bluuebunny/crossref_metadata_2025 huggingface dataset:
The Morphologic Effects of Histamine on the Lateral Cochlear Wall
Authors: Duvall Arndt J. , Hukee Margaret J. , Santi Peter A.
Published: April 2016

The chinchilla lateral cochlear wall (stria vascularis, spiral ligament, and spiral prominence) was examined by morphologic and histochemical techniques following various doses of intravenous histamine. The three main findings were as follows: (1) the basic ultrastructure was not altered by histamine; (2) there is a time‐ and dose‐dependent change in the rate of stria vascularis vessel permeability to a small protein tracer (horseradish peroxidase), but the mode of transport (large pore system) is unchanged; and (3) glycogen depletion in stria marginal cells occurs with its apparent mobilization into stria intercellular spaces.
Differential Diagnosis of Superficial Ulcerations of the Oral Mucosa
Authors: Chole Richard A. , Domb George H.
Published: April 2016

Superficial ulcerations of the oral mucosa often present a diagnostic challenge to the physician because of the similarity of one ulcer to another. A diagnosis is made by the analysis of multiple factors, including the lesion's location, size, grouping, onset, patient's age, involvement of other systems of the body, and course of the disease. The histopathology of the lesion may be specific, especially in certain potentially fatal diseases.

This paper presents the means for the differential diagnosis of a variety of superficial ulcers of the oral mucosa: varicella, herpangina, recurrent aphthous stomatitis, Behcet's disease, Stevens‐Johnson syndrome, traumatic ulcer, verrucous carcinoma, primary herpetic gingivostomatitis, recurrent herpetic stomatitis, pemphigus vulgaris, and benign mucous membrane pemphigoid.
Thyroid Carcinoma in a Patient with a Coexisting Functional Adenoma
Authors: Blitzer Andrew , Som Max L.
Published: April 2016

Fourteen case reports have been published in which “hot” nodules have been documented as carcinoma, with or without coexisting adenomas. The diagnosis of these lesions is difficult, since hot nodules usually represent benign disease. These carcinomas are not functional, but represent coexistence of a functional area or a malignant degeneration. Hot nodule carcinomas should be suspected in high‐risk patients.

A euthyroid, 31‐year‐old woman who, as a teenager, had radiotherapy for acne is reported. She was followed up with yearly scans for a hot nodule in the right lower lobe of her thyroid. When she was 36, a node was discovered in the right side of her neck, and carcinoma was suspected. Surgical excision revealed a papillary‐follicular carcinoma adjacent to an adenoma with metastases to regional lymph nodes.
Mucosal Tattooing In Oral Cavity Carcinoma
Authors: Burkett Patrick R. , Miller Thomas F.
Published: April 2016

Tattooing provides accurate localization for tumor surgery following radiation therapy. This paper describes studies done on tattooing technique and instruments available currently. Procedures tested included hypodermic needles and three types of surgical instruments. Chemicals tested included india ink, iron oxide, and colored pigments.

India ink and iron oxide used with the Spaulding‐Rogers Outliner gave satisfactory tattoos.
Deglutition After Conservation Surgery for Cancer of the Larynx and Hypopharynx
Authors: Sessions Donald G. , Zill Roberta , Schwartz Sandra L.
Published: April 2016

Conservation surgery for cancer of the larynx results in deglutition problems. Rehabilitation of swallowing function can successfully be managed by a team including a surgeon, a dietitian, and a nurse. This report details surgical reconstruction to prevent or treat aspiration, postsurgical dietetic management, and the nursing approach to deglutition training in a group of patients.
Endoscopic Nomenclature for Bronchopulmonary Anatomy
Authors: Jafek Bruce W. , Carter Donald R.
Published: April 2016

Development of the flexible fiberoptic bronchoscope (FFB) has allowed visualization of the peripheral tracheobronchial tree to the level of fifth‐order bronchi. Examination of this area requires an extended anatomic nomenclature to describe the pathology of findings. A system of description is presented that combines the concepts of Jackson and Huber, Boyden, Ikeda, and Weibel into a practical endoscopic shorthand lettering designation for endobronchial anatomy. Using the system, a sub‐sub‐subsegmental (fifth order) bronchus in the right lung could be designated RB1b1α. The principles are described and Illustrated.
Squamous Metaplasia of the Middle Ear Mucosa During Vitamin a Deprivation
Authors: Chole Richard A.
Published: April 2016

Adult and juvenile albino rats were maintained on a vitamin A‐free test diet for 2 to 28 weeks. Histologic study of the middle ear and eustachian tube mucosa of these animals showed extensive focal squamous metaplasia when compared with the control group. Keratinization of large areas of normally columnar, ciliated epithelium was observed without frank keratoma formation. In over half of the most vitamin A‐deficient animals, acute otitis media with effusion was found. It is hypothesized that vitamin A deficiency disrupts the mucociliary clearing mechanism in the middle ear and eustachian tube, which may lead to effusion and otitis media.
Detection of Middle Ear Disease in Cleft‐Palate Patients
Authors: Hunter David , Keim Robert J.
Published: April 2016

A prospective study of 17 cleft‐palate patients under the age of 37 months was performed. The otoscopic findings, as reported by the primary physician and otolaryngologist, were compared with the results of tympanometry. Preoperatively, all tympanograms were abnormal. Ears with an As pattern were not described as abnormal by any physician, and postoperatively, these ears all progressed to a more advanced stage of disease.
The Freeze‐Injection Method of Hypertrophic Scar and Keloid Reduction
Authors: Babin Richard W. , Ceilley Roger I.
Published: April 2016

