, caval resistance changed proportionately with the degree of mucosal congestion; but, more surprisingly, vestibular resistance changed similarly. This was due in part to the observed forward expansion of the anterior ends of the inferior turbinates with congestion. EMG recordings in subjects breathing through both nostrils demonstrated a gradation of inspiratory alar dilator muscle activity with increased minute ventilation and with mucosal congestion, and there was no evidence of inspiratory alar collapse. But with elevated ventilation through one nostril only, or when the alar muscles were paralyzed by lidocaine block of the VIIth nerve, alar collapse occurred.

These findings are of importance in the management of the congested but anatomically normal nose and in surgery of the nasal tip.
Allergic mucociliary dysfunction
Authors: Wanner Adam
Published: October 2006

Allergic rhinitis is typically associated with excessive nasal secretions and morphologic changes of the nasal mucosa; however, an impairment of mucociliary transport, the ultimate expression of mucociliary function, has so far not been clearly demonstrated. Tracheal mucociliary transport rates are decreased in patients with allergic asthma, and inhalation challenge with antigen causes a further impairment that appears to be related to the liberation of chemical mediators, notably slow reacting substance of anaphylaxis. Physiologic studies of mucociliary function in the nose similar to those that have been reported for the lower airways will be required to assess the role of mucociliary dysfunction in allergic rhinitis.
Survival rates in 548 patients with multiple neoplasms of the upper aerodigestive tract
Authors: Gluckman Jack L. , Crissman John D.
Published: October 2006

The high incidence of multiple primary carcinomas occurring in the upper aerodigestive tract is well documented, with the accepted incidence being as high as 20–30%. The full clinical significance of this phenomenon is, however, only now becoming apparent. Herein 548 cases of documented multiple primary neoplasms, presenting initially in the upper aerodigestive tract, are evaluated retrospectively to establish the survival in these patients. The overall 5 year survival rate after diagnosis of the second neoplasm was found to be 22.3% which was significantly lower than a control group.

The reasons for this poor survival are considered. These include: 1. the high incidence of second cancers developing in the lung and esophagus which have an extremely poor survival rate; 2. the frequent late diagnosis of the second lesions, with resultant advanced staging, and therefore poor prognosis; 3. inability to institute the appropriate therapy for these lesions due to the effects of previous radical therapy utilized for the first tumor.

The clinical implications of this problem are discussed.
Incisions in tympanoplasty: Anatomic considerations and indications
Authors: Farrior Jay B.
Published: October 2006

The endaural, postauricular and transmeatal incisions are the most commonly used surgical approaches for tympanoplasty. Each incision used in tympanoplasty has its own advantages and limitations so that no single approach is the best approach for all tympanic membrane perforations. The incision selected for tympanoplasty should be determined by the location and extent of disease. Forty adult temporal bones were studied to understand the limiting factors for each surgical approach used in tympanoplasty.

The external endaural incision has been modified to permit easier visualization of the crescentic endomeatal canal incisions. The anterior external endaural incision allows direct exposure of temporalis fascia, the external meatus, bony canal and perforation involving the posterior tympanic membrane and ossicular chain. The postauricular incision gives direct exposure of the anterior tympanic membrane with preservation of the anterior canal wall skin. The transmeatal approach should be reserved for smaller central perforations with limited risk for squamous ingrowth into the middle ear. In the transmeatal tympanoplasty, the ear canal should permit the use of a speculum large enough to expose the entire perforation.
Head and neck manifestations of gastroesophageal reflux
Authors: Bain Walter M. , Harrington James W. , Thomas Lawrence E. , Schaefer Steven D.
Published: October 2006

Gastroesophageal reflux (GER) is a common condition with many manifestations which are of interest to the otolaryngologist. Factors predisposing to GER include anatomic abnormalities of the esophagus and pharynx, neurogenic disease and diet induced decreased lower esophageal sphincter pressure. Three interesting cases are reported, including subglottic stenosis which has not previously been thought to be a complication of GER. A literature review of otolaryngologic symptoms, the problems of diagnosis, and a suggested treatment plan are presented.
Treatment of early vocal cord carcinoma: A comparison of apples and apples
Authors: Dickens W. Jackson , Cassisi Nicholas J. , Million Rodney R. , Bova Francis J.
Published: October 2006

