bluuebunny/crossref_metadata_2025 huggingface dataset:
Results following cochlear implantation and rehabilitation
Authors: Engelmann Larry Robert , Hough J. V. D. , Waterfall M. Kathleen
Published: October 2006

Nine post‐lingually deafened adults received single‐electrode cochlear implants and afterwards participated in a rehabilitation program. For these nine patients the average threshold sensitivity in soundfield was significantly better with use of the cochlear prosthesis than with hearing aid amplification in the same ear prior to implantation. Significant changes also occurred in discrimination of environmental sounds, recognition of words and stress patterns, and in speechreading skill. Certain aspects of phonation (harshness, control of intensity, and habitual pitch) and some articulation problems improved, while inflection abnormalities were not altered. Data concerning daily hours of implant activation, an indicator of patient acceptance, reveal that seven of the nine use their cochlear prosthesis for at least eight hours per day. These results suggest that the single electrode cochlear implant is a clinically useful tool in the rehabilitation of selected profoundly deaf individuals.
Suturing techniques in endolaryngeal surgery
Authors: Kirchner Fernando R.
Published: October 2006

In the past 15 years surgery of the endolarynx has been greatly expanded. This development has been the product of three main factors: technological advancements such as the microcautery, improved knowledge about the healing properties of the endolarynx, and new surgical techniques. These types of approaches are being increasingly used in the treatment of complex reconstructive procedures of the larynx. An integral part of these new procedures are special suturing techniques.

At present suturing techniques are being used to fulfill a number of requirements, including approximation and lateralization of anatomical structures for operative or exposure purposes, intraoperative retraction of endotracheal tubes, closure of wounds and securement and fixation of skin grafts, intralaryngeal molds, and interfacing Silastic® sheeting materials.

With amazing simplicity the above requirements can be met if a few basic steps are comprehended and followed.
Immunologic mechanisms in the production of food sensitivities
Authors: Trevino Richard J.
Published: October 2006

Fifty‐five test patients and ten control patients were selected for provocation of symptoms using the oral challenge test. The provoking food was selected with the use of the leukocyte cytotoxic test. The test patients developed adverse symptomatology clinically while the control patients did not. During the phase of symptomatology it was shown that IgE did not change in the blood and, therefore, the Type I, anaphylactic type of reaction, which is IgE dependent, did not participate in symptom production. It was shown that 2 components of the classical pathway of complement C3 and C4 were utilized in the test group and not in the control group. Complement is 1 of the 2 components of the humoral system of the human immune system. C4 is one of the components that is triggered by the classic complement pathway, whose stimulus is IgG and IgM, and not by the other complement pathways. It can therefore be hypothesized that all the components of the circulatory humoral system are participating in this reaction and that Type II, the cytotoxic, and Type III, the immune‐complex type of immunologic reaction, are the major contributors in the production of symptoms.
Primary hyperparathyroidism and laryngeal carcinoma: A cause of associated hypercalcemia
Authors: Haar J. G. , Boulos Ekram John
Published: October 2006

Two cases of laryngeal carcinoma are presented which, upon initial evaluation, were noted to have asymptomatic hypercalcemia with no evidence of bone metastases. Exploration of the parathyroid glands at the time of definitive surgery revealed parathyroid pathology in both cases. Calcium levels returned to normal postoperatively in both cases.

We conclude that in patients with head and neck cancer with hypercalcemia and no evidence of bone metastases, parathyroid pathology should be considered. Exploration of the parathyroid glands at the time of definitive surgery or as a separate procedure may prove rewarding.
Aerodigestive tract papillomatosis: Bacille calmette‐guérin (BCG) immunotherapy
Authors: Strauss Melvin , Conner George H. , Harvey Harold A. , White Deborah S.
Published: October 2006

Aerodigestive tract papillomatosis (ADTP) remains a distinct challenge for the otolaryngologist. None of the myriads of therapies utilized to date offers a distinctly improved prognosis with less frequent clinical recurrences or absolute cure rates. Significant complications are avoided by withholding tracheotomy whenever possible and avoiding overly aggressive papilloma removal. Laser technology seems to offer a distinct benefit as regards the latter. Despite much activity in this area, little new knowledge has actually influenced the outcome of patients afflicted with papillomatosis. The disorder remains one of long‐term morbidity in those acquiring it early in life and one with a significant rate of mortality for those with involvement of the lower airway.

A review and selected discussion of our experience at The Milton S. Hershey Medical Center of The Pennsylvania State University with ADTP from 1974 to 1981 is presented. Nineteen patients ranging in age at the time of presentation from 1.5 to 68 years old have been diagnosed and treated. For the most part, therapy consisted of repeated microendoscopies with forceps removal of papillomas until recurrences ceased. However, in four adult patients with either rapidly recurring laryngeal and/or tracheobronchial papillomas, bacille Calmette‐Guérin (BCG) immunotherapy has been administered. Two of these patients are evaluable for greater than 12 months. The rationale and efficacy of the treatment of a high risk group in this fashion are discussed.
Carotid rupture and tissue coverage
Authors: Hillerman Braxton L. , Kennedy Thomas L.
Published: October 2006

