bluuebunny/crossref_metadata_2025 huggingface dataset:
Bioglass Middle Ear Prosthesis: Preliminary Report
Authors: Merwin Gerald E.
Published: October 2014

The current status of materials for use in middle ear reconstruction is discussed with particular emphasis given to alloplastic implants including bioinert and bioactive materials. Bioglass is a bioactive transparent glass which forms a bond with living tissues. Its development and characteristics are discussed, and the early results of a clinical trial using a Bioglass middle ear prosthesis are presented. The satisfactory tissue response and hearing results found in this preliminary group of patients encourage further clinical evaluation of the Bioglass middle ear prosthesis for use in ossicular reconstruction.
Reference Values for Serial Vestibular Testing
Authors: Proctor Leonard , Glackin Robert , Smith Craig , Shimizu Hiroshi , Lietman Paul
Published: October 2014

This study defines the normal limits of day-to-day variation in vestibular function. A short-acting caloric test was used and nystagmus intensity was measured by means of an interactive computerized technique. Data were analyzed from 30 normal subjects tested on three successive days and from ten of these subjects who were also tested on 11 additional occasions. Individual caloric test scores generally remained between 55% and 170% of their initial value; narrower ranges resulted when scores were averaged together. There was very little habituation of caloric responses. The upper normal limits of test-retest variation in scores for right-left difference and directional preponderance of caloric responses were 24% and 22%, respectively.
Current Modifications of the Salivary Bypass Tube and Tracheal T-Tube
Authors: Montgomery William W.
Published: October 2014

Recent changes in the salivary bypass tube and the silicone tracheal T-tube (Montgomery Safe-T-Tube) are reported. The esophageal tube, a precursor of the salivary bypass tube, was introduced as a device to bridge the gap between the pharyngostome and esophagostome following laryngoesophagectomy and the first stage reconstruction of the cervical esophagus. It has continued to serve this function as well as others and has been modified a number of times. The salivary bypass tube, a silicone modification, is currently available in four sizes. Illustrations and descriptions for inserting, maintaining, and removing this tube are presented. The silicone tracheal T-tube has been modified to prevent accidental displacement of the extraluminal portion of the T-tube into the trachea. Although this complication has been rare in 21 years of usage, it can be fatal. Ridges and grooves have been constructed on the extraluminal portion of the T-tube so that a ring can be attached to prevent posterior displacement. Drainage grooves have also been added along the long axis to aid in the drainage of secretions and to differentiate the T-tube from the silicone tracheal cannula on which there is only one longitudinal groove.
Histopathology of an Ear after 5 Years of Electrical Stimulation
Authors: Simmons F. Blair , Schuknecht Harold F. , Smith Lee
Published: October 2014

Four electrodes were placed in the cochlea and eighth nerve of a 57-year-old man, deafened earlier by neomycin. One electrode received over 4,000 known hours of electrical stimulation and the others fewer, but still substantial hours during extensive psychometric and speech-related testing. While tissue examination showed nerve damage in the basal turn secondary to the implant surgery, there were 18,450 surviving neurons (25,000 are normal for age). There was little or no local tissue reaction and no erosion of the electrode tips caused by electrical stimulation.
Histologic Study of the Vestibulocochlear Nerve
Authors: Schefter Robert P. , Harner Stephen G.
Published: October 2014

The vestibulocochlear nerve was studied histologically in cross section from the brain stem to the lateral fundus of the internal auditory canal. The fascicular pattern of the eighth cranial nerve varied widely within the posterior cranial fossa. The cochlear fibers were denser and darker than the vestibular. This difference created double staining of the eighth cranial nerve in the posterior cranial fossa. At the porus acusticus, the nerve fibers became myelinated. Myelin appeared on vestibular fibers more medially than on cochlear fibers. A discrete point of vestibular-cochlear separation was consistently identified in the lateral portion of the internal auditory canal near Scarpa's ganglion. These results suggest that the most reliable point for discrimination of cochlear from vestibular nerves occurs inside the internal auditory canal.
Primary Intralabyrinthine Schwannoma
Authors: Huang Tsun-Sheng
Published: October 2014

This paper describes a case of primary intralabyrinthine schwannoma removed by transmastoid labyrinthectomy. This case, together with a review of other cases, suggests that the tendency to preserve hearing by surgical treatment of Meniere's disease and the tendency for these tumors not to be discovered unless a labyrinthectomy is performed may mask their occurrence rate. Furthermore, I would hereby introduce both surgical and pathologic evidence suggesting that there may be a predilection in the site of origin of such solitary tumors.
Tuberculous Mastoiditis
Authors: Samuel Julian , Fernandes C. M. C.
Published: October 2014

Twenty-three cases of tuberculous mastoiditis are presented, nine of which were complicated by facial palsy. Six presented with acute mastoiditis, and two had meningitis. Surgery was required in 16 patients; in four cases the diagnosis was made by culture and in another four by biopsy of the granulations or polyp of the external canal. The response to antituberculous treatment was satisfactory in 22 cases. One patient, whose case was complicated by meningitis, died.
Amylase Secretion by Nasal Glands
Authors: Tachibana Masayoshi , Morioka Hiroyuki , Tanimura Fumiko , MacHino Mitsuo , Mizukoshi Osamu
Published: October 2014