Radiation therapy, hemilaryngectomy, and even cordectomy will cure a very large percentage of patients with early vocal cord cancer and preserve the voice. However, hemilaryngectomy and cordectomy are conceded by most surgeons to usually produce a poorer voice, compared to radiation therapy, and the operations are restricted to certain anatomical distributions. Those surgeons advocating hemilaryngectomy or cordectomy have compared their results with radiation therapy series which include a proportion of patients with lesions not suitable for voice‐sparing operations. One hundred and thirty‐nine patients with T1–2 carcinoma of the vocal cords with a 2–15 year follow‐up, who were treated initially by radiation therapy, were analyzed in detail by initial extent of disease. Patients were identified whose lesions were anatomically suitable for hemilaryngectomy or cordectomy, and results for these patients compared to operative results. Since the curative results with voice sparing by irradiation were at least equal, and since the quality of the voice is thought to be much better, there is little justification for recommending a major operation except in specific situations. Lesions initially suitable for voice‐sparing operations which subsequently recur after irradiation can usually be treated by a voice‐sparing operation.
Problems with surgical (RLN section) treatment of spastic dysphonia
Authors: Dedo Herbert H. , Izdebski Krzysztof
Published: October 2006

For over a century spastic dysphoria — a disorder of phonation — remained enigmatic and highly resistant to treatment. Recurrent laryngeal nerve surgery provides patients with elimination of their spastic dysphonia symptoms. Maintenance of long‐term surgical results has been a problem in some cases. Management of this problem and of problems in the diagnosis and treatment of patients with spastic dysphonia are discussed. The observations and conclusions are based on almost 300 patients examined and/or treated for this disorder.
Malignant hyperthermia in the head and neck surgery patient: An update and review
Authors: Pollock Richard A. , Britt Beverley A.
Published: October 2006

Malignant hyperthermia, a disorder often initiated by exposure to a variety of anesthetic agents, continues to be of major importance to the head and neck surgeon because:1. approximately 40% of all reported reactions have occurred during anesthesia for head and neck surgery;2. the possibility of mortality still exists despite the use of new pharmacologic agents, such as dantrolene; and,3. subtle variations in the intraoperative and postoperative presentation of malignant hyperthermia are being increasingly recognized and treated. The authors briefly tabulate the 280 cases — which have occurred worldwide during otolaryngologic, dental, facial plastic, ophthalmologic and neurosurgical procedures — that are registered with the Department of Anaesthesia, University of Toronto, Canada. A case report depicting a less‐than‐typical reaction is presented. The authors emphasize that early recognition of the clinical features of an ongoing reaction, whether mild or severe, is by far the most important factor in reducing morbidity and mortality of patients who suffer hyperthermic crises while undergoing head and neck surgery.
Behavior of cancer at the anterior commissure of the larynx
Authors: Bagatella Francesco , Bignardi Luigi
Published: October 2006

The present research is concerned with the behavior of the vestibular cancer with respect to the portion of the anterior commissure of the larynx which the authors have named the “x‐space.” The research is based on the analysis of semiseriated vertical sections showing cancers of the vestibule in stages T1 and T2 with histological gradings 1 and 2. The specimens show that, at least in the early stages of the neoplastic spread, the fibrous structures of the x‐space act as a fairly effective barrier to deep diffusion of the tumor. This fact enables the surgeon to estimate macroscopically the lower borders of the tumor growth on the basis of the superficial spread of the cancer in the zone of the x‐space.
Polytomographic evaluation of the clivus and petrous apices: A new view
Authors: De La Cruz Antonio
Published: October 2006

The base of the skull lesions that arise anterior to the porus acusticus, clivus, or from the jugular carotid or hypoglossal canals present difficult surgical access. Plain films, arteriograms, and the conventional AP, lateral, and full base tomograms have often fallen short in allowing an easy understanding of the surgical relationships between these structures.

The objectives of this thesis are 1. to present a previously unpublished tomographic view based on the surgical relationships, as encountered by the surgeon, that complement the traditional views and simplify the preoperative assessment of the lesion, 2. to review the literature on the subject, and 3. to present the author's experience with this view in use since 1976.
Qualitative measurement of drugs
Authors: Westerman S. Thomas , Golz Avishay , Komorowski Frank S. , Gilbert Liane M.
Published: October 2006

It has been noted for several years that certain drugs produce abnormal test results in patients who are administered the elcctronystagmograph (ENG) test. Drug specific waveforms, termed drug evoked potentials (DEP), have been identified by using the ENG for alcohol, marijuana, cocaine, tranquilizers, amphetamines, barbiturates, opiates, hallucinogens, caffeine, aminophylline, dopamine, several gases and approximately 75 combinations of drugs (N=821). Tests for double blind diagnosis of drug intake as well as tests for repeatability within the same subject were conducted. Subjects included surgical candidates, healthy volunteers, and neonates (N=248). Drugs tested were ketamine hydrochloride, fentanyl, sodium pentothal, cocaine, dextroamphetamine, sodium seconal, morphine sulfate, phenobarbital, and meperidine. Placebos of dextrose in water and sucrose tablets were also used (N=25).

