bluuebunny/crossref_metadata_2025 huggingface dataset:
Magnetic Resonance Imaging of the Head and Neck
Authors: Baker Shan R. , Latack Joseph T.
Published: November 2015

Magnetic resonance imaging (MR) has already gained wide acceptance in the evaluation of intracranial and spinal canal abnormalities. MR also provides excellent resolution of certain tumors of the head and neck and is particularly useful for the evaluation of neoplasms in the vicinity of the skull base. The absence of a bone signal prevents the streaking artifact so troublesome with computerized axial tomography (CT) and allows better definition of tumor. MR does not use ionizing radiation and appears to be an innocuous imaging mode—thus multiple examinations in young patients are not objectionable with MR. The ability to obtain images in multiple planes by control of the magnetic gradients allows for axial, sagittal, and coronal imaging, without changing the supine position of the patient. Multiple projections are helpful in providing better preoperative assessment of the extent and size of certain neoplasms Of the neck.
Computed Tomography and the Thyroglossal Duct Cyst
Authors: Ward Robert F. , Selfe Robert W. , St. Louis Leslie , Bowling David
Published: November 2015

Thyroglossal duct cysts (TDC) classically present as midline neck masses in close relation to the hyoid bone; yet—not uncommonly—their locations may be varied from the midline and from the hyoid. By means of the diagnostic modality of computed tomography (CT), high‐resolution images of several cases of alternate presentations and locations of the TDC are examined. Included are examples of TDC in the suprahyoid, transhyoid, infrahyoid, and lateral positions. The potential value of CT in the diagnosis of the unusual cyst will be demonstrated and discussed.
Lymphocyte subpopulations infiltrating squamous carcinomas of the head and neck: Correlations with extent of tumor and prognosis
Authors: Wolf Gregory T. , Hudson Jerry L. , Peterson Karen A. , Miller Harriet L. , McClatchey Kenneth D.
Published: November 2015

Because little is known about the mechanisms involved in local tumor‐host immune reactions in squamous carcinoma of the head and neck, a study was undertaken to better characterize the types of immune cells present at the local tumor site and determine their relationship to tumor extent, systemic cellular immune parameters, and clinical outcome. In 40 untreated patients, lymphocyte subsets (LS) at the tumor‐host interface were quantitated immunohistologically from serial sections of frozen tumor specimens and correlated with concurrently measured peripheral LS levels and in vitro lymphocyte reactivity to phytohemagglutinin (PHA). The majority of infiltrating lymphocytes were T cells with rare B or Leu 7 cells. Proportions of T4 and T8 were similar in peritumor stroma; however, T8 cells predominated tumor parenchyma. Stromal and parenchymal infiltration by LS were not related to peripheral blood LS levels, lymphocyte reactivity, or tumor site. However, parenchymal T11 and T4 cell infiltration was less in advanced primary tumors (T3, T4) than in early tumors (T1, T2) (P = 0.01, P = 0.067, respectively), as was peripheral lymphocyte reactivity to PHA (P = 0.013). Short‐term disease‐free interval and actuarial survival differed significantly—according to parenchymal T11 and T4 cell infiltration—and were not related to T8, leu 7, and B‐cell infiltration. The findings extend prior studies of lymphocytic infiltration in head and neck cancer and demonstrate the potential importance of differences in tumor stromal and parenchymal infiltration. Together with recent evidence that T4 cells are critical for lymphokine production and for the proliferation of cytotoxic effector cells, the current results suggest that T4 cells play a critical role in the local immune response in squamous carcinoma of the head and neck.
Chemotherapy for salivary gland cancer
Authors: Kaplan Michael J. , Johns Michael E. , Cantrell Robert W.
Published: November 2015

Because of the scarcity of such lesions, little is known about the efficacy of chemotherapy for advanced salivary gland cancers. Although surgery and irradiation are the mainstays of treatment, patients with recurrent tumors and those with unresectable or metastatic cancer are not candidates for this usual approach. Ten patients with recurrent, metastatic, or unresectable salivary gland tumors were treated with combination chemotherapy, primarily with cisplatin, doxorubicin hydrochloride (Adriamycin), and cyclophosphamide, or cisplatin with 5‐fluorouracil. In patients whose tumors exhibited no response, second‐line drugs were used. The overall response rate was 50%—with one complete response—but the duration of response was short. This report contributes to the growing data base that demonstrates definite chemosensitivity of these tumors. To date, 116 patients have been reviewed. Adenocarcinoma‐like cancers respond best to cisplatin, doxorubicin hydrochloride, and 5‐fluorouracil. Highgrade mucoepidermoid carcinoma may show a sensitivity similar to that of squamous cell carcinoma. Multi‐institutional protocols need to be developed to assess the roles of adjuvant and palliative chemotherapy in the treatment of salivary gland cancer.
Speech performance by patients with multichannel cochlear implants
Authors: Parkin James L. , Dankowski M. Korine
Published: November 2015

