bluuebunny/crossref_metadata_2025 huggingface dataset:
Basic Principles of Chemotherapy in the Treatment of Metastatic Head and Neck Cancer
Authors: Needleman Samuel W.
Published: October 2014

For patients who fail to achieve control of head and neck cancer with local therapy, chemotherapy offers limited benefit at present. Better understanding of the phenomena which surround tumor cell killing by active agents should allow for the rational design of more effective programs. For example, as tumors grow larger, many cells cease to engage in DNA synthesis and are refractory to drugs like methotrexate. In such a case, alkylating agents might be more effective. Tritiated thymidine uptake and nuclear DNA fluorescence studies can be exploited to analyze the kinetic and metabolic behavior of tumor cells, and are described. For animal models these studies have allowed the design of “kinetic” regimens of enhanced efficacy. Methotrexate, hydroxyurea, cyclophosphamide, vinblastine, and cis-platinum have appreciable antitumor activity in head and neck carcinoma. Combining active agents in a rational sequence could be facilitated by kinetic analysis of a patient's tumor, giving rise to specific regimens with more cytoreduction, less toxicity and resistance, and ultimately, better survival.
Tetracycline Bone Labeling
Authors: Canalis Rinaldo F. , Lechago Juan
Published: October 2014

A simple modification of the tetracycline bone labeling techique, based on the use of incident fluorescence, is introduced. The method has proven effective in the study of osteoneogenesis in bone grafts assisted by a soft tissue pedicle. The results obtained are highly specific, with new bone showing as a yellow band against blue background. The degree of fluorescence appears to be related to that of osteoneogenesis and correlates well with histological findings of the same specimens when examined by conventional light microscopy. The main advantages of this new technique over currently used methods are 1) avoidance of the time-consuming thinning procedure; 2) ability to study bone and surrounding soft tissues simultaneously; and 3) one-to-one comparison and documentation of the results of fluorescence and histological examination of the same specimen.
Sudden Deafness Due to Infection by Mycoplasma Pneumoniae
Authors: Shanon Eliahu , Redianu Chaim , Zikk Daniel , Eylan Emanuel
Published: October 2014

A case is described of sudden unilateral deafness associated with Mycoplasma pneumoniae. The hearing function of the patient returned to normal on the third day of treatment with tetracycline. M pneumoniae is a common causative agent of protean respiratory disease and the true incidence of hearing loss in these cases may be higher than reflected by the occasional reports. Therefore, appropriate laboratory studies should be included in the evaluation of sensorineural loss associated with diverse infections of the respiratory tract. Prompt diagnosis facilitates the administration of specific treatment. However, the actual contribution of tetracyclines to restoration of hearing cannot be assessed.
Bony Auditory Tube and Otitis Media with Effusion
Authors: Duncan R. Bruce
Published: October 2014

The author has for 25 years manually probed the malleus handle for indications of middle ear pathology. Dissection of the bony auditory tube (BAT) and isthmus comprised 120 fresh autopsy and 26 anatomically prepared temporal bones. The semicanal lamina was not completely ossified in all infants and children and 52% of adults. The tensor tympani muscle was edematous and prolapsed into the superior portion of the BAT in eight ears with otitis media with effusion. Infants and children have the tendon of the tensor tympani muscle inserting into the neck of the malleus at an angle of 60° or greater, possibly explaining the relatively large muscle bulk. It is suggested from these autopsy findings that the BAT and isthmus lumen is a functional 2-way channel for air superiorly and mucus streaming interiorly. Manual palpation of the cartilaginous auditory tube in infants did not suggest malacia.
Accuracy of Auditory Brainstem Evoked Response with Hearing Level Unknown
Authors: Smith Lee E. , Simmons F. Blair
Published: October 2014

We reported a comparison of auditory brainstem response (ABR)-estimated hearing levels with hearing levels by pure-tone audiogram for 84 ears of 42 children. Their average age was 34 months at the time of ABR and 73 months for the audiogram. Thus, all of these children were managed clinically on the basis of their ABR results. The ABR accurately predicted the pure-tone average (PTA) in 76% and was in error by no more than about ± 10–12 dB in another 18%.
Simultaneous round and Oval Window Fistulae in a Child
Authors: Pashley Nigel R. T.
Published: October 2014

Sudden hearing loss from simultaneous rupture of both oval and round windows, occurring in the only hearing ear of a child, is described. The condition was surgically managed with recovery of hearing. Of particular note was the presence of air aspirated into the labyrinth at the time of membrane rupture, which has not previously been described. The possible mechanisms and some clinical correlates associated with anatomic predisposition to such rupture are discussed.
Laryngotracheal Invasion by Thyroid Carcinoma
Authors: Friedman Michael , Shelton Vicki K. , Berlinger Frederick G. , Skolnik Emanuel M. , Arab Mohammad
Published: October 2014

Laryngotracheal invasion by well-differentiated thyroid carcinoma is an uncommon occurrence. Recommendations for therapy have primarily included total laryngectomy or shaving of the tumor from laryngeal or tracheal cartilages. Clear guidelines have not been established for the applicability of partial laryngeal resections. In a retrospective analysis of patients with thyroid carcinoma, 13 patients had airway invasion. Of the five patients with laryngeal involvement, three were treated by a partial laryngeal resection. An experimental study was undertaken to determine more precisely the amount of cricoid cartilage which could be resected without reconstruction. Varying amounts of cricoid cartilage were resected. The results indicate that 25% of the cricoid cartilage may be resected without appreciable airway narrowing. On the basis of the retrospective analysis and experimental study, we feel a partial laryngeal resection is possible in most cases of airway invasion by thyroid carcinoma.
Extended Transantral Approach to Pterygomaxillary Tumors
Authors: Krause Charles J. , Baker Shan R.
Published: October 2014