Analysis of the waveforms produced by surgical candidates and healthy volunteers revealed no false negatives or false positives. Analysis of waveforms produced by neonates whose mothers had been administered meperidine demonstrated a diminishing effect over the course of a 3 day period.

Results of repeated studies revealed reliability within subject. One subject who was administered dextroamphetamine did not produce a wave consistent with amphetamine with a dosage of 5 mg. He did, however, produce an amphetamine wave when administered 10 mg of dextroamphetamine. These findings suggest a dose related effect, indicating the need for establishment of minimal levels of detection.

Results indicate that with refinement and further research, this method could be used for identification of drugs diagnostically.
University of pennsylvania smell identification test: A rapid quantitative olfactory function test for the clinic
Authors: Doty Richard L. , Shaman Paul , Kimmelman Charles P. , Dann Michael S.
Published: October 2006

Despite the fact that clinical otolaryngologists are often presented with complaints of olfactory dysfunction, they have limited means to diagnose these problems. A major reason has been the lack of a clinically‐useful and reliable quantitative test of olfactory function. Recent work at our Clinical Research Center has resulted in the development of such a test. This test — the University of Pennsylvania Smell Identification Test (UPSIT) — can be self‐administered and uses microencapsulated odorants which are released by scratching standardized odor‐impregnated test booklets. As indicated in this paper, studies have demonstrated that the UPSIT can identify most malingerers and is sensitive to age, gender, smoking habits, and a wide variety of olfactory disorders. A description of this new test, along with some of its applications, is presented.
Comparative study in tympanoplasties with nitrous oxide anesthesia
Authors: Ramirez‐Camacho Rafael A. , Jimenez Dolores
Published: October 2006

A number of intra and postoperative accidents in close cavity surgery when using nitrous oxide have been reported. In order to check the influence of nitrous oxide anesthesia in tympanic surgery, 38 patients were operated on by the usual techniques in middle ear surgery. Half the patients received continuous nitrous oxide inhalation throughout the procedure while, in the remaining cases, the anesthetic gas was suspended 30 minutes before applying the tympanic graft. Audiological differences in both groups, as controlled at 6 and 12 months, were negligible.
Bioactive glass‐ceramics in ear surgery: Animal studies and clinical results
Authors: Reck Ralf
Published: October 2006

In the search for better materials for middle ear reconstruction, ceramics have been suggested as an alternative. The bioactive glass‐ceramic Ceravital8 was made available to us for animal experiments and clinical trials.

To test its suitability in ear surgery, 101 ear operations were carried out in 53 rabbits including the reconstruction of 78 posterior auditory canal walls and the insertion of 174 middle ear implants. Parameters studied include the effects of bone paté in inducing new bone growth, the chronological course of bone apposition and remodeling, microscopic examination of mucous membrane growth on the implants and degree of lysis of the implant.

In the past two and one half years some 250 ossicular prostheses have been implanted in man for reconstruction of the ossicular chain. A statistical analysis of 119 tympanoplasties after a follow‐up of one and one half years shows no perforations of the tympanic membrane over the implants or rejection of the prosthesis from the middle ear. The audiological results achieved were more favorable with the use of ossicular prostheses made of bioactive glass‐ceramic than those using allogenic ossicular grafts.

On the basis of the histologic findings and observed clinical results, the bioactive material Ceravital® is remarkably well suited for reconstruction of the posterior auditory canal wall and for implantation in direct contact with the tympanic membrane.
A prospective study of laryngotracheal sequelae in long‐term intubation
Authors: Whited Robert E.
Published: October 2006

A series of 200 patients having endotracheal intubation between 2 and 24 days were studied prospectively. The data was organized into 3 groups as follows: Group I: 2 to 5 days intubation, (50); Group II: 6 to 10 days intubation, (100); and Group III: 11 to 24 days intubation, (50).

For the Group I population, the most significant injury is in the posterior commissure of the larynx which in this site leads to acute and chronic sequelae. At these intubation times, cuff site injury has not been prominent.