Amylase, an enzyme that hydrolyzes starch, has been localized in the nasal mucosa for the first time by the protein A-gold technique. The amylase appeared to be produced by serous cells of the nasal glands. This enzyme has the potential for use as a tumor marker for cancer of the nasal cavity. The function of amylase in the physiology of nasal secretions is discussed.
Air Conduction Thresholds after Myringoplasty and Stapes Surgery: A Conventional and High Frequency Audiometric Comparison
Authors: Mair I. W. S. , Laukli E.
Published: October 2014

A comparison has been made of air conduction thresholds after myringoplasty and stapes surgery for otosclerosis in both the conventional (0.25 to 8 kHz) and high frequency (8 to 20 kHz) ranges. Significant threshold losses occurred in the high frequencies following both procedures. Threshold improvement was significantly greater at the lower frequencies following stapes surgery, while high frequency threshold deterioration was significantly less in the myringoplasty group. High frequency audiometry may prove to be a sensitive monitor of middle ear surgical techniques.
Efficacy of Acoustic Reflectometry in Detecting Middle Ear Effusion
Authors: Avery Christine A. , Gates George A. , Prihoda Thomas J.
Published: October 2014

The acoustic otoscope measures the amount of sound reflected from the tympanic membrane. Since the amount of reflected sound is increased by fluid in the middle ear, it seemed likely that the acoustic otoscope could be used for detection of otitis media. We compared acoustic reflectometry with over 4,000 tympanometric and otoscopic examinations in 451 children who were examined at regular intervals following surgery for chronic otitis media with effusion. The data indicate a lower sensitivity and specificity of acoustic reflectometry than had been reported previously. The receiver-operator characteristics of this device are discussed.
Diagnosis and Treatment of Small Cell Carcinoma of the Larynx: A Critical Review
Authors: Ferlito Alfio
Published: October 2014

Small cell carcinoma of the larynx is an uncommon neuroendocrine tumor with particular pathologic, therapeutic, and prognostic connotations. The first case of this lesion was observed in Canada in 1972. Fourteen cases of small cell carcinoma of the larynx were observed in the Ear, Nose, and Throat Department of Padua University in a series of 3,284 primary and secondary laryngeal and hypopharyngeal malignant neoplasms. This number constitutes the largest collection from a single institution in the literature and brings the total recorded cases to 66. The tumor is thought to arise from the argyrophilic Kulchitsky cells normally found in laryngeal mucosa. The diagnosis is based on the light microscopic appearance of the neoplasm and can be confirmed by electron microscopy. The differential diagnosis must be made from carcinoid, atypical carcinoid, small cell squamous carcinoma, small cell ductal carcinoma, lymphoma, mycosis fungoides, and metastatic lung small cell cancer. Systemic chemotherapy with radiation therapy is the accepted manner of treatment today. The survival of the patients treated with these modalities may be significantly improved, and some patients may be cured.
Effect of Radiotherapy on the Outcome of Pharyngeal Reconstruction Using Free Jejunal Transfer
Authors: McCaffrey Thomas V. , Fisher Jack
Published: October 2014

Eighteen patients had free jejunal reconstruction of the pharynx and cervical esophagus following pharyngoesophagectomy for malignant tumors. Four patients had no radiation therapy, four had postoperative radiotherapy, and ten had preoperative radiotherapy. Comparison of complication rates indicated no increased risk of complication in patients receiving 6,100 to 6,400 rad of postoperative radiotherapy. Patients having preoperative radiotherapy had a higher incidence of graft failure due to vessel thrombosis, suggesting that radiation endarteritis may increase the risk of graft failure.
Tracheotomy in the Preterm Infant
Authors: Kenna Margaret A. , Reilly James S. , Stool Sylvan E.
Published: October 2014

Over the last decade, prolonged survival of preterm infants (gestation ≤ 36 weeks) who require lengthy periods of mechanical ventilation has necessitated that many of these infants undergo tracheotomy. The complication rate for tracheotomy in these preterm infants has not been reported. We compared 83 full-term (FT) infants who underwent tracheotomy in their first year of life with 41 preterm infants. Twenty-three preterm infants had birth weight ≥ 1,500 g (PT), and 18 of the preterm infants had gestational age ≤32 weeks and birth weight ≤ 1,500 g (PT-VLBW). Early complications (day 0 to 7) occurred in over 50% of the PT-VLBW compared to only 24% of the FT infants. Late complication rates were similar for all three groups. This higher early complication rate for PT-VLBW infants may be related to gestational age, low birth weight, and medical condition rather than surgical technique.
Epiglottoplasty for the Treatment of Laryngomalacia
Authors: Zalzal George H. , Anon Jack B. , Cotton Robin T.
Published: October 2014

Laryngomalacia is the most common congenital laryngeal anomaly. Patients present with different degrees of stridor and feeding problems that usually resolve by 18 months of age. A small number present with severe feeding problems, failure to thrive, stridor with cyanosis, and apnea, which may result in cardiopulmonary disease. These infants require surgical intervention, usually a hyomandibulopexy or tracheotomy. We present a new procedure, epiglottoplasty, that is performed endoscopically and involves excision of redundant mucosa over the lateral edges of the epiglottis, aryepiglottic folds, arytenoids, and corniculate cartilages. Ten patients have undergone this procedure with good results. Epiglottoplasty represents an alternative to tracheotomy in severe laryngomalacia. Indications, techniques, postoperative management, and complications are presented.
Effect of Experimentally Induced Otitis Media on Cochlear Implants
Authors: Franz Burkhard K-H. , Clark Graeme M. , Bloom David M.
Published: October 2014