Hypertrophic scars and keloids continue to plague the head and neck surgeon as an unpredictable consequence of trauma or incision. The myriad suggested methods of revising such lesions indicate that no one method is foolproof. The application of conventional cryotherapy to the lesion, followed by the dilute intralesional Iriamcinalone injection, offers several advantages over other methods.
Office Organization and Experiences with Hearing Aid Dispensing
Authors: Bailey H. A. Ted , Pappas James J. , Graham Sharon S. , Winston Michael E. , Parrott Peggy
Published: April 2016

Roles of the otolaryngologist and the audiologist in providing hearing health care are expanding as a result of current trends in amplification technology, legislation, and patient populations. Within clinic dispensing of hearing aids has become a part of this role expansion. Requirements for setting up a dispensary, fitting procedures, fee analysis, and statistical results of 4 1/2 years' experience are discussed. On the basis of the benefits described, direct dispensing is advocated.
Aerobic Isolates in Hemovac Lines
Authors: Yoder Milton G. , Silva Joseph
Published: April 2016

Positive aerobic isolates from hemovac lines were found in 41 of 68 patients (60%) who had major head and neck procedures requiring the hemovac drainage system during the postoperative period. When studied up to six days of placement, the number and the type of organisms in a hemovac system generally remained the same. A clue to impending infection was the isolation of two or more different genera from the hemovac system.

Isolates from hemovac lines can frequently indicate the cause of the complication. Possible pathogens in postoperative head and neck infections include gram‐positive bacteria, gram‐negative bacteria, and fungi.
Carcinoma of the Larynx in An 11‐Year‐Old Boy with Late Cervical Metastasis: Report of a Case with a Ten‐Year Follow‐up
Authors: Ossoff Robert H. , Tucker Gabriel F. , Norris Charles M.
Published: April 2016

An 11‐year‐old boy with laryngeal carcinoma underwent a partial laryngectomy. Subsequently, a cervical metastatic node developed eight months following a tonsillectomy; a radical neck dissection was performed. The patient has remained free of disease over a ten‐year follow‐up period. In our review of the English literature, no similar case report was found. The potential relationship of tonsillectomy to alterations in local T cell‐mediated immune response is discussed.
Biophysical Measurements in The Implanted Cochlea
Authors: Spelman Francis A. , Pfingst Bryan E. , Miller Josef M. , Hassul Michael , Powers Walt E. , Clopton Ben M.
Published: April 2016

Electrical stimulation via implanted electrodes has been used to produce perceptions of sound in human subjects. This study describes preliminary work needed to understand the implanted ear and the distribution of current within it so that a stimulus system can be designed that is optimal for longevity, information transfer, and safety.
Biophysical Measurements in the Implanted Cochlea
Authors: Spelman Francis A. , Pfingst Bryan E. , Miller Josef M. , Hassul Michael , Powers Walt E. , Clopton Ben M.
Published: April 2016

Electrical stimulation via implanted electrodes has been used to produce perceptions of sound in human subjects. This study describes preliminary work needed to understand the implanted ear and the distribution of current within it so that a stimulus system can be designed that is optimal for longevity, information transfer, and safety.
Primary Ewing's Sarcoma of the Mandibular Ramus: A Case Report
Authors: Mikaelian Diran O. , Scherr Stuart A. , Delucca Leopoldo E.
Published: April 2016

Primary Ewing's sarcoma of the mandible is an exceedingly rare finding in the practice of otolaryngology. A case of this neoplasm occurring as a parotid mass is presented. It represented a diagnostic dilemma because of its elusive histopathologic findings. The gross and clinical appearances, microscopic findings, differential diagnosis, and prognosis of this neoplasm are discussed.
Malignant Cervical Teratomas
Authors: Tobey David N. , Mangham Charles
Published: April 2016

A case of malignant cervical teratomas is presented. Treatment based on chemotherapy protocols for testicular teratoma may improve the outcome of this rapidly progressive disease.
Synovial Cell Sarcoma
Authors: Hirokawa Ronald H. , Stucker Frederick J. , Bryarly Richard C.
Published: April 2016

Synovial sarcoma of the head and neck is a rare lesion. Based on previous literature reports, these lesions carry a poor prognosis. Case reports of two patients diagnosed and treated recently for head and neck lesions of this type are presented. A review of pathologic sections at the Armed Forces Institute of Pathology (AFIP) suggests that this lesion is more common than believed previously.
An Unusual, Highly Aggressive, Anaplastic Carcinoma of the Nasal Cavity
Authors: Frankel Marie , Chaudry Anand , Teruel Lorenzo
Published: April 2016

The case of a patient who had a rapidly growing anaplastic carcinoma of the nasal cavity is reported. The patient died from local recurrences, regional lymph nodes, and distant pulmonary metastases within seven months of the initial diagnosis.
Bezold's Abscess with Extension to the Suprascapular Space
Authors: Edison Bruce
Published: April 2016

