bluuebunny/crossref_metadata_2025 huggingface dataset:
Mastoid and Middle Ear Cavity Obliteration for Control of Otitis Media
Authors: Gacek Richard R.
Published: October 2014

Total soft tissue obliteration of the mastoid-middle ear cavity and primary closure of the external auditory meatus were employed in six patients to control chronic suppurative otitis media. Previously, all these patients had unsuccessful surgery and all but one had profound loss of cochlear function. Thorough removal of cholesteatoma, granulation tissue, and ear canal skin is necessary before total obliteration can be performed safely. Wound healing was complete by one to two weeks postoperatively and all patients have been asymptomatic for two to seven years.
Tissue Culture of Human Adult Adenoids and of Middle Ear Mucosa
Authors: Drucker Ilana , Weisman Ziva , Sadé Jacob
Published: October 2014

The increased number of mucus producing cells as well as the presence of stratified squamous epithelium in pathological and experimental middle ear conditions, point towards the possibility of metaplastic changes of the middle ear mucosa, similar to the metaplastic capabilities of respiratory mucosae in general, as observed clinically or provoked experimentally. The purpose of this study was to develop a model of postembryonic human respiratory mucosae, in vitro, for the study of triggering or inducing factors involved in its normal and metaplastic differentiation. Explants from adenoids and middle ear mucosa were cultured, both as organ cultures and monolayers, for periods of up to two weeks, and their developmental characteristics were studied and described. Over 50% of the explants showed mitosis, epithelial and monolayer growth, ciliary activity and differentiation into ciliated and into mucus-producing cells. Adenoid explants were grown in air without and with added 5% CO2. Under the latter conditions, the proportion of explants and monolayers showing ciliary activity was 50% greater. It is concluded that this model might be suitable for further studies of the factors which control cyto-differentiation in mucociliary epithelia. Maintaining its growth for a longer period would, however, be desirable.
Electrically Evoked Taste Threshold
Authors: Føns Mogens
Published: October 2014

How accurately can the electrically evoked taste threshold be determined? Why have standards of normal values not yet been generally accepted? In order to answer these questions, 80 normal subjects were examined by means of the method of adjustment. The results showed a greater variability of threshold values and side differences than found by other authors. In explanation, it is suggested that the method of adjustment minimizes the biasing effect of the examiner, which normally leads to an underestimation of the threshold variability as well as of the side differences. The method of adjustment is therefore suitable for certain experimental purposes. For clinical use, a simple procedure like Krarups should be preferred. Due to its limited validity, however, only side differences of 100% or more should be considered pathological. A log-scale with rather large units (25% increment steps) is recommended.
Vocal Shimmer in Sustained Phonation of Normal and Pathologic Voice
Authors: Kitajima Kazutomo , Gould Wilbur J.
Published: October 2014

Vocal shimmer during sustained phonation was measured in normal subjects and patients with laryngeal polyps, using the mean amplitude difference between consecutive cycles expressed in dB. A small laboratory computer was then used for measuring each discrete amplitude and for data processing. The results showed some overlap between the values for two groups studied, but nevertheless it appears that the measured value may be a useful index in screening for laryngeal disorders and for definitive diagnosis of such disorders.
Initiation of Reflex Glottic Closure
Authors: Suzuki Masafumi , Sasaki Clarence T.
Published: October 2014

Review of the literature reveals scant information regarding the initiation of reflex glottic closure. Using the adult cat as our experimental model, we have attempted to analyze both the ipsilateral and crossed laryngeal adductor responses involved in reflex closure of the glottis. These ipsilateral and crossed reflexes are particularly well developed in the cat allowing their study with relative ease. From multifiber and single unit recurrent laryngeal nerve preparations, detailed descriptions of both peripheral and central neural organizations of these reflexes may be obtained. These data further elucidate the mechanism for initial incoordination of the glottic closure reflex, resulting from weak stimulus applied simultaneously to both superior laryngeal nerves, or from unilateral superior laryngeal denervation due to surgical trauma, metabolic neuropathy, or direct tumor involvement.
Microbiology of the Canine Nasal Cavities
Authors: Abramson Allan L. , D'Amato Richard F. , Isenberg Henry D. , Pryor William H.
Published: October 2014

The microbiota of both nasal cavities were investigated in 37 dogs by both aerobic and anaerobic techniques. The predominant microorganisms were composed of enterococci and staphylococci. A surprisingly high incidence (46%) of Gram-negative rods was noted from the inferior portion of the nose. Microorganisms from the superior region of the nose, as obtained with a surgical approach, differed both qualitatively and quantitatively from the respective transnasal cultures. Thus, it appears that different bacterial populations are present within various anatomic regions of the nose and a routine transnasal culture cannot accurately reflect the microbiology of the entire nasal cavity.
Unusual Presentation of a Large Leiomyoma of the Esophagus
Authors: Arena Sebastian
Published: October 2014

A case is presented with a giant pedunculated leiomyoma of the esophagus. The difficulties of diagnosis are presented along with a review of the literature. Surgical removal is safe and curative.
Epidermoid Carcinoma Arising from within an Epidermoid Inclusion Cyst
Authors: Davidson Terence M. , Bone Robert C. , Kiessling Peter J.
Published: October 2014