A review of 14 patients treated between 1975 and 1979 is reported. The lesions were quite extensive in most of the patients, having extended beyond the nasopharynx in all but one. An extended transantral approach was utilized in nine of the patients to facilitate removal of lateral and superior extensions of tumor. Two of the patients (14%) developed recurrent tumor, one six months and one nine months following treatment. The extended transantral approach appears to be an effective method of approaching the pterygomaxillary extension of the tumor.
Correction of Posterior Glottic Incompetence following Horizontal Partial Laryngectomy
Authors: Biller Hugh F. , Lawson William , Sacks Steven
Published: October 2014

Posterior glottic insufficiency following horizontal partial laryngectomy results in persistent aspiration. A new method of correction of this occurrence is described. The procedure is an extralaryngeal approach. A tracheotomy is not required. The procedure was successful in 4 of 6 patients.
Primary Vocal Rehabilitation Using the Blom-Singer and Panje Voice Prostheses
Authors: Maves Michael D. , Lingeman Raleigh E.
Published: October 2014

Vocal rehabilitation by means of tracheoesophageal puncture and placement of either the Blom-Singer or Panje silicone prosthesis has become a standard method of speech production following total laryngectomy. The same technique has been employed primarily at the time of the laryngectomy by the Department of Otolaryngology-Head and Neck Surgery, Indiana University Medical Center, and our experience with 11 patients undergoing this technique forms the basis for this report. Of the ten patients available for evaluation, all have developed satisfactory prosthetic speech 2–12 weeks following total laryngectomy. Advantages of this technique include the utilization of standard laryngectomy without compromise of oncologic principles, elimination of a second procedure to place the tracheoesophageal puncture, elimination of the nasogastric tube, care in the pharyngeal closure to afford the maximum success of prosthetic speech production, and finally, the psychological boost. Limitations of the technique have been few but relate to limited voicing with postoperative radiotherapy and unrealistic patient expectations.
Chemical Modulation of the Hypoxic Fraction in the Treatment of Head and Neck Cancer
Authors: Weichselbaum Ralph R. , Ervin Thomas J. , Miller Daniel
Published: October 2014

Treatment of large squamous carcinomas of the head and neck often requires intensive or multidisciplinary treatment. Despite such aggressive measures, local recurrence is common. Possible reasons for such local failure are numerous. Hypoxic but viable tumor cells may be one means of resistance to radiotherapy and chemotherapy. If surgical removal cannot eliminate these cells, tumor regrowth may occur. Modulation of the hypoxic fraction is one means of potentially altering resistance to radiotherapy. Misonidazole, a radiosensitizer, has been thought to increase free radical formation in hypoxic cells in vitro thus increasing the radiosensitivity. This observation is discussed with reference to advanced head and neck cancer.
Metastatic Patterns of Salivary Gland Neoplasms
Authors: Batsakis John G.
Published: October 2014

Long-term follow-up of salivary gland carcinomas allows a better evaluation of their biologic malignancy than the traditional five-year period. Metastases (distant and local) are possible over the entire lifetime of a patient and are dependent upon histologic grade, persistence of neoplasm and clinical stage. Distant metastases to bone and lungs are manifested by nearly every carcinoma. Metastases to regional lymph nodes vary according to histologic type and it appears that the adenoid cystic carcinoma has the lowest incidence of that event.
Wegener's Granulomatosis of the Subglottis and the Upper Portion of the Trachea
Authors: McDonald Thomas J. , Neel H. Bryan , DeRemee Richard A.
Published: October 2014

A relatively little-known complication of Wegener's granulomatosis is involvement of the subglottis and upper part of the trachea, which is illustrated in this report on 17 patients. Each of the patients had biopsy-proved Wegener's granulomatosis of the nose and paranasal sinuses. Some had concomitant involvement of the eye, kidney, lung and skin. Nine of the 17 patients required tracheotomy; 5 still require a tracheotomy tube, and 4 have had decannulation (1 had successful reconstructive surgery of the trachea). Medical treatment consisted of cyclophosphamide, with or without corticosteroids. All 17 are currently alive, the average follow-up having been 81 months. The otolaryngologist plays a key role in the detection and management of patients with Wegener's granulomatosis, particularly when the onset is a sudden progressive upper tracheal obstruction with airway symptoms that may overshadow the sometimes more subtle nasal manifestations.
Wegener's Granulomatosis Appearing Initially in the Trachea
Authors: Arauz J. Carlos , Fonseca Rolando
Published: October 2014

We treated ten patients with Wegener's granulomatosis whose clinical picture differed only in the stage of the disease at the time of the first visit. All patients were female with a mean age of 30 years and all presented with a picture of high tracheal obstruction. Three died and six have a permanent tracheostomy. Surgical treatment was unsuccessful; corticosteroids provided only transient improvement but cyclophosphamide induced remission. Removal of the stenosis either by open surgery or endoscopically by laser was not successful in accomplishing decannulation.
Dynamics of Venturi Jet Ventilation through the Operating Laryngoscope
Authors: Woo Peak , Eurenius Stephen
Published: October 2014