Since the advent of antibiotics, instances of untreated chronic otitis media have decreased considerably. The Bezold abscess seen occasionally with cases of acute otitis media has also become almost extinct. Its occurrence in association with chronic otitis media has always been even less frequent. This paper presents a case of Bezold's abscess associated with chronic otitis media, with the unusual clinical finding of extension to the suprascapular space.
Herpes Simplex Polyganglionitis
Authors: Adour Kedar K. , Hilsinger Raymond L. , Byl Frederick M.
Published: April 2016

Evidence suggests that many cranial nerve syndromes, such as migraine headache, acute vestibular neuronitis, globus hystericus, carotidynia, acute facial paralysis (Bell's palsy), and Meniere's disease, are caused by the neurotropic herpes simplex virus (HSV). Because transitory cranial nerve dysfunction during acute HSV infection can be asymptomatic but often occurs in conjunction with mucocutaneous vesicles, we tested five subjects with herpes labialis for cranial nerve dysfunction. Four of the subjects had hypesthesia of the trigeminal nerve (which recurred in two); four, hypesthesia of the glossopharyngeal nerve; and two, hypesthesia of the second cervical nerve. Three of the subjects had positional or spontaneous nystagmus (which recurred in one); one of the subjects had a unilateral, decreased caloric response of 50%. Unilateral weakness of the cricothyroid muscle or the palate occurred in three of the subjects (and recurred in one). Volitional electromyograms were normal in all the subjects, but two of the subjects had increased facial nerve latency (which recurred in one). Similar findings of an acute, transitory nature should suggest to the clinician a viral polyganglionitis caused by HSV infection.
The Effects of Frequency Modulation on Middle Ear Reflex
Authors: Meeks Thomas , Owens Laurence , Melnick William
Published: April 2016

The effect of frequency modulation on acoustic middle ear muscle reflex persistence was studied. Changes in impedance at the tympanic membrane were used as an indirect indication of reflex activity. Signals were a 2‐kHz pure tone, a narrow band of noise centered at 2‐kHz, and FM signals centered at 2‐kHz modulated 70, 140, and 280 times per second.

Acoustic reflex persistance for FM signals resembled that observed with pure‐tone stimulation rather than that produced by a filtered noise.
Home Temporal Bone Dissection: Anatomic Approaches to Ear Surgery
Authors: Farrior Jay B.
Published: April 2016

The anatomy of the temporal bone can only be mastered by repeated surgical and anatomic dissections. For the otolaryngologist who does not have access to laboratory facilities, a technique for dissecting temporal bones at home using readily available and inexpensive equipment is described. The basic home dissecting kit consists of dry temporal bones, a high‐speed hobby drill, dental burrs, loupes, and paints. The preparation of temporal bones for dissection and approaches to anatomic, transmastoid, transcanal, and neuro‐otologic dissections are presented. The relative benefits of home dissection in learning temporal bone anatomy and developing new surgical approaches, such as a transcanal‐transcochlear approach to the internal auditory canal, are discussed.
Prostaglandins and Otitis Media: Studies in the Chinchilla
Authors: Jung Timothy T.K. , Smith Douglas M. , Juhn S.K. , Gerrard Jonathan M.
Published: April 2016

Prostaglandins (PG) are naturally occurring, cyclic, unsaturated fatty acids that possess a wide range of potent biologic activities. Prostaglandins have been found in human middle ear effusions and may have implications for understanding the inflammation and, possibly, the bone resorption seen in chronic otitis media. In the study presented, PGs were measured by radioimmuno‐assay in middle ear effusions from experimentally induced serous and purulent otitis media in chinchillas. The ability of chinchilla middle ear mucosa to synthesize PGs from 14C‐arachidonic acid was also demonstrated. The authors suggest an active role for PGs in the inflammation and the bone resorption seen in otitis media.
Otolaryngology Drug Capsule: Otic Topical Agents
Authors: Fairbanks David N.F.
Published: April 2016

Chairman's Comments: Every otolaryngologist is familiar with topical medications for use in treating ear disease. Because there are so many preparations, it may be difficult to know which is the ideal agent for any given clinical situation. David N.F. Fairbanks, MD, member of the Committee on Drugs—Otolaryngology, has reviewed topical otic medications and has summarized them for the Academy membership.
Salivary Probe and Dissector
Authors: Mantovani Mario , Mann Douglas , Sasaki Clarence T.
Published: April 2016

Salivary calculi, preponderating in the submaxillary duct, produce distension of the ductile system, as well as pain and fever, when they enlarge sufficiently to obstruct salivary flow. Although calculi may pass spontaneously by eroding into the oral cavity, they must usually be removed surgically under local anesthesia.

The device presented simplifies extraction of multiple sialoliths. Soft tissue trauma is minimized, and patient comfort is significantly increased.
Otolaryngologic Manifestations of Orbital Pseudotumors
Authors: Fortson James K. , Shapshay Stanley M. , Weiter John J. , Vaughan Charles W. , Strong M. Stuart
Published: April 2016

Orbital pseudotumor is believed to be a nonspecific, acute or chronic inflammatory process involving the intraorbital soft tissue. Orbital pseudotumor may masquerade as sinusitis with orbital complications or as a severe upper respiratory tract infection.

Five cases are presented to illustrate the difficulties in diagnosis when initial symptoms relate to the upper respiratory system rather than to an isolated orbital mass. In these cases, orbital ultrasound and computed tomograms were helpful in making the diagnosis. Treatment consisted of systemic corticosteroids in four of the five patients.