Thirteen patients were implanted with multichannel cochlear implants between April 1,1984 and February 25,1985. The patients are fitted with the sound processor unit 4 to 6 weeks postsurgery. One patient had a single‐channel unit replaced with a multichannel implant. She reported improved sound quality. All patients use their implants daily and all patients would undergo implantation again (based on their current performance). Evidence exists that continued use leads to improved performance. Patient S.S. progressed from auditory‐only scores of 12% and 24% to 100% and 100% in 4 months. The average open set auditory‐only performance of six patients in the first 4 months on a spondee word list was 22%. The average of eight patients—more than 4 months post sound processor—is 44%, indicating improvement with use. Patients perform better when combining auditory input with visual input than they do with lip reading alone. The multichannel implant is well tolerated and accepted, and results in speech performance improvement.
Precaution and safety in carbon dioxide laser surgery
Authors: Lim Romeo Y. , Kenney Catherine L.
Published: November 2015

The introduction of the carbon dioxide laser‐(in 1972) by Strong and Jako1 as a surgical tool for removal of laryngeal papilloma‐heralded a new period of surgical refinement and precision in otolaryngology and also led to adjustment and precautions in operating room setup and in the administration of anesthetics. This article recounts 8 years of experience in carbon dioxide laser surgery on 3500 head and neck patients. Techniques and precautions of administering anesthetics for laser surgery are presented. The management of a laser‐ignited burn is also discussed. (OTOLARYNGOL HEAD NECK SURG 95:239,1986.)
Otosurgical Model in the Guinea Pig (Cavia porcellus)
Authors: Wells James R. , Gernon William H. , Warp George , Davis R. Kim , Hays Leonard L.
Published: November 2015

The guinea pig is a useful model for otologic research. Common problems encountered In working with Individual animals include preexisting chronic middle ear disease, anesthetic deaths, and a lack of knowledge of the surgical anatomy and landmarks of the middle and inner ear. The methods detailed in this article will benefit those interested In a reliable, inexpensive, otosurgical animal model.
Radiographic Imaging of the Cochlear Implant Candidate: Preliminary Results
Authors: Balkany Thomas J. , Dreisbach James N. , Seibert Charles E.
Published: November 2015

Preoperative radiographic imaging of the temporal bone is well accepted in otology for both the diagnosis of disease and the delineation of anatomic structure for surgical planning. Until recently radiographic techniques have unfortunately failed to demonstrate fibrous or bony obstruction of the basal turn of the cochlea, which may cause difficulties during cochlear implantation. Intraoperative findings have been correlated with preoperative imaging in a consecutive group of six cochlear implant recipients and a series of consistent radiographic signs that may indicate the presence of obstruction of the scala tympani have been identified. A classification system has been developed. Based on thin‐section high‐resolution computerized tomography (HRCT), the system has been used preoperatively on six cochlear implant recipients. In addition, a systematic evaluation of the temporal bone has been developed for precochlear implant evaluation. This includes (1) the thickness of the parietal bone for seating of the receiving device, (2) the degree of pneumatization of the mastoid, (3) the measurement of the size of the facial recess, (4) the description of the size and orientation of the round window niche, and (5) the patency of the basal turn of the cochlea.
Decision Analysis of Auditory Brainstem Responses and Rotational Vestibular Tests in Acoustic Tumor Diagnosis
Authors: Mangham Charles A.
Published: November 2015

This study addresses the problem of the escalation of the costs of medical care which make diagnosis of acoustic tumor expensive. Specifically, we examined the hypothesis that a test protocol of the auditory brainstem response (ABR) in parallel with sinusoidal harmonic acceleration (SHA) is more cost‐effective in identification of the risk of tumor than ABR alone. The subjects were 74 patients with acoustic tumors and 78 controls. ABR and SHA data from these subjects were submitted to decision analysis. ABR was more cost‐effective than the protocol of ABR in parallel with SHA. Using these data, we outlined a “decision tree” for acoustic tumor diagnosis that fit the goals of high sensitivity when earlier probability of tumor was high, and high specificity when earlier probability of tumor was low.
Sensory Nerve Endings in the Mucosa of the Epiglottis—Morphologic Investigations with Silver Impregnation, Immunohistochemistry, and Electron Microscopy
Authors: Shin Takemoto , Watanabe Shun , Wada Shigeru , Maeyama Tadatsugu
Published: November 2015

This study was conducted in order to investigate the structure of sensory nerve endings of the human epiglottis and substance P immunoreactive nerve fibers of the canine epiglottis in relationship to physiologic functions of the larynx. The human epiglottis was observed by light microscopy (silver impregnation) and electron microscopy, and the canine epiglottis was studied by peroxidase‐anti‐peroxidase (PAP) immunohistochemistry. The results are summarized as follows: (1) In the membranes of the epiglottis, we observed free endings of simple or complex tree shape, corpuscle endings with glomerular patterns, and taste‐bud‐like structures, and (2) electron microscopic studies revealed varicosity of the terminal axon with processes that contained small, clear and large, dense cored vesicles. Substance P was observed in these structures, and it was suggested that substance P was related to perception in the larynx.
Intracranial and Intratemporal Facial Neuroma
Authors: Lipkin Alan F. , Coker Newton J. , Jenkins Herman A. , Alford Bobby R.
Published: November 2015