The unusual occurrence of epidermoid carcinoma within an inclusion cyst arising on the forehead of a patient is documented. The importance of any irregular change or clinically abnormal behavior in such a lesion is underscored and the necessity for routine histological examination of all tissue excised is reaffirmed.
Etiology of Bilateral Abductor Vocal Cord Paralysis
Authors: Holinger Lauren D. , Holinger Paul C. , Holinger Paul H.
Published: October 2014

The etiology of 389 cases of partial or complete bilateral abductor vocal cord paralysis has been determined and classified. One hundred and forty-nine were infants and children 12 years of age and under; 240 were adults, age 13 and older. In the infants and children the paralyses were congenital in 82 cases, of which 43 were associated with other congenital anomalies, and 39 were without associated anomalies. Fifty-nine cases were considered acquired, most being secondary to underlying congenital anomalies, particularly the associated findings of meningomyelocele, Arnold-Chiari malformation, and hydrocephalus. Eight cases of paralysis in this age group were of undetermined etiology. Of the 240 adult cases of bilateral vocal cord paralysis, 138 followed thyroidectomy. Fifty-two cases were associated with various neurologic disorders, including poliomyelitis, Parkinson's disease, cerebrovascular accident, Guillain-Barré syndrome, multiple sclerosis, neoplasm, and other miscellaneous neurologic conditions. Sixteen cases were due to malignant neoplasms of the neck and mediastinum. The remaining 34 cases constitute a miscellaneous group which includes foreign bodies, bilateral neck dissection, infection, congenital lesions, trauma, and idiopathic paralyses. The characteristic symptoms of bilateral abductor vocal cord paralysis include normal or near normal phonation with inspiratory stridor which may progress to complete respiratory obstruction. These symptoms are due to the stationary but flaccid midline position of the vocal cords which places them in a phonating position, where they both obstruct the airway and produce a fairly clear voice or cry. This paradoxical combination of symptoms was frequently found to be responsible for a failure or delay in diagnosis.
Fiber Components of the Recurrent Laryngeal Nerve in the Cat
Authors: Gacek Richard R. , Lyon Michael J.
Published: October 2014

Experimental neuroanatomical methods were employed in 21 adult cats to determine 1) the number and size of myelinated motor and sensory fibers in the recurrent laryngeal nerve (RLN), and 2) the fiber components originating in the nucleus ambiguus (NA) and retrofacial nucleus (RFN) of the brain stem. Intracranial transection of the X and XI cranial nerves and selective destruction of the NA or RFN were the experimental lesions inflicted in order to obtain the following results. About 55% (312) of the right RLN (565 fibers) is composed of myelinated motor nerve fibers which measure 4 μ − 9 μ in diameter. Nine percent come from the RFN and are smaller (4–6 μ) than the 46% which emanate from the NA and measure 6–9 μ in diameter. The remaining 45% of the RLN is made up of sensory neurons which can be divided into three groups. 1)The largest numerical group (32%) is very small in caliber (1–3 μ) and supplies extralaryngeal regions (trachea, esophagus). 2) The intermediate size fiber group (4–9 μ) comprises 11% of the RLN and probably supplies the subglottic mucosa. 3) The smallest group (2%) of sensory fibers is the largest in diameter (10–15 μ) and may represent either the innervation of muscle spindles or afferents from the superior laryngeal nerve coursing down into the chest.
Mucus Gland Tumors of the Larynx and Laryngopharynx
Authors: Spiro Ronald H. , Lewis John S. , Hajdu Steven I. , Strong Elliot W.
Published: October 2014

During the 30–year period from 1939 through 1968, 20 patients were seen who had “minor salivary” tumors arising in the mucus glands of the larynx or laryngopharynx. This group comprised about 3% of more than 600 patients with mucus gland tumors of the upper aerodigestive tract treated at Memorial Sloan-Kettering Cancer Center during the same interval. In each instance the tumor was malignant, and all but three of these patients were men. Location and histology of these uncommon tumors is described. Only 2 of 18 treated cases were “cured.” Uncontrolled cervical lymph node involvement or distant metastasis was more often the reason for treatment failure, rather than local recurrence at the primary site.
Laryngeal Suspension and Epiglottic Flap in Laryngopharyngeal Trauma
Authors: Olson Nels R.
Published: October 2014

Physicians treating laryngeal trauma are still looking for ways to improve results. Severe disruption of the supporting structures between hyoid and trachea may allow stretching and narrowing of the laryngeal lumen during the healing period. This can easily be prevented by placing wires across the disrupted zone. In addition, loss of the epithelial lining of the larynx is a serious cause of stenosis. By dissecting out the epiglottic cartilage, one can create a sizeable, useful flap of mucous membrane based in the vallecula to use in relining of the anterior larynx.
Acquired and Congenital Subglottic Stenosis in the Infant
Authors: Parkin James L. , Stevens Michael H. , Jung August L.
Published: October 2014

