bluuebunny/crossref_metadata_2025 huggingface dataset:
Dynamic Changes of Nasal Resistance
Authors: Hasegawa Makoto , Kern Eugene B. , O'Brien Peter C.
Published: October 2014

Fifty human subjects were studied and evaluated utilizing posterior rhinomanometry techniques. The main purpose of the investigation was to study the physiologic dynamic range of nasal resistance so that the data might serve as a baseline, not only for evaluation and diagnosis of pathologic states but also for the assessment of nasal responses to various physiologic, drug-induced, or pathologic challenges. Analysis was divided into two parts: first, the evaluation of the average resistance and average change in resistance for each patient, and, second, determination of the maximal amount of change to be expected over 15-minute periods in a healthy subject. These studies give the investigator an idea of the magnitude of change that one might expect in normal physiologic situations, based on the 50 subjects that allowed 1,272 observations for justification of the concept of percent change in nasal resistance and not the value of nasal resistance alone. We concluded that the physiologic change in nasal resistance in a normal individual during a 15-minute interval should be less than 53% of the previous observation of nasal resistance. A change greater than 53% suggests a significant change that cannot be attributed to physiologic variability.
Monocular Nystagmic Responses to Caloric Stimulation
Authors: Wolfe James W.
Published: October 2014

Twenty-five normal subjects and 173 clinical patients received standard bithermal caloric testing. Vestibular nystagmus was evaluated for cumulative slow phase velocity from the summated horizontal eye recording and independent recording of the left and right eye. These data revealed that cold water stimulation produced more intense activation of the ipsilateral eye. Simultaneous closed-circuit video and D.C. electro-oculographic recordings from eight normal rhesus monkeys in response to cold water irrigations confirmed the fact that this stimulus leads to differential activation of the extraocular muscles. A possible explanation for this finding is discussed.
Upper Airway Obstruction Associated with Regional Enteritis
Authors: Kelly James H. , Goodman Max L. , Montgomery William W. , Mulvaney Thomas J.
Published: October 2014

Two patients are presented with upper airway obstruction associated with regional enteritis (Crohn's disease). Two mechanisms for this obstruction are proposed. The first is involvement of the cricoarytenoid joint with the inflammatory process and the second is extensive edema of the upper airway due to submucosal involvement with the disease process. We were unable to find any previous reports of upper airway obstruction associated with regional enteritis. The data from these patients suggests that Crohn's disease should be included in the differential diagnosis of chronic persistent laryngeal edema.
Treatment of Syphilitic Hearing Loss
Authors: Zoller Michael , Wilson William R. , Nadol Joseph B.
Published: October 2014

Twenty-nine patients with presumed syphilitic hearing loss, either congenital or acquired, were treated on one or more occasions according to a three-month protocol using penicillin and prednisone. Changes in hearing were carefully followed during treatment and for at least one year thereafter. Of 58 ears studied in 29 patients, 19 demonstrated significant partial improvement in hearing during treatment. However, 11 ears returned to pretreatment hearing levels after therapy, and only 8 ears, or 15%, maintained the hearing gains one year later. Enhanced discrimination occurred more commonly than gains in pure tone threshold. Long-term alternate day prednisone therapy was required to sustain hearing improvement in a small number of patients.
Adenoids and Otitis Media with Effusion
Authors: Ruokonen Jorma , Sandelin Karin , Mäkinen Judit
Published: October 2014

At adenoidectomy specimens for bacteriological, virological, and histological investigation were obtained from the adenoids of 144 children, 53 of whom suffered from otitis media with effusion, or frequently recurring otitis media. Comparison of findings in the children with ear diseases with those obtained in the rest of the material showed that Hemophilus influenza was cultured from 50% of the specimens from the children with ear diseases, while only 14% of the cultures from the other children yielded H. influenza. Virus isolates were made from 17 adenoids. In children with ear diseases a virus was isolated from 28% of the specimens, whereas positive isolates were obtained in only 3% of the rest of the specimens. Both findings are statistically significant and support the view that the adenoid tissue may play an important role in the etiology of otitis media with effusion. The infected adenoid may be the direct source of the primary infections, or continuous microbial irritation in the nasopharynx may indirectly be the cause of otitis media with effusion, as persistent infection and edema maintain chronic dysfunction of the eustachian tube. Thus adenoidectomy may be beneficial in the treatment of frequently recurring otitis media, preventing otitis media with effusion from developing.
Malignant Transformation of Tracheobronchial Juvenile Papillomatosis without Prior Radiotherapy
Authors: Siegel Stuart E. , Isaacs Hart , Cohen Seymour R. , Stanley Philip
Published: October 2014

Squamous cell carcinoma of the trachea and bronchi developed in a 19-year-old male with recurrent laryngeal papillomata since age four, who had received no prior radiotherapy, but who was tracheotomized for obstructive laryngeal papillomata. Treatment with intravenous cytosine arabinoside, “moderate dose” methotrexate, topical 5-fluorouracil and irradiation failed to alter tumor growth, and the patient succumbed to recurrent arterial tumor emboli.
Bilateral Abductor Vocal Cord Paralysis in Charcot-Marie-Tooth Disease
Authors: Holinger Paul C. , Holinger Lauren D. , Vuckovich D. M. , Holinger Paul H.
Published: October 2014