Cat cochleas implanted with scala tympani prostheses were investigated histologically after inoculating the bullae with a suspension of group a streptococci. The prosthesis was passed through the round window membrane in one ear. In the other the prosthesis bypassed the round window via an opening anteroinferior to the round window niche. Before death, horseradish peroxidase was administered as a tracer for possible pathways of infection. Results showed that group a streptococci were pathogenic to the cat and caused inflammation in the bulla. The unimplanted round window membrane and the seals around the electrode entry points prevented infection from entering the cochlea. The seals around electrodes inserted either through the round window membrane or an opening drilled anteroinferior to the niche were equally effective. The horseradish peroxidase tracer studies showed, however, that a gap existed between the electrode and membranous seal, and this could be a potentially vulnerable site under certain conditions. Drilling an anteroinferior opening into the cochlea resulted in bony sequestra entering the cochlea. This can be avoided by blue-lining the opening and removing bone with picks before making an opening through the endosteum.
Computed Tomography of the Ethmoid Labyrinth and Adjacent Structures
Authors: Simonetti G. , Meloni F. , Teatini G. , Salvolini U. , Rovasio S. , Masala W. , Dedola G. L.
Published: October 2014

The architecture of ethmoid labyrinths as well as their relationships with adjacent structures are reviewed, giving special emphasis to the anatomic variants common in this area. The study was performed on six young normal subjects who were submitted to high resolution computed tomography. Approximately 25 axial scans, parallel to the floor of the anterior cranial fossa, were performed on each subject; four to five coronal CT scans were also added. Further data were supplemented by examinations of 62 patients affected by nonneoplastic disease of the paranasal sinuses.
Early Hair Cell Loss in Experimental Hydrops
Authors: Albers Frans W. J. , Veldman Jan E. , Huizing Egbert H.
Published: October 2014

One, 2, and 4 months after surgical obliteration of the endolymphatic sac, the sequence of degenerative changes in the organ of Corti of the guinea pig was studied. The block surface technique with interference differential (Nomarski) microscopy was used for this investigation to study the morphological changes in the organ of Corti. The hair cell loss was calculated and mapped in cytocochleograms. One month postoperatively a minimal loss of only outer hair cells was observed in the apical cochlear turn. At 2 months a progression of outer hair cell loss was seen, which proceeded in the 4-month group. At 4 months the inner hair cells showed a slight tendency to degenerate, again beginning in the most apical part of the cochlea.
Osteochondrosis of the Temporomandibular Joint Presenting as an Apparent Parotid Mass
Authors: Cannon C. Ron
Published: October 2014

A mass in the preauricular area usually indicates the presence of a neoplastic or inflammatory process within the parotid gland. Osteochondrosis is an unusual disease process affecting large joints. Particularly the knee. Rarely, the temporomandibular joint (TMJ) may be affected. The disease process involves the synovial lining of the TMJ and is commonly ascribed to a benign neoplastic process or metaplasia, although trauma and inflammation have also been implicated. This process can result in single or multiple loose cartilage bodies (joint mice)within the joint cavity. Symptoms are usually those of a mass in the preauricular area, or those of TMJ dysfunction (pain, dislocation, click, decreased range of motion). Physical findings are limited to presence of a mass in the pre-auricular parotid area with a paucity of other parotid findings. Treatment involves removal of the loose cartilage bodies from the TMJ and possibly the synovial lining, if it appears to be severely damaged.
House Dust Mite-Specific Ige, Igg1, and Igg4 Antibodies in Patients with Perennial Rhinitis
Authors: Ohashi Yoshihiro , Nakai Yoshiaki , Nakagawa Takemasa , Kihara Shoko , Miyamoto Terumasa
Published: October 2014

Serum samples were obtained from patients with house dust mite–sensitive nasal allergies before and 6 months after immunotherapy, and the level of immunoglobulin (Ig)E, IgG1, and IgG4 antibodies in those sera was determined by the enzyme-linked immunosorbent assay. The present data showed that the mite-specific IgG4 antibodies increased in patients who responded well to immunotherapy but not in those who responded poorly. It was suggested from the present study that IgG4 antibodies seem to act as “blocking antibodies” to reduce the allergic reaction in the target organ, and that an increase of allergen-specific IgG4 antibodies following immunotherapy can be of clinical benefit to patients suffering from mite-specific nasal allergy.
Cricothyroidotomy: A Decade of Experience in Denver
Authors: Esses Barbara A. , Jafek Bruce W.
Published: October 2014

In an attempt to evaluate cricothyroidotomy as described by Brantigan and Grow in 1976, the authors have reviewed the literature and compared it to the decade of experience following Brantigan and Grow's report. The records of over 1,000 patients requiring ventilatory assistance were reviewed. A comparison of this experience with Brantigan and Grow's original series and subsequent reports was used to establish the criteria and technique for cricothyroidotomy. It appears that while cricothyroidotomy has specific advantages, it also has disadvantages and a higher incidence of airway stenosis than either of the procedures it was designed to replace (low tracheotomy or endotracheal intubation). For this reason, its use has been severely restricted in Colorado, where it was popularized.
Vocal Function following Hemilaryngectomy
Authors: Hirano Minoru , Kurita Shigejiro , Matsuoka Hidetaka
Published: October 2014