Venturi jet ventilation with the oxygen injector needle placed within the lumen of the laryngoscope was studied systematically in two dogs undergoing repeated general anesthesia suspension laryngoscopy. Using a total body plethysmograph, the effect of changes of needle angle, position and its effect on tidal volume delivery were measured. The changes of pressure regulator, flow rate and needle size were correlated with the volume delivery. Intratracheal pressure during Venturi ventilation was measured. Correlation of arterial blood gases and minute ventilation with the system was done. While ventilatory capacity is able to be achieved predictably, there are many variables. Optimal placement of the needle tip for maximum safety and efficiency appears to be at the midthird or lower third of the laryngoscope. It is important to center the needle axis to the laryngoscope axis. Other parameters subject to choice are the selection of needle size, regulator pressure setting and flow rate setting. By first selecting the correct needle size that will hyperinflate the subject, the pressure regulator can then be reduced to achieve ventilatory volumes similar to spontaneous tidal volumes. In prolonged use, the Venturi system was able to provide excellent ventilation safely and predictably.
Foregut Cysts in Infants and Children
Authors: Cohen Seymour R. , Geller Kenneth A. , Birns Jeffrey W. , Thompson Jerome W. , Meyer Bert W. , Lindesmith George G.
Published: October 2014

The charts of 15 patients with foregut cysts were reviewed. The lesions were intrathoracic in 14 patients and in the cervical area in one child. The importance of early diagnosis and surgical management is stressed. In untreated infants with foregut cysts, severe progressive and life-threatening airway obstruction may develop. Since the symptoms of this congenital lesion may simulate other more common diseases of the tracheobronchial tree and esophagus, the physician should become familiar with this disease entity so that proper diagnosis and surgical treatment will not be delayed. The study includes symptomatology, methods of diagnosis, pathologic findings and classification of the cysts.
Mediastinoscopy for Extrathoracic Malignancies
Authors: Welsh Louis W. , Welsh John J. , Chinnici J. C. , Huck George F.
Published: October 2014

Metastatic tumors from extrathoracic sources appear in the mediastinum infrequently and from a variety of locations. In this series of approximately 350 malignancies of the mediastinum, 20 (6%) originated from the breast, prostate, kidney, pelvis, and gastrointestinal tract. A radiologic review of these cases does not identify a unique pattern, although paratracheal masses present most often, while unilateral hilar adenopathy occurs somewhat less frequently. The history of previous surgery for malignancy suggests metastatic disease into the mediastinum. However, other entities of second primaries, lymphoma, Hodgkin's disease, and benign processes warrant consideration. Mediastinoscopy is reemphasized as a valuable diagnostic technique for the solution of these problems.
Endolymphatic SAC Surgery for Menière's Disease
Authors: Spector Gershon J. , Smith Peter G.
Published: October 2014

An endolymphatic-mastoid Silastic shunt procedure was performed in 122 cases of Menière's disease having a mean follow-up period of three years. In accordance with American Academy of Ophthalmology and Otolaryngology 1972 criteria, there were 43 % class A, 20% class B, 21% class C, and 17% class D results. Analysis of 35 recent cases having a mean follow-up period of nine months revealed 57% class A, 25% class B, 9% class C, and 9% class D results. Sixteen percent of the patients who experienced classes A, B or C results complained of other fluctuating symptoms which were not relieved by surgery. Moreover, three new eases of otolithic crisis were found in the postoperative group. Seven of ten patients who experienced a class A or B result had either a recrudescence of their vertigo or a significant decrement in hearing in response to a postoperative salt-loading test. It is concluded that the surgical success rate decreases with time and that the procedure appears to alter the symptom complex but does not cure Menière's disease.
Peripheral Blood T and B Lymphocyte Subpopulations in Bell's Palsy
Authors: Aviel Aharon , Ostfeld Ervin , Marshak Gabriel , Burstein Rimona , Bentwich Zvi
Published: October 2014

A prospective clinical, virological and immunological study was performed on 25 consecutive Bell's palsy (BP) patients. Multiple cranial nerve involvement was found in 15 patients. A significant decrease in the peripheral blood T lymphocyte percentage as well as an increase in B lymphocyte percentage (p<0.001) were found in 13 of the BP patients during the first 24 days from the clinical onset of the paralysis. No correlation was found between the peripheral blood lymphocyte subpopulations and the patient's age, sex, degree of paralysis or recovery rate. No changes were detected in the levels of immunoglobulins (IgG, IgM), complement (C3, C4) and antiviral antibodies to herpes simplex and zoster, EBV, cytomegalic virus, adenovirus, influenza and mumps. The clinical and immunological data of BP show a similar pattern to those of Guillain-Barre syndrome suggesting that BP may be an antoimmune demyelinating cranial polyneuritis which may be caused by a preceding viral infection.
Experimental Study of Velocity Fields in a Human Nasal Fossa by Laser Anemometry
Authors: Girardin Marc , Bilgen Ertugrul , Arbour Pierre
Published: October 2014