During the calendar year of 1974, the Intermountain Newborn Intensive Care Center at the University of Utah Medical Center had 603 admissions. A representative group of 293 charts were reviewed which indicated that 44% of these children were intubated from hours to weeks. The overall mortality rate for the 293 children was 29%. Eighteen of the 603 children were diagnosed as having subglottic stenosis. Fifteen of these children appeared to have acquired subglottic stenosis secondary to endotracheal intubation. Three children had congenital subglottic stenosis. Tracheostomy was necessary in the management of 15 patients. Ten of the 18 patients have survived and two of these patients still have tracheostomy tubes in place. The survival and thickness of the stenotic area are inversely proportional to the birth weight and the duration of intubation. Endoscopic excision, dilatation and stenting were techniques utilized in the treatment of these stenotic lesions. The extubation technique utilized is described. The factors involved in the production of acquired subglottic stenosis are presented along with suggestions to decrease the incidence of this problem in the intubated child.
Educational Training in Endoscopy
Authors: Rayl John E.
Published: October 2014

An educational training need has developed as a result of the recent rapidly increasing acquisition of endoscopes. This acquisition has been occurring at a rate faster than training programs can acquaint physicians with their use. A Veterans Administration (VA) feasibility study has determined that color television-endoscopy can provide the type of instructional materials that could be used to assist a larger number of physicians in acquiring skills in endoscopy. Since the budget requirements for television-endoscopy are substantial, it seemed expedient for the VA to establish a Center for Endoscopic Programs (VACEP). The purpose of this Center is to prepare instructional materials that will enhance educational training in endoscopy. We believe that the provision of self-instructional and teaching supplement types of audiovisual materials are essential to the accomplishment of VACEP's educational objectives. Our society today is video oriented, and we believe very strongly in the value of the television medium as an educational adjunct in teaching endoscopy.
Flexible Fiberoptic Nasopharyngolaryngoscope
Authors: Silberman Harvey D. , Wilf Harold , Tucker John A.
Published: October 2014

A new practical flexible fiberoptic nasopharyngolaryngoscope is introduced. This instrument allows for a completeness of examination heretofore not totally possible in all cases as an office or bedside procedure. The ease of examination and patient tolerance make for a superior new clinical tool.
Transbronchoscopic Cryosurgery of Respiratory Structures: Experimental and Clinical Studies
Authors: Gorenstein Aryeh , Neel H. Bryan , Sanderson David R.
Published: October 2014

Although resection is the only treatment proven effective for localized malignant tumors in the tracheobronchial tree, alternative methods for cure or control of unresectable or recurrent tumor should be explored. In 24 dogs, cryonecrosis of sizable portions of carina, main stem bronchi, first division bronchi, and lung parenchyma was well tolerated, and the necrosis was localized, reproducible, and followed by prompt healing of frozen tissue. The gross architecture of the bronchi was not permanently altered, and no strictures formed. Six patients with endobronchial tumors were treated transbronchoscopically with cryosurgery. All patients tolerated the procedures well, and there were no complications. Palliation was achieved in five of the six patients.
Physiological Basis of Cochlear Transduction and Sensitivity
Authors: Honrubia Vicente , Strelioff David , Sitko Stephan T.
Published: October 2014

Experiments were conducted in the guinea pig cochlea and the Xenopus laevis lateral line organ to obtain information about the electrical impedance properties of the cochlea, the sources and characteristics of the cochlear potentials, and to determine if hair cells are electrically excitable. The significance of the resting and evoked cochlear potentials in the transduction process leading to excitation of the acoustic nerve fibers was evaluated by comparing the results of electrophysiological experiments with the prediction of a model of the cochlea designed after the mechanoelectric theory of hair cell function. The results of these experiments 1) were compatible with the prediction of the mechoelectric theory of cochlear function; 2) made it possible to estimate and compare the energy dissipated in generating and maintaining the cochlear potentials with the stores of biochemical energy available in the cochlea; and 3) showed that the hair cells are electrically excitable, from which it was concluded that interaction between the hair cells is feasible.
Degeneration Patterns in Human Ears Exposed to Noise
Authors: Johnsson Lars-Göran , Hawkins Joseph E.
Published: October 2014

Various forms of sensorineural degeneration patterns related to noise exposure are illustrated in six pairs of temporal bones selected from a group of 33 male patients with histories of noise exposure. For the entire group the commonest form of lesion, associated with a 4-kHz dip in the audiogram, was a relatively diffuse degeneration in the second quadrant of the basal turn, in the 9–13 mm area. An advanced form of this lesion had a wide gap of more or less complete sensorineural degeneration affecting the entire second quadrant and displaying various degrees of extension toward the apex and base. The pattern associated with an “abrupt high-tone loss,” with more or less complete hair cell and nerve degeneration in both the second and first quadrants and extending to the basal end of the cochlea, was rare. In one case this pattern appeared to have evolved from the first type of lesion as the remaining nerve fibers in the first quadrant had degenerated. The protective effect of the acoustic shadow of the head for the right ear, in shooting from the right shoulder, is demonstrated for the higher frequencies. Two almost identical cases of sharply-circumscribed single areas of degeneration in the first quadrant and one case with two such areas represent the third type of lesion. In one of these cases there was a history of firearm usage. It is postulated that this type of lesion is caused by impulse noise. In most of the material the degeneration pattern differed markedly from the diffuse degeneration seen with presbycusis. Degeneration patterns with knife-sharp transitions between completely degenerated and apparently undamaged areas appear to be characteristic of noise-induced injuries.
Sodium Loading of Inner Ear Fluids
Authors: Silverstein Herbert , Takeda Tiero
Published: October 2014