Despite the selection of patients for conversion to tracheotomy in order to prevent complications, there is an increased incidence of significant sequelae in Group II population. A most noticeable trend accompanying the increased incidence is the changing nature of the resultant stenosis to include continuous damage from the posterior glottis through the cervical trachea. These trends become evident in those patients having intubation times greater that 7 days.

In Group III population, the increased incidence, as well as the severity of post‐intubation complications become clearly evident. Conversion to tracheotomy before serious organ disruption occurs at these prolonged intubation times is preventative.
Stapedectomy in residency training
Authors: Engel Thomas L. , Schindler Robert A.
Published: October 2006

The number of new patients with otosclerosis seen by the average otolaryngologist has declined over the past several years. As a result, a controversy has arisen regarding the ability to train residents adequately in the technique of stapedectomy. In this regard, we have analyzed 44 consecutive stapedectomies performed by senior residents, under direct faculty supervision, at the University of California, San Francisco. All procedures were total stapedectomies, performed under local anesthesia, utilizing either wire‐vein or wire perichondrium technique. Four of the ears required footplate or promontory drilling. Closure to within 10 dB of the preoperative bone conduction, averaged over the speech frequencies of 500, 1000, and 2000 Hz, was achieved in 75% of ears, and closure to within 20 dB in 93% of ears. In no patient was hearing made worse. While there were no permanent complications, self‐limited problems occurred in 9% of the procedures.

Despite a declining caseload of otosclerotic ears in residency programs, it is possible to train residents safely in stapes surgery, given a program of consistent technique and close faculty supervision.
A destructive maxillary cemento‐ossifying fibroma following maxillofacial trauma
Authors: Wenig Barry L. , Sciubba James J. , Cohen Alfred , Goldstein Mark N. , Abramson Allan L.
Published: October 2006

The cemento‐ossifying fibroma, a mesodermal type of non‐odontogenic tumor, is rarely discussed in the otolaryngologic literature. It is a tumor that is seen more in blacks than in whites, appears largely in the elderly, is chiefly located in the mandibular molar or premolar area and is generally neither aggressive nor excessively destructive. The triggering mechanism for its derivation from aberrant periodontal membrane growth or development from endosteal fibrous tissue remains controversial.

We report a case of cemento‐ossifying fibroma in a 26‐year‐old Hispanic male which was located in the posterior portion of the maxilla which destroyed the maxillary bone, orbital floor, and the lateral wall of the nose. One year prior to discovery of the lesion the patient sustained severe facial trauma resulting in facial bone fractures. It may be speculated that the trauma sustained was the critical triggering factor allowing for unchecked growth and destruction associated with an otherwise non‐aggressive tumor, which may have been present prior to the traumatic incident.
Infantile methemoglobinemia induced by a topical anesthetic, cetacaine
Authors: Seibert Robert W. , Seibert Joanna J.
Published: October 2006

A 2‐month‐old infant developed severe methemoglobinemia following topical pharyngeal application of a common benzocaine containing agent (Cetacainer̀). Although a number of reports of this complication have appeared in recent years, this is apparently the first case reported in the Otolaryngology literature. The pathophysiology, pharmacology, and treatment of this condition are reviewed.
Meniere's disease: A 30‐Year epidemiologic and clinical study in rochester, mn, 1951‐1980.
Authors: Wladislavosky‐Waserman Pablo , Facer George W. , Mokri Bahram , Kurland Leonard T.
Published: October 2006

One hundred eighty cases of Meniere's disease were identified in the Rochester, MN population during the 30‐year period, 1951 through 1980. The annual age‐adjusted incidence rate per 100,000 population was 15.3; the preponderance for females (16.3) over males (13.3) was not statistically significant. There was no change in annual incidence rate from 1951 through 1970, and a slight decrease in the period, 1971 through 1980. The prevalence rate on January 1,1980, was 218.2 per 100,000 population. Clinical aspects of Meniere's disease noted during the course of this study are reported.
Goblet cells in the laryngeal mucosa in cancer of the larynx
Authors: Nielsen Kristian Otto , Bak‐Pedersen Kristian
Published: October 2006