Vocal function following hemilaryngectomy was investigated in 54 cases in which a superiorly based sternohyoid muscle flap was used for glottic reconstruction. Four types of material were employed for covering the muscle flap: Hypopharyngeal mucosa, lip mucosa, thyroid perichondrium, and island cervical skin flap. The vocal function varied greatly from individual to individual; however, the following tendencies were observed in many cases: 1) the glottis did not close completely; 2) supraglottic structures (false fold, arytenoid region, and epiglottis) were hyperfunctional and vibrated instead of or together with the unaffected vocal fold; 3) vibrations of the laryngeal structures were irregular; 4) maximum phonation time was short; 5) mean airflow rate was high; 6) fundamental frequency and intensity ranges of phonation were limited; 7) the voice was rough, breathy, and/or strained; and 8) cases with poor vocal function were most frequent in the skin flap group and least frequent in the lip mucosa group.
Treatment of Spastic Dysphonia without Nerve Section
Authors: Friedman Michael , Grybauskas Vytenis , Toriumi Dean M. , Applebaum Edward L.
Published: October 2014

Spastic dysphonia is a disorder characterized by strained, constricted phonation with excessively adducted vocal cords. Despite initial success with recurrent laryngeal nerve section, the search for other treatment continues. Our clinical study involved inserting a needle electrode percutaneously into the region of the recurrent laryngeal nerve in five patients with spastic dysphonia. Electrical stimulation resulted in dramatic improvement in three patients and minimal improvement in two. Our experimental study was designed to create an animal model for an implantable nerve stimulator to be used on a long-term basis. A Medtronic spinal cord stimulation system was implanted into a dog, and a cuff electrode was positioned around the recurrent laryngeal nerve. Vocal cord position could be altered by varying the stimulus frequency. Long-term stimulation of the recurrent laryngeal nerve was relatively safe and effective. Eventually, we plan to implant nerve stimulators into spastic dysphonia patients who respond well to percutaneous stimulation.
Pediatric Laryngeal Sarcoidosis
Authors: Rybak Leonard P. , Falconer Randall
Published: October 2014

Numerous cases of sarcoidosis, but few cases of well-documented laryngeal involvement, have been reported in the pediatric literature. Isolated laryngeal involvement is a most unusual presentation of sarcoidosis. Such a case is reported here, along with a review of laryngeal sarcoidosis in the pediatric population. Differential diagnosis, diagnostic evaluation, and treatment options are discussed. Intralesional steroid injection provides local therapy with fewer complications than systemic steroids.
Ultrastructural Changes in Vestibulo-Ocular Neurons following Vestibular Neurectomy in the Cat
Authors: Gacek Richard R. , Lyon Michael J. , Schoonmaker Joanne
Published: October 2014

Vestibulo-ocular (VO) neurons in the superior vestibular nucleus were labeled retrogradely with horseradish peroxidase and studied quantitatively using electron microscopy to determine the morphologic correlates of vestibular compensation. Eleven VO neurons from three normal cats were compared to 26 VO neurons in four animals killed 8 weeks after vestibular neurectomy and 13 VO cells from two animals killed 1 year after vestibular neurectomy. The results demonstrated a marked reduction (74%) in the number of synaptic profiles (SPs) on the VO cell soma in both experimental groups. Synaptic vesicles in the remaining SPs on VO neurons were fewer, smaller, and rounder than vesicles in control animals. The residual SPs also were associated with more asymmetric synapses. The experimental VO neuron showed a significant decrease in soma and organelles associated with protein synthesis.
Stapedectomy Trends for the Resident
Authors: Coker Newton J. , Duncan Newton O. , Wright Geoffrey L. , Jenkins Herman A. , Alford Bobby R.
Published: October 2014

The diminishing number of cases of otosclerosis limits the training experience in stapes surgery during residency. Results are suboptimal. Closure of the preoperative air conduction to within 10 dB of bone conduction was obtained in only 64 % of resident cases Efforts to maximize experience and improve results include closer faculty supervision, use of one stapedectomy technique, and a prospective study of individual residents' performance.
Depression of T Cells in Bell's Palsy
Authors: Jonsson Lars , Sjöberg Olof , Thomander Lars
Published: October 2014

We analyzed T-lymphocytes and their subsets in 20 patients with Bell's palsy. We used the monoclonal antibodies anti-Leulanti-Leu-2a, and anti-Leu-3a directed against T-lymphocytes and T suppressor/cytotoxic (Ts) and T helper/inducer (Th) cell subsets. Blood samples taken in the acute and convalescent phases of the illness were compared. The percentage of T cells (Leu-1+ cells) was decreased during the acute stage, mainly because of a reduction of the Th cell subset (Leu-3+ cells). No significant alteration was found in the Ts cell subset (Leu-2+ cells). The T cell and Th cell subset depressions were restored to normal within 4 to 6 weeks of the onset of the palsy. The T cell changes in the peripheral blood in the acute stage of Bell's palsy indicate the involvement of cellular immune mechanisms.
Study of Toynbee Phenomenon by Combined Intranasopharyngeal and Tympanometric Measurements
Authors: Finkelstein Yehuda , Zohar Yuval , Talmi Yoav P. , Laurian Nelu
Published: October 2014