This report describes the unusual association of bilateral abductor vocal cord paralysis (BAbVCP) and Charcot-Marie-Tooth disease in a boy and his natural mother who have been followed for eight years. The boy initially presented with life-threatening respiratory distress at age ten years; BAbVCP was documented by direct laryngoscopy. Mirror laryngoscopy confirmed BAbVCP in the mother. Neurological diagnosis was made by history, physical examination, electromyography, and nerve conduction velocity studies. The BAbVCP may represent an additional genetic marker within the spectrum of heredodegenerative disorders. Of clinical importance is examination of voice and respiratory symptomatology of patients with heredodegenerative diseases and neurological work-up of patients with familial vocal cord paralysis. Further genetic and clinical studies of X cranial nerve involvement in heredodegenerative disorders are warranted.
Loss of Secretory Activity in the Glands of Nasal Polyps
Authors: Nakashima Tadashi , Hamashima Yoshihiri
Published: October 2014

Secretory activity in the glands of the nasal polyps from 15 patients with or without allergic histories was examined by using a direct (anti-IgA) or indirect (anti-SC) immunofluorescent technique. Glands were found in all the examined nasal polyps, but in many, only a few were present. Active secretory process of IgA was observed in the intraepithelial glands of the ciliated, pseudostratified epithelium and in some of the glandular ductules lined with simple, cuboidal epithelium. Most of the dilated glandular ductules, on the contrary, appeared to be lacking in secretory activity of IgA. Such were commonly filled with mucus materials and their epithelial glandular cells showed no fluorescence for anti-SC, whereas the active IgA secreting cells showed a heavy fluorescence for secretory component (SC) in indirect immunofluorescent studies. Activity of the glandular ductules, therefore, was determined by examining the SC producing activity. In some extracted polyps, SC containing dilated glands were present. These active glands, however, lost the SC producing activity followed by the stasis of mucus flow in the lumen. Thus, when the glands were occupied by mucus materials, stretched and cystic degeneration ensued.
Variation of Endocochlear Po2 and Cochlear Potentials by Breathing Carbon Dioxide
Authors: Prazma Jiri , Fischer Newton D. , Biggers W. Paul , Ascher David
Published: October 2014

The effect of carbon dioxide on oxygen tension in the endolymph was determined by the micropolarographic technique. Different concentrations (5% and 10% CO2) and different exposure times (3, 5, and 20 minutes) were investigated. The highest levels of Po2 in the endolymph (101.7, 93.9 and 69.5 mm Hg) were accomplished by respiration of 10% CO2, 90% O2, for 20, 5, and 3 minutes consecutively. The lowest Po2 increase, 50.7 mm Hg was observed after breathing 5% CO2, 90% O2 for 20 minutes. Extreme hypercapnia caused an increase of endocochlear potentials (EP) in all groups. In the second group EP increased from +79.3 to +84.9 and in all groups they had returned to the pretreatment level after CO2 discontinuation. These results support the theory that carbonic anhydrase participates in the generation of EP. At the same time that EP increased, cochlear microphonics declined and opposite after the breathing mixture was discontinued. The results permit the conclusion that high levels of Po2 in endolymph is achievable even with short periods of respiration with high CO2 mixture, and suggest the role of carbonic anhydrase during EP generation.
Radiologic Diagnosis of Labyrinthitis Ossificans
Authors: Hoffman Ronald A. , Brookler Kenneth H. , Bergeron R. Thomas
Published: October 2014

Labyrinthitis ossificans is the pathological ossification of the membranous labyrinthine spaces in response to processes which are destructive of the membranous labyrinth or the endosteum of the otic capsule. It has been primarily a histopathologic diagnosis. Complex motion tomography however, allows a detailed view of the osseous labyrinth and permits the diagnosis in the living state. Radiologic documentation of labyrinthitis ossificans is objective evidence of a process destructive of the membranous labyrinth. It supports the likelihood of an absence of cochlear and vestibular function. It alerts the surgeon to the possible obliteration of key inner ear anatomical landmarks.
Congenital Anosmia: Detection Thresholds for Seven Odorant Classes in Hypogonadal and Eugonadal Patients
Authors: Rosen Saul W. , Gann Peter , Rogol Alan D.
Published: October 2014

Detection thresholds for a representative from each of seven odorant classes (putrid, pepperminty, ethereal, camphoraceous, pungent, musky, floral) were determined by double-blind smell testing of seven normal males, six normal females, 6 patients with uncomplicated congenital anosmia and 13 patients with the syndrome of congenital anosmia and hypogonadotropic hypogonadism (the Kallmann syndrome, olfactogenital dysplasia). The median detection thresholds did not differ significantly between hypogonadal and eugonadal anosmics for any of the odorants, suggesting that the endocrine deficit does not result from inadequate rhinencephalic input to brain centers controlling gonadotropin release. Phenylethylmethylethylcarbinol (PEMEC), a stable chemical of the floral class, was detected at very low concentrations (10−6 to 10−8 M in water) by all normals tested. Since no patient with congenital anosmia was able to distinguish even undiluted PEMEC from water, we suggest that this compound is the material of choice for convenient, rapid and objective testing of the sense of smell (cranial nerve I).
Acute Vestibular Paralysis in Herpes Zoster Oticus
Authors: Proctor Leonard , Lindsay John , Perlman Henry , Matz Gregory
Published: October 2014