From 70 patients with laryngeal cancer, pieces of mucosa were taken from the subglottis, the entrance to the sinus of Morgagni, and from the ventricular fold. There were 35 taken at the time of diagnosis and the other 35 were taken after radiotherapy. By means of an elective staining method and a whole mount technique, morphological and quantitative studies of the goblet cells were performed. The findings were compared with corresponding investigations of goblet cells in normal larynges. The significantly lower density in the subglottis than in the sinus of Morgagni and ventricular fold observed in normal larynges was not found in the two groups of cancer patients. Instead, there was a tendency to an equalization of the goblet cell density in all 3 laryngeal regions. In the irradiated group the goblet cell density was lower, in all 3 regions, than in the nonirradiated cancer group and in normal larynges. In the close vicinity of the cancer the goblet cell density was reduced, possibly because the cancer process had initiated metaplasia to an epithelium which was poor in goblet cells. Between the two cancer groups and normal larynges there were no morphological differences in the goblet cells.
Endoscopic laser arytenoidectomy for the treatment of bilateral vocal cord paralysis
Authors: Ossoff Robert H. , Sisson George A. , Moselle Herbert I. , Duncavage James A. , Andrews Philip E. , Mcmillan Willis G.
Published: October 2006

Most patients with bilateral vocal cord paralysis have a fairly satisfactory voice, but their airway is usually compromised. The management of such patients presents a challenge to the otolaryngologist‐head and neck surgeon. Numerous surgical procedures have been developed in an attempt to improve the patients's airway insufficiency without leaving him with a breathy, weak voice.

Arytenoidectomy is currently the most reliable method of treating patients with bilateral vocal cord paralysis. Although both endoscopic and external approaches have been described for performing an arytenoidectomy, the endoscopic technique is more desirable since it requires no incision and theoretically allows for the immediate assessment of airway size. The addition of the CO2 laser to the surgical armamentarium offers certain refinements to the technique of endoscopic arytenoidectomy.

Eleven patients with bilateral vocal cord paralysis of the larynx have been treated by endoscopic laser arytenoidectomy by the authors utilizing a technique developed by the two senior authors and subsequently taught to over 200 participants of the CO2 laser workshops sponsored by the Department of Otolaryngology‐Head and Neck Surgery at Northwestern University Medical School; 10 of the 11 patients have been successfully decannulated. The technique and problems of this operation will be discussed.
Sir Morell Mackenzie revisited
Authors: Chalat Ned I.
Published: October 2006

The story of Sir Morell Mackenzie and his famous pnticnt, Frederick III, Crown Prince of Germany naturally divides itself into four segments: the physician, his famous patient, the illness, and its consequences both medically and historically.

The circumstances of Frederick's death have affected us all. Medically, the cause of biopsy for carcinoma of the larynx was set back many years. For generations biopsy was considered unnecessary to the diagnosis.

Had Frederick lived and remained Emperor, and had he encouraged Bismarck to continue a more liberal government and constitutional monarchy; had he continued the non‐aggression treaty between Russia and Germany; had he honored his pledge to Queen Victoria for a “close and lasting friendship between our two nations,” how different our history might have been.
Adenoid cystic carcinoma of major and minor salivary gland origin
Authors: Matsuba Howard M. , Thawley Stanley E. , Levine Laurence A. , Simpson Joseph R. , Mauney Marc
Published: October 2006

The records of 76 patients with adenoid cystic carcinoma of major and minor salivary gland origin seen at the Washington University Medical Center from 1963‐1980 were reviewed to determine factors involved in local control, development of distant metastasis, and survival. Twenty‐four (32%) patients were initially treated with surgery alone, 36 (47%) with combined surgery and irradiation, and 16 (21%) with irradiation alone.

Local control after treatment was determined for all patients and was analyzed with respect to extent of surgery and dose of irradiation. Of 75 patients evaluable for local control, 30 (40%) failed with a median time of less than 5 years. There was no significant difference for pntients treated vigorously for local recurrences after surgery.

Patients who had a complete surgical resection (i.e., negative margins) survived significantly longer than patients treated by incomplete resection or biopsy alone followed by irradiation.

Distant metastases developed in 50% of patients regardless of local control. Median survival after development of distant metastases was 40 months. There was no difference between major and minor gland sources for development of metastases. Lymph node involvement was rare.

Our data indicate that complete and radical surgery results in the best survival. Combined modality therapy with surgery and irradiation optimizes the control of local disease. However, since distant metastases develop in spite of local control, in most instances we cannot recommend mutilating surgery for this disease entity.
Epiglottic reconstruction after supraglottic laryngectomy.
Authors: Calcaterra Thomas C.
Published: October 2006

It has been well established that supraglottic laryngectomy is an effective treatment of laryngeal cancer arising above the vocal cords with cure rates equaling total laryngectomy. Although there is preservation of a near normal voice after supragloltic laryngectomy, chronic aspiration occurs in some patients particularly after extended supraglottic laryngectomy or when there is associated compromised pulmonary function.