A slow intracarotid infusion of hypertonic sodium chloride solution, 350 mEq/L, and potassium chloride, 5 mEq/L, was used to increase serum sodium chloride over a 90-minute period in 85 cats. A slow, steady rise in serum sodium occurred, which reached almost 208 mEq/L at the end of 90 minutes. A concomitant rise in sodium occurred in the cerebrospinal fluid and perilymph. In contrast, the sodium showed only a transient slight increase in the cochlear and vestibular endolymph. Endolymph potassium appeared to rise in order to balance out the increase in sodium concentration of the surrounding and extracellular fluids. The ratio of sodium to potassium ions in both the endolymph and perilymph compartment remained relatively constant before and after the infusion with hypertonic NaCl. After infusion, the total concentration of ions in endolymph was similar to that of perilymph. These experiments indicate that the endolymph compartment has a built-in mechanism for maintaining a low-sodium concentration while keeping ionic balance with the surrounding perilymph and serum.
Masking Level Differences for Cochlear and Brain Stem Lesions
Authors: Olsen Wayne O. , Noffsinger Douglas
Published: October 2014

Masking level differences (MLD) for 500 Hz pure tones and for spondees were obtained from 48 subjects. Twelve were without otologic or neurologic complaints (normal), 12 had high frequency, noise-induced hearing losses, 12 were diagnosed otologically as having Ménière's disorder, and 12 had neurologically diagnosed central nervous system (CNS) disorders. Results indicated that high frequency, noise-induced hearing losses do not affect MLD for 500 Hz stimuli, but do diminish the size of MLD for speech. Masking level differences for both 500 Hz and spondees were decreased for the Ménière's disorder group. The group of patients having CNS disorders attributed to multiple sclerosis, to inflammatory lesion of the pons, to degenerative processes of the cerebellum and adjacent nervous tissue, or to brain stem cerebrovascular accident had normal hearing according to conventional pure tone and speech testing, but attained smaller than normal MLD for 500 Hz and spondees. These findings agree closely with results obtained in an earlier study and continue to suggest that, given normal peripheral auditory function, MLD tests may have unique value in detection of subtle lesions of the central auditory nervous system.
New Developments in Evaluating Central Auditory Mechanisms
Authors: Berlin Charles I.
Published: October 2014

Five tests are reviewed for their ability to assist in the evaluation of the central auditory mechanism. These are: 1) the Masking Level Difference (MLD); 2) ipsilaterally and contralaterally evoked stapedius muscle reflex; 3) electrocochleography; 4) early brain stem responses; and 5) dichotic listening. A summary chart outlining the tests most commonly in use and their areas of special productivity is also presented.
Sensorineural Hearing Loss in Chronic Ear Surgery
Authors: Smyth G. D. L.
Published: October 2014

The author's series of 3000 consecutive operations of tympanoplasty from 1960 to 1975 were reviewed in regard to the occurrence of sensorineural hearing loss as a consequence of the surgical procedure. Worsening of bone conduction thresholds by 10 dB through the frequencies 500 to 4000 cps, or a 10% reduction in speech discrimination scores were considered significant. Whereas in transcanal tympanoplasty the incidence of cochlear damage was greater in ears when initially the ossicular chain was incomplete, by contrast in combined approach tympanoplasty the risk was greater when the chain was intact initially. It was concluded that cochlear trauma was usually due to 1) the hydraulic effect of excessive stapes manipulation during the removal of disease, and 2) the development of a perilymph fistula. The unpredictable predisposing threat of cochlear fragility due to genetic and inflammatory factors was emphasized and the poor results of tympanoplasty in tympanosclerosis were underlined. The current methods of treating sensorineural hearing loss after tympanoplasty were enumerated and discussed. It was concluded that although those aimed at improving labyrinthine circulation had theoretical backing, there is as yet little experimental or clinical evidence to support the claims of their protagonists.
Labyrinthitis Ossificans
Authors: Suga Fumiro , Lindsay J. R.
Published: October 2014

Three cases with postinflammatory inner ear sequelae are presented to illustrate unusual histopathologic changes. Endolymphatic hydrops without change in the perilymphatic system was present in one ear following “influenza” meningitis and labyrinthitis ossificans in the contralateral ear. The characteristic histopathological changes of the temporal bones with hematogenic bacterial infection were an extensive labyrinthine ossification associated with a generalized sclerotic change of the whole periotic bone. Bony fixation of the stapedial footplate occurred with the generalized inflammatory process of the otic capsule. Severe and diffuse labyrinthitis ossificans occurred in one case due to tympanogenic inflammation spreading through the round window membrane in the course of suppurative otitis media. A general immunosuppression leading to fatal termination was the apparent factor predisposing to the inner ear complication.
Hemifacial Spasm Associated with Benign Parotid Tumor
Authors: Nussbaum Moses
Published: October 2014

A case of hemifacial spasm associated with a benign parotid tumor is reported. Excision of the tumor relieved the symptoms.
Posturally — Evoked Vomiting; Association with Posterior Fossa Lesions
Authors: Drachman David A. , Diamond Ellis R. , Hart Cecil W.
Published: October 2014