A case of herpes zoster oticus is presented in which the lateral and superior semicircular canals of the labyrinth were affected unilaterally. The results of several electronystagmographic examinations are described and correlated with the patient's description of symptoms. This case study indicates that disease affecting the lateral semicircular canal is reliably detected by the conventional caloric test. However, the fact that the posterior semicircular canal remained intact could not be inferred from the results of the caloric test in this case. Also, the appearance of nystagmus upon eye closure appears to have been a more sensitive index of the state of the disease process than was the caloric test.
Cellular Immunity in Patients with Laryngeal Cancer Developing Additional Primary Malignant Tumors
Authors: Bartal Arie , Goldsher Moshe , Mekori Tamar , Eliachar Izhak , Robinson Eliezer
Published: October 2014

Eleven patients with laryngeal cancer associated with additional primary tumors underwent cutaneous delayed hypersensitivity tests and lymphocyte stimulation studies with phytohemagglutinin for evaluation of their cellular immunity. Five of the 11 patients were anergic or hypoergic as shown by skin tests to recall antigens and seven of nine patients had impaired lymphocyte transformation. Depressed immunity was more often observed in patients with an active malignancy. The level of serum immunoglobulins was elevated in two of eight studied patients, and in the remaining patients was within the normal range. All patients had a history of excessive smoking. Most frequently, second tumors were found in the lung, urinary tract and skin. The prognosis seemed to be determined by the additional tumor rather than by the laryngeal cancer.
Congenital Cerebrospinal Otorrhea
Authors: Gacek Richard R. , Leipzig Bruce
Published: October 2014

Four locations for congenital cerebrospinal fluid fistula in the region of a normal labyrinth are reviewed. A congenital leak may occur through the petromastoid canal, a wide cochlear aqueduct, Hyrtl's fissure, or the facial canal. A fistula through the initial segment of the fallopian canal was successfully repaired in a two-year-old boy who had three episodes of meningitis following otitis media. Knowledge of these four sites of congenital defects provides a guideline for the surgeon in the identification and repair of cerebrospinal fluid leaks in the region of the labyrinth.
Median Palatal Cyst
Authors: Cinberg James Z. , Solomon Marshall P.
Published: October 2014

The existence of a median palatal cyst has been questioned. Such a lesion would represent an unusual anomaly of a unique embryological process. The radiologic and pathologic criteria necessary to establish such a diagnosis are inconclusive in the ten case reports that have appeared in the English language literature. A median palatal cyst that is distinct from other palatal defects would have specific characteristics that included: 1) a true epithelial-lined cyst; 2) no salivary gland, vascular, or neural elements in the cyst wall; and 3) location in the palate at a distance sufficiently posterior to avoid confusion with structures of the nasal palatine region. We report the findings of a palate lesion excised from a 27-year-old male which by location and histology were consistent only with a median palatal cyst. These data appear to authenticate, for the first time, the median palatal cyst as a distinct pathological entity.
Surgical Anatomy of the Orbit
Authors: Rontal Eugene , Rontal Michael , Guilford F. T.
Published: October 2014

When operating in and around the orbit, the key to a successful operative result is precise, anatomic localization. This study was constructed to give pertinent anatomic measurements to which the maxillofacial surgeon may refer. The safe distances noted from this study are: 1) medially 30 mm from the anterior lacrimal crest; 2) inferiorly 25 mm from the infraorbital foramen; 3) superiorly 30 mm from the supraorbital notch; and 4) laterally 25 mm from the frontozygomatic suture.
Thermal Hazard during Mastoid Surgery
Authors: Erdreich John , Keim Robert J. , Love Tom J.
Published: October 2014

Torque speed characteristics of two mastoid drills were measured. Potential temperature elevations in temporal bones were calculated from these measurements. Measured temperature elevations in temporal bones drilled without irrigation agreed well with predictions. Irrigation was demonstrated to be of critical importance in minimizing thermal hazard from mastoid drills.
Resident Education: Past, Present and to Where
Authors: Work Walter P.
Published: October 2014

The specialties in medicine and surgery developed slowly during the later 19th century and the early decades of this century. The American boards were the focal points for sponsoring specialty societies through which these developments occurred. The resident review committees have also played an important role. Otolaryngology resident education has developed into a progressively structured educational experience so that presently otolaryngology resident education is a broad experience in head and neck oncology, plastic and reconstructive surgery, otology, laryngology, rhinology, allergy and immunology, bronchoesophagology, teaching and research. Resident education is not static. The year of 1978 can be noted as the year of change, for the Resident Review Committee in Otolaryngology recommended that resident education be of five years in duration, one year being in surgery, three years in otolaryngology and one year being elective as to content. Such programming can be highly structured to meet a candidate's present and future needs in manpower, superspecialization and general otolaryngology. In this system superspecialization can and will be recognized and awarded through channels already established in otolaryngology. Manpower and general otolaryngology will also profit.
Leiomyosarcoma of the Cervical Trachea
Authors: Fredrickson J. M. , Jahn A. F. , Bryce D. P.
Published: October 2014