Recognition of early symptoms and findings, along with earlier involvement with the ophthalmologist, will make a more effective treatment regimen possible.
Myofascial Pain‐Dysfunction Syndrome: The Role of Nonmasticatory Muscles in 91 Patients
Authors: Curtis Arthur W.
Published: April 2016

Ninety‐one new patients with myofascial pain‐dysfunction (MPD) syndrome were studied prospectively. The patients experienced aural fullness, tinnitus, vertigo, odynophagia, and headache in addition to the cardinal symptoms of otalgia, muscle tenderness, temporomandibular joint (TMJ) click, and trismus. Some nonmasticatory muscles were found to be tender as frequently as the masticatory muscles. It is proposed that MPD syndrome as seen clinically involves more than just the masticatory musculature and is a composite of several head and neck myofascial pain syndromes including tensor tympani syndrome, muscle tension headache, cervical syndrome, and hyoid syndrome.
Simultaneous Carcinomas of the Esophagus and Upper Aerodigestive Tract
Authors: Shapshay Stanley M. , Hong Waun Ki , Fried Marvin P. , Sismanis Aristides , Vaughan Charles W. , Strong M. Stuart
Published: April 2016

A review of 150 consecutive head and neck cancer patients over a 22‐month period revealed a multiple primary cancer rate of 19%, 9% in the head and neck region. Nine patients (6%) had simultaneous esophageal and head and neck cancers. Complete systematic esophagoscopic examinations, in addition to barium swallow radiographic studies, are recommended for all patients with head and neck cancers.
Computerized Axial Tomography in Inflammatory Pseudotumor of the Orbit
Authors: Rowe Lee D. , Tsiaras William , Nichols Charles , Myers Allen R.
Published: April 2016

Although thyrotoxicosis and orbital complications of acute ethmoid or frontal sinusitis are among the most common causes of unilateral exophthalmos, inflammatory pseudotumor is frequently accompanied by progressive acute unilateral proptosis. Because the associated chemosis, scleral erythema, and ophthalmoplegia constitute a spectrum of clinical findings present in numerous inflammatory orbital disorders and systemic diseases, the diagnosis of inflammatory pseudotumor is one of exclusion, often requiring orbital biopsy.

Four patients without evidence of sinusitis, endocrinopathy, collagen vascular disease, or Wegener's granulomatosis are described. The diagnosis of orbital pseudotumor was disclosed by computed axial tomography, thus avoiding orbitotomy. The finding of scleral and choroidal thickening with enhancement following intravenous contrast injection represents a select group of patients with orbital pseudotumor and differentiates them from patients with endocrine exophthalmopathy or neoplasms. This noninvasive technique is extremely valuable because early diagnosis is critical for successful treatment.

All four patients responded dramatically to high‐dose corticosteroid therapy. In the absence of significant clinical response, however, Wegener's granulomatosis, lymphoma, and rhabdomyosarcoma, especially in younger patients, must be carefully excluded. Orbital exploration or decompression or both are used when proptosis, headache, or orbital pain does not resolve promptly, visual acuity deteriorates, or the diagnosis remains unknown.
Benign Osteoblastoma of the Maxillary Sinus
Authors: Tom Lawrence W.C. , Lowry Louis D. , Quinn‐Bogard Ann
Published: April 2016

The benign osteoblastoma is an uncommon bone tumor. It is a benign but actively growing neoplasm that must be differentiated from more aggressive bony lesions. A review of the literature indicates that 14% of benign osteoblastomas are located in the head. The clinical, radiologic, and pathologic features and treatment of the benign osteoblastoma are discussed. In addition, the third case of a benign osteoblastoma of the paranasal sinuses, and the first of the maxillary sinus, is described.
Scanning Electron Microscopic Demonstration of Goblet Cell Discharge and Mucous Layer on Nasal Ciliated Respiratory Epithelium
Authors: Dudley James P. , Cherry James D.
Published: April 2016

Respiratory cilia is covered by a layer of mucus. The manner in which the mucus makes its way to the cilia tips and distributes itself on the tips is not known. Scanning electron microscopic examination of nasal mucosa demonstrated cone‐like goblet cell discharge as well as a thin layer of mucus enmeshed in the cilia tips. Further demonstration of mucus may demonstrate the differences in these two components.
Hypotympanotomy Retractor
Authors: Epley John M.
Published: April 2016

This hypotympanotomy retractor is designed for use in procedures that require an inferiorly oriented approach to the middle ear (Fig 1). Its primary value is for posterior ampullary nerve transection, the transcochlear approach to the internal auditory meatus, or glomus tympanicum resection.
Implanted Cochlear Prosthesis Analogue In Primates
Authors: Balkany Thomas J. , Mischke Robert E. , Pauley James D. , Stynes Andrew J. , Asher David L.
Published: April 2016

Electronic cochlear prostheses are currently being implanted in the profoundly deaf. Little, however, is known about the biologic effects of electrical stimulation of the auditory system.

To study some effects of intracochlear electrical stimulation in monkeys, a totally implantable device that produces a constant current similar to that produced by devices now used in human implantation was designed and miniaturized. This paper reports on the characteristics of the device and a pilot project designed to test it in vivo. The feasibility of primate implantation and behavioral observation, as well as histopathologic study, was also determined.