Posturally-evoked vomiting (PEV) dissociated from vertigo was present in two patients with proven posterior fossa mass lesions. In both instances PEV was a major aspect of the patients' symptomatology before other findings clearly indicated the presence of an infratentorial mass lesion. A distinction is drawn between benign postural vertigo, which almost always indicates a benign disorder of the peripheral vestibular apparatus, and PEV which indicates a central lesion within the posterior fossa. A possible anatomic-physiologic basis is offered for PEV, based on the dissociation of the “vestibular syndrome,” in which PEV increases while vertigo and nystagmus diminish.
Laryngeal Spasm: A Neurophysiologic Redefinition
Authors: Suzuki Masafumi , Sasaki Clarence T.
Published: October 2014

Within the limits of standard neurophysiologic techniques, we have attempted to redefine laryngeal spasm as distinct from the glottic closure reflex. This distinction is based upon the observation that laryngeal spasm is solely mediated by the superior laryngeal nerve. Stimulation of other afferent nerves, capable of eliciting the glottic closure reflex, produces little adductor after-discharge activity that is characteristic of laryngeal spasm. In this regard, modification of output function from the adductor motoneuron aggregate by means of temporal and spatial summation of sensory input data has been described, and its characteristics further defined in response to varying ventilatory states and barbiturate levels.
Ototoxic Interactions of Ethacrynic Acid and Streptomycin
Authors: Mathog Robert H. , Capps Mary Jayne
Published: October 2014

Various aminoglycoside antibiotics and potent diuretics are known to depress cochlear and vestibular function. Several clinical and research studies suggest that the drugs administered together produce enhanced ototoxicity. The present series of experiments determines the depressive effects of ethacrynic acid and streptomycin, alone or in combination, upon the vestibular system of the cat. The changes in function, when quantified, indicate an addition, rather than a potentiation of toxicity, and suggest different sites of action.
Effect of CO2 on the Perilymphatic Oxygen Tension in Cats
Authors: Murata K. , Fisch U.
Published: October 2014

A microelectrode with a tip of 100μ permitting recording of the oxygen tension in the perilymphatic space according to the polarographic principle and having a minimal drift of 1–2.5% per hour has been developed. The effects of apnea, hypo- and hyperventilation as well as those of inhalation of pure oxygen, and CO2 upon the perilymphatic Po2 have been measured by placing the electrode in the perilymph through the fenestrated stapedial footplate of 87 adult cats. The correlation between the arterial Pco2 and the perilymphatic Po2 is so close that even hypo- or hyperventilation in presence of air does influence the oxygen content of the perilymphatic space. In view of the effect of the smallest accumulation of alveolar CO2, particular attention has to be paid to the system used for respiration of the experimental animal, when determining the action of drugs or inhaled gas mixtures on the oxygenation of the inner ear fluids. The measurement of the perilymphatic oxygen tension also indicates that the rate of blood flow cannot be used to deduct with accuracy the actual degree of oxygenation of the inner ear fluids.
Development of Hearing Loss in Kanamycin Treated Chinchillas
Authors: Ryan Allen , McGee Therese J.
Published: October 2014

Behaviorally determined auditory theresholds of chinchillas were monitored before, during and after daily administration of kanamycin sulfate (200 mg/kg per day). Drug treatment was terminated as soon as a shift in high-frequency thresholds was observed. In surviving animals, hearing loss spread toward lower frequencies and stabilized after eight to nine days. The stable hearing loss was limited, on the average, to frequencies above 3 kHz. The magnitude of the loss was constant across affected frequencies and averaged about 40 dB. Virtually complete outer hair cell loss was seen in the basal portion of the cochleae of all surviving animals.
Effect of Click Rate on the Latency of Auditory Brain Stem Responses in Humans
Authors: Don Manuel , Allen Aaron R. , Starr Arnold
Published: October 2014

Auditory brain stem responses are the far-field reflections of electrical activity originating in the auditory pathway in its course from the cochlea to cortex that can be recorded from scalp electrodes using computer averaging techniques. There are seven components in the initial 10 msec following a click signal which have been shown to have an orderly change in latency as a function of signal intensity. The results of this study show that click repetition rate can also significantly affect the response latency measure. Responses were measured in six normal hearing subjects at click rates of 10, 30, 50, and 100/sec and at four intensity levels (30, 40, 50, and 60 dB sensation level). The mean latency shift of component V was approximately 0.5 msec when the responses at 10 and 100/sec were compared. This is equivalent to a 15–20 dB decrease in signal intensity at the 10/sec click rate. An analysis of the time of occurrence of this shift using brief click trains at 100/sec showed the shift in latency to be complete by the fifth click. The latency shift was similar at the four signal levels tested. The latency shift of component V appeared to be a monaural and therefore a potentially peripheral process. The results are interpreted as an objective measure of adaptation in the human auditory system with implications for the measurement in disorders of hearing.
Anaerobic Bacteria in Otitis Media
Authors: Fulghum R. S. , Daniel H. J. , Yarborough J. G.
Published: October 2014