A case of leiomyosarcoma of the cervical trachea is described, detailing clinical presentation, pathologic diagnosis and surgical management. The rarity of this tumor in this location accounted for difficulties in clinical diagnosis and pathologic classification. Surgical treatment involved resection of two thirds of the circumference of the infracricoid trachea, with partial resection of the cricoid cartilage and thyroid gland. The defect was reconstructed using bilateral “butterfly” advancement flaps and a latissimus dorsi myocutaneous island flap. The technique and advantages of the latissimus dorsi flap are briefly described.
Clinical Course of Unusual Malignant Sarcomas of Head and Neck
Authors: Setzen Michael , Sobol Steven , Toomey James M.
Published: October 2014

The clinical manifestations of 29 recently encountered sarcomas of the head and neck were analyzed in an attempt to define more accurately the diagnostic characteristics and therapeutic responses of these unusual tumors. The host factors of age, sex distribution, race, habits and associated features differ sufficiently to distinguish the sarcoma from the carcinoma population. In addition, the clinical course of sarcoma patients as monitored by mode of presentation, site of involvement, tumor histology, diagnostic features and certain elements of management and outcome, further indicates that these tumors can be defined and managed as a distinct group of lesions. A review of the recent literature supports the major conclusions of this study.
Radiation Fibrosis and Necrosis of the Larynx
Authors: Chandler James R.
Published: October 2014

The deleterious effects of ionizing radiation upon the normal tissues of the larynx, even when it is not the specific target of the radiation therapist, are always apparent to the observant and experienced laryngologist. On occasions they are so marked as to obscure the diagnosis of concomitant persistent or recurrent cancer. There is a direct relationship between the number of rads delivered and the severity of the subsequent radiation reaction. A system of classifying such reactions is proposed. Grade 0 is normal. Grades I and II are expected. Grades III and IV may be considered complications and require specific and even energetic treatment. In grade IV reactions, which require operative intervention, laryngectomy may be the treatment of choice.
Cholesteatoma of the Frontal and Ethmoid Areas
Authors: Campanella Ruth S. , Caldarelli David D. , Friedberg Stanton A.
Published: October 2014

Cholesteatomas of the frontoethmoid region must always be considered in the differential diagnosis of a mass in the frontoethmoid region. A painless, slow-growing mass, often accompanied by proptosis and diplopia, but without history of trauma or infection, should make one suspect of this pathologic entity. Although histologically a benign lesion, the keratinizing squamous epithelial lining will continue to desquamate and expand, leading to erosion of surrounding structures which could be life-threatening. In order to prevent recurrence, complete removal of the cyst lining is mandatory. Cosmetic reconstruction, often requiring obliteration of the surgical cavity, should be delayed for one year to insure against recurrence of the covering of active squamous tissue adjacent to dura, cribriform plate or ocular structures.
Recurrent Laryngeal Nerve Section for Spasmodic Dysphonia
Authors: Levine Howard L. , Wood Benjamin G. , Rusnov Melinda , Batza Eugene , Tucker Harvey M.
Published: October 2014

Spasmodic dysphonia is a severe disorder of phonation accompanied by extreme tension of the entire phonatory system. The expressive functions of speech such as laughter, singing, and whispering are much less affected if at all. Psychotherapy, speech therapy, stimulant and psychotropic drugs, hypnotism and acupuncture have all been tried as treatment without success. In 1976, Dedo reported 34 patients who were managed with recurrent laryngeal nerve section for spasmodic dysphonia. All of these patients had marked improvement in voice with relief of spasticity. Twenty-two patients with documented spasmodic dysphonia present for at least one year have been managed at the Cleveland Clinic since Dedo's report. None of them had any improvement with conventional voice therapy and were subjected, therefore, to recurrent laryngeal nerve section.
Electrical Stimulation of the Auditory Nerve in Cats
Authors: Simmons F. Blair
Published: October 2014

Each of five cats (one congenitally deaf) had Pt-Ir electrodes placed in the modiolus. Some electrodes were stimulated with a 100 μamp, 0.25 msec balanced biphasic 50/sec pulse for 2 hours for a total of 20 to 40 hours each over periods of several months. Pre- and poststimulation measures of click-evoked N1 responses, averaged brain stem potentials, and impedances showed no long-term effects of damage to the nerves. Light microscopy showed very acceptable tissue tolerance and no evidence of damage caused by electrical stimulation. The deaf cat had about 10% residual nerve fibers which responded to stimulation.
Intercellular Junctions in the Differentiating Rat Otocyst
Authors: Khan Khalid M. , Marovitz William F.
Published: October 2014

Intercellular junctions between cells of the rat otocyst on the 12th day of gestation were studied using lanthanum tracer and freeze-fracture techniques. At the luminal surface, the intercellular space is closed by a series of tight junctions. Gap junctions are also present between cells both within and below the luminal junctional complex. The presence of tight and gap junctions at this early stage in the differentiating otocyst is probably essential for the development of a normally functioning adult ear.
Innervation of the Feline Eustachian Tube
Authors: Uddman Rolf , Alumets J. , Ekelund M. , Lorén I. , Densert O. , Håkanson R. , Sundler F.
Published: October 2014