The Toynbee maneuver, swallowing when the nose is obstructed, leads in most cases to pressure changes in one or both middle ears, resulting in a sensation of fullness. Since first described, many varying and contradictory comments have been reported in the literature concerning the type and amount of pressure changes both in the nasopharynx and in the middle ear. In our study, the pressure changes were determined by catheters placed into the nasopharynx and repeated tympanometric measurements. New information concerning the rapid pressure variations in the nasopharynx and middle ear during deglutition with an obstructed nose was obtained. Typical individual nasopharyngeal pressure change patterns were recorded, ranging from a maximal positive pressure of + 450 to a negative pressure as low as −320 mm H2O.
Facial Muscle Reinnervation: A Comparison of Neuromuscular Pedicle with Direct Nerve Implant
Authors: Hall Samuel J. , Trachy Ronald E. , Cummings Charles W.
Published: October 2014

Two methods of reinnervation, the neuromuscular pedicle (NMP) and the nerve implant (NI), were compared in a model using the rabbit's denervated mentalis muscle. Results from evoked electromyographic (EMG) and muscle tension studies (twitch and tetanic contraction) provided the basis of comparison. In addition, the timing of denervation was studied (ie, at the time of implantation of the NMP or NI, or 2 weeks following implantation). The NMP achieved more rapid reinnervation and produced stronger contractions than the NI. Demonstrable reinnervation with an NMP was accelerated when the implantation occurred prior to the denervation. This was not the case with the NI. There was poor correlation between the evoked EMG potential and the strength of both twitch and tetanic contraction. It was concluded on the basis of this study that muscle tension provided a more accurate means of assessing reinnervated muscle function. Of the two methods, the NMP would seem, therefore, to be the technique of choice when it is available. The NI is certainly effective and should be used when a satisfactory NMP is not available.
Chronic Herpetic Laryngitis with Oropharyngitis
Authors: Karnauchow Paul N. , Kaul William H.
Published: October 2014

Chronic herpetic laryngitis, with or without involvement of the oropharynx, is uncommon. We describe a case that was initially diagnosed and treated as squamous cell carcinoma. The subsequent course of the disease, review of the histologic material, and additional laboratory investigation suggested that the lesion was of viral origin and probably was caused by herpes simplex.
Vascular Effects of Neuropeptides on Nasal Mucosa
Authors: Ichimura Keiichi , Mineda Hiroyuki , Seki Atsuro
Published: October 2014

We used dog nasal blood vessels and an in vitro muscle tension-detecting technique to examine the vascular effects of several neuropeptides: Vasoactive intestinal polypeptide, substance P, neurotensin, somatostatin, and neuropeptide Y (NPY). Electrically induced vasoconstriction was inhibited by every peptide except neurotensin, which enhanced this response. Every preparation treated with somatostatin, and one tissue treated with NPY, showed an enhanced noradrenaline-induced contraction. Only NPY caused a tissue contraction. Preparations precontracted by methoxamine were relaxed by every peptide. These results indicate that all peptides examined have marked but varied vasoactivities.
Study of Humidification Potential of a Heat and Moisture Exchanger in Tracheotomized Dogs
Authors: Myer Charles M. , Hubbell Richard N. , McDonald John S. , Stith John
Published: October 2014

Though a heat and moisture exchanger (HME) has been used in clinical practice following a tracheotomy on a limited basis, no work has been done to document the humidification potential of an HME in this situation. Eighteen dogs underwent tracheotomy and were killed at either 1 day (nine dogs) or 10 days (nine dogs) postoperatively. Following the tracheotomy, the animals were divided into three groups according to the type of humidification received: Ambient conditions, warm mist, or HME. The tracheal mucosa was studied for histologic changes in the cilia, the epithelium, submucosal reaction, and mucus production at the level of the carina. The results were significant (p = .02) for the interaction of the experimental type and method of treatment in their effect on the histologic changes noted at the carina. The study supports the use of an HME as an alternative for long-term humidification in a patient with a tracheotomy.
Alveolar Soft-Part Sarcoma
Authors: Batsakis John G.
Published: October 2014

Approximately 25% of all alveolar soft-part sarcomas have their origin in the head, where the tongue and orbit are sites of predilection. The neoplasms possess characteristic light and electron-optic features, yet their histogenesis remains unclear. Recurrences, early metastases, and lethality over a prolonged period are pertinent biologic findings.
Follow-up Study of Recurrent Parotitis in Children
Authors: Geterud Åke , Lindvall Ann-Marie , Nyléan Olle
Published: October 2014

Recurrent parotitis in children is a well-described but rare condition of unknown cause. In this follow-up investigation the long-term course of the disease was studied both clinically and radiographically. In 23 of 25 patients investigated, the clinical symptoms disappeared before the patients were 22 years of age, independent of a given therapy. However, sialographic changes, mostly in the form of sialectasis, were seen on follow-up in the majority of cases, in spite of the fact that the patients were clinically symptom free.
Pneumocystis Carinii in the Temporal Bone as a Primary Manifestation of the Acquired Immunodeficiency Syndrome
Authors: Breda Stephen D. , Gigliotti Francis , Hammerschlag Paul E. , Schinella Roger
Published: October 2014