Velocity fields were mapped in a model of a human nasal fossa by laser doppler velocimetry, an innovative, quantitative and noninvasive method of optical anemometry, and by computerization. Other pertinent parameters were also calculated. Studies made at different cross sections of the nasal fossa showed the very definite influence not only of shapes and dimensions but also of direction of flow on velocity fields. The turbinates had a streamlining effect on the velocity fields while the liminal valve had a directional effect. Flow was usually greater in the lower half of the fossa and closer to the septum. The flow was generally turbulent. Velocity fields appear to give more information on intranasal aerodynamics than the calculated flow and Reynolds number for the sections studied, and this allows one to at least theorize that there may be an aerodynamic basis to certain pathological conditions of the nasal airway and its adjoining cavities, the paranasal sinuses, and the eustachian tubes.
Type II Collagen-Induced Autoimmune Sensorineural Hearing Loss and Vestibular Dysfunction in Rats
Authors: Yoo T. J. , Cremer M. A. , Tomoda K. , Townes A. S. , Stuart J. M. , Kang A. H.
Published: October 2014

Autoimmune sensorineural hearing loss was induced in rats by immunizing them with native bovine type II collagen. Type I and denatured type II collagen, administered by an identical immunization procedure, would not induce disease. Evidence of sensorineural hearing loss was obtained by measuring the brainstem evoked potential and by observing histopathologic changes consisting of cochlear nerve degeneration and perineural vasculitis in affected animals. Immunized animals had high levels of antibodies to native type II collagen.
Giant Intraluminal Polyps of the Esophagus
Authors: Vrabec Donald P. , Colley A. Thompson
Published: October 2014

Giant intraluminal polyps of the esophagus are relatively rare. Their diagnosis often presents a confusing picture; radiographic studies are frequently misinterpreted as achalasia, and the endoscopic picture is often difficult to interpret. This report describes the case histories of three patients with giant intraluminal polyps of the esophagus. Each presents slightly different clinical features. The signs and symptoms are discussed in terms of the pathophysiology. Common pitfalls in diagnosis are reviewed. Suggestions to enable more accurate identification of these lesions are given. Finally, a systemic approach to treatment is outlined which offers the patient symptomatic relief while minimizing surgical complications and morbidity.
Quantitative and Objective Evaluation of Vocal Cord Function
Authors: Rontal Eugene , Jacob H. John , Rontal Michael , Rolnick Michael I.
Published: October 2014

Objective and quantitative evaluation of vocal cord function is a goal that has been difficult for voice clinicians to obtain. To be useful as a clinical screening tool it must be easy to perform, it must produce numerical storable data, it must have a high degree of accuracy, and it must be cost-effective. The results of this study have shown that using the perturbation factor and the equipment described, a successful rate of greater than 93% can be obtained in evaluating vocal cord dysfunction. The results further indicate that this equipment can be used much in the same way as an audiogram to follow-up and clinically evaluate on an objective basis the function of the vocal cords.
The Deaf Child: Habilitation with and without a Cochlear Implant
Authors: Ling Daniel , Nienhuys Terry G.
Published: October 2014

The rationale underlying the habilitation of deaf children through the use of cochlear implants is discussed. Areas of child development which are especially relevant in the habilitation process are highlighted. The need for rigorous ongoing evaluation is emphasized.
The Petromastoid Canal
Authors: Proctor Bruce
Published: October 2014

The embryology and anatomy of the petromastoid canal is reviewed. This structure may be responsible for the passage of some infections of the middle ear cleft into the posterior fossa. It also transmits important blood vessels to a portion of the bony labyrinth, to the facial canal, and to the mucosa of the mastoid air cell system.
Histology of Human Eustachian Tube Muscles: Effect of Aging
Authors: Tomoda Koichi , Morii Sotokichi , Yamashita Toshio , Kumazawa Tadami
Published: October 2014

Forty-eight specimens of human eustachian tube tensor and levator muscles were examined histologically in order to study their functions and the effect of aging. The muscle fibers reach their maximum growth in the third decade with a narrow short diameter: tensor 21.8 μm and levator 24.5 μm; with advancing age, they were prone to atrophy, particularly in the tensor. Three muscle fiber types, red, white, and intermediate, were identified in the tubal muscles. The white fibers predominated in the tensor, and they were a main component of muscle fibers in fetuses and elderly adults. Lipofuscins were located in the periphery of muscle fibers, dominantly in the levator, and became numerous and larger with age. Our observations suggest that 1) the tensor produces a rapid opening of the eustachian tube while the levator creates tension and dilates the pharyngeal orifice of the tube for a relatively long period, and 2) these muscle functions deteriorate with advancing age.
Transdermal Scopolamine in the Treatment of Acute Vertigo
Authors: Babin Richard W. , Balkany Thomas J. , Fee Willard E.
Published: October 2014

A double-blind, parallel investigation was undertaken to evaluate the efficacy of transdermally delivered scopolamine hydrobromide in acute vertigo as compared to meclizine hydrochloride and placebo. Statistical analysis of subjective patient responses and clinical observations suggested that both scopolamine and meclizine are more effective than placebo. Both have significant, but different, side effects.
Mucopolysaccharidosis I-H (Hurler's Syndrome) and Human Temporal Bone Histopathology
Authors: Schachern P. A. , Shea D. A. , Paparella M. M.
Published: October 2014