Carotid rupture following the treatment of head and neck malignancy is the most dreaded complication faced by the head and neck surgeon. Tissue coverage of the carotid artery has been advocated as the method of protection likely to prevent carotid rupture. A retrospective study was carried out to assess the benefit of carotid coverage and whether such protection plays a role in decreasing mortality and morbidity. A brief history of carotid protection is presented. A series of 194 head and neck cancer patients who underwent resection of their mucosal primary in continuity with radical neck dissection over a ten‐year period was reviewed. No coverage was used in 120 cases, while 72 cases received carotid coverage. There was a 13% fistula rate and a 15% rate of wound complication without fistula. Six patients without recurrence who had carotid rupture or ligation for imminent rupture were identified. This group was scrutinized with regard to several parameters. Three received tissue coverage of the carotid system, while the other three were left unprotected.

There was a 50% mortality rate and 25% rate of neurologic sequelae amongst the survivors. This review tends not to support the premise that tissue coverage is a major factor in the prevention of carotid rupture.
Intranasal antrostomy — causes of failure
Authors: Sogg Alan J.
Published: October 2006

A brief historical review of the intranasal antrostomy is followed by a list of possible causes of failure of the procedure. Definitions of various terms employed are given and a full description of the author's technique of making the antral window. Long‐term follow‐up of between 6 and 12 years has been possible in 87 patients. The various causes of recurrent problems in this group of patients are reported. Emphasis is placed on the desirability of informing the patient of the reasons for the antrostomy and explaining what can and cannot be expected from the procedure.
Management of mandibular fractures using biphasic pins and mandibular splints
Authors: Cooper Jeffrey , Rojer Charles L. , Rosenfeld Philip A.
Published: October 2006

Often the otolaryngologist is asked to manage the patient with facial trauma. Mandibular fractures make up 20 to 39% of all facial trauma cases, and thus necessitate a diversified and complete set of management tools. We have selected two seldom discussed modes of therapy for the complicated jaw fracture to present in this paper: 1. external fixation or Joe‐Morrison Hall biphasic pins, and 2. mandibular dental appliances — splints. The advantage of the biphasic pin apparatus is that the fracture can be repaired and stabilized at a point remote from the infected fracture site. The high risk patient, endentulous patient, and patients with fractures from gunshot wounds all prove to be more easily managed by using the external appliances.

The splint technique eliminates medial or lingual tip rotation and resultant postoperative malocclusion. Endentulous patients, pediatric patients, and those with multple facial trauma also benefit from this procedure.
Toxic shock syndrome: Otolaryngologic presentations
Authors: Tag Arnold R. , Mitchell Foy B. , Harell Moshe , Morrison Winsor V.
Published: October 2006

Toxic shock syndrome is a recently discovered and widely publicized disease found to occur in young menstruating women and thought to be associated with the use of vaginal tampons. To this date, there has been no known report of a similar disease being caused by nasal or sinus packing.

The following is a discussion of the toxic shock syndrome (TSS) and a presentation of two cases that demonstrated a striking similarity to that disease.
Ossicular chain reconstruction: The torp and porp in chronic ear disease.
Authors: Jackson C. Gary , GlasscockIii Michael E. , Schwaber Mitchell K. , Nissen Alan J. , Christiansen Sidney G. , Smith Peter G.
Published: October 2006

The traditional objectives of tympanoplasty are infection control, closure of the ear by grafting techniques, and hearing rehabilitation via ossicular reconstruction. The multiplicity of contemporary prostheses and surgical options available would seem to underscore the magnitude of the ossicular reconstruction problem in the difficult chronic ear relative to all else. The success of stapedectomy has led to great expectations for all problems of ossicular reconstruction. The circumstances of the chronic ear is a milieu hostile in comparison and precludes any such comparison.

Multiple sites of ossicular pathology, variations in mucosa health, inconsistent middle ear aeration and the overall complexity of the chronic ear present the otologist with a physiodynamic problem the solution of which is far from simplistic. The TORP and PORP have been enthusiastically endorsed in this regard, as a very suitable answer. Such enthusiasm, however, has been largely derived from data accumulated in the short term, often in less than a year's follow‐up.

This report reviews the authors' results in 141 patients in whom 86 TORPs and 55 PORPs were employed. For comparison, hearing data in 276 ears in which the fitted incus prosthesis, the authors' preferred reconstruction format, was used. Success for TORP reconstruction was assessed as air‐bone gap closure to within 30 dB and for PORP, to within 20 dB. This was accomplished in 85% and 49% respectively. Extrusion rate, overall, was 10%.