Extrapulmonary infection with Pneumocystis carinii is rare and is usually associated with severe systemic illness. We report, in two patients, the histologic, ultrastructural, and monoclonal cell surface antibody identification of P carinii in otic polyps. Both patients had serum antibody to human immunodeficiency virus. These P carinii infections in the temporal bone are unusual in their location and in the apparent absence of associated pulmonary infection. This otologic presentation was the primary manifestation of the acquired immunodeficiency syndrome.
“Saber-Sheath” Trachea
Authors: Callan Edward , Karandy Eugene J. , Hilsinger Raymond L.
Published: October 2014

Narrowing of the intrathoracic trachea in the coronal plane with anteroposterior lengthening is characteristic of the saber-sheath trachea deformity. This structural disorder is strongly associated with chronic obstructive pulmonary disease and may be related to chronic bronchitis. Although lateral compression suggests weakening and collapse, the supporting tracheal cartilage is usually thickened and densely calcified. We present a patient who was discharged after uneventful total laryngectomy but later complained of increasing airway obstruction from crusted secretions, resulting in visits to the emergency room and admission to the hospital. After the diagnosis was made by computed tomography, tracheal dilation was performed with some improvement. The diagnostic findings of the saber-sheath trachea, differential diagnosis, possible causes, and clinical implications are discussed.
Bronchoesophageal Manifestations of Acquired Immunodeficiency Syndrome
Authors: Lucente Frank E. , Meiteles Lawrence Z. , Pincus Robert L.
Published: October 2014

Among the more common manifestations of acquired immunodeficiency syndrome (AIDS) are tumors and infections that occur in regions treated by the bronchoesophagologist. In reviewing our institutional experience in the diagnosis and treatment of 396 patients with AIDS in 1987, we have noted that 226 (57%) had some form of pneumonia and 133 (34%) had candidiasis. In this communication we discuss the various types of bronchopulmonary, oropharyngeal, and esophageal infections that have been reported among AIDS patients. We also review the universal precautions and specific guidelines recommended for safeguarding the bronchoesophagologist and other health care workers who treat these patients.
Osteogenesis Imperfecta of the Temporal Bone and its Relation to Otosclerosis
Authors: Nager George T.
Published: October 2014

Osteogenesis imperfecta (OI) designates a heterogeneous group of heritable disorders of connective tissue that in addition to bone may affect tendons, ligaments, fascia, skin, sclerae, blood vessels, teeth, and hearing. The current classification identifies at least four major syndrome groups or types. It also recognizes a considerable number of additional syndromes that may represent supplementary types or subgroups. Loss of hearing is the least constant of the prominent features of OI. Its incidence varies between 26% and 60%. In OI, formation and remodelling of bone are variously affected. In the temporal bone the development of the inner ear capsule may be involved severely. In the stapes the disturbance in lamellar bone formation can lead to extreme thinness, dehiscence, and nonunion of the stapedial superstructure with the footplate. Osteogenesis imperfecta can be associated with otosclerosis, another bone dysplasia with a different morphology. Otosclerosis, in turn, may interfere with sound conduction and perception. Thus, the hearing loss encountered in OI may be the result of OI, otosclerosis, or a combination of both.
Superselective Embolization of Glomus Jugulare Tumors
Authors: Young Nancy M. , Russell Eric J. , Wiet Richard J. , Monsell Edwin M.
Published: October 2014

The purpose of this report is to introduce the technique of superselective embolization (SSE) and to review our experience in surgically treating glomus jugulare tumors with and without preoperative SSE. Retrospective chart review was performed to determine estimated blood loss and operative time, and illustrative case reports are presented. The technique of preoperative SSE represents an important advance in the surgical management of glomus jugulare tumors. In our experience, surgical ligation of tumor-feeding vessels or nonselective embolization of the external carotid system is unsatisfactory. Inadequate devascularization and excessive risk of complications have caused us and others to abandon these procedures. However, SSE performed by an experienced neuroradiologist can produce effective and safer tumor devascularization. Preoperative SSE results in shrinkage of tumor size and significantly decreases blood loss. The advantages to the surgeon include improved visualization and ease of dissection as well as increased confidence that complete tumor excision has been achieved.
Otologic Complications following Temporomandibular Joint Arthroscopy
Authors: Applebaum Edward L. , Kumar Arvind , Berg Lawrence F. , Mafee Mahmood F.
Published: October 2014

The recent application of arthroscopic surgical techniques to the temporomandibular joint (TMJ) has facilitated the diagnosis and treatment of TMJ disorders. However, as TMJ arthroscopy is performed more frequently, new complications are being recognized. We report three patients who developed severe otologic complications following TMJ arthroscopy. Two sustained complete or severe sensorineural hearing loss and severe vertigo from trauma to the ipsilateral ear. The third patient had complete facial paralysis from trauma to the facial nerve in the middle ear and a conductive hearing loss from incus dislocation. Complete hearing loss and facial paralysis from trauma to the main trunk of the facial nerve have not been reported previously as complications of TMJ arthroscopy.
Computed Tomography in Patients with Laryngeal Carcinoma: A Clinical Perspective
Authors: Werber Josh L. , Lucente Frank E.
Published: October 2014