The device was implanted in each of two Macacca nemestrina monkeys, which were then observed. One monkey was killed and the implanted cochlea studied with scanning electron microscopy. Evidence of osteogenesis of the scala tympani was found.
Glomus Jugulare Tumor Surgery with Intracranial Extension
Authors: Kinney Sam E.
Published: April 2016

Total surgical excision of a glomus jugulare tumor is the treatment of choice for this benign tumor. If the tumor has extended beyond the temporal bone into the intracranial spaces, most often the posterior fossa, the surgical excision becomes more difficult.

If the tumor has extended anteriorly and posteriorly into the posterior fossa or if a portion of the tumor is exposed in the external auditory canal with the concurrent infection that is seen with this presentation, the intracranial portion of the tumor should be removed as a first step in a planned two‐stage removal of the tumor.

If the intracranial extension is limited and there is no infection present with the tumor, a combined otologic‐neurosurgical approach using transtemporal and suboccipital access to the temporal bone will allow successful total removal of the tumor in a one‐stage procedure.

Details are presented to demonstrate this combined otologic and neurosurgical approach to large glomus tumors with intracranial extension.
Sellar Lesions
Authors: Lee Keat‐Jin , Goodrich Isaac
Published: April 2016

A thorough knowledge of the surgical anatomy of the sellar region is prerequisite to understanding the symptoms and the pathophysiology of diseases in this area. The differential diagnoses of sellar and parasellar lesions includes pituitary tumor, craniopharyngioma, carotid aneurysm, empty sellar syndrome, metastatic tumor, optic or hypothalamus glioma, meningioma, chordoma, mucocele, and bony tumor of the sphenoid sinus. The preoperative evaluation should encompass the consultations of an endocrinologist, an ophthalmologist, and a neurosurgeon.
Rehabilitation of Patients with Postoperative Deficits, Cranial Nerves VIII through XII
Authors: Tucker Harvey M.
Published: April 2016

Increasingly aggressive surgical attack upon disease in and about the base of the skull will continue to produce various combinations of deficits of the 8th through 12th cranial nerves. Although isolated paralyses of these nerves usually can be managed with little difficulty, various combinations of paralyses can result in loss of airway, voice, or swallowing functions that are challenging to the head and neck surgeon. A thorough understanding of the disordered physiologic conditions that these lesions can produce, coupled with a logical medical and surgical approach to their management, may result in better rehabilitation of these patients.
The Metabolic Evaluation in Meniere's Disease
Authors: Kinney Sam E.
Published: April 2016

Meniere's disease remains today a poorly understood and difficult‐to‐manage inner ear problem. Numerous articles have been written about the medical and surgical management of Meniere's disease. Previous authors have suggested that a metabolic abnormality may be a contributing etiologic factor in the disease.

Since 1976, 384 patients with Meniere's disease were seen in the Department of Otolaryngology and Communicative Disorders of the Cleveland Clinic Foundation. In 180 of these patients, the results of a metabolic evaluation were reviewed, including the five‐hour glucose tolerance test, lipid profile, free thyroxine index, and the fluorescent treponemal antibody absorption test (FTA‐ABS).

The results of these tests suggest that thyroid abnormalities are rare in Meniere's disease. There may be a fairly high false‐positive rate in using the FTA‐ABS as a screening procedure. Carbohydrate abnormalities are found; however, hypoglycemia was not a major factor in this series of patients. A significant number of patients were found to have lipid abnormalities, and dietary management of these is believed helpful in the medical management of a patient with Meniere's disease.
The Incidence and Significance of the Tullio Phenomenon in Man
Authors: Erlich Mark A. , Lawson William
Published: April 2016

The purpose of this study was to investigate the incidence and significance of the Tullio phenomenon in a group of human subjects. The subjects included 40 patients with complaints of auditory or vestibular symptoms. Ten otologically normal subjects were included in the study as a control group. All subjects underwent routine audiologic evaluation as well as electronystagmogram (ENG) testing. All subjects were then tested for the presence of the Tullio phenomenon by the method described.

The results of this study showed that of the 40 subjects with known auditory or vestibular disorders, 90% (36) demonstrated nystagmus in response to high‐intensity sound stimulation. All patients in the otologically normal control group demonstrated the presence of the Tullio phenomenon. No specific correlations were made between the presence of the Tullio phenomenon and specific audiologic or ENG findings.

Studies on the effects of sound on the vestibular system are reviewed and lend support to the finding that the Tullio phenomenon may be a normal physiologic response in man under certain test conditions.
Retropharyngeal Abscess in the Adult
Authors: de Clercq Lucas D. , Chole Richard A.
Published: April 2016

Retropharyngeal and prevertebral abscesses, although uncommon, present a perplexing diagnostic and therapeutic problem. In the adult, the disease is less common than in the child, but its etiology may be more diverse. Four cases of retropharyngeal or prevertebral abscesses in the adult are presented, resulting from (1) endotracheal intubation trauma, (2) esophageal perforation, (3) tuberculosis of the cervical spine, and (4) coccidioidomycosis. The pathophysiologic conditions and pertinent anatomy are discussed in relation to the medical and surgical approach to these lesions.
Parenteral Nutrition in Patients with Head and Neck Cancer: Techniques and Results
Authors: Daly John M. , Dudrick Stanley J. , Copeland Edward M.
Published: April 2016