Relative advantages and disadvantages of the TORP and PORP are discussed and serve as a basis for the decision to continue to use this method of ossicular reconstruction. This data is put into perspective in acknowledging that the TORP and PORP are not the ultimate solution to this problem. When employed in combination with newer techniques in cartilage tympanoplasty, further improvement is expectant.
Intracranial complications of acute and chronic infectious ear disease: A problem still with us.
Authors: Gower David , McGuirt W. Frederick
Published: October 2006

Among 334,884 admissions to the North Carolina Baptist Hospital from 1963 through 1982, 100 patients had central nervous system (CNS) complications of middle ear disease. The complications occurred predominantly in young patients, 85 of the 100 being less than 20 years of age. Meningitis occurred in 76 patients; the acute form was more prevalent (63 cases). The less common nonmeningitic complications included brain abscess (n=6), effusion (n=5), lateral sinus thrombosis (n=5), otitic hydrocephalus (n=5), and empyema (n=3). Overall mortality was 10%. One patient with brain abscess died; 9 of the 76 patients with meningitis died (12%), with 4 of those deaths occurring among the 13 patients with chronic meningitis (31%). Because these complications have declined markedly since the advent of antibiotics, many contemporary otolaryngologists have been unexposed to these complications. However, as this series shows, they do still occur, their natural history remains the same, and the resulting mortality is still alarmingly high. A plea is made for otolaryngologists to maintain an awareness of these complications and to work with pediatricians and neurosurgeons for the best team care of patients with CNS complications of middle ear disease.
Mini‐craniotomy for management of csf otorrhea from tegmen defects.
Authors: Adkins W. Y. , Osguthorpe J. D.
Published: October 2006

CSF otorrhea arising from defects in the tegmen and middle fossa dura may be congenital or acquired. It may be spontaneous or secondary to trauma, chronic ear disease, tumor or surgical treatment. In the six cases presented, the tegmen defect and associated CSF leak were secondary to chronic ear disease in two cases, to mastoid surgery in two cases, to temporal bone fracture and congenital origin in one case each. The successful management of these patients utilizing a mini‐craniotomy in conjunction with mastoid surgery is described. Mini‐craniotomy facilitates precise extradural, intracranial placement of an autogenous graft over the tegmen defect which can be technically difficult in the transmastoid approaches, yet avoids the morbidity and potential complications of a full middle fossa craniotomy. It does not significantly add to the length of the mastoid procedure or its complications.
Tip suspension suture for superior tip rotation in rhinoplasty
Authors: Davidson Terence M. , Murakami Wilson T.
Published: October 2006

Superior tip rotation is sometimes necessary to relieve functional obstruction as well as improve the esthetic appearance in the aging nose and the thick skinned heavy tip nose. Conventional techniques including thinning resection, rim strip, lateral crural flap and even external skin excisions are often inadequate to obtain and maintain sufficient superior tip rotation. A technique is described to permanently suture the lower lateral crus to the upper lateral cartilages and to the cartilaginous septum. Long‐term follow‐up supports this technique's cosmetic and functional effectiveness.
Histological acoustic tumor involvement of the viith nerve and multicentric origin in the viiith nerve
Authors: Luetje Charles M. , Whittaker C. Keith , Callaway L. Alan , Veraga Gerardo
Published: October 2006

The surgical plane between the VIIth nerve and acoustic tumor is often elusive. This histological relationship was reviewed in three patients who underwent VII‐VII neuroanastomosis at tumor removal disclosing an inseparable surgical plane in two. In the third patient, tissue sections did not accurately show the relationship. In all three, surgical planes were not apparent at tumor removal.

Another patient had a second, isolated tumor in the same VIIIth nerve proximally at the brain stem root entry zone. This was seen only on permanent section.

In considering “total” tumor removal by microsurgical standards, these histological findings should be kept in mind. We advocate removal of the entire VIIIth nerve to the brain stem root entry zone along with smaller tumors.
Role of the tympanic ring in the pathogenesis of congenital cholesteatoma
Authors: Aimi Kenji
Published: October 2006

Topographic study of congenital cholesteatomas revealed that the majority of these congenital epidermal cysts occur near the tympanic isthmus of the middle ear. Since this is the junction of the first and second brachial arch, the origin of the cholesteatoma could be linked to the migration of the external canal ectoderm into the middle ear at the early stage of development.

Embryologic study showed that the tympanic ring plays an important role in limiting the medial extent of the external canal to the level of the tympanic annulus. Migration of the ectodermal tissue into the middle ear beyond the annulus is likely to be caused by the failure of this inhibitory function of the tympanic ring.

Microscopic sections of human fetuses were studied to determine the developmental relationships between the external canal ectoderm and the tympanic ring. A section from a 16 1/2‐week fetus showed significant papillary ectodermal tissue projection into the mesenchyme near the tympanic isthmus, while the tympanic ring was absent in that site.

Anatomical distance between the tympanic ring and the internal auditory canal is extremely short in these fetuses. This is suggestive of the source of petrous cholesteatomas from the canal ectodermal migration.