The distribution of adrenergic, cholinergic and peptidergic nerves in the feline eustachian tube was studied using histochemical techniques. Adrenergic, acetylcholinesterase-positive and vasoactive intestinal polypeptide immunoreactive nerves were numerous in the tubal wall. All three types of nerve fibers occurred in the subepithelial layer, around small blood vessels and around the acini of seromucous glands. No nerves displaying substance P or enkephalin immunoreactivity were observed.
The Combined Computerized Tomography-Sialogram
Authors: Som Peter M. , Biller Hugh F.
Published: October 2014

The preoperative differentiation of a deep lobe parotid tumor from a parapharyngeal tumor is important to the surgeon in determining the correct surgical approach. The combined parotid sialogram and CT scan provide more information than either study alone, and we feel that a reliable preoperative differentiation can be made on this combined study.
Psychophysical Evaluation of Cochlear Prostheses in a Monkey Model
Authors: Pfingst Bryan E. , Miller Josef M. , Donaldson James A. , Spelman Francis A.
Published: October 2014

Functional aspects of cochlear prostheses implanted in the scala tympani were tested in monkeys trained to perform a simple reaction-time task. Thresholds for detection of electrical stimulation and dynamic ranges were tested for a wide range of frequencies of sinusoidal stimulation and for biphasic rectangular pulses of various durations and repetition rates. The results are comparable with available data from implanted human patients and extend these findings, exploring various aspects of electrical stimulation in greater detail.
Photoplethysmography in the Prediction of Experimental Flap Survival
Authors: Bardach Janusz , McCabe Brian F. , Voots Richard J. , Hsu Mow Ming
Published: October 2014

A standard photoplethysmograph, modified to differentiate between arterial and venous vasculature in skin tissue, has been used to measure arterial supply in 100 unipedicle skin flaps in 25 pigs. A datum transform from a light intensity scale to a relative arterial blood density scale has been introduced and empirically labelled the vascular coefficient (VC). Statistical analysis of the VC data shows a significant difference between necrotic and surviving flap group mean data as early as 24 hours. Additional analysis in which a normal ogive was fitted to the sample VC data distributions suggests that statistically significant predictions of the probability of eventual flap necrosis can be made using VC measurements obtained immediately postoperatively. It is concluded that the modified photoplethysmograph in conjunction with the VC data transform, constitutes a usable measuring technique for skin flap viability prediction in the experimental animal.
Vertebrobasilar Insufficiency
Authors: Valvassori Galdino , Dobben Glen D.
Published: October 2014

Permanent or transient reduction of the blood flow to the brain is often responsible for dizziness and occasionally sensorineural hearing loss. So far the diagnosis of this condition has been made by angiography, either carotid or vertebral arteriography, but there is a justified reluctance of subjecting unselected patients to this invasive procedure. It is the purpose of this paper to present a new approach to the diagnosis of cerebral vascular insufficiency based on a three-step protocol. The two initial steps are formed by noninvasive techniques and may be used for the selection of those cases requiring additional diagnostic procedures. 1) Cerebral hemodynamic evaluation provides a physiologic assessment of the direct carotid and indirect carotid and vertebral blood flow. It includes ocular plethysmography and ophthalmodynamometry obtained with the patient supine and erect, without and during carotid compression. 2) Computerized tomography allows an evaluation of the brain substance and of the changes produced by vascular insufficiency such as brain atrophy, infarcts and encephalomalacia. A new form of radiographic assessment based on a dynamic evaluation of regional blood flow will be introduced in this paper. 3) Carotid and vertebral arteriograms are performed only on those cases demonstrating a significant cerebral vascular insufficiency by the previous tests and in cases where corrective surgery is contemplated.
Mastoid Surgery
Authors: Rambo J. H. T.
Published: October 2014

Variation in the quality of healing in mastoid cavities has never been clearly understood. It is the author's contention that the factor responsible for the wide variation in healing, even though all chronic disease has been removed, is buried mucosa which leads to cystic formation. Over the past 20 years the author has followed the principle of removing all mucosa from the mastoid segment and has been rewarded with dry ears routinely in open cavity surgery. For the past 12 years he has removed cholesteatoma through tympanoplasty and modified radical mastoidectomy. These cases, also, have been consistently free of cavity problems. In the late 50s and early 60s closed cavity operations were tried in radical mastoidectomy, fenestration and tympanoplasty with mastoidectomy. Postoperative healing difficulties were encountered then that are similar to those being reported now with intact canal wall operation. No conclusions are drawn in the controversy between open and closed cavity techniques. The observation may be made, nevertheless, that the problems of closed cavity operations have not been solved. It is the thesis of this paper that the main objection to open cavity operations, ie, poor quality of healing, has been resolved.
Necrotizing (“Malignant”) External Otitis Histopathologic Processes
Authors: Kohut Robert I. , Lindsay John R.
Published: October 2014