Six temporal bones from three patients with mucopolysaccharidosis I-H are described. All three patients were diagnosed as having mucopolysaccharidosis I-H by enzyme analysis, and all fit the phenotypic criteria of this disease. Family histories of the three cases described were negative for mycopolysaccharide-storage diseases. All three of the patients suffered chronic recurrent otitis media from infancy through death. Common histopathologic findings include otitis media, residual mesenchyme in the round window niche, partial occlusion of the middle ear cavity, and basophilic concretions within the stria vascularis. The common severe histopathologic changes observed in this study and similar findings in the temporal bones described in other studies lead the authors to believe that ear involvement in this disease may be more common than was previously suspected.
Neuraminidase Activity in Middle Ear Effusions
Authors: LaMarco Karen L. , Diven Warren F. , Glew Robert H. , Doyle William J. , Cantekin Erdem I.
Published: October 2014

Analyses of Streptococcus pneumoniae culture filtrates and middle ear effusions (MEE) containing S pneumoniae for various hydrolytic enzymes have demonstrated substantial levels of neuraminidase activity when measured employing a sensitive fluorometric assay. S pneumoniae neuraminidase exhibits optimum activity near neutral pH (6.0 to 6.5), and catalyzes the cleavage of sialic acid residues from glycoproteins, gangliosides and mucopolysaccharides. S pneumoniae begins secreting large amounts of neutral neuraminidase (mean [x̄] = 43.3 units/mL culture filtrate) when cells enter the stationary phase. Nearly all (96%) human chronic MEEs yielding positive cultures for S pneumoniae contain neuraminidase activity (x̄ = 0.200 units/mg protein), while only 21.1% to 45.5% of all other effusions contain the enzyme. Middle ear effusions obtained from S pneumoniae infected-chinchillas contained large amounts of neuraminidase activity (approximately 200 units/mL), which decayed exponentially in vivo with an apparent half-life of 8 ½ days. Three neuraminidase isoenzymes (designated I-III) were identified in S pneumoniae culture filtrates, as well as in MEEs from chinchillas infected with the organism, using a combination of ion-exchange and gel filtration chromatography. With 4-methylumbelliferyl-N-acetylneuraminic acid serving as substrate, preparation I from both culture filtrates and MEEs was characterized by a high Michaelis constant (Km), while forms II and III had low Km values. Preferred substrates were orosomucoid and neuramin-lactose; gangliosides, thyroglobulin, and bovine submaxillary mucin were poorer substrates.
Molded Tympanic Heterografts
Authors: Gamoletti Roberto , Lanzarini Paolo , Sanna Mario , Zini Carlo , Bacciu Salvatore
Published: October 2014

The histologic appearance of the molded tympanic heterograft developed at the ENT Clinic of the University of Parma, Italy, is investigated with light and electron microscopy. Evaluation of the graft before insertion disclosed a unique structure of interwoven collagen bundles. Examination of grafted tympanic membrane showed a structure closely resembling the normal human tympanic membrane. The fate of the heterologous material and the host reaction to it are discussed in relation to histologic findings.
Immunology of the Inner Ear: Evidence of Local Antibody Production
Authors: Harris Jeffrey P.
Published: October 2014

Previously we reported the capacity of the inner ear to respond immunologically by demonstrating a rise in perilymph antigen-specific antibody following inner ear sensitization. This rise in perilymph antibody was either the result of increased vascular permeability to serum immunoglobulins or the result of local antibody production. In order to determine if the inner ear was the source of antibody, a serum reference was established by systemically immunizing animals to bovine serum albumin (BSA). With anti-BSA as a serum marker during inner ear immunization with keyhole limpet hemocyanin (KLH), we were able to demonstrate an increase in anti-KLH perilymph antibody levels without a corresponding increase in anti-BSA levels. This suggested that increased vascular permeability was not responsible for the increased perilymph levels and that local production of antibody had occurred within the inner ear. The response was independent of the cerebrospinal fluid.
Recovery of Vestibulo-Ocular Reflex and Gaze Disturbance in Patients with Unilateral Loss of Labyrinthine Function
Authors: Takahashi Masahiro , Uemura Takuya , Fujishiro Takehisa
Published: October 2014

Vestibulo-ocular reflex (VOR) gain and the ability of gaze fixation were investigated in patients with unilateral loss of labyrinthine function during the time course of compensation (four days to 6 months). A marked directional difference in the VOR gain in the acute stage (0.51 to 0.73 at four days) decreased proportionately to the logarithm of time on rotations to the affected side and to the intact side by an increase and a slight decrease of the gain, respectively. Gaze disturbance, which occurred only on rotations to the affected side, recovered in parallel with the decrease of directional difference in the VOR gain; it was still found at 1 Hz at 6 months. Recovery of gaze disturbance in unilateral lesions seems to be accomplished not only by the change in the VOR gain, but also by intensified amplification of this gain to make up for a low VOR gain.
Bactericidal Activity of Wet Cerumen
Authors: Stone Mary , Fulghum Robert S.
Published: October 2014

The viable populations of seven species of bacteria were reduced 17% to 99% by treatment with a 3% suspension of human cerumen of the soft or “wet” type. Species tested for susceptibility to cerumen were Staphylococcus aureus, Staphylococcus epidermidis. Streptococcus pyogenes, Propionibacterium acnes, Corynebacterium spp, Escherichia coli, and Serratia marcescens. The reduction depended upon the species of bacterium and the age of the culture. Pathogenic species appeared to be more susceptible than others, while cultures in logarithmic growth were more susceptible than stationary phase cultures to the bactericidal activity of wet cerumen. There appeared to be little difference in the bactericidal activity between the two lots of cerumen used. The bactericidal activity of wet cerumen was found to be quite similar to that of dry cerumen as reported earlier in the literature.
Experimental Sendai Virus-Induced Labyrinthitis in Guinea Pigs
Authors: Tanaka Katsuhiko , Suenaga Toru , Fukuda Satoshi , Hirai Toshifumi , Terayama Yoshihiko , Matsumiya Hidemi
Published: October 2014