These observations form the basis of the author's theory that the pathogenesis of congenital cholesteatomas is caused by migration of external canal tissue into the tympanic isthmus or into the petrous bone as a result of developmental error in which the advancing external canal ectoderm failed to receive stop signal of the tympanic ring that contains the ectoderm at the annular plane.
Cervical vertebrae subluxation
Authors: Hopla Dan M. , Mazur John M. , Bass Richard M.
Published: October 2006

Rotary subluxation of the atlantoaxial joint is an uncommon complication of head and neck surgery and infections. Reported sequelae of this disorder range from torticollis to death from compression of the spinal cord. Two cases of C1‐C2 rotary subluxation will be discussed. These complications occurred following otitis media, repair of choanal atresia, and an adenoidectomy. The literature is reviewed.
Radiographic assessment of squamous cell carcinoma of the temporal bone
Authors: Olsen Kerry D. , Desanto Lawrence W. , Forbes Glenn S.
Published: October 2006

Squamous cell carcinoma of the temporal bone usually presents with tumor and edema occluding the external auditory canal. Accurate evaluation of the extent of such a tumor is therefore difficult. Assessment of these tumors and subsequent surgical management depends primarily on the preoperative radiographic findings. This paper discusses the evolution of the radiographic assessment of carcinomas of the ear canal. Certain cases have been selected to demonstrate the advantages and disadvantages of the radiographic studies in use. Mastoid x‐ray views and petrous tomograms have been the standard methods of studying these lesions. Their interpretation, however, often exaggerates or underestimates the true extent of these carcinomas. Early and later generation computed tomography (CT) scans offered improvement in determining tumor involvement but still did not give the needed detail for surgical planning. High‐resolution CT scanning of the petrous bones now offers the surgeon excellent views of these tumors. This paper places special emphasis on this technique and also discusses indications for operability.
The argon laser in surgery for chronic ear disease and otosclerosis
Authors: Mcgee T. Manford
Published: October 2006

The use of the argon laser in chronic ear disease and otosclerosis surgery is reviewed. Its advantages and limitations are discussed, and safe parameters for use established. The argon laser is an effective tool to remove, cut, and coagulate tissue. It was used in over 500 microsurgical otologic procedures without deleterious effects. One hundred primary laser stapedotomies were performed, and the audiological results were compared to those obtained using conventional small fenestra stapedectomy techniques. No significant statistical difference was present in the audiologic results after 1 year of observation. The clinical course of the laser stapedotomy patients suggested this technique was less traumatic than conventional techniques.
Neuropathology of spasmodic dysphonia
Authors: Schaefer Steven D.
Published: October 2006

Spasmodic dysphoria is a devastating voice disorder of unknown etiology, with a variable clinical presentation and response to treatment. Three independent evaluations of brain stem function were performed on spasmodic dysphonic patients, and age and sex‐matched controls. Statistically significant (p < 0.01˜0.05) differences were noted between these groups, and the findings were consistent with impairment of somatic and visceral brain stem pathways.

A significant correlation (p < 0.05) was found between the severity of tested central nervous system impairment and vocal tremor, number of associated neurologic signs and duration of illness. Possible etiologies (viral or traumatic), age, and sex, did not correlate with the severity of brain stem impairment. Clinical signs and the brain stem findings appeared to stabilize 3 to 5 years after onset of dysphonia. The investigation of other spasmodic cranial nerve disorders afforded insight into the etiology and therapy for spasmodic dysphonia. Drawing upon previous observations and the results of the brain stem tests, two models are proposed for neuronal processing in spasmodic dysphonia, and future strategies are discussed.

The evidence cited in this research project are consistent with spasmodic dysphonia being one of several spasmodic brain stem disorders with variable presentation which are known by the cranial nerve nuclei or pathways of major clinical involvement.
Self‐induced orbital emphysema as a presenting sign of munchausen's syndrome
Authors: Winans James M. , House Leland R. , Robinson Harrell E.
Published: October 2006

A bizarre case of severe, debilitating pneumo‐orbit resulting in proptosis, blindness, and eventual exenteration of the right eye and threatening the same fate for the left eye was worked up painstakingly for over 10 years before a final diagnosis of Munchausen's syndrome was uncovered. Five days after the diagnosis was made and appropriate management was instituted the severely proptotic left eye had returned to normal and the patient was discharged for out‐patient psychiatric follow‐up. A discussion of the differential diagnosis of pneumo‐orbit is presented and Munchausen's syndrome, the final diagnosis in this case, is discussed from both an historical and psychiatric perspective.
Halo external fixation of nasal fractures
Authors: Wurman Leonard H. , Sack J. Garry , Flannery John V.
Published: October 2006

The halo, long in medical use for cervical traction, subsequently has been adapted as a method of external fixation for severe facial fractures. We have recently used a light‐weight halo in four patients with severe mid‐facial fractures and crushed nasal skeletons. External traction proved to be superior to any method we have previously used to support the repositioned nasal bones. We strongly recommend external traction for severe nasal fractures in which other methods may not give a complete and stable bony reduction.
An igd extramedullary plasmacytoma involving the sphenoid sinus at onset: An immunohistochemical study
Authors: Humphrey David M. , Aufdemorte Thomas B. , Gates George A.
Published: October 2006

A 60‐year‐old man developed a left VIth‐nerve paralysis and underwent biopsy of an extramedullary plasmacytoma in the sphenoid sinus. Immunohistochemistry demonstrated cytoplasmic IgD and lamba determinants. Subsequent specimens from left clavical and thoracic epidural lesions also showed a plasma cell neoplasm with IgD and lamba determinants. No abnormal plasma cells were found in bone marrow specimens. Lambda Bence‐Jones protein and monoclonal IgD‐lambda protein in the serum were detected several months after onset. The patient died with disseminated plasmacytoma 1 year after diagnosis. The mode of presentation, pattern of metastasis, and secretory features were typical of extramedullary plasmacytoma arising in the upper airway. Immunohistochemistry was more productive than serum electrophoresis and immunoelectrophoresis for following the course of this neoplasm.
Anatomical characteristics of the anterior vestibular nerve of the bullfrog
Authors: Honrubia Vicente , Sitko Stefan , Kuruvilla Alexander , Lee Regina , Schwartz Ilsa R.
Published: October 2006