Primary tumors of the facial nerve are relatively rare and have a variety of presenting symptoms. This article reviews 248 cases of facial neuroma in the world's literature and adds seven cases that were managed at the Baylor College of Medicine. Facial weakness was most common symptom, with facial spasm or tics, hearing loss, and masses in the external auditory canal also being frequently seen. At surgery, the tympanic, vertical, and labyrinthine segments were the most commonly involved areas. On the basis of this review, general principles have been drawn up to help the clinician in diagnosis and management of this (at times) difficult problem.
Relationship of the Optic Nerve to the Paranasal Sinuses as Shown by Computed Tomography
Authors: Bansberg Stephen F. , Harner Stephen G. , Forbes Glenn
Published: November 2015

Restricted exposure and inconsistencies in sinus pneumatization place the optic nerve at risk during operations on the sphenoid sinus and posterior ethmoid cells. In this study, computed tomography was used to examine these relationships. We reviewed 80 patients who underwent high‐resolution computed tomographic scanning for ophthalmologic complaints in which the scan was negative. Forty‐eight percent of posterior ethmoid cells are separated from the optic nerve by the thin bony lamina of the optic canal. Nearly 90% of sphenoid sinuses contact the ipsilateral optic nerve and 10% contact both nerves. Eight percent of posterior ethmoid cells override the ipsilateral sphenoid sinus and contact the optic nerve on that side. Paraxial reformatted displays allowed estimation of the degree of projection of the optic nerve into adjacent sinus cavities. Three percent of optic nerves have significant projection into the posterior ethmoid cell, and 23% project significantly into the sphenoid sinus. The width of the bony plate that separates the optic nerve from the sinus cavity was the same for sphenoid and ethmoid sinuses. Although sinus pneumatization varies among individuals, right and left sides are generally similar within one person.
Treatment of Patients with Stage IV Cancer: Do the Ends Justify the Means?
Authors: Burns Lawrence , Chase Dan , Goodwin W. Jarrard
Published: November 2015

Most experienced head and neck surgeons recommend aggressive treatment‐Including radical surgery—for patients with resectable Stage IV cancers. Yet, given the poor overall cure rate of 15% and the deformity and disability often associated with treatment, one of the most frequently asked questions at our conference on tumors was: Are we really helping these patients? We found little data in the relevant literature to answer this or other questions. Are there subgroups with a better outlook? What is the evidence for palliation in the 85% of patients who fail treatment and how is it best achieved? How do patients and their families view their treatment In retrospect? To find the answers, we studied the records of 76 consecutive patients (previously untreated) who presented with Stage IV carcinoma of the upper aerodigestive tract in 1981–82. We also interviewed surviving patients or family members and friends by phone. Overall mean survival was 15 months, with a 2‐year disease‐free survival rate of 16%. More to the point, resectable patients treated with curative intent had a mean survival of 19.4 months, and 12 of 42 patients (29%) were disease‐free at 2 years. Patients with laryngeal cancer had the best survival results, and patients with sinus cancers had the worst (25.2 vs. 10.5 months). Those with N2A staging lived longer than other groups (24.1 vs. 12.1 months). T4 lesions portend a particularly poor prognosis; mean survival was just 7.5 months and only 1 of 28 patients (3.6%) was alive and disease‐free at 2 years. Twenty‐five percent of patients returned to normal function, but 75% had significant problems eating or speaking. Thirty‐four interviews revealed that 44% of patients enjoyed life after treatment and that 55% (in retrospect) would accept treatment. Quality of life, as determined by our adjustment index, was better In patients who had undergone operation; radiation and/or chemotherapy—when offered for palliation—gave little benefit. We conclude that the results justify aggressive treatment in resectable Stage IV cancer of the head and neck—particularly in patients who do not have T4 primary tumors.
Further Clinical Experience with the Silicone Tracheal Cannula in Obstructive Sleep Apnea
Authors: Fedok Fred G. , Strauss Melvin , Houck John R. , Cadieux Roger J. , Kales Anthony
Published: November 2015

We report on the perioperative and postoperative course of 47 patients with severe obstructive sleep apnea, who underwent tracheostomy by use of a silicone tracheal cannula developed by Dr. William Montgomery. Our initial experience with the first 20 of these patients (presented in 1982) was quite favorable because of the ease of insertion and care, a high degree of patient acceptance, and infrequent complications. With our current sample, larger experience, and more prolonged follow‐up, we noted that symptomatic granulation tissue formation, with or without wound infection, occurred more frequently than was initially appreciated. In 21% (10 of 47) of the cases, the only way to resolve this problem was to remove this device and replace it permanently with a metal (or other type) tracheostomy tube. Other complications included tracheal narrowing and cannula malpositioning and fragmentation. This full report lists in detail the incidence of complications associated with our use of this cannula and modifications which may lessen these.
The Effects of Cigarette Smoking on Voice‐Fundamental Frequency
Authors: Murphy Christopher H. , Doyle Philip C.
Published: November 2015

Previous group research has shown that the mean voice‐fundamental frequency (F0) for individuals who smoke is lower than that of age‐ and sex‐matched nonsmokers. It is believed that this reduction in F0 is a result of edema of the vocal folds caused by tobacco smoke. This study investigated F0 changes during smoking and no‐smoking periods. Data were collected before, during, and after a 40‐hour period of no‐smoking. Analysis of the voice recordings showed a rise in voice F0 for the two smoking subjects during the 40‐hour no‐smoking period. Age‐ and sex‐matched control subjects did not show a rise in their F0 during the same tasks. Results suggest that the pitch‐lowering effects of cigarette smoking may be reversed after as few as 40 hours of smoking cessation.
Lathyrogenic Agents as Therapy for Subglottic Stenosis—A Pilot Study
Authors: Livingston Gary L. , Schild Joyce A.
Published: November 2015