Guinea pigs were inoculated with a Sendai virus into the scala tympani and subsequent pathological changes of the cochleas were investigated by electron microscopy. Replication of the virus was indicated by buddings at the endolymphatic surface and by the intracytoplasmic occurrence of filamentous substances, ie, nucleocapsids. Budding viruses or free virus particles observed in a series of our experiments were identified as Sendai viruses by means of the immunological labeling with ferritin. Viral lesions, which were defined as the pathological changes of the cells associated with virus multiplication, were found in eight cochleas out of 20. This study revealed that the early lesions of the cochleas infected by Sendai viruses were primarily confined to Reissner's membrane and the stria vascularis, but the sensory cells were not affected.
Aspergillosis of the Paranasal Sinuses
Authors: Stammberger H. , Jakse R. , Beaufort F.
Published: October 2014

Aspergillosis is not a rare disease of the paranasal sinuses; more than 80 cases were reported from 1976 to 1982 in the University ENT Clinic at Graz, Austria. Of 59 patients studied, 27 presented almost metal-dense x-ray shadows resembling foreign bodies in one of the sinuses. By means of light and electron microscopic investigations as well as x-ray fluorescence analysis, it can be demonstrated that these areas are equivalent to local enrichment of calcium phosphate in the center of the noninvasive fungal masses in the sinuses. A detailed description of the histopathology of Aspergillus fumigatus is given. For clinical diagnosis, the detection of almost metal-dense x-ray shadows in the absence of foreign-body history in our experience may be regarded as almost certain for aspergillosis of the paranasal sinuses.
Chondroma of the Tongue
Authors: Segal Karl , Katzav Yehudit , Sidi Jack , Rotem Arieh
Published: October 2014

Lingual chondromas are very rare tumors. It can be assumed that chondromas of the tongue develop from heterotopic embryonal cartilage. Chondromas are usually seen on the lateral borders of the tongue. Because chondrosarcomas can appear in this location, wide excision of the lesions should be performed. The CO2 laser facilitates the excision, providing a dry surgical field. Two cases of lingual chondroma are presented and their probable cause discussed.
Epiglottic Abscess Due to Group B Streptococcus
Authors: Ridgeway Nathan A. , Verghese Abraham , Perlman Paul E. , Berk Steven L.
Published: October 2014

A group B Streptococcus caused epiglottitis with abscess formation in an adult with diabetes mellitus. Group B streptococci are being more commonly isolated from adults, and epiglottitis is another infection in which this organism has been implicated.
Extracranial Meningiomas
Authors: Batsakis John G.
Published: October 2014

Extracranial meningiomas are most often due to extension from an intracranial primary and less so from meningocytic cells found with arachnoid clusters or modified mesenchymal cells. The most common presentation of all forms is cutaneous, either primary or secondary. Orbital, paranasal, temporal bone and oral presentations follow in that order.
Voice Preservation in Pyriform Sinus Carcinoma by Hemicricolaryngopharyngectomy
Authors: Krespi Yosef P. , Sisson George A.
Published: October 2014

Hemicricolaryngopharyngectomy was performed for anterior pyriform sinus carcinomas with preservation of voice and swallowing. The surgical specimen includes the homolateral half of the hypopharynx, larynx, and cricoid ring. The pharynx is reconstructed with a pectoralis myocutaneous flap, a deltopectoral flap, skin or dermal graft. A semirigid mucosa-lined speech tube is created by folding in the remaining half of the larynx. This tube, which is 4 to 5 mm in diameter, serves as a phonatory structure. Speech is produced by occluding the stoma with the finger and shunting air via this dynamic pseudolarynx. Patients maintain a permanent tracheostomy. Our experience includes 14 cases with up to 4-year follow-up.
Nasopharyngeal Angiofibromas: Staging and Management
Authors: Chandler James R. , Moskowitz Lee , Goulding Richard , Quencer Robert M.
Published: October 2014

We propose a system for staging nasopharyngeal angiofibromas based on clinical evaluation and computerized tomography. Twenty-three patients with this pathologic diagnosis have been managed at the University of Miami/Jackson Memorial Medical Center in the past two decades. In 13 patients, the clinical diagnosis was confirmed by transnasal biopsy as a minor outpatient procedure. This avoided unnecessary diagnostic studies, shortened the hospital stay, and expedited treatment. Computerized tomography has replaced conventional x-ray studies and routine tomography, although angiography is still necessary for proper evaluation of larger tumors. Stage groupings recommended on the basis of this experience are stage I — tumor confined to nasopharynx; stage II — tumor extending into nasal cavity and/or sphenoid sinus; stage III — tumor extending into one or more of the following: antrum, ethmoid sinus, pterygomaxillary and infratemporal fossae, orbit, and/or cheek; and stage IV — tumor extending into cranial cavity. Surgical excision is recommended for stages I, II, and III. Stage IV tumors require surgical resection and/or radiation therapy with the possible addition of hormonal therapy.
Verrucous Carcinoma of the Ear
Authors: Proops D. W. , Hawke W. M. , Harwood A. R. , van Nostrand A. W. P. , Lunan M.
Published: October 2014