Protein‐calorie malnutrition occurs commonly in patients with head and neck cancers, secondary to poor dietary habits and oncologic treatments that compromise further a patient's ability to ingest adequate nutrients. Intravenous nutritional support of 70 patients with head and neck malignancies has allowed weight gain, improved wound healing, and increased serum protein levels during radiation therapy, chemotherapy, and in the perioperative period.
Epidermoid Carcinoma of the Floor of the Mouth: Surgical Therapy vs Combined Therapy VS Radiation Therapy
Authors: Panje William R. , Smith Bruce , McCabe Brian F.
Published: April 2016

A retrospective analysis of 103 selected patients with floor‐of‐mouth epidermoid carcinoma compared the effectiveness of surgical therapy alone vs planned preoperative radiation combined therapy vs irradiation therapy. All three treatment methods appeared equally effective in irradicating stage I and II disease. Stage III floor‐of‐mouth epidermoid carcinoma was similarly controlled by either surgical therapy or combined therapy. Irradiation therapy alone was markedly inferior in treatment of stage III disease. Stage IV disease was poorly handled by any of the treatment methods. Histologic factors, tumor characteristics, tumor spread, nodal status, and staging did not appear in the majority of cases to significantly influence treatment selection or survival or both.
Transseptal Transsphenoidal Hypophysectomy
Authors: Spooner Thomas R. , Grin Oliver D. , Herz David A.
Published: April 2016

The usual surgical approach to the sella turcica is via a labial sulcus incision over the nasal spine with continuation backward to the nasal septum and sphenoid sinus. In our series of 25 transsphenoidal hypophysectomies, a primary transseptal approach was used, avoiding the oral incision. The operating time was reduced, and the visualization was adequate. The morbidity associated with the labial sulcus incision was also avoided. The surgical approach and results are discussed.
Parathyroid Microautotransplantation and the Viscerovertebral Angle
Authors: Tenta Louis T. , Keyes Geoffrey R. , Caldarelli David D.
Published: April 2016

Conservation of physiologic values of circulating parathormone is a surgical objective in those instances in which a hyperfunctional parathyroid state exists as well as in those instances in which cervical evisceration employed as an ablative measure for the management of neoplastic disease threatens to impose postoperative tetany.

Because the parathyroid glands may vary in number and in anatomic sites, a predictable and reproductible surgical approach that permits the operator an avenue of access to these structures is used. The viscerovertebral angle provides a surgical modality which facilitates the operative effort. The method has been applied in more than 70 patients.
Combined Therapy for Pyriform Sinus Cancer Using Postoperative Irradiation
Authors: Donald Paul J. , Hayes H. Randall , Dhaliwal Ranjit
Published: April 2016

A review of 33 patients with pyriform sinus carcinoma, seen between September 1972 and September 1978, is done. Preoperative irradiation is done in seven patients, resulting in a 28% survival rate. Postoperative irradiation in 14 patients yields a 64% survival rate. The average follow‐up is 39.2 months. Survival is unaffected by the factor of geographic center of the tumor origin. Irradiation alone is done, mainly in patients who are inoperable or refuse surgery. There is a poor survival rate.
Macrophage (Monocyte)‐Derived Mucous Secretagougue (MMS) is Released into the Fluid of the Middle Ear of Patients with Otitis Media with Effusion
Authors: Bernstein Joel M. , Goswami S. , Marom Zvi
Published: April 2016

Macrophage (monocyte)‐derived secretogogue (MMS) is a low molecular weight peptide released by activated macrophages. This substance can enhance incorporation of carbohydrates into protein and result in the production of glycoproteins. It is believed that increased glycoproteins lead to the increased tenaciousness of mucoid effusions. Sixteen of 28 middle ear effusions demonstrated significant amounts of MMS. It is suggested that MMS is produced by activated macrophages in MEE and may lead to the development of glycoprotein by secretory epithelial cells. This substance may lead to the development of the mucoid effusion in otitis media with effusion in children.
Vestibular Autorotation Testing of Meniere's Disease
Authors: O'Leary Dennis P. , Davis Linda L.
Published: April 2016

Ten patients with previously confirmed diagnosis of acute‐stage Meniere's disease were tested with the Vestibular Autorotation Test (VAT), a portable computerized test that measures the higher‐frequency vestibulo‐ocular reflex (VOR) to compute gain and phase. Patients were asked to fixate on a target and move their heads in synchrony with a computer‐generated, sweep‐frequency audible cue (0.5 to 6.0 Hz) through an 18‐second test epoch. Head movements in both horizontal (yaw) and vertical (pitch) planes were used separately to test horizontal and vertical VORs, respectively. All subjects easily performed the VAT. Results of the horizontal tests were within normal limits for both gain and phase. The vertical gain was markedly high throughout the 2 to 6 Hz range. Mean vertical phase lags were reduced at higher frequencies. These results imply that the vertical VORs of acute‐stage Meniere's patients are hypersensitive to the faster vertical head movements that occur commonly in dally activities.
Labyrinthine Ossification after Meningitis: Its Implications for Cochlear Implantation
Authors: Novak Michael A. , Fifer Robert C. , Barkmeier Joseph C. , Firszt Jill B.
Published: April 2016

Labyrinthine ossification can be found in a high percentage of patients with profound deafness resulting from bacterial meningitis. Radiographic evidence of ossification can be found as early as 2 months after the acute infection, indicating that the intracochlear process probably begins much earlier. If long, intracochlear cochlear implants are to be most successfully used in these patients, an aggressive approach to clinical management following the meningitis should be taken. Illustrative case reports and suggested guidelines for evaluation and treatment are given.
Regional Blood Flow of the Canine Vocal Cord: The Microsphere Surface Technique
Authors: Arnstein David P. , Berke Gerald S. , Trapp Terrence K. , Bell Ted , Natividad Manuel
Published: April 2016