The surgical repair of subglottic stenosis (SGS) is often unsuccessful because of recurrence of the scar contracture. Over the past few years, two lathyrogenic agents (compounds that inhibit collagen cross‐linking) have been shown effective in prevention of stenosis in animal models that have deep caustic esophageal burns. Since the principles of induced lathyrism have not been applied to the treatment of laryngotracheal stenosis, a pilot study using a canine model was conducted to test the efficacy of penicillamine and N‐acetyl‐L‐cysteine in reduction of the rate of reformation of SGS. In all six animals used, a complete, 10 to 15 mm thick, mature SGS was induced experimentally, then opened with a Co2 laser. The dogs that were treated with lathyrogenic agents exhibited a lower rate of re‐stenosis (one maintained patency throughout the 5 weeks of treatment) when compared to the two control dogs. Histologic sections of the subglottis in each dog revealed severe cricoid collapse, necrosis, and scarring, and thus demonstrated similarities to SGS in human beings. The two lathyrogenic agents used in this study are already approved for human use and may represent a valuable form of adjunctive therapy in the surgical management of SGS.
Functional Restoration after Subtotal Glossectomy and Laryngectomy
Authors: Mitrani Moises , Krespi Yosef P.
Published: November 2015

Extensive resection of carcinoma that involves the tongue base and supraglottic larynx is accompanied by significant potential morbidity and mortality. This is often indicated by poor rates of cure and the limited palliation afforded by radiotherapy alone. Removal of a significant portion of the posterior tongue frequently results in intractable aspiration. Techniques in reconstruction of the oropharyngeal defect and tongue base have included primary closure, random flaps, and myocutaneous flaps. Each of these techniques has been successful, to some degree, in resurfacing pharyngeal defects. However, the functional results in regard to deglutition are less than satisfactory as a result of aspiration. Frequently, simultaneous or delayed total laryngectomy is performed to deal with the pulmonary complications. Various types of laryngoplasty do not uniformly correct the problems of aspiration and deglutition associated with subtotal glossectomy. Our experience includes eight patients who had advanced squamous cell carcinoma of the tongue base, vallecula, and the supraglottic larynx. All patients underwent partial or subtotal glossectomy and laryngectomy. The mucosal defect was reconstructed with pectoralis myocutaneous flap. In order to reestablish voice, a primary tracheopharyngeal shunt was created with the use of a portion of cricoid and upper trachea. The majority of these patients have had successful rehabilitation of deglutition, mastication, and speech.
Radiation Therapy for Carcinoma of the Nasal Vestibule
Authors: Chobe Rashmi , McNeese Marsha , Weber Randall , Fletcher Gilbert H.
Published: November 2015

From 1963 to 1984, 32 patients with squamous cell carcinoma of the nasal vestibule received definitive radiation therapy. Of these, 11 patients whose superficial lesions were suitably located received radium implants, and the other 21 patients were treated with a combination of electron beam and 60Co. The implant doses ranged from 60 to 75 Gy and the external beam doses ranged from 55 to 70 Gy. In 12 patients, the submandibular and subdigastric nodes were electively treated with 60Co with doses of 45 to 50 Gy, and in 12 patients the strip of skin between the nose and the free border of the mandible was also electively irradiated. None of the 11 patients treated by interstitial implant experienced treatment failure. In the 21 patients treated by external beam, one patient had primary tumor recurrence and four patients failed in the unirradiated neck. A metastasis developed in the unradiated tissues between the nose and the neck of the only patient who died of the disease. Necrosis of the anterior part of the upper jaw of one patient developed as a result of a hot spot. Today, when treatment is calculated with the help of a computer program and special techniques to optimize tumor dose, hot spots can be prevented.
Computer‐Aided Three‐Dimensional Reconstruction and Measurement of the Vestibular End‐Organs
Authors: Takagi Akira , Sando Isamu , Takagi Akira , Sando Isamu
Published: November 2015

It is very valuable for temporal bone morphologists to be able to recognize temporal bone serial sections in three dimensions and to be able to measure temporal bone structures three‐dimensionally. We can now do 3‐dimensional reconstruction to visualize the structures of vestibular endorgans (utricular and saccular maculae) and measure these endorgans in space by means of a small computer system and software that we developed. As well as obtaining the dimensions—such as length and area—of the utricular and saccular maculae, we also found that (1) most of the utricular macula lies in one plane, which is the same as the plane of the lateral semicircular canal, (2) the saccular macula is shaped like part of a sphere, and (3) the angle between the two maculae is less than a right angle. Such knowledge is indispensable to the evaluation of the function of the utricular and saccular maculae.)
Infrared/Video Eng Recording of Eye Movements to Evaluate the Inferior Vestibular Nerve Using the Minimal Caloric Test
Authors: Linthicum Fred H. , Waldorf Ron , Luxford William M. , Caltogirone Sharon
Published: November 2015