A case report of verrucous carcinoma in the ear of a patient subject to persistent discharge from that ear for more than 30 years is presented. The histology conformed to that in Ackerman's classic description and a literature search revealed that this is only the second case of this disease reported. The patient was treated surgically followed by radiotherapy and was well 18 months later.
Sensorineural Hearing Loss following Chronic Ear Surgery
Authors: Tos Mirko , Lau Torben , Plate Søren
Published: October 2014

The incidence and characteristics of postoperative sensorineural hearing loss were analyzed in 2,303 cases of chronic otitis and its sequelae, representing our total series from 1965 to 1980. Sensorineural hearing loss occurred in a total of 1.2 % of cases: 0.5 % became totally deaf, and 0.7% acquired a high tone loss, most often at 4 kHz only. The incidence was highest in congenital malformations, granulating otitis and cholesteatoma, mastoidectomy (especially canal-down), and during the period from 1965 to 1974. The most common causes of anacusis were removal of cholesteatoma from the semicircular canal and removal of the fistula membrane. Different types of severe high tone loss are described and, in addition, 19 patients with mild high tone loss are discussed.
Chondrosarcoma of the Larynx
Authors: Lavertu Pierre , Tucker Harvey M.
Published: October 2014

Of the 250 cartilaginous tumors of the larynx reported in the literature, at least 69 (28%) were chondrosarcomas. Of these, 46 are sufficiently well documented to permit detailed analysis. One new case, previously reported as a benign chondroma, is added here. Initial diagnosis, type of treatment, and ultimate survival of these cases can be analyzed to arrive at a basis for treatment philosophy.
Complications Associated with a Narrow Bore Nasogastric Tube
Authors: Grossman Thomas W. , Duncavage James A. , Kay Jonathan , Dennison Bruce , Toohill Robert J.
Published: October 2014

The use of a new narrow bore nasogastric feeding tube with stylet has resulted in two cases of misplacement with traumatic laceration of the visceral pleura. Diagnoses were made by chest x-ray film, one case immediately and the other 24 hours later. In both cases, the narrow bore tube was inserted asymptomatically by a graduate physician. Detailed case reports of both patients are presented, those patients at risk for abnormal placement of this nasogastric tube are discussed, and new guidelines for safer use are proposed.
A New Pediatric Microlaryngoscope
Authors: Benjamin Bruce
Published: October 2014

A new pediatric microlaryngoscope has been designed for use in children from infancy to adolescence.
Age-Related Responses of Laryngeal Airway Resistance to Peripheral and Central Chemoreceptor Stimulation
Authors: Blum Daniel J. , McCaffrey Thomas V.
Published: October 2014

Laryngeal airway resistance was measured in anesthetized dogs ranging in age from one day to adult during central and peripheral chemoreceptor stimulation by hypoxia and hypercapnia. Chemoreceptor-mediated regulation of airway resistance was found to be qualitatively similar in all age groups; however, there was a progressive increased sensitivity to both hypoxia and hypercapnia with increasing age. The reduced sensitivity of the laryngeal airway to hypoxic and hypercapnic stimulation in the young animal may predispose the young animal to airway obstruction during periods of hypoxia or hypercapnia. This may bear some relevance to the etiology of certain cases of sudden infant death syndrome.
Repair of Traumatic Cervical Esophageal Stenosis Using Microvascular Free Jejunum Transfer
Authors: McCaffrey Thomas V. , Fisher Jack
Published: October 2014

Three cases of nonneoplastic stricture of the cervical esophagus and pharynx repaired by free jejunal transfer are reported. This technique permits repair of various circumferential defects of the pharynx and esophagus in a single stage without compromising laryngeal function. None of the patients required subsequent dilatation to restore satisfactory swallowing.
Stapes Surgery in Patients with Osteogenesis Imperfecta
Authors: Armstrong B. W.
Published: October 2014

Osteogenesis imperfecta is not in itself a contraindication to stapedectomy. Thirty stapedectomies were performed on 24 patients with osteogenesis imperfecta. Thin ossicles, crural fractures, and thick, mushy, granular footplates predominate in this condition. Deficient, short crura that did not contact the footplate were noted in three patients; this is possibly a new clinical observation. Three times in this small series the endosteum was so thick that it was possible to fenestrate the soft, granular, mush-like footplate without invading the vestibule. Extreme caution in handling the incus is necessary. Conductive hearing loss can be relieved through stapedectomy in patients with osteogenesis imperfecta with about the same level of predictability as in those with otosclerosis.
Obliteration of the Middle Ear and Mastoid Cleft in Subtotal Petrosectomy: Indications, Technique, and Results
Authors: Coker Newton J. , Jenkins Herman A. , Fisch Ugo
Published: October 2014

Lateral surgical approaches to the base of the skull through the temporal bone often result in a large cavity with exposed dura and vascular structures and no possibility of reconstruction of the middle ear conductive hearing mechanism. Subtotal petrosectomy with tympanomastoid obliteration provides a relatively safe and secure closure of the surgical defect in the temporal bone and eliminates the problems associated with an open mastoid cavity. Eradication of all accessible air cell tracts and mucosa in the petrous pyramid, obliteration of the eustachian tubal orifice, closure of the external auditory canal, and fat obliteration of the middle ear and mastoid clefts are essential in the procedure. Over the last 10 years this technique has been utilized in 372 base of skull procedures with a complication rate of less than 5%. Infection occurred only in those cases with draining cavities or contaminated wounds.
Predictive Value of Tympanometry in Middle Ear Effusion
Authors: Gates George A. , Avery Christine , Hearne Erwin M. , Cooper J. C. , Holt G. Richard
Published: October 2014