Study was made of the dimensions of the nerves to the receptor organs in the anterior branch of the bullfrog vestibular nerve. The number of fibers and their diameters and trajectories in the nerve and Scarpa's ganglion were studied. A correlation was made between the anatomical and physiological properties of neurons identified with intracellular injections of horseradish peroxidase. The data suggest a specific pattern of innervation of the organs, organization of fibers and cells in the vestibular nerve, and significant correlation between the anatomical and physiological properties of individual neurons. A comparison was made between the information obtained from the bullfrog and that from other animals, which suggests a similarity between species and supports the hypothesis of a differential physiological role of the neurons in each vestibular organ according to anatomical characteristics.
Otorhinological brain abscess therapy – past and present
Authors: Brand Benjamin , Caparosa Ralph J. , Lubic Lowell G.
Published: October 2006

In the past several years a concensus approach has been reached in diagnosis and therapy of brain abscess. The ease and accuracy of evaluation of intracranial lesions afforded by third generation computerized tomography scanners has lead to reliable, quick, nonsurgical diagnoses and monitoring which is relatively non‐invasive. The use of multiple agent, increased spectrum, antimicrobials has resulted in acceptable reduced morbidity and mortality. This has decreased the need for therapeutic surgical intervention.

The non‐surgical approach was preceded by several other modes of management which were acceptable in their time. During the past 21 years, 17 patients have been under the care of one or more of the above authors. A review of these cases is presented with instructive and informative histories. A knowledge of past therapeutic modalities and their attendant complications compared with present medical therapy assures an acceptance of the latter as the method of choice. A search of the general literature shows wide acceptance in other fields; however, no reference could be found in the recent otolaryngological literature to support a non‐surgical approach.
Pathology of thyroid cancer: Summary and update
Authors: Barney Philip L.
Published: October 2006

This brief presentation attempts to summarize the pathologic characteristics and the results of recent studies of the major thyroid malignancies. The clinical information now available, as well as advanced histologic and cytologic techniques, should provide a sound basis for diagnosis, management and further study of these neoplasms.
Temporomandibular joint surgery: Results of a 14‐year joint implant study
Authors: House Leland R. , Morgan Douglas H. , Hall William P. , Vamvas S. James
Published: October 2006

This paper analyzes the surgical techniques that are now used in treating organic temporomandibular joint (TMJ) disease. The authors attempt to evaluate the high condylectomy procedure which has been recommended by one group as the only surgical approach. In particular, the authors describe their experiences in using metallic and/or metal and plastic prosthetic devices for repairing damaged joints. The procedure used most frequently is a form of joint resurfacing, although total TMJ replacement is also described.

On January 9, 1978, 205 questionnaires were mailed to patients who had undergone TMJ implant surgery. The population surveyed, representing 314 TMJ procedures, were asked to make a subjective overall assessment of the surgical result, and to rate the improvement, elimination, or worsening of each of 22 surgical indications (whenever such indications were applicable to themselves). The survey was done by the Clinical Research Division of a major company in the orthopedic field. The authors did not see the results of the evaluation until they were computed and analyzed by this independent group.

The overall group assessment results were: Excellent — 41.7%; Good — 28.8%; Fair — 14.1%; and Poor — 15.3%. The 5 most common symptoms of patients who had surgery were a grating sound in the joint, partial inability to open the mouth, pain in the joint, clicking in the joint, and headaches.

A review of TMJ surgical procedures other than TMJ implants is also presented.
Cryotherapy for chronic vasomotor rhinitis: Technique and patient selection for improved results
Authors: Bumsted Robert M.
Published: October 2006

Current methods of therapy of chronic vasomotor (non‐allergic) rhinitis are frequently unsuccessful. This led to the development of a standardized technique of intranasal cryotherapy (longer freeze duration and larger area of therapy than previously reported) which was utilized in 50 patients. Indications for cryotherapy included: Failure of medical therapy in anatomically normal patients with mucosal disease caused only by vasomotor rhinitis. Minimal follow‐up was 2 years. Obstructive symptoms (subjective and objective evaluation) were eliminated in 92% and markedly improved in the remaining 8%. Excessive drainage (subjective) was relieved in 47%, markedly improved in 41%, and minimally improved (therapeutic failure) in 12%. Complications were minor; however, increased postoperative pain, drainage and healing duration (compared to prior series) were encountered. This cryotherapy technique provides significantly improved results in the treatment of vasomotor rhinitis when proper patient selection and technique are utilized.
Castleman's disease — The lymphoma impostor
Authors: Denenberg Steven , Levine Paul A.
Published: October 2006