The technique was originally developed to test the inferior vestibular nerve in tumor suspects whose high‐frequency hearing loss exceeded the capabilities of the auditory brainstem response tests and whose electronystagmographic results showed no significantly reduced vestibular response. The test has subsequently been found effective to demonstrate persistent singular nerve fiber function in patients with persistent vertigo after retrolabyrinthine vestibular nerve section.
Vestibulo‐Ocular (VOR) Abnormalities at High Rotational Frequencies in Patients with Meniere' Disease
Authors: Dayal V.S. , Mai M. , Tomlinson R.D.
Published: November 2015

Although visual feedback is required to maintain gaze stability during low‐frequency rotations (below 1 Hz) because of suboptimal VOR gain in this frequency range, such behavior is not as evident at higher frequencies. Benson1 and Hydén et al.2 noted a steady increase in VOR gain in the higher‐frequency range (2 to 5 Hz), where visual feedback has little effect. Similar behavior has also been reported in the monkey models. Eleven patients with diagnoses of Meniere's disease had tests of VOR and VOR cancellations performed with the use of pseudorandom oscillations as high as 5 Hz. The reponses at various frequencies were compared with normal data from 17 subjects. The VOR gain in patients exhibited a more rapid rise at high frequencies than that observed in normal subjects. For example, at 3.5 Hz the normal gain was 1.09, whereas patients exhibited a gain of 1.35 (mean of 11 subjects). When the performance during VOR cancellation tasks was compared, Meniere's patients appeared to be less able to perform these tasks; however, when the values were compared by use of a cancellation index that compensates for any difference in VOR gain, this apparent difference disappeared.
Concomitant Hydroxyurea, 5‐Fluorouracil, and Radiation Therapy for Recurrent Head and Neck Cancer: Early Results
Authors: Vokes Everett E. , Panje William R. , Weichselbaum Ralph R. , Schilsky Richard L. , Moran William J. , Awan Azhar M. , Guarnieri Carol M.
Published: November 2015

We tested the combination of hydroxyurea (HU), 5‐fluorouracil (5‐FU), and concomitant radiotherapy (XRT) in a group of patients with advanced or recurrent head and neck cancer. Both drugs are effective single agents, have shown synergistic activity in vitro, and can act as radiation sensitizers. A 5‐day course of radiotherapy, with simultaneous HU and continuous infusion 5‐FU, was followed by a 9‐day rest period; cycles were repeated until completion of XRT. Sixteen patients have completed their therapy. Eleven patients had recurrent disease after previous therapy with surgery (11 patients), radiotherapy (9 patients), and combination chemotherapy (4 patients). Five patients had not received previous local therapy. These patients had persistent disease after induction chemotherapy and/or were inoperable because of poor general medical condition. Of 15 patients evaluable for response, 9 had complete response, including 5 patients who had earlier local therapy; 5 had partial response; and 1 failed to respond. Toxicities included mild myelosuppression and mucositis. No unusual complication related to previous radiotherapy was observed. This regimen has shown impressive activity in a cohort of patients who are not usually responsive to other types of currently available therapy. We are continuing our investigation to further define efficacy, toxicity, and maximally tolerated doses of this regimen.
A Method of Closure after Resection of Anterior Floor of Mouth Cancers
Authors: Weissler Mark C. , Goldsmith Manning M. , Martinkosky Stan
Published: November 2015

A variety of methods may be used to reconstruct head and neck defects after ablative surgery for cancer. Increasingly, choices of reconstructive techniques must be made on the basis of functional results attained. Described is a method of reconstruction for anterior floor of mouth defects with marginal mandibulectomy, which has yielded good functional results. All patients undergoing this form of reconstruction are on a soft oral diet, without drooling and with good speech intelligibility.
Is Chronic Gastroesophageal Reflux a Causative Factor in Glottic Carcinoma?
Authors: Morrison Murray D.
Published: November 2015

Several forms of laryngeal dysfunction and pathology can be attributed to the effects of chronic gastric reflux through direct acid irritation, from a reflex alteration in voluntary muscle tone or referred sensation. It is widely accepted that contact ulcers and granulomata over the arytenoid are associated with gastric reflux, but there have not been well‐documented cases of glottic carcinoma that are reflux‐related. This article presents six cases of glottic carcinoma, all with T1 lesions of the anterior two‐thirds of the vocal cord. All of these patients are lifetime nonsmokers, and all had no other ailments other than moderately severe chronic gastroesophageal reflux. Clinical details from the study of these patients gives strong indication that the reflux may have been a factor in the development of the disease. In addition, review of 21 lifetime nonsmokers with glottic carcinoma presenting over a 10‐year period at the Cancer Control Agency of British Columbia revealed that 48% had probably experienced reflux, compared to 16% in a group that had stopped smoking 10 or more years earlier. While this small number of cases cannot be said to prove the etiologic relationship between reflux and glottic carcinoma, it is important for the otolaryngologic community to be aware of the possible clinical relationship.
Mechanical Properties of Septai Cartilage Homografts
Authors: Glasgold Mark J. , Kato Y. Pedro , Christiansen David , Hauge Joy A. , Glasgold Alvin I. , Silver Frederick H.
Published: November 2015