The presence of middle ear effusion may be inferred from a tympanogram by the configuration of the pressure compliance curve. Not infrequently, however, effusion is absent at the time of surgery when strongly indicated by preoperative tympanometry. We evaluated this discrepancy by contrasting preoperative tympanograms with the findings at surgery in 462 children, aged 4 to 8 years, with clinical evidence of persistent effusion in 909 ears. Based on these results we can classify tympanograms as to high risk for effusion, intermediate, and low risk. The proportion of ears with effusion was 83%, 47%, and 34%, respectively. The proportion of ears with fluid in the high risk tympanogram group did not change appreciably over a 1- to 8-week period, ie, no trend toward spontaneous resolution occurred. The high incidence of effusion at surgery in our low risk group is far higher than expected and is presumably due to reinfection of these ears during the time between examination and operation.
Collagenase in Human Head and Neck Tumors and Rat Tumors and Fibroblasts in Monolayer Cultures
Authors: Huang Cheng-Chun , Blitzer Andrew , Abramson Maxwell
Published: October 2014

Invasive tumors must release collagenase to break down the surrounding host connective tissues. The cellular origin of this enzyme is still unclear. We used anticollagenase antibodies to localize collagenase in the human head and neck tumor and rat tumor tissues. Collagenase appeared to be localized in the tumor connective tissue stroma but not in tumor cells. The rat skin fibroblasts in monolayer culture treated with the rat tumor cell-conditioned medium demonstrated marked extranuclear and particulate staining. Fibroblasts without treatment showed no staining. Tumor cells in the culture also showed no staining. Assay of culture media demonstrated that only fibroblasts with the addition of the tumor cell-conditioned medium produced collagenase. These findings suggest the following: 1) collagenase is produced by fibroblasts which are harbored in the connective tissue stroma, but not by tumor cells; 2) cellular interaction between tumor cells and fibroblasts appears to be involved in breakdown of the host connective tissue for tumor cell invasion; and 3) tumor cells release soluble factors which stimulate production of collagenase by fibroblasts.
Extended High Frequency Hearing Sensitivity a Normative Threshold Study in Musicians
Authors: Johnson David W. , Sherman Robert E. , Aldridge Jeffrey , Lorraine Adele
Published: October 2014

Sixty members of the Minnesota Orchestra (aged 24 to 64 years) and 30 nonmusicians (aged 20 to 69 years) were evaluated for hearing sensitivity within the conventional audiometric range (0.25 to 8 kHz) and within the extended high frequency audiometric range (9 to 20 kHz). Threshold data were evaluated by age, sex, and musician-nonmusician categories for the respective frequencies, and data were compared to other studies. Musician hearing appeared no poorer than nonmusician hearing, suggesting no major hearing loss from musicians' exposure to orchestral noise. Hearing acuity of the two groups was similar to some normal groups reported in the world literature but appeared poorer in comparison to some normal groups defined by a very restrictive definition of normal hearing. Issues relating to the definition of normal hearing are explored. A mathematical model descriptive of extended high tone hearing sensitivity for musicians and nonmusicians evaluated was calculated. The formula is presented from which typical age-specific extended high frequency thresholds may be calculated for the 90 subjects evaluated.
Cutaneous Malignant Lymphoma of the Nasal Tip
Authors: Strauss M. , Kolkova Z. , Laurian N. , Zohar Y.
Published: October 2014

Cutaneous lymphomas are relatively rare malignant lesions. Lymphomas limited to the skin are uncommon and most patients have a generalized disease. The head and neck are the most common sites of presentation. This lesion is diagnostically problematic since histologic distinction from several benign cutaneous lymphocytic infiltrates is occasionally difficult and thus its clinical behavior is unpredictable. The most common histopathologic subtype is diffuse histiocytic lymphoma and therapy is analogous to that for lymphomas arising elsewhere. The prognosis of lymphoma presenting in the skin is dependent upon the initial extent of the disease and probably upon histology. A case of cutaneous malignant lymphoma arising at the nasal tip, surgically treated, is presented.
Audiological and Temporal Bone Findings in Myxedema
Authors: Parving A. , Ostri B. , Hansen J. M. , Bretlau P. , Parving H.-H.
Published: October 2014

Fifteen patients with confirmed myxedema at a median age of 48 years (range 32 to 60 years) were referred for audiological evaluation before and after treatment with levothyroxine. The median interval between the pretreatment and posttreatment investigations was 18 months (range 9 to 27 months). In addition, 13 patients at a median age of 78 years (range 64 to 95 years) were audiologically reexamined after long-standing levothyroxine treatment. The observation period upon treatment with levothyroxine was 40 months (range 32 to 46 months). No improvement in hearing sensitivity could be demonstrated either in the younger patients or in the elderly. When compared to an age- and sex-matched unscreened population, the myxedematous patients did not demonstrate any different degree of hearing loss. Histological investigation of the temporal bones from an 83-year-old woman with myxedema, however, showed no morphological changes or deposition of glycosaminoglycans, changes which are compatible with true age-related hearing loss. It is concluded that no association exists between myxedema and hearing impairment and that no morphological or structural changes due to myxedema can be demonstrated in the temporal bones.