Among the various diagnostic modalities that have been recommended for preoperative assessment of the patient with laryngeal carcinoma is computed tomography. While good overall correlation between CT findings and operative findings has been noted, a significant number of false positives and false negatives have been found, particularly with regard to cartilage invasion and lymphadenopathy. We compared the findings of direct laryngoscopy, palpation of the neck, and CT with pathologic specimens in 29 patients who underwent surgery for carcinoma of the larynx. We found that CT scanning underestimated the extent of neoplastic involvement in over half the cases. With respect to cartilage invasion we determined a significant number of false-negative findings. Computed tomographic scanning was equivalent to palpation in predicting cervical metastasis. Our findings indicate that the role of CT scanning may be more limited than previously acknowledged, particularly in patients for whom nonconservation surgery is planned.
Laryngeal Synkinesis: Its Significance to the Laryngologist
Authors: Crumley Roger L.
Published: October 2014

Basic research and surgical cases have shown that the injured recurrent laryngeal nerve (RLN) may regenerate axons to the larynx that inappropriately innervate both vocal cord adductors and abductors. Innervation of vocal cord adductor muscles by those axons that depolarize during inspiration is particularly devastating to laryngeal function, since it produces medial vocal cord movement during inspiration. Many patients thought to have clinical bilateral vocal cord paralysis can be found to have synkinesis on at least one side. This will make the glottic airway smaller, particularly during inspiration, than would true paralysis of all the intrinsic laryngeal muscles. Patients with bilateral vocal cord paralysis should undergo laryngeal electromyography. If inspiratory innervation of the adductor muscles is present, simple reinnervation of the posterior cricoarytenoid muscle will fail. The adductor muscles also must be denervated by transection of the adductor division of the regenerated RLN.
Asymmetry of the Laryngeal Framework: A Morphologic Study of Cadaver Larynges
Authors: Hirano Minoru , Yukizane Keiichiro , Kurita Shigejiro , Hibi Seishi
Published: October 2014

Asymmetry of the laryngeal framework was investigated with 50 excised human larynges, ten from newborns (five males, five females), 20 from adults in their 20s (ten males, ten females), and 20 from adults in their 50s (ten males, ten females). All adults were right-handed. The results are summarized as follows. 1) The laryngeal framework was asymmetric to a greater or lesser extent in all larynges. 2) The degree of asymmetry did not differ among different age groups or between sexes. 3) In newborns, there was no directional preponderance in asymmetry. 4) In older adults, there was a directional preponderance in asymmetry. The right thyroid lamina tended to tilt laterally whereas the left lamina showed a tendency to tilt medially. The right cricoarytenoid joint tended to be located slightly more laterally, posteriorly, and inferiorly than the left joint. The longitudinal axis of the thyroid cartilage was inclined to shift to the right posteriorly against the axis of the cricoid cartilage. The thyroid cartilage as a whole tended to tilt to the right against the cricoid cartilage. 5) There must be some compensatory mechanisms for the asymmetric framework to keep the vocal fold edges relatively symmetric.
Model of a New Generation of Tracheostomy and Endotracheal Tubes
Authors: Rao A. Jagannadha , Shimada Yasuhiro , Aiyer Chandrasekhar R. , Yanagita Noriyuki , Komatsu Toru , Hattori Shuzo
Published: October 2014

The feasibility of monitoring cannula obstruction was studied by conversion of the electrical resistance of substances that are capable of causing obstruction into audible auditory signals. Copper-nickel-gold electrodes were thermal pressed onto polyimide-based flexible films placed as 1-mm wide strips along the inner surface of tracheostomy and endotracheal tubes. The responses were fed into a resistance-to-frequency converter (IC 555 timer), and the output was frequency selected to generate auditory responses through a piezoelectric beeper. Quantitative estimates of responses from the IC output were computer averaged. Instantaneous obstruction detection was made possible by the immediate responsiveness of the device in the presence of obstruction.
Actomyosin Adenosine Triphosphatase Activities of the CAT Infrahyoid Muscles
Authors: Hisa Yasuo , Malmgren Leslie T. , Gacek Richard R.
Published: October 2014

By use of actomyosin ATPase histochemistry, it was found that there were large differences among the three cat infrahyoid muscles (sternohyoid, sternothyroid, and thyrohyoid) with respect to their percentages of different muscle fiber types. It has been established that the individual activity patterns of the component motor units in each muscle drive the biochemical and physiologic differentiation of the muscle fibers associated with each motor unit. Therefore, the data obtained in the present investigation provide an indication of the characteristics of long-term use of each of the various types of motor units, as well as the associated differences in the physiologic capacities of the different motor unit types composing each of these infrahyoid muscles.
Botulinum Toxin for Relief of Bilateral Abductor Paralysis of the Larynx: Histologic Study in an Animal Model
Authors: Cohen Seymour R. , Thompson Jerome W. , Camilon Felizardo S.
Published: October 2014