The compressive mechanical properties of untreated and chemically and physically treated nasal septum homografts were determined. Mechanical properties of control, saline‐, thimerosal (Merthiolate)‐ and Alcide‐treated specimens were similar. At high strains, the stiffness of treated cartilage ranged from 12.8 to 22.5 MPa and was unaffected by storage time. In comparison, irradiated and freeze‐dried nasal septum exhibited stiffnesses of 35 and 37.5 MPa, respectively, after approximately 1 month of storage. These values of stiffness were significantly different from controls at a 0.95 confidence level. On the basis of these results, it was concluded that Alcide and Merthiolate treatment did not alter the compressive mechanical properties of cartilage and that a combination of these treatments may adequately sterilize and preserve nasal septum homografts.
Primary Fallopian Canal Glomus Tumors
Authors: Bartels Loren J. , Pennington James , Kamerer Donald B. , Browarsky Irwin
Published: November 2015

Primary fallopian canal glomus tumor has been reported only once previously, although the occurrence of glomus body tissue in the fallopian canal was documented many years ago. Facial paresis as a presenting symptom of glomus tumors is well known, as is facial nerve invasion by glomus tumors. However, a primary fallopian canal glomus tumor that extends extratemporally to the pes anserinus is unusual. Although facial nerve grafting may be necessary for removal of some glomus jugulare tumors, the need for facial nerve grafting appears to be uniform in the patients with primary fallopian canal glomus tumors. The primary fallopian canal glomus tumors that we report did not involve the jugular fossa or the Jacobson's branch of the glossopharyngeal nerve. Both tumors did extend to the middle ear and mastoid and followed the facial nerve extratemporally. The latter features appear to typify primary fallopian canal glomus tumors.
Recurrent Laryngeal Nerve Paralysis Associated with Thoracic Aortic Aneurysm
Authors: Teixido Michael T. , Leonetti John P.
Published: November 2015

The association of vocal cord dysfunction with thoracic aortic aneurysm (TAA) has been noted in the cardiovascular and otolaryngologic literature.1–6 A retrospective review of 168 cases of TAA was performed in order to: (1) define the natural history of associated recurrent laryngeal nerve paralysis (RLNP) and (2) propose mechanisms for the development of RLNP in operated and nonoperated aneurysms. Of 168 aneurysms, 5% manifested hoarseness secondary to RLNP. All had type I aneurysms. Only one patient regained vocal cord function after surgical treatment of the aneurysm. RLNP developed as a sequela of TAA repair in 12% of the patients managed surgically. RLNP associated with TAA type III repair had a higher incidence of recovery than paralysis that occurred after TAA type I repair (40% vs. 0% recovery). Sixty‐six percent of all patients with permanently paralyzed larynges in this series attained glottic competence sufficient to avoid Teflon injection, and 27% of all RLNP associated with TAA in this series required Teflon injection for aspiration, severe dysphonia, or both. Seventeen percent of the patients with vocal cord paralysis associated with TAA recovered within 12 months. Aneurysm classification and pertinent anatomic relationships are discussed with reference to various mechanisms of recurrent laryngeal nerve paralysis.
Head Shape and Abnormal Appearance of Tympanic Membranes
Authors: Stolovitzky J. Pablo , Todd N. Wendell
Published: November 2015

We examined 187 males to evaluate the hypothesis that short‐headed persons more often have otitis media than long‐headed persons. The subjects were seen as part of routine health screening before attending recreational summer camp. The photographic appearance of each tympanic membrane was judged on two separate occasions by an otolaryngologist who categorized them as “normal”, “abnormal”, or “cannot determine”. The repeatability of the categorizations was fair: kappa = 0.44. Only the tympanic membranes categorized identically twice were used for data analysis. The left‐right symmetry of the tympanic membrane categorizations was fair: correlation coefficient phi = 0.42. Subjects categorized as having bilaterally normal tympanic membranes were considered to have not had previous otitis media (N = 95). In contrast, subjects categorized as having at least one abnormal tympanic membrane were considered to have had previous otitis media (N = 13). Head length and width, measured by calipers, and the cephalic index (width divided by length) × 100 were determined for each person. On the average, the cephalic index of the normal subjects was lower than that for the subjects with otitis media (t = 3.06, p < 0.005). These data support the suggestions of Pautow (1925) and Worley et al. (1987): dolichocephalic persons have otitis media less often than do brachycephalic persons. Though this association is not useful in clinical care of the individual patient, it may be considered a weak external manifestation of the different cranial base and eustachian tube anatomy found in persons with otitis media.
Pressure‐Equalization (PE) Tubes in Treatment of Otitis Media: National Survey of Otolaryngologists
Authors: Heald Melinda M. , Matkin Noel D. , Meredith Keith E.
Published: November 2015