The histologic findings in a serially sectioned temporal bone, from a patient who succumbed to brain abscess secondary to necrotizing (“malignant”) external otitis, are described. The mechanism of invasion of the ear canal appears to be due to local bone necrosis. This in turn extends to the submucosal vasculature of the pneumatic spaces. The infective process extends submucosally, establishing one or several sites of bone destruction. The lumen of the pneumatic space is not involved. In this process, the periphery of the fibrous inflammatory tissue formation is the site of active bone destruction. In pneumococcal petrositis, the peripheral fibrous elements are protective. The process in malignant external otitis may extend directly to adjacent central nervous system structures inoculating the structure with Pseudomonas. Development of Pseudomonas brain abscesses can be slow, allowing for new bone closure of the site from which the infection spreads as demonstrated in this specimen. Therefore, apparent local control of the disease can be established while a central infective process progresses.
Current Status of Multichannel Cochlear Protheses
Authors: Hambrecht F. Terry
Published: October 2014

Multichannel cochlear prostheses are being developed and evaluated with emphasis on providing sensory deaf individuals enough information about their acoustic environment to permit communication by ordinary speech. Studies of the safety of the electrode arrays and stimulus values indicate that the remaining nerve fibers will not be damaged at the levels that will be typically used in human prostheses, but that a narrow safety range exists for suprathreshold stimuli. Early multichannel human implants have demonstrated that place pitch can be utilized with scali tympani implants, but this has not been demonstrated with modiolar electrode arrays. With both approaches, information about pitch can be conveyed by the frequency of stimulation. Research questions remain on the long-term viability of the eighth nerve with stimulated implants, on the interactions of closely spaced electrodes, on optimal methods of encoding the acoustic signal for multichannel nerve stimulation and on the ability of deaf individuals to utilize this information.
Organ of Corti in the Human Fetus
Authors: Tanaka Katsuhiko , Sakai Noboru , Terayama Yoshihiko
Published: October 2014

The organ of Corti in the five-month human fetus was studied by transmission and scanning electronmicroscopy. Differentiation of the surface organization of the organ of Corti into a single row of inner and three to four rows of outer hair cells was complete at this stage except at the apical end. The morphological aspects of the hair bundles changed with maturation of the sensory cells; the inner hair cells preceded the outer hair cells in cytodifferentiation at a given location.
Small Cell Undifferentiated Carcinoma of the Larynx
Authors: Johnson Glenn D. , Mahataphongse V. Patrick , Abt Arthur B. , Conner George H.
Published: October 2014

A patient with a small cell, undifferentiated carcinoma of the larynx is described. The tumor appeared to arise in close association with subglottic minor salivary glands. Ultrastructural study of the tumor cells showed neurosecretory granules similar to those seen in normal Kulchitsky cells and pulmonary oat cell carcinomas. Bronchogenic oat cell carcinoma and small cell undifferentiated carcinoma of minor salivary gland tissue probably originate from the same cell type. The aggressive behavior of this tumor suggests the need for early systemic treatment including combination chemotherapy.
Pediatric Laryngobronchoesophagology
Authors: Tucker Gabriel F.
Published: October 2014

The Jackson heritage in Pediatric Laryngobronchoesophagology is briefly outlined. It has been precisely 25 years since the author completed his pediatric endoscopic residency. With the aid of references to the scientific papers presented at the meetings of the American Broncho-Esophagological Association, the evolution of a number of facets of present day Laryngobronchoesophagology have been delineated over the intervening quarter century.
Endotracheal and Tracheostomy Tube Cytology
Authors: Fortson J. Kevin , Janfaza Parviz
Published: October 2014

Carcinoma of the lung is the leading cause of death from malignancy in this country. Twenty percent of patients with lung carcinoma are asymptomatic early in the course of the disease. Survival rates are much better when lung carcinoma is discovered at the asymptomatic or radiographically occult stage, therefore improved screening methods should be investigated. Many tumors in the tracheobronchial tree shed malignant cells into the bronchi and sputum cytology has been of value in the early diagnosis of carcinoma of the tracheobronchial tree. Thousands of patients are intubated daily. During endotracheal anesthesia, secretions are stimulated in the tracheobronchial tree and endotracheal or tracheostomy tubes are coated with these secretions. In a preliminary study, the cytology examination of the secretions adherent to 50 endotracheal tubes suggests that endotracheal and tracheostomy tube cytology will prove to be a reliable, noninvasive and cost-effective means of screening high risk patients for occult primary carcinomas of the lung and upper aerodigestive tract.
Epiglottitis: Evolution in Management
Authors: Wetmore Ralph F. , Handler Steven D.
Published: October 2014

In the past decade, changes have occurred in the management of epiglottitis. A ten-year retrospective study of 64 patients admitted to the Children's Hospital of Philadelphia with the diagnosis of epiglottitis was performed. An evolution in the management of epiglottitis was demonstrated in this series of patients. The morbidity and mortality of currently employed modes of airway management (medical observation, endotracheal intubation or tracheostomy) were compared. There were no deaths in the series. Endotracheal intubation had a lower rate of complication than treatment with tracheostomy. A small, select group was conservatively managed with close observation. The use of antibiotics and steroids was analyzed. Suggested guidelines for management of epiglottitis are presented.
Optical Stylet
Authors: Berci G. , Katz R.
Published: October 2014