Anaerobic bacteria, Peptostreptococcus intermedins and Propionibacterium acnes, were found in mixed culture specimens from four of ten tested cases of chronic secretory otitis media. These anaerobic bacteria were in a mixed infection flora with aerobic bacteria, most often Staphylococcus epidermidis and Corynebacterium sp. which do not fit any established species. The finding of anaerobic bacteria in otitis media is consistent with the sporadic reports of the involvement of anaerobic bacteria in otitis media in the literature since 1898.
Microclip Application in Tympanoplasty
Authors: Williams J. David
Published: October 2014

A new technique for attaching a tympanoplastic graft to its recipient bed is presented. One millimeter stainless steel “microclips” are used to hold the tympanic graft securely in position. Results and experience of microclip application in 404 cases are discussed.
Cochlear, Brain Stem, and Cortical Evoked Responses in Nonorganic Hearing Loss
Authors: Sohmer H. , Bauberger-Tell L. , Feinmesser M. , Edelstein E.
Published: October 2014

After complete but inconclusive audiometric evaluation, 30 suspected cases of nonorganic hearing loss (NOHL) were referred to this laboratory for a complete battery of electric response audiometry tests (recording of cochlear, brain stem and cortical evoked responses). The chief advantages of these tests lie in their ability to more objectively confirm the presence of NOHL and to elicit the true threshold of the subject. Such tests along with psychiatric evaluation, indicate that NOHL can be subdivided into categories, examples of which are presented and discussed: Malingering or conscious simulation of deafness for obvious personal gain, and psychogenic deafness in which an emotional problem ( e.g., combat stress, anxiety) is unconsciously converted into a hearing problem in an escape mechanism. The basis of NOHL in some cases may be a mixture of both conscious components (malingering) and unconscious components (psychogenic). Several cases of NOHL are really nonorganic overlays or exaggeration on a small to moderate organic hearing loss. The psychogenic hearing loss seen in soldiers with combat neurosis may have originally developed as a psychogenic exaggeration of a temporary threshold shift induced by the noise of battle. Thus objective electrophysiological hearing tests and psychiatric evaluation have contributed to a better understanding of NOHL.
Fibrous Histiocytoma of the Subglottic Larynx
Authors: Johnson Jonas T. , Poushter David L.
Published: October 2014

Histiocytic tumors are being reported with increasing frequency in the medical literature. In spite of confusion regarding nomenclature, appropriate diagnostic and treatment modalities exist. A malignant fibrous histiocytoma of the subglottic larynx is reported. Discussion of the present criteria for a diagnosis of malignancy and a rationale of treatment is presented.
Immunological Concept for Bell's Palsy
Authors: McGovern Francis H. , Estevez Jose , Jackson Robert
Published: October 2014

This report concerns itself with additional experimental evidence to support the immunologic concept for the pathogenesis of Bell's palsy, using the mast cell as an index of immunological activity. In a previous experimental study, we postulated that degranulation of mast cells activated by complement or specific allergens with release of histamine and other substances may be the mechanism leading to nerve edema, ischemia, and paralysis. In this study we observed a loss of granulated mast cells in the more severely damaged facial nerves of immunized dogs after the intrafallopian canal injection of various substances, in contrast with the relative abundance of these cells in nerves that showed little or no evidence of injury. In addition, we demonstrated that cromolyn sodium, a mast cell degranulation inhibitor, when infused intravenously at the time of the intrafacial canal injection of horse serum, very effectively lessened the degree of experimental paralysis and histologic nerve injury.
A System of Rhinomanometry in the Clinical Evaluation of Nasal Decongestants
Authors: Dressler W. E. , Myers T. , Rankell A. S. , London S. J. , Poetsch C. E.
Published: October 2014

The utility of an anterior rhinomanometric method for the assessment of decongestant drug activity is illustrated with representative clinical data. Controlled studies employing topical nasal spray, nasal inhaler, and oral syrup formulations were conducted under single- or double-blind conditions in patients with allergic or coryzal rhinitis. The method provided an objective means to distinguish active from placebo (vehicle) treatments and to discriminate differences in decongestant activity between two active formulations. Furthermore, objectively determined increases in nasal patency paralleled the patients' subjective perception of improved airflow. In conclusion, this rhinomanometric methodology provided objective confirmation of drug activity with orally-administered, inhaled, and topically-applied decongestant drug formulations.
Differential Diagnosis of Xerostomia by Quantitative Salivary Gland Scintigraphy
Authors: Häusler Rudolf J. , Ritschard Jürg , N'Guyen Van Thien , Montandon Pierre B.
Published: October 2014

A new and rapid method of quantitative salivary gland scintigraphy has been developed. The uptake of pertechnetate in the glandular tissue and in a reference area in the neck are measured. The ratio between these measurements gives an index of salivary gland activity. By using this activity index, quantitative information on the functional state of the parotid and submandibular glands can be obtained. In cases of xerostomia such measurements may be particularly helpful in differentiating Sjogren's syndrome and sialosis and hence in the choice of appropriate treatment.
Temporal Bone Showing Otosclerosis, Paget's Disease and Adenocarcinoma
Authors: Kelemen George
Published: October 2014