The asymptomatic neck mass in the middle‐aged adult is not an uncommon clinical dilemma for the otolaryngologist‐head and neck surgeon. After a complete medical evaluation and panendoscopy with multiple “blind” biopsies, the patient usually comes to excisional biopsy, when the prior work‐up has not added any positive information. Most commonly, in this age group, the mass represents metastatic cancer from a head and neck primary, a carcinoma from a distant site, or a lymphoma. We present a case of Castleman's disease, a benign lymphoepithelial disease that can easily be mistaken for lymphoma.
Primary and secondary keratomas of the frontal sinus
Authors: Hopp Martin L. , Montgomery William W.
Published: October 2006

Keratomas in the paranasal sinuses have been described in the world literature with variable frequency and the inaccurate terminology of cholesteatoma. This paper describes an illustrative case and provides a discussion of the etiology and pathology of this disease. Because the pathologic findings are that of a true keratoma, classification of this disease as primary and secondary keratomas is recommended. The classification 1. primary keratoma is recommended for the epidermal cyst of congenital rest origin and 2. secondary keratoma is suggested for epithelial layers and cysts that are secondary to squamous cell implantation or migrations.
Subglottic hemangiomas in infants: Treatment with CO2 laser
Authors: Mizono Gary , Dedo Herbert H.
Published: October 2006

Subglottic hemangiomas in infants are rare but potentially lethal. Although the majority tend to regress after 12 to 18 months, lethal compromise of the airway is always possible until then, A plethora of treatments have been advocated for subglottic hemangiomas, each with significant morbidity. Eleven consectuve patients have undergone laser resection of subglottic hemangiomas at the University of California, San Francisco. Three infants have been managed without a tracheotomy. If a tracheotomy is required, earlier removal can be achieved with laser resection. No subglottic stenosis or hemorrhage has occurred following laser resection. CO2 laser resection is now the safest and most effective treatment available.
Sudden hearing loss: Eight years' experience and suggested prognostic table
Authors: Byl Frederick M.
Published: October 2006

The etiology, incidence, acute and late prognosis, and treatment of sudden hearing loss (SHL) are described variously in the literature. In an 8‐year prospective study of 225 SHL patients, initiated in July 1973, overall, normal, or complete recovery occurred in 45% of patients and late otologic complications in 28%. Important prognostic indicators were severity of initial hearing loss and vertigo, time to initial audiogram, and elevated erythrocyte sedimentation rate; other indicators were age >60 and <15 years, midfrequency audiogram configuration, and hearing status of the opposite ear. A common inflammatory cause is suggested for all degrees of severity in SHL, and a prognostic table is provided to aid the practitioner in predicting recovery. There is still no evidence that treatment achieves a result better than expected with spontaneous recovery.
Microscopic rhinoscopy in the treatment of inverted papillomas
Authors: Hoffman Sanford R. , Stinziano Gerald D. , Goodman Denise
Published: October 2006

Inverted papillomas are endophytic lesions arising from tissues in the nose and paranasal sinuses noted for their local destruction, propensity to recur, and tendency for malignant transformation. It has been well documented that complete removal is essential in the prevention of recurrence; however, use of the operating microscope to ensure this has not been widely described in the past. We present 4 patients, ages 36 to 56, for whom the operating microscope was used intra‐operatively and for follow‐up examinations. The patients have been followed for 1 to 5 years without any evidence of recurrence to date. We submit that the operating microscope is an extremely valuable tool for the surgical treatment of this lesion in light of the absolute necessity for its complete removal.
Steroid use in idiopathic sudden sensorineural hearing loss
Authors: Moskowitz Dan , Lee K. J. , Smith Howard W.
Published: October 2006

Few studies have investigated the effect of steroids on idiopathic sudden hearing loss (ISHL). Recently, Wilson, et al., reported a double blind study demonstrating a statistically significant improvement of hearing using steroids in ISHL. This report, fashioned after the Wilson study, confirms his findings and analyzes the relationship of several factors to the probability of hearing recovery.
Identification of subsets of lymphocytes infiltrating head and neck tumor tissue: A preliminary report
Authors: Rabin Bruce S. , Johnson Jonas , Claassen Diana
Published: October 2006

Monoclonal antibodies reactive to distinct subclasses of lymphocytes were used to identify lymphocytes infiltrating tissue obtained from patients with squamous cell carcinoma of the head and neck. The majority of lymphocytes present were T‐cells with very few B‐lymphocytes and natural killer cells present. A variety of patterns of infiltration and relationship of T‐helper to T‐suppressor lymphocytes was noted. Long‐term follow‐up studies will be required to determine the clinical significance of infiltration by different T‐lymphocyte subclasses.
The clinical significance of radionuclide bone and gallium scanning in osteomyelitis of the head and neck
Authors: Noyek Arnold M. , Kirsh Joel C. , Wortzman George , Freeman Jeremy L. , Greyson N. David , Jazrawy Helen , Blair Robin L. , Chapnik Jerry S.
Published: October 2006