An optical stylet was developed which can be inserted into an endotracheal tube, and the passage through the vocal cords and position of the cuff in the trachea could be controlled visually. It is of great help in difficult intubations in adults and children. It became an invaluable tool in teaching endotracheal intubation by coupling a teaching attachment (beam splitter) to the optical system. The operator and the second observer (student) can see the actual manipulations simultaneously.
Multiple Primary Malignancies of the Upper Aerodigestive System
Authors: Vrabec Donald P.
Published: October 2014

Multiple primary carcinomas were found in 11.5% of 1,518 patients presenting with an index tumor in the oral, pharyngeal or laryngeal areas. These additional malignancies were subdivided into two groups: 1) those occurring in distant or unrelated tissues and 2) those occurring in a multicentric zone defined as including the oral area, pharyngeal area, larynx, esophagus and tracheobronchial tree. Although some trends were noted, a primary lesion may be found anywhere in the zone of multicentricity. The dynamic nature of the progressive transition of the potentially malignant tissues in the multicentric zone is reemphasized. The physician, treating patients with head and neck cancer, should be prepared not only to cope with simultaneously occurring primary cancers but also to be constantly vigilant for the later development of subsequent primary carcinomas.
Foreign Body and Caustic Ingestion: Management 1979
Authors: Cantrell Robert W. , Jahrsdoerfer Robert A. , Johns Michael E. , McLean W. Copley
Published: October 2014

Most physicians involved in the diagnosis and management of foreign body aspiration and caustic ingestion assume that the numbers of these cases are decreasing. A sizeable number of patients die of caustic ingestion and poisoning annually, and deaths from foreign body ingestion have more than doubled since 1950. Increasing the significance of these needless tragedies is the fact that the most frequent victim is a young, healthy child. Physicians should encourage educational campaigns to alert parents to the dangers of caustic agents and small items capable of being aspirated. They should be conversant with the treatment of both. This paper reviews current opinions regarding management.
Rheumatoid Cricoarytenoid Arthritis Complicated by Upper Esophageal Ulcerations
Authors: Montgomery William W. , Goodman Max L.
Published: October 2014

Arthritis of the laryngeal joints occurs with most of the diseases which are manifest by polyarthritis. This publication discusses an unusual extension or complication of cricoarytenoid arthritis, ulcerative necrosis of the postcricoid cervical esophagus which necessitated a total laryngectomy in a patient with advanced rheumatoid arthritis.
Intracanalicular Neurilemmomas Clinicopathologic Study
Authors: Kasantikul Vira , Netsky Martin G. , Glasscock Michael E. , Hayes James W.
Published: October 2014

Twenty-five patients with intracanalicular neurilemmomas were studied, the largest series yet reported. The tumors were most frequent in men by a ratio of 2:1, occurred more often on the left acoustic nerve, were generally associated with long duration of symptoms, and were equally distributed in the third to fifth decades, but the prevalence slightly increased in the sixth and seventh decades. A shorter length of illness occurred in younger persons as well as most patients with von Recklinghausen's disease. The length of illness ranged from six months to 35 years. Symptoms generally were limited to the auditory nerve except in three instances of involvement of the facial nerve. These three cases were the only ones with preoperative facial palsy. Posterior fossa myelogram was the most useful diagnostic aid. The rate of growth in one patient was estimated to be 1 to 2 mm per year by serial study of myelograms, but the growth rate is probably variable. CT scans were not useful in detecting small tumors. Histologically, most tumors less than 1 cm in diameter were primarily composed of Antoni type A tissue. Vascular malformations were found within the tumor in three cases. Altered blood vessels are the mechanism whereby characteristic changes occur in the cerebrospinal fluid (CSF). Small tumors generally lack blood vessels, hence are less often associated with abnormal CSF.
A Study of the Physiologic Relationship of Lower and Upper Airways with 133Xe
Authors: Silberstein E. B. , Lewis J. T. , Quenelle D. J.
Published: October 2014

In order to test the hypothesis that there is air streaming through the upper airways to the ipsilateral lung, and that reflex hypoventilation of the ipsilateral lung may occur in unilateral nasal obstruction, 11 volunteers and three patients were examined for these phenomena, employing Xenon-133 (133Xe) and a special mask permitting inhalation of the gas through one nostril at a time. Patients with deviated nasal septa were also examined, one of these before and after surgery. There was no difference in 133Xe distribution between right and left lungs when gas was inhaled through either normal nostril as compared to inhalation through the mouth, in patients with deviated septa or with cotton obstruction of the contralateral nostril. Furthermore, there was no evidence of delayed washout of 133Xe from either lung or any segment thereof under conditions of nasal obstruction. Thus acute or chronic nasal obstruction does not alter the distribution of inspired gas to the lungs. Neither air streaming nor reflex bronchoconstriction occurs with nasal obstruction.
Lymphoid Hyperplasia of Larynx Simulating Neoplasia
Authors: Pellettiere Edmund V. , Holinger Lauren D. , Schild Joyce A.
Published: October 2014

A rare case of lymphoid hyperplasia of the adult larynx (hyperplasia of the laryngeal tonsil) is reported. While this benign lesion recurred following surgical excision, the patient has been followed for more than two years without additional therapy and is asymptomatic. Seven additional cases of laryngeal lymphoid hyperplasia in the English literature are reviewed. The problems related to inadequate sampling (biopsy) and the histologic criteria for diagnosis are emphasized. To define the pathogenesis and ultimate biologic potential of this lesion, more cases must accrue and be studied with a longer follow-up.
Surgical Treatment of Recurrent Perilymph Fistula with Anacusis
Authors: Ulsø Claus , Hentzer Erwin
Published: October 2014