In a pair of temporal bones serial sectioning revealed widespread Paget's disease with otosclerosis on both sides and, at the right side, adenocarcinoma added. Stapedial fixation was produced on the right by otosclerosis, and on the left by Paget's disease. In the contest to reach the inner cochlear space, Paget was the winner on the left, where, at the tympanic scala, otosclerosis and Paget's disease almost met, while the immediately adjacent organ of Corti was uninvolved.
Cystic Lesions of the Petrous Apex: Transsphenoid Approach
Authors: Montgomery William W.
Published: October 2014

The transsphenoid approach to cystic lesions of the petrous tip has been made possible by the advances in techniques for diagnosis. These include polytomography, improved angiography, and computer tomographic (CT) brain scanning. The results of these studies can determine the size, shape, and thickness of the cystic lesion, as well as its exact relationship to the sphenoid sinus. A number of surgical approaches have been used to reach the cystic lesion of the petrous apex. Most notably, these include the middle fossa extradural craniotomy and posterior fossa craniotomy. These surgical techniques allow the cyst to be biopsied but do not establish permanent drainage. The translabyrinthine approach accomplishes wide access to the petrous apex, but cochlear and vestibular functions are sacrificed. The transsphenoid approach to cystic lesions of the petrous apex should be the ideal operation provided that the anterior aspect of the cyst abuts against the posterior wall of the sphenoid sinus. The cyst can be completely evacuated and permanent fistulization established into the sphenoid sinus using a septal mucosal flap and a silicone drainage device. The operation is accomplished without destruction to the inner ear.
Limitations of Computed Tomography in the Investigation of Acoustic Neuromas
Authors: Parker Stephen W. , Davis Kenneth R.
Published: October 2014

Seventy percent of 80 surgically proven acoustic neuromas were visualized on preoperative computed tomography (CT) scans. Many more tumors were seen on contrast enhanced scans than on unenhanced scans (55 vs 25). No intracanalicular tumors and only one of 15 tumors less than 2 cm in size were visualized on CT scan. Most medium size tumors (2.0–3.0 cm) and all large tumors (>3.0 cm) were visualized on CT scan when optimal technique was used. Positive CT scans often replace more invasive diagnostic studies in the investigation of acoustic neuromas. Negative scans do not rule out tumors as intracanalicular, and small tumors are usually not visualized with current techniques. If there is clinical suspicion of an acoustic neuroma, positive contrast posterior fossa cisternography should be done when the CT scan is negative.
Cholesteatoma Surgery: Residual and Recurrent Disease
Authors: Sheehy James L. , Brackmann Derald E. , Graham Malcolm D.
Published: October 2014

This is an analysis of 1,024 primary cases of mastoid surgery for cholesteatoma operated upon during a ten-year period at the Otologic Medical Group, inc. Our philosophy of management of the mastoid in these cases has been as follows: 1) avoid an open mastoid cavity when possible; 2) perform the operation in two stages if necessary; 3) reexplore the mastoid and middle ear for residual cholesteatoma when indicated. One-third of 380 revised cases had residual cholesteatoma, disease left by the surgeon. In 260 cases in which the surgeon felt it unlikely that there was residual disease he found it in 23%. In 4% this residual cholesteatoma was found in the mastoid. The incidence of residual cholesteatoma was higher in children and in planned, as opposed to unplanned, revisions. Residual cholesteatoma was detected in the middle ear more frequently than in the epitympanum, and in the epitympanum more frequently than the mastoid. Indications for, and timing of, the reexploration are discussed. Recurrent cholesteatoma refers to a retraction pocket and must be differentiated from residual cholesteatoma; the causes, prevention and treatment are different. Recurrent cholesteatoma was detected in 5%. The most common complication of the disease was a labyrinthine fistula (10%). Operative facial nerve damage occurred in one case. The most common postoperative complication was graft failure (3%). Intact canal wall tympanoplasty with mastoidectomy should be performed as a two-stage procedure in most cases when used in the treatment of aural cholesteatoma.
Natural History of Sudden Sensorineural Hearing Loss
Authors: Mattox Douglas E. , Simmons F. Blair
Published: October 2014

This is a prospective in-depth study of patients with sudden idiopathic sensorineural hearing loss. We found that 65% recover completely to functional hearing levels spontaneously and independent of any type of medical treatment. The majority do so within 14 days and many within the first few days. Prognosis can be predicted according to the slope of the initial audiogram (low-frequency losses do better than high-frequency losses), hearing at 8 kHz, erythrocyte sedimentation rates, in some select instances spatial disorientation symptoms, and speech discrimination scores. There was a very poor correlation between hearing and vestibular test abnormalities, except hypoactive calorics. There were no correlations with age (excepting the very elderly), with antecedent respiratory infections. hypertension, diabetes, or other chronic diseases. We conclude that there is a fundamental difference in the behavior of apical and basal cochlea losses, that hearing recovery is always better at low than at high frequencies, that because of the high spontaneous recovery rates, tympanotomies seeking perilymph fistulas should be delayed ten days unless there is a progressive hearing loss, and that none of the current recommended treatments, especially histamine, have any effect on the outcome.
Pathogenesis of Otitis Media
Authors: Juhn S. K. , Paparella Michael M. , Goycoolea Marcos V. , Kim C. S. , Giebink Scott
Published: October 2014