Osteomyelitis of the head and neck remains a difficult clinical problem both in diagnosis and treatment evaluation. The purpose of this manuscript is to review our clinical experience with 25 cases of osteomyelitis distributed evenly among the temporal bone and skull base, the paranasal sinuses, and the mandible. Radionuclide bone and gallium scan images accurately depicted the biologic activity of the disease process and permitted accurate treatment evaluation and patient monitoring. This work demonstrates the potentials and limitations of radionuclide imaging with bone and gallium scan agents and attempts to define a role for their contemporary use in the management of osteomyelitis of the head and neck.
Past, present, and future applications of the auditory middle latency response
Authors: Musiek Frank E. , Geurkink Nathan A. , Weider Dudley J. , Donnelly Karen
Published: October 2006

For many years (auditory) middle latency response (MLR) reportedly has been an excellent electrophysiological procedure for estimating frequency specific auditory thresholds. Currently the 40 Hz potential, a derivative of the MLR, holds even greater promise for threshold testing. MLR also appears to have potentially valuable applications in the evaluation of functional hearing loss and assessment of higher auditory function. However, MLR is not without controversy. Questions of origin, filtering effects, and its use in pediatric assessment are current issues surrounding applications of MLR. The following article analyzes the values and limitations of MLR within the framework of past, present, and future research and clinical uses.
Repair of mandibular fractures via compression plating and more traditional techniques: A comparison of results
Authors: Kellman Robert M.
Published: October 2006

To evaluate the results of compression plating in the repair of mandibular fractures, a retrospective analysis of mandibular fractures repaired at Upstate Medical Center in the past 3 years was performed. Only patients treated as inpatients were included. A total of 68 cases were reviewed, and follow‐up data were available in 59. Of these, 18 had been repaired using A‐O compression plating techniques, and the remaining 41 were treated using interosseous wiring, intermaxillary fixation, external fixation, soft diet, or any combination of these. Nonunion and malocclusion were considered major complications, while all other complications were considered minor. Using these criteria, there were no major complications in fractures treated with compression plates, and there were 6 minor complications in 4 patients (22% of patients). Using the more traditional techniques, there were 13 major complications, 6 malocclusions and 7 nonunions, or an incidence of 32%, and 5 minor complications in 4 patients (10% of patients). These findings suggest that compression plating is a useful and highly effective technique for repair of mandibular fractures. The technique generally obviates intermaxillary fixation and dental splints, particularly in the edentulous patient. The main disadvantage is the need for 2 open procedures.
Surgical treatment of pyriform sinus cancer: A retrospective study
Authors: Yates Alan , Crumley Roger L.
Published: October 2006

Patients with squamous cell carcinoma of the pyriform sinus treated surgically from 1959 through 1979 at the University of California, San Francisco were reviewed. As several reports had previously suggested that the addition of radiation therapy, preoperatively or postoperatively, did not increase survival, our data collection and analysis was performed in such a way as to determine whether similar trends were present in our patients. Data were tabulated for patients having:1. surgery alone (SA);2. preoperative radiation and surgery (RS); and3. surgery and postoperative radiation (SR).

The surgery alone group demonstrated the best results, with 65% 3‐year determinant survival, and 56% 5‐year survival, compared to 50% 3‐year and 33% 5‐year survivals in the combined groups. In this patient population, the increased death rate in the combined therapy group appeared to be due primarily to a higher distant metastasis rate (50%vs.26% for the surgery alone group).

Although our numbers are too small for any of the comparisons to be significant, the findings of similar cure rates of pyriform sinus cancers by surgery alone support similar data from other authors. As staging was similar in the two groups, and none of the other variables examined appeared to explain these results, we could only conclude that further data is needed, and that the exact role of radiation therapy, in combination with surgery for pyriform sinus cancer remains to be defined.
Ventilation during laryngoscopy in chronic obstructive lung disease
Authors: Fredrickson John M. , Haight James S. , Soder Christian M.
Published: October 2006

Many patients requiring direct examination of the upper airway and gastrointestinal tract under general anesthesia have chronic obstructive lung disease, yet virtually no work has been done to assess the adequacy of their ventilation during laryngoscopy and in the early postoperative period.

This study demonstrates that, using the Carden tube, their blood gases are well maintained even when areas outside the endolarynx, such as the upper esophagus, are examined. The Carden tube is shown to be easy to insert and remove as well as permitting a superior view of the larynx. Also, this study pinpoints the period of maximum danger of respiratory failure as occurring postoperatively in the recovery room. This should be independent of the method of ventilation employed at surgery and indicates the need for cocainization of the vocal cords before extubation, as well as careful, early postoperative monitoring.

The problems of ventilation during direct examination of the upper airway and gastrointestinal tract are discussed and alternative methods evaluated.
Adenoid cystic carcinoma of the head and neck: A clinical study of 37 cases
Authors: Dalmaso M. , Llppi L.
Published: October 2006

Thirty‐seven cases of adenoid cystic carcinoma treated at the Otolaryngologic Clinic of the University of Florence between 1962 and 1979 were studied. The patients were treated with radical surgical excision (20), non‐radical surgery associated with radiotherapy (13), or with palliative treatment (4).