The vocal fold's microcirculation has been well described, but there are few reports regarding the blood flow to this region. A number of methods have been used to evaluate the blood flow to an organ system. Among the most sensitive is the microsphere surface technique, which has been used to measure blood flow in many organ systems, including the cochlea. In this study, the blood flow to the canine vocal fold was assessed using the microsphere surface technique. Overall flow was measured, as well as flow to the lamina propria and muscularis layers. The technique and the results are reported.
Estrogen and Progesterone Binding by Acoustic Neuroma Tissue
Authors: Monsell Edwin M. , Wiet Richard J.
Published: April 2016

Tissue samples from 37 acoustic neuromas were assayed for estrogen and progesterone hormone receptor binding by radioimmunoassay using a dextran‐coated charcoal method and Scatchard plot analysis. Twenty‐one of the samples were from men, and 16 of the samples were from women. Seven of 37 samples (19%) were positive for estrogen receptor and six of 36 samples (17%) were positive for progesterone receptor. Three of 37 samples (8%) were positive for both receptors. There was no correlation of estrogen receptor positivity with the sex of the patient. These results indicate that estrogen or progesterone receptor binding activity or both are present in a small subset of acoustic tumors. Evidence is lacking, however, that binding of estrogen to the receptor results in growth changes in the tumor. The empirical use of antiestrogen treatment in acoustic neuroma does not appear to be justified at the present time.
The Use of Masseter Electromyography with Electroneurography in the Evaluation of Facial Paralysis
Authors: Coker Newton J. , Salzer Thomas A.
Published: April 2016

In the evaluation of facial paralysis, electroneurography provides a quantitative assessment of the degree of degeneration. Near the endpoint of degeneration, the facial musculature compound action potential may be contaminated by masseter artifact resulting from supramaximal stimulation. We propose the use of both masseter electromyography and electroneurography in the evaluation of advanced degeneration to better define the current level for supramaximal stimulation, to eliminate masseter artifact, and to more accurately assess the degree of facial nerve degeneration.
Postnatal Development of the Middle Ear: Areal Ratios in Kittens
Authors: Thomas James P. , Walsh Edward J.
Published: April 2016

Developmental changes in tympanic membrane to stapedial footplate areal ratios were investigated in kittens from birth through the twentieth postnatal day. Measurements from 45 kittens (85 temporal bones) were obtained from the pars tensa region of the tympanic membrane and the stapedial footplate region bounded by the annular ligament using standard macrophotographic and computer digitization techniques. Tympanic membrane and stapedial footplate areas were approximately 70% and 80%, respectively, of their adult size at birth and relevant areas increased exponentially during early postnatal life. Adultlike dimensions were achieved by the end of the first postnatal week. Tympanic membrane:stapedial footplate areal ratios increased from approximately 25:1 to 30:1 during the first postnatal week, before the developmental period during which adultlike auditory thresholds and response amplitudes are acquired. Thus, the areal ratio influences on impedance‐matching characteristics of the middle ear do not appear to significantly affect the postnatal development of auditory function in cats.
Magnetic Transcranial and Electric Direct Stimulation of the Facial Motor Cortex in Dogs
Authors: Estrem Scott , Haghighi Siavash , Davis William E.
Published: April 2016

Magnetic stimulation may allow noninvasive study of the entire course of the facial nerve. Our goal was to determine if evoked muscle action potentials can be obtained in facial musculature using electric direct cortical and noninvasive transcranial magnetic stimulation of the canine motor cortex. Thirty‐four dogs were studied with electric direct cortical stimulation through a craniotomy and magnetic transcranial stimulation of the facial motor cortex. Facial nerve stimulation in the cerebellopontine angle allowed comparison to cortical responses. Latencies of 6.08 and 9.52 msec for orbicularis oculi and levator nasolabial, respectively, were determined with magnetic transcranial stimulation, compared with 4.22 and 5.78 msec with electric direct cortical stimulation. In conclusion, magnetic stimulation of the facial motor cortex is possible in dogs, with longer central conduction times than with electric direct stimulation.
Sigmoid Sinus Thrombosis Diagnosis by Contrasted MRI Scanning
Authors: Fritsch Michael H. , Miyamoto Richard T. , Wood Terrance L.
Published: April 2016

Septic thrombosis of the transverse‐sigmoid sinuses and the jugular bulb is a highly lethal condition. The presenting signs and symptoms of this disease entity are subtle and not in proportion to the magnitude of the problem. Later in the disease course, sudden fulminant findings appear. A high index of suspicion, combined with scanning techniques of either enhanced MRI or CT, allows prompt diagnosis and treatment. MRI enhanced with gadolinium‐DTPA (Gd) is a valuable adjunct that confirms the diagnosis and delineates the extent of suspected pathology.
The dizzy patient: Etiologic treatment
Authors: Brookler Kenneth H. , Rubin Wallace
Published: April 2016