Pathogenesis of otitis media was studied in humans and various animal models primarily from a pathological and chemical point of view. Findings were correlated and interpreted for various forms of otitis media in longitudinal and parallel studies, including acute purulent otitis media (POM), serous otitis media (SOM), mucoid or secretory otitis media (MOM), and chronic suppurative otitis media (COM), especially as regards the continuum or interrelated changes of various groups. Purulent otitis media was produced in chinchillas by direct inoculation of less than 100 pneumococci into the middle ear space. Serous otitis media was produced in chinchillas and cats following Eustachian tube obstruction with silicone. Mucoid otitis media followed the development of SOM in cats after two to four weeks of tubal occlusion. Samples of middle ear effusion (MEE) and serum, obtained from children with SOM and MOM after myringotomy for ventilation tube placement, were evaluated. The three components studied were MEE, epithelium and the subepithelial space (SES). Inflammatory changes in the SES were significant for all forms of otitis media, but especially for POM and SOM. Epithelial metaplasia to secretory cells was most prominent in MOM. Chemical factors involved in pathogenesis and defense were studied. Lactic dehydrogenase and lysozyme, chemical indicators of inflammatory activity, were greater in POM and MOM than in SOM. Immunoglobulins (A, G, & M) were greater in MOM than in SOM. The similarity of findings between the groups suggests a strong relationship between them. The ability of certain types of otitis media to evolve into another substantiates the concept of the continuum for some patients. Pathogenesis is dependent upon various extrinsic factors of etiopathogenesis, while the form that otitis media takes seems to rely mostly on relative activity of the SES and the epithelium.
The Brain and Hearing: Auditory Discriminations Affected by Brain Lesions
Authors: Neff William D.
Published: October 2014

After bilateral ablation of the auditory areas of the cerebral cortex, experimental animals have a severe deficit in ability to discriminate between temporal patterns of tonal stimuli and to localize sound in space. These two kinds of discrimination are basic for communication and for attack or avoidance of prey and predator. Recognition of which ear is stimulated may also depend upon excitation of auditory cortex contralateral to the given ear. Binaural discriminations are dependent upon interaction of nerve impulses from the two ears at a low level in the auditory nervous system. Similar hearing losses have been reported for human patients.
Inner ear Hemorrhage and Endolymphatic Hydrops in a Leukemic Patient with Sudden Hearing Loss
Authors: Sando Isamu , Egami Tetsuya
Published: October 2014

Several significant histopathological findings were noted in a case of sudden hearing loss in a patient with chronic lymphocytic leukemia. The major pathological findings were leukemic hemorrhage into both perilymphatic and endolymphatic spaces in the cochlear and vestibular systems, endolymphatic hydrops in the cochlea and sacculus, and a relatively narrowed and straightened vestibular aqueduct and endolymphatic sac. Additional interesting findings include: loss of hair cells in the organ of Corti and vestibular end-organs; destruction of the stria vascularis (possibly the origin of the blood); fibrosis in the perilymphatic spaces in the cochlea and the vestibule, and in the endolymphatic space in the vestibule; and new bone formation in the perilymphatic spaces in the vestibule. The leukemic infiltrate observed in both the cochlea and the vestibule was not considered to be significant. Hemorrhage into the cochlea is thought to be the most reasonable cause of the sudden hearing loss in this case. Also discussed are fibrosis and osteogenesis as a late consequence of hemorrhage, and the coexistence of endolymphatic hydrops with an anomaly of the vestibular aqueduct and endolymphatic sac.
Otosclerotic Stapes: Morphological and Microchemical Correlates
Authors: Lim David J. , Saunders William H.
Published: October 2014

A total of 32 otosclerotic stapes is thin-sectioned without decalcification and examined using transmission and scanning electron microscopes, with a nondispersive x-ray analyzer attached to the latter. These otosclerotic stapes are classified as spongiotic, sclerotic, or preotosclerotic, according to their pathologic characteristics and state of mineralization. Either diffuse or patchy demineralization in the ground substance appears to be the initial stage of otosclerosis, and this area coincides with preotosclerotic lesions (also known as blue mantle) in light microscopy. Therefore, it is interpreted that demineralization precedes the destruction of ground substance in the preotosclerotic lesion. Bone mineral deposits in new otosclerotic bone appear to be related to the collagen fibrils that are embedded in the ground substance. No mineral deposit could be seen without the ground substance deposition; therefore, it is suggested that this ground substance is the single most important factor in the poor mineralization of the otosclerosis. The sclerotic lesions are well mineralized and show a typical pattern of hydroxyapatite by x-ray diffraction study. We could not confirm the notion that the sclerotic lesion is hypermineralized as compared to the normal stapes. The spongiotic lesions are poorly mineralized, with low calcium salt. Using the Ca/P ratio and x-ray diffraction pattern as criteria, it was determined that spongiotic lesions belong to unstable, immature bone.
Teflon® Injection in the Nasopharynx to Improve Velopharyngeal Closure
Authors: Smith Jeanne K. , McCabe Brian F.
Published: October 2014

Eighty patients with marginal velopharyngeal competency received Teflon® injections to improve closure of the nasopharyngeal port. Sixty percent of these experienced no further voice problem and an additional 18% exhibited improved voice quality.