This study was designed to describe those indicators for the insertion of pressure‐equalization (PE) tubes given highest priority by board‐certified otolaryngologists. An original questionnaire was mailed to 1000 board‐certified otolaryngologists practicing in the United States. The respondents rated the relative importance of 22 indicators on a 6‐point scale. These indicators were grouped into four categories: Medical History, Physical Examination, Audiologic Evaluation, and Related Indicators. With a return rate of 52.7%, approximately 1 of every 9 board‐certified, practicing otolaryngologists in the United States was represented in the study. The five indicators with the highest ratings were: “persistence of fluid for 3 or more months per episode,” “presence of speech‐language delay,” “presence of bilateral conductive hearing loss of 20 dB or more,” “total number of episodes of otitis media,” and “lack of response to suppressive antibiotic therapy.” Additional analyses of the data yielded information regarding characteristics of the responding physicians and the self‐generated indicators.
Rhinectomy: Timing and Reconstruction
Authors: Teichgraeber John F. , Goepfert Helmuth
Published: November 2015

Cancer of the nasal skin is usually well‐circumscribed, superficial, and has an excellent prognosis. However, a small number of aggressive lesions require a partial or total rhinectomy. We retrospectively reviewed patients seen at the M.D. Anderson Cancer Center between January 1, 1970, and December 31, 1980, for nasal cancer. There were 147 patients identified as requiring full‐thickness nasal resections, of whom 68 (46.3%) required a hemi‐ or complete rhinectomy. Lesions requiring extensive rhinectomy usually involved the ala or were recurrent multicentric, squamous cell carcinomas greater than 4 cm. These patients had significantly poorer prognoses than the group in general. Recurrence developed in 45 patients (30.6%), and two thirds of all recurrences were seen within 2 years. In this series, the histology of the malignancy and its size, in the case of large basal cell carcinomas, were both predictive of a poor prognosis. Only the primary site was significant in predicting recurrence, whereas tumor size and histology were significant predictors of the need for an extensive rhinectomy. Delayed reconstruction is recommended in patients who are in poor health and have large recurrent lesions that are multicentric or involve the ala or dorsum. The timing of reconstruction is individualized, but a 2‐year wait after surgery is recommended. Prosthetic rehabilitation is a good interim measure.
The Office Diagnosis of Nasal and Sinus Disorders Using Rigid Nasal Endoscopy
Authors: Levine Howard L.
Published: November 2015

Functional nasal endoscopic surgery has become increasingly popular because of the development of fiberoptic ridge nasal endoscopes. These same nasal endoscopes play an important role in the office diagnosis of nasal and sinus disorders. While not all physicians or medical institutions can afford the cost of nasal endoscopes for nasal sinus surgery, the cost of an office examination set is reasonable and the patient benefits are great. One hundred and fifty consecutive patients with nasal and/or sinus complaints and normal anterior rhinoscopic nasal speculum and posterior rhinoscopic nasopharyngeal examinations were each examined with rigid fiberoptic nasal endoscopy by two physicians to confirm each findings. Nasal endoscopy revealed fifty‐eight (38.7%) patients with nasal pathology who had not been seen with traditional anterior and posterior rhinoscopic examination. The pathology found included obstructed natural maxillary sinus ostia and several pathologic disorders in the middle meatus, such as polyps and “synechiae”. Many of these patients had seen several physicians and exhibited frustrating longstanding symptoms, some of which included postnasal catarrh, postnasal drainage, headache, facial pain, “sinus”, pressure, and congestion. Nasal endoscopy can find nasal and sinus pathology that might easily be missed with routine speculum and nasopharyngeal examination. For patients with unexplained nasal sinus symptoms, the general otolaryngologist might consider rigid nasal endoscopic office examination as part of the routine office examination.
Congenital Malformations of the External Middle, and Inner Ear Produced by Isotretinoin Exposure in Mouse Embryos
Authors: Jarvis Bennie L. , Johnston M.C. , Sulik K.K.
Published: November 2015

Isotretinoin (Accutane), a widely used dermatologic drug, produces severe congenital malformations when used during pregnancy. The isotretinoin teratogen syndrome consists of multiple cardiovascular and craniofacial anomalies, most commonly involving the external ear. This study examined the pathogenesis of isotretinoin teratogenicity in a mouse model, using microdissection and histologic examination of fetal mouse ears after treatment with the drug at various stages of embryonic development. In this study, earlier treatment times frequently produced microtia similar to that seen in affected infants, as well as recognizable patterns of temporal bone and ossicular abnormalities; exposure at a later developmental stage resulted in facial tags with less severely affected ears. Possible teratogenic mechanisms of isotretinoin are discussed. Suitability of the mouse model for studying human congenital craniofacial malformations, such as Goldenhar's and Treacher Collins Syndrome, is also explored.
Glomus tumors of the temporal bone: Electron microscopic and immunohistochemical evaluation
Authors: Farrior Jay B. , Packer James T.
Published: November 2015

Glomus tumors arising In the temporal bone are now recognized as being part of the diffuse neuroendocrine system. Material from 12 glomus tumors was studied by means of electron microscopic and immunohistochemical techniques to determine whether there was an association between tumor size, patient age, and the neuroendocrine functions of these tumors. Electronmicroscopic evaluation (seven tumors) revealed a highly variable concentration of neurosecretory granules. Immunohistochemical staining (nine tumors) demonstrated that glomus tumors do arise from neural ectoderm and that they all contain serotonin. The concentration of serotonin seems to correlate with the concentration of neurosecretory granules seen on electronmicroscopy. In addition, higher levels of serotonin were found In two patients who were in their late sixties. It is possible that some of the neuroendocrine activity associated with glomus tumors could be the result of the release of serotonin.
Endoscopic sinus surgery: Outcome in 155 cases
Authors: Matthews Brian L. , Smith Lee E. , Jones Robert , Miller Chase , Brookschmidt Joni K.
Published: November 2015