During normal deglutition, the epiglottis serves to divert food to the pyriform fossae and partially covers the inlet to the airway. These important functions can be accomplished after supraglottic laryngectomy by reconstructing a neoepiglottis from an epiglottic remnant whenever one third or more of the epiglottis can be preserved which is microscopically free of tumor. Our results in 14 patients have shown no clinically significant aspiration after epiglottic reconstruction.
Crib‐o‐gram vs. auditory brain stem response for infant hearing screening.
Authors: Shimizu Hiroshi , Walters Roger J. , Allen Marilee C. , Kennedy David W. , Markowitz Ricka K. , Luebkert Frances R.
Published: October 2006

As a part of the longitudinal evaluation of a cluster of neonatal hearing screening procedures in a single high risk population, Crib‐O‐Gram (COG) and auditory brain stem response (ABR) screening have been administered to 190 infants in the NICU. Multiple COG screening showed inconsistent results in 25% of the infants. The COG failure rate was 27.9% with 2 out of 3 pass criterion. In the two‐intensity ABR screening (70 dB and 30 dB), 17.9% failed at 30 dB bilaterally and 30.0% failed unilaterally. The repeated ABR screening and behavioral observation audiometry at age 6 months indentified one infant with a significant hearing loss in 78 infants. Two thirds of the COG failures and a little more than half of the ABR failures had a problem mainly with the middle ear. Advantages and disadvantages of each procedure are presented.
Acoustic reflex abnormalities in behaviorally disturbed and language delayed children.
Authors: Grady Thomas W. , Mcmurry Gene , Pillsbury Harold C.
Published: October 2006

Contralateral and ipsilateral acoustic reflex thresholds were measured in 62 subjects referred for suspected delays in development of language, learning disabilities, or disorders of auditory processing, with normal peripheral hearing thresholds and normal tympanometry. Thirty‐two percent of the subjects in this study showed abnormal contralateral and ipsilateral acoustic reflex thresholds. Both contralateral and ipsilateral acoustic reflex thresholds were involved when subjects showed abnormal reflex thresholds. Although a high percentage of abnormal acoustic reflexes occurred in this population, no strong correlation could be found with specific areas of language delay. A slight positive correlation was found between abnormal acoustic reflexes and delayed psychomotor development. Increased or absent acoustic reflex thresholds are usually associated with peripheral or low brain stem pathologies. While not conclusive, these results suggest brain stem involvement in this population.
The effects of radiation therapy in microvascular anastomoses
Authors: Fried Marvin P.
Published: October 2006

The otolaryngologist, as a head and neck surgeon, commonly cares for patients with upper aerodigestive tract malignancies. Therapy of these neoplasms often requires wide excision. One standard reconstructive procedure utilizes pedicled regional flaps, both dermal and myodermal which have some disadvantages. The shortcomings of these pedicled regional flaps have led to the use of the vascularized free flap in certain cases. The occasional case may lead to catastrophe if microanastomoses fail when combined with radiation. Notwithstanding, many surgical series have reported success when radiation has been given.

The present investigation was undertaken to assess the effects of radiation therapy on microvascular anastomoses when radiation is administered pre‐ or postoperatively or when nonradiated tissue is transferred to an irradiated recipient site. These effects were observed serially in an experimental rat model using a tubed superficial epigastric flap that adequately reflected tissue viability and vascular patency. The histologic changes were then noted over a three month period after completion of both radiation and surgery.

This study adds credence to the observation of the lack of deleterious effects of radiation on experimental microvascular anastomotic patency whether the radiation is given before or after surgery or if radiated tissue is approximated to nonradiated vessels.
Transcutaneous electrical stimulation for tinnitus
Authors: Engelberg Marvin , Bauer William
Published: October 2006

The use of electrical stimulation to treat tinnitus was evaluated in a two‐experiment study. The stimulus was a low amperage, low frequency variable square wave applied to 13 sites on the auricle of the ear with tinnitus. The sites were selected for their increased electrical conductivity as measured by low electrical resistance readings. Experiment 1 results defined improvement as either a complete remission of the tinnitus or a decrease in the frequency of the tinnitus. Experiment 2 utilized a single blind protocol with 20 subjects comprising 33 ears with tinnitus. Eighty‐two percent of the 33 ears showed improvement by either of the two criteria. The permanence of the improvement ranged from 20 minutes to at least six months. The variables associated with this procedure were discussed. The adverse effects from the stimulation were minimal.