We previously reported the effectiveness of botulinum toxin injections in the cricothyroid muscle under electromyographic guidance for lateralization of the true vocal cord in the mongrel dog. These additional experiments were performed to substantiate the effectiveness of botulinum toxin injections in laryngeal muscle to overcome airway obstruction produced by bilateral abductor vocal cord paralysis. A predetermined aliquot of the toxin was injected into the cricothyroid muscle of ten dogs, the duration of its effectiveness was noted, and repeated injections were given the animals. Biopsies of the injected muscles were obtained in three of the animals for routine histologic and electron microscopic studies. The effects of the toxin were recorded by cinelaryngoscopy and videotape documentation. In all the dogs, the true vocal cord was lateralized effectively and there was no morbidity, dysphagia, aspiration, or deaths. This study also confirms that the effects of the toxin in the canine larynx are spontaneously reversed and that multiple injections do not cause irreparable damage to the laryngeal muscles.
Internal Anatomy of the Larynx and the Spread of Cancer
Authors: Welsh Louis W. , Welsh John J. , Rizzo Thomas A.
Published: October 2014

This project investigated the potential spread of cancer within the larynx by an analysis of the permeability and resistance of the subepithelial spaces. Permeation and diffusion of dye injections in the loose connective tissues below the epithelium was analyzed by histologic preparations in the sagittal plane. The margins of the infusion were identified grossly and microscopically, and the influence of the fibrous, elastic, and muscular components was analyzed with reference to the dispersion of the dyes. A close correlation between laboratory data from normal postmortem larynges and clinical problems of laryngeal cancer was observed in this study.
Pharyngeal Fistulas in Postoperative Hypothyroid Patients
Authors: Talmi Yoav P. , Finkelstein Yehuda , Zohar Yuval
Published: October 2014

Hypothyroidism is a well-recognized complication of combined treatment for head and neck cancer. We discuss four patients who developed pharyngeal fistulas after total laryngectomy and preoperative (one patient) or postoperative (three patients) radiation therapy. The fistulas were refractory to conservative and surgical repair. Once the existence of hypothyroidism was established, immediate substitution therapy resulted in rapid healing of the fistulas and marked improvement of the patients' general condition. Few clinical reports exist on postoperative hypothyroidism and wound healing complications. Experimental work shows delay and impairment of wound healing in hypothyroid animals as opposed to hyperthyroid ones, in which wound healing was accelerated. Suspicion is warranted in patients after treatment for head and neck cancer when they exhibit even minimal symptoms of hypothyroidism or develop postoperative complications refractory to conservative treatment.
Minor Congenital Laryngeal Clefts: Diagnosis and Classification
Authors: Benjamin Bruce , Inglis Andrew
Published: October 2014

Cleft larynx is a rare congenital anomaly. Detection of an unsuspected minor cleft may be difficult, but the pediatric laryngologist should suspect the possibility of cleft larynx from the clinical features. Four minor clefts are reported, three cases of supraglottic interarytenoid cleft and one of partial cricoid cleft. The technique for endoscopic diagnosis and the distinctive features are described and a classification into four types is proposed.
Cochlear Hair Cell Stereocilia Loss in LP/J Mice with Bone Dysplasia of the Middle Ear
Authors: Chole Richard A. , Chiu Maggie
Published: October 2014

LP/J inbred mice spontaneously develop bony lesions of the middle ear and otic capsule that are similar to those of human otosclerosis and tympanosclerosis. These mice also have progressive loss of hearing due to cochlear hair cell loss. The purpose of this study was to describe quantitatively the deterioration and loss of cochlear hair cells to serve as a basis for future experiments attempting to alter the course of this disorder. Cochleas from 37 LP/J inbred mice were examined by scanning electron microscopy. The stereocilia loss in the cochlea was evident as early as 15 weeks of age and progressed from the basal turn to the apex. Outer hair cells were affected more than inner hair cells. As outer hair cells deteriorated we observed fusion, bending, and breakage of stereocilia. There were no apparent differences in the mode of deterioration among the three rows of outer hair cells. Stereocilia fusion of inner hair cells occurred at an older age, and giant, elongated stereocilia were found in some of the animals.
Sialocysts of the Parotid Glands
Authors: Batsakis John G. , Raymond A. Kevin
Published: October 2014

Sialocysts of salivary glands are outnumbered greatly by pseudocystic lesions, exemplified by mucoceles. In the major salivary glands, sialocysts are preponderantly lesions of the parotid glands, where they are classified as 1) salivary duct cysts, 2) lymphoepithelial cysts, or 3) dysgenetic or congenital cysts. All arise from salivary ducts and have no relation with the branchial apparatus.
Computer-Aided Three-Dimensional Reconstruction: A Method of Measuring Temporal Bone Structures Including the Length of the Cochlea
Authors: Takagi Akira , Sando Isamu
Published: October 2014

To visualize the three-dimensional (3-D) shapes of structures in the temporal bone from histologic sections, we developed computer software to create computer-generated 3-D images from two-dimensional (2-D) materials. Using those images, we have been able to measure these structures in three dimensions. This means that quantitative 3-D measurements can be performed regardless of the angle at which the specimen was cut. This report describes this method for 3-D reconstruction and measurement and discusses its implications. For instance, in addition to showing the 3-D shape of the cochlea from different angles, we have been able to measure the length of the cochlea and have shown that measurements made by use of the conventional 2-D graphic reconstruction method can be distorted considerably by variations in cutting angle of the specimen.