A woman with substantiated well-preserved premorbid cochlear function developed right-sided anacusis due to a perilymph fistula twice at an interval of 20 months. The fistula was presumably a sequel to previous operative damage to the stapes footplate. On both occasions she was treated surgically with a good result.
Clear Cell Carcinoma of the Larynx
Authors: Seo In Sook , Tomich Charles E. , Warfel Kathleen A. , Hull Meredith T.
Published: October 2014

A case of clear cell carcinoma of the larynx is presented. By light microscopy the lesion was composed mainly of sheets of clear cells, containing intracytoplasmic mucin and glycogen. Glandular lumina, tonofilaments, and desmosome-tonofilament complexes were observed on electron microscopy. The presence of these features established that this unusual neoplasm was a clear cell variant of mucoepidermoid carcinoma.
Nasal Secretory Iga Circadian Rhythm: A Single-Dose Suppression Test
Authors: Menzio P. , Morra B. , Sartoris A. , Molino R. , Bussi M. , Cortesina G.
Published: October 2014

The existence of a clear circadian rhythm in the local secretion of nasal IgA is a well-known phenomenon which is confirmed in the present research. Since the temporal pattern of secretory IgA (SIgA) strictly parallels the ACTH-cortisol cycle, a dependence was hypothesized in previous research, but the suppression of adrenal rhythm by means of massive doses of exogenous corticosteroids showed no influence on the SIgA cycle. In the present research a more sophisticated method of corticoid-incretion suppression was used; the single-dose suppression test with dexamethasone, which influences only the impulsive phase of the rhythm. In this case too, however, no influence was demonstrated on nasal SIgA secretion.
Otoconial Formation in the Fetal Rat
Authors: Salamat M. Shahriar , Ross Muriel D. , Peacor Donald R.
Published: October 2014

The development of otoconia in the fetal rat was investigated by scanning and transmission electron microscopy and by x-ray elemental analysis. The transmission electron microscopical results indicate that primitive otoconia are highly organic appearing but are trigonal in cross section, indicating that they already possess a three-fold axis of symmetry and a complement of calcite. These otoconia develop into spindle-shaped units which accrue fibrous, organic material at an angle to their surfaces. Dumbbell-shaped otoconia, with distinct central cores and peripheral zones, result. These otoconia then mature to the adult crystal configuration having a more cylindrical body and pointed ends. The existence of trigonal, spindle- and dumbbell-shaped otoconia was verified by scanning electron microscopy of fresh-frozen material. Tissues prepared for transmission electron microscopy proved (by elemental analysis) to have been decalcified inadvertently, fortuitously revealing the arrangement of the organic material. Subsequent transmission electron microscopy of dumbbell-shaped otoconia not exposed to fluids during embedment showed that calcite deposits mimicked the arrangement of the organic material. X-ray elemental analysis demonstrated that calcium was present in lower quantities in the central core than peripherally. Findings are interpreted to indicate that organic material is essential to otoconial seeding and directs otoconial growth.
Surgical Landmark for the Facial Nerve in the Epitympanum
Authors: Gacek Richard R.
Published: October 2014

The bony partition between the epitympanum and the anterior epitympanum serves as a reliable landmark for the facial nerve canal which is located at its base. The consistency of this landmark probably relates to the fact that it forms part of the fallopian canal during fetal development. This surgical landmark is useful where middle ear anatomy is obscured by disease or when a total facial nerve decompression procedure is planned.
Intraoral and Cutaneous Juvenile Xanthogranuloma
Authors: Ossoff Robert H. , Esterly Nancy B. , Levin Donald L. , Tucker Gabriel F.
Published: October 2014

A three-year-old male with histologically proven intraoral and cutaneous juvenile xanthogranuloma is described. In our review of the literature published in English we were unable to find a similar case report. The clinical and histologic features of this disorder are discussed.
Sphenooccipital Chordoma Presenting as a Nasopharyngeal Mass
Authors: Eisemann Michael L.
Published: October 2014

While the nasopharynx is most commonly regarded by the otolaryngologist as a primary site of neoplastic involvement, it is also an avenue of spread of base-of-the-skull tumors presenting as bulging nasopharyngeal masses. The temporal sequence of clinical signs and symptoms may reliably predict the origin of a ventrally extending sphenooccipital chordoma seen on a nasopharyngeal examination. This tumor may cause extensive bony erosion of the petrous apex, sphenoid sinus, and clivus and may suggest a more rapidly growing and aggressive tumor type. The extent of the tumor may be accurately determined by conventional tomography, computerized axial tomography, and arteriography. Several surgical approaches including the infratemporal fossa approach, transoral transpalatal approach and rhinoseptal transphenoidal approach may be appropriately utilized singly or in combination to remove this tumor in whole or part; however, the rhinoseptal transphenoidal approach is emphasized and regarded as the most rational treatment plan for subtotal resection, recognizing the usual futility of an en bloc resection with its associated high morbidity.