The basis for the vestibular complaint in dizzy patients should be viewed as having an etiology rather than a description of its clinical presentation. Effective treatment of vestibular disorders is based on the stabilization of the vestibular abnormality, to allow for central vestibular compensation. While not all of the etiologies for dizziness have been described, there are effective etiologic treatments available. These fit into categories of neurotransmitters, blood sugar and blood fat control, hormones, minerals, and treatments for autoimmune dizziness.
Etiologic Diagnosis in Neurotologic Disease
Authors: Rubin Wallace , Brookler Kenneth H.
Published: April 2016

The inner ear is a converter (transducer) of mechanical to electrical energy for both hearing and balance functions. This task is accomplished as a result of the presence of the chemicals within the perilymph and endolymph. Maintaining normal hearing and balance function is dependent upon the availability of the proper chemicals to perform this transduction task. The inner ear functions as an internal body organ and its efficiency in regard to performing its tasks related to hearing and balance function are chemically dependent upon many body systems.
Fine‐needle aspiration in the diagnosis of head and neck growths: Is it necessary?
Authors: Guyot Jean‐Philippe , Obradovic Dragan , Krayenbuhl Matthew , Zbaeren Peter , Lehmann Willy
Published: April 2016

The results of fine‐needle aspiration cytology performed on 150 patients at the Geneva Clinic of Otolaryngology were analyzed. The accuracy rate was 80%. The study was nondiagnostic in 10% of the cases and falsely negative in another 10%. These results are similar to those in other centers. Nevertheless, several recent reports attest to the accuracy of fine‐needle aspirations cytology, and in some clinics it is now part of the initial workup of every patient with a growth in the head and neck. On the basis of our own retrospective analysis, we believe fine‐needle aspiration is a useful study only in patients with a previously treated malignancy and who have a new lump in the neck suspected to be a recurrence.
Retinoid‐induced ear malformations
Authors: Granström Gösta
Published: April 2016

Treatment of pregnant Sprague‐Dawley rats with retinoic acid or etretinate pregnancy day 8.5 to 9.0 resulted in craniofacial defects in 100% of the embryos. A morphologic investigation of the malformations occurring in the ear was performed. Outer ears were missing, microtic, low‐placed, and dorsally situated. External acoustic meatus was short or absent. Middle ear structures were delayed in differentiation, middle ear ossicle primordia were hypoplastic and malformed, the stapedial artery and facial nerve were hypoplastic, and their relation to the stapes was variable. In the inner ear, the otic capsule was thick, the cochlea had fewer turns and the semicircular ducts showed poor differentiation.
Otic capsule bony lesions in the palmerston north autoimmune mouse
Authors: Hertler Craig K. , Trune Dennis R.
Published: April 2016

Otosclerosis is an otic capsule disorder of unknown etiology. While autoimmunity has been proposed as part of the etiopathogenesls of otosclerosis, no spontaneous autoimmune disease animal model has been identified. In the Palmerston North mouse, a model for systemic lupus erythematosus, sclerotic lesions consistently develop within the modiolus that are correlated with systemic autoimmune disease symptoms. No lesions were seen in 2‐month‐old mice, which is before autoimmune disease onset at 4 months. Lesions were first seen in mice at 6 to 8 months of age and increased in size and frequency thereafter. By 20 months, all ears examined had the otic capsule lesions, which were primarily perivascular in location and composed of both noncellular and cellular elements. The noncellular material was globular to fibrillar in arrangement and stained positively for calcium. The associated cells appeared to be metabolically active fibroblasts. It is proposed that the Palmerston North mouse may serve as a model to further investigate the role of autoimmunity in otosclerosis and other forms of otic capsule osteogenesis.
A method for allocation of hearing handicap
Authors: Dome Robert A.
Published: April 2016

A three‐stage method is proposed for allocation of hearing handicap. First, for a given injury or noise exposure period, the percentage of loss allocable for each ear is calculated as a simple ratio of hearing change (after age correction) to final hearing level. Second, final hearing handicap is divided between the two ears using a formula derived from the 1979 AAO‐HNS/AMA standard. The percentage of hearing handicap allocable to a given period for each ear is simply the product of that ear's scores from the first two steps.
31P localized magnetic resonance spectroscopy of head and neck tumors—preliminary findings
Authors: Hendrix Robert A. , Lenkinski Robert E. , Vogele Katherine , Bloch Peter , McKenna W. Gillies
Published: April 2016

Magnetic resonance imaging (MRI) is a powerful tool for accurate assessment of the anatomic extent of head and neck neoplasms. The development of methods for spatial localization by use of multiply tuned radio frequency colls that permit the measurement of multiple nuclear MR spectra (1H and 31P) from precisely defined volumes of interest has provided a basis for integrating spectroscopy into the clinical MRI examination. This offers a means for noninvasive monitoring of relative concentrations of mobile metabolites within a tumor. With the use of imaging to determine proper coll placement, a test‐retest variance of about 17% is seen on MR spectroscopy. Data are presented from MRI/MRS studies for four head and neck lesions: (1) a squamous cell carcinoma of the lip; (2) a Juvenile angiofibroma extending into the nasal cavity; (3) a massive chondrosarcoma of the nasal septum; and (4) a cervical nodal metastasis of a squamous ceil carcinoma of the pharynx. Spectra are evaluated by comparison of relative concentrations of phosphorus compounds. The concentrations of phosphomonoesters and phosphodiesters are significantly higher in the neoplasms studied than in normal skeletal muscle. The developing role of integrated MRI/MRS to monitor the response of malignant neoplasm to radiation therapy is discussed.