The aim of this study is to evaluate the course of the disease according to the site and type of operation. Our results show that nonradical surgical treatment associated with radiotherapy seems to give results comparable to those obtained with radical surgery alone.
Voice quality following laryngeal reinnervation by ansa hypoglossi transfer
Authors: Crumley Roger L. , Izdebski Krzysztof
Published: October 2006

Recurrent laryngeal nerve injury resulting in chronic unilateral vocal fold paralysis has been treated traditionally by implantation of various materials into the paralyzed vocal fold. Although the usage of these techniques, especially Teflon®‐glycerin paste injection, has been clinically established, they do not restore full functionality to the larynx (abduction, adduction, and vibratory synchronization of the vocal folds). Restoration of these functions, necessary for improved phonation, has been achieved at least on an experimental basis by reinnervation techniques previously described.

This study demonstrates excellent human voice quality following reinnervation of the vocal folds in two cases using ansn hypoglossi‐recurrent laryngeal nerve anastomosis. Although the reinnervated vocal fold neither abducted nor adducted, it presented itself in the midline for precise apposition with the nonparalyzed cord. Voice data were analyzed within a single subject experimental design at the following intervals: preoperatively, immediately postoperatively, midterm, and long‐term (3 and 6 years). The data was analyzed by subjective and objective means, including acoustics and electroglottography. Patient selection, surgical techniques, results, and implications are reviewed.
Spontaneous csf otorrhea from tegmen and posterior fossa defects
Authors: Ferguson Berrylin J. , Wilkins Robert H. , Hudson William , Farmer Joseph
Published: October 2006

Spontaneous cerebrospinal otorrhea (SCSFO) from tegmen or posterior fossa defects is uncommon. Twenty‐nine cases have been detailed in the literature to date. We report an additional four cases from three patients. This group of 33 cases of SCSFO from tegmen or posterior fossa defects is characterized by certain clinical features. These patients are usually older adults (mean age 48 years, range 8 months to 80 years). Aural fullness with a serous appearing middle ear effusion, or clear otorrhea, often subsequent to tube myringotomy, are the usual initial symptoms. Meningitis was the initial manifestation in eight patients (24%), and ultimately occurred in an additional four patients (12%).

The pathophysiologic basis for SCSFO from tegmen defects is discussed. Methods for diagnosing and treating CSF otorrhea from tegmen defects are reviewed.
Treatment of secretory otitis and pneumatization
Authors: Stangerup Sven‐Eric , Tos Mirko
Published: October 2006

In 33 children, median age 4 years, with bilateral secretory otitis, adenoidectomy was performed, a grommet was inserted in the right ear, and paracentesis was done on the left side. Seven years postoperatively x‐rays were taken of the children's mastoid cell systems and these were measured by planimetry. A significantly larger cell system was found on the side with grommets, which is considered to support the environmental theory of pneumatization.
Amelioration of Cisplatin‐Induced ototoxicity by fosfomycin
Authors: Schweitzer Vanessa G. , Dolan David F. , Davidson Thomas , Abrams Gerald E. , Bs Ronald Snyder
Published: October 2006

The continued chemotherapeutic application of cisplatin (cis‐diamminedichloroplatinum [II]) necessitates reduction of its doselimiting toxicity without decreasing its tumoricidal effect. This research project evaluated the efficacy of fosfomycin, a phosphonic acid antibiotic, in decreasing or ameliorating the ototoxicity (high frequency sensorineural hearing loss) and nephrotoxicity (renal tubular necrosis and interstitial nephritis) of cisplatin. Experimentally, fosfomycin effectively inhibits aminoglycoside‐induced ototoxicity and nephrotoxicity in animals and humans. The efficacy of fosfomycin in blocking platinum‐induced toxicity in the guinea pig was evaluated histologically and functionally using cytocochleography and light microscopy of the organ of Corti and the auditory brain stem evoked response (ABR), and light microscopy of renal corticomedullary tissues, small bowel, liver, lung, and peripheral nerve. The results demonstrate that fosfomycin ameliorates the acute renal tubular necrosis and interstitial nephritis and markedly inhibits the elevation of ABR thresholds and simultaneous outer hair cell loss that can result from cisplatinum administration. Fosfomycin should be considered apotential antidote for the dose‐limiting ototoxicity and nephrotoxicity of cisplatin chemotherapy.
Vestibular morphological analysis of the effects of cisplatin VS. platinum analogs, CBDCA (JM‐8)
Authors: Schweitzer Vanessa G. , Rarey Kyle E. , Abrams Gerald E. , Dolan David F. , Sheridan Christine
Published: October 2006

Synthetic second generation chemotherapeutic platinum analogs are presently being tested to identify an analog with greater antitumor activity, but less ototoxicity and nephrotoxicity than cisplatin. The objective of this study was to analyze potential vestibular effects of cisplatin and of the two platinum analogs, CBDCA (cis‐diammine 1,1‐cyclobutane dicarboxylato [2]‐0,0 platinum or JM‐8) and CHIP (cis‐dichlorotransdihydroxybisisopropylamine platinum [IV] or JM‐9) using scanning and transmission electron microscopy of vestibular neuroepithelium from the albino guinea pig. Vestibular neuroepithelial damage was not demonstrated in either cisplatin‐ or the analog‐treated animals when administered at equitoxic doses.