For this retrospective study of endoscopic sinus surgery, charts of 22 patients from a medical center and 133 patients from a private practice (N = 155) were reviewed. Preoperative complaints, clinical findings, computed tomographic evidence of extent of sinus disease, surgical outcome, possible predictors of success, and complications were considered. Indications for endoscopic surgery were persistence of symptoms despite aggressive medical therapy and radiologic evidence of a significant sinus abnormality. Median followup was 12 months. Hemorrhage occurred postoperatively in two patients (1.5%); 17 patients required additional endoscopic surgery. Overall, 140 (91%) patients believed that the surgery was beneficial. Patients with facial pain pre‐operatively showed the greatest improvement. All patients having simultaneous septoplasty (N = 64) had successful outcome. The total number of opacified sinuses was not a predictor of outcome, but opacification of the sphenoid sinus correlated with a poorer outcome. The patients seen at the medical center had poorer results, but had a larger number of opacified sinuses, were more likely to have had previous sinus surgery, and were more likely to have underlying medical conditions contributing to their sinus disease.
The potassium‐titanyl phosphate laser for treatment of turbinate dysfunction
Authors: Levine Howard L.
Published: November 2015

Patients with nasal turbinate dysfunction most often are seen by the physician with such symptoms as watery nasal secretions, nasal obstruction, congestion, facial pressure, or pain. There will often have been multiple attempts to manage the problem medically and symptomatically with antihistamines, decongestants, antibiotics, nasal cromolyn, and topical or systemic steroid therapy. Some patients will have undergone numerous attempts at surgical therapy, most often with cryosurgery or cauterization. The cause of the symptoms of turbinate dysfunction for most of these patients is either vasomotor rhinitis, allergic rhinitis, or polypoid hypertrophic turbinates. A visible‐wavelength laser with a wavelength of 532 nm, the potassium‐titanyl phosphate laser has been used with nasal endoscopes to perform laser photocoagulation of the nasal turbinates. A description of the technique and early results have been previously reported. This article reports good long‐term results with the technique.
CT evaluation of the paranasal sinuses in symptomatic and asymptomatic populations
Authors: Calhoun Karen H. , Waggenspack Gerard A. , Simpson C. Blake , Hokanson James A. , Bailey Byron J.
Published: November 2015

The frequency of concha bullosa, paradoxical middle turbinate, and septal deviation on coronal computed tomographic scans evaluating sinus disease is known, but the incidence in normal subjects is unknown. We compared 100 consecutive scans performed for evaluation of sinus disease with 82 consecutive scans performed for evaluation of orbital pathology. Patients with sinus disease had significantly more frequent findings of disease in the osteomeatal complex and all sinuses. Concha bullosa was more common in patients with sinus disease (p < 0.05), as was septal deviation (p < 0.01). Paradoxical turbinate was equally common. Concha bullosa was associated with anterior ethmoid disease (p < 0.04). Septal deviation was associated with osteomeatal complex disease (p < 0.01) and with anterior (p < 0.04) and posterior (p < 0.04) ethmoid disease. Paradoxical turbinate was not associated with sinus abnormalities. These data imply a possible causal relationship between concha bullosa or septal deviation and sinus disease.
Longitudinal followup of patients with meniere's disease
Authors: Green J. Douglas , Blum Daniel J. , Harner Stephen G.
Published: November 2015

The etiology, pathophysiology, and natural history of Meniere's syndrome are poorly understood. The reported studies have had inadequate followup or insufficient numbers of patients to allow conclusions about the natural history. Our study group was 119 patients who had the classic symptom complex of episodic vertigo, tinnitus, and hearing loss in the year 1970. After initial review of these charts, follow‐up information was obtained by questionnaire, telephone interview, chart review, or repeat examination, when possible, both in 1983 and in 1988, for a total followup of 18 years. In the patients with followups of at least 14 years, vertiginous episodes had disappeared completely in 50% of patients and somewhat resolved in 28%; hearing was absent in 48% and worse in 21%. Surprisingly, 43% of patients underwent surgery at some point for control of vertigo. Bilateral disease was present initially in 13% and developed subsequently in 45% of patients. Other areas reviewed included the efficacy of long‐term medical treatment, frequency and severity of vertiginous attacks, and contralateral ear symptoms.
Ossifying fibroma of the mid‐face and paranasal sinuses: Diagnostic and therapeutic considerations
Authors: Marvel Jeffrey B. , Marsh Michael A. , Catlin Francis I.
Published: November 2015

Ossifying fibroma is a benign, usually slow‐growing tumor that may behave in an un‐predictably aggressive fashion. Most of these unusual tumors affect the mandible. Their behavior in the mid‐face and paranasal sinuses is not well documented. In our review of the subject, and of the cases presented, it appears that these lesions behave more aggressively than their mandibular counterparts. A more aggressive approach may be more beneficial than expectant observation or curettage in the initial management of this neoplasm.