bluuebunny/crossref_metadata_2025 huggingface dataset:
Computerized Tomography Scanning of the Temporal Bone
Authors: Hanafee William N. , Jenkins Herman A. , Mancuso Anthony A. , Winter James
Published: October 2014

Computerized tomography (CT) scanning has reached a degree of sophistication that requires alteration of technical factors to demonstrate different parameters of temporal bone pathology. The techniques for pontocerebellar angle display, eustachian tube, middle ear pathology, and overall temporal bone display are quite different. Close cooperation between the radiologist and otologic surgeon are required for optimal use of CT scanning advances.
Absence of Otoconia in a Human Infant
Authors: Wright Charles G. , Hubbard David G. , Graham J. Wallace
Published: October 2014

Temporal bone specimens were obtained at autopsy from a six-week-old victim of sudden infant death syndrome. The inner ears were microdissected and studied by a combination of light and scanning electron microscopy. Otoconia were completely absent from the sensory organs of the saccule and utricle on both sides. However, the gelatinous otoconial membranes, neuroepithelia, and innervation were normal. In parallel with unusually light pigmentation of the skin in this Negro infant, relatively few melanocytes were found in the membranous walls of the saccule and utricle. No abnormalities were present in other inner ear structures. This anomaly, which we believe was congenital in nature, is strikingly similar to a genetically determined inner ear defect which has been extensively studied in experimental animals.
Laryngoscopy in Space Travel
Authors: LeJeune Francis E.
Published: October 2014

The need for laryngoscopy aboard a spacecraft on a mission of one to three years is anticipated. Therefore, the inexperience of the potential endoscopists and the problems they face in the free-floating environment of space are considered. A simplified coaxial intubation technique employing a split-apart modification cf a Jako-type laryngoscope is suggested.
Laryngeal Clefts
Authors: Lim Timothy A. , Spanier Suzanne S. , Kohut Robert I.
Published: October 2014

The histopathologic findings in a case of laryngeal cleft studied by serial sectioning, and a literature review of this clinical entity are presented. The primary micropathologic findings include a cleft deformity of the posterior cricoid lamina, and alterations in muscle differentiation involving the interarytenoid and posterior cricoarytenoid muscles. Possible embryogenic mechanisms are discussed. The clinical picture is characterized by signs and symptoms of aspiration with airway obstruction, and definitive diagnosis is achieved by endoscopic examination. Treatment consists of surgical repair, although some patients with type 1 laryngeal clefts may be managed on a conservative trial. The need for uniform classification of laryngeal clefts in future reporting is emphasized.
Tracheotomy for Infant Botulism
Authors: Wolfe Judith A. , Pasquariello Patrick , Rowe Lee D. , Potsic William P.
Published: October 2014

Botulism is a serious intoxication caused by ingestion of food containing preformed botulinus toxin and characterized by rapidly progressive bulbar paralysis, generalized weakness, and respiratory insufficiency. In 1976 a distinct clinical entity of infant botulism was recognized. The disease apparently results from intraintestinal toxin production which produces a defect in neuromuscular transmission by interfering with release of acetylcholine at cholinergic synapses. Five cases of infant botulism were identified at the Children's Hospital of Philadelphia between 1975 and 1977. Initial symptoms included constipation, slow feeding, lethargy and weak cry. Four of the patients progressed to respiratory insufficiency requiring nasotracheal intubation. Three of the infants with respiratory failure required tracheotomy. Because infants with respiratory failure may require support for months, we recommend that a tracheotomy be performed early in the management to avoid the complications associated with prolonged intubation. The effectiveness of antitoxin or antibiotics to treat infant botulism remains questionable and therefore prolonged respiratory supportive care is the mainstay of therapy. In addition, we offer guidelines for decannulation in cases of infant botulism. None of the patients in our series could be decannulated prior to initial discharge from the hospital.
Ewing'S Sarcoma of the Mandible
Authors: Som Peter M. , Krespi Yosef P. , Hermann George , Shugar Joel M.
Published: October 2014

Ewing's sarcoma is an uncommon neoplasm that primarily occurs in the long bones of the lower and upper extremities. Only 2% involve the mandible, and the maxilla is involved one eighth as often as the mandible. The most common site of metastases is the lung. Increasing pain is the most common presenting symptom. A case of mandibular involvement is presented. The combination of a large, soft tissue mass adjacent to an area of bone destruction in a young male should suggest the diagnosis. The previously poor five- and ten-year survival rates of 8 and 4% respectively, may have promise of marked improvement. This improvement lies in a changing philosophy of treatment. Four-drug chemotherapy combined with prophylactic whole-lung irradiation has been added to local irradiation of the tumor bed. Five-year survival figures of 20 to 30 % appear obtainable. Although extensive surgical resection of the primary tumor in the long bones has for the most part been replaced by local irradiation for control, surgery in mandibular cases may still be the treatment of choice.
Emergency Management of Tracheal Stenosis
Authors: Eliachar Isaac , Simon Kurt , Birkhan Jesmond H. , Joachims Henry Z.
Published: October 2014

A new technique for immediate though temporary relief of airway obstruction due to tracheal stenosis is described. Introduction of a small gauge cuffed endotracheal tube past the stenotic segment, followed by repeated withdrawal with the cuff inflated, allows for effective and safe retrograde bougienage. Airway patency is maintained throughout. Following this procedure introduction of an endotracheal tube or tracheostomy cannula is facilitated and definitive surgery can be planned.
Laryngeal Sarcoidosis with Airway Obstruction
Authors: Weisman Robert A. , Canalis Rinaldo F. , Powell William J.
Published: October 2014

Sarcoidosis is a chronic systemic granulomatous disease that occasionally affects the larynx. When the degree of involvement is marked, significant airway obstruction can occur. We present four cases of laryngeal sarcoidosis that resulted in airway obstruction. The clinical features of sarcoidosis of the larynx are discussed, and current methods of treatment are summarized. The laryngologist should include laryngeal sarcoidosis in the differential diagnosis of patients with airway obstruction, and should play a major role in its management.
Asymptomatic Nasal Septal Perforations in Systemic Lupus Erythematosus
Authors: Reiter David , Myers Allen R.
Published: October 2014

Nasal septal perforation has been considered a diagnostic criterion for systemic lupus erythematosus since 1971. However, little has been published in the otorhinolaryngologic literature regarding this lesion. We report six patients having asymptomatic anteroinferior nasal septal perforations and symptomatic lupus. No obvious clinical correlates were found. We support the hypothesis that nasal septal perforation in systemic lupus erythematosus is a common phenomenon, and attribute its infrequent detection to the asymptomatic nature of the lesion in this setting.
Normal Ciliary Ultrastructure in Children with Kartagener's Syndrome
Authors: Herzon Fred S. , Murphy Shirley
Published: October 2014

Kartagener's syndrome has been found to be associated with the immotile cilia syndrome (lack of dynein arms and defective radial spokes in cilia). The ultrastructure of cilia of a child with Kartagener's syndrome was examined and found to be within normal limits. The implications of this are discussed.
Otorhinolaryngology
Authors: Bordley John E.
Published: October 2014

The present status of the expanding specialty of Otorhinolaryngology is discussed. Some of the intradisciplinary problems which are developing as a result of growth and expansion of the specialty are reviewed and some solutions are suggested.
Impacted Esophageal Foreign Bodies of Dental Origin
Authors: Nwafo D. C. , Anyanwu C. H. , Egbue M. O.
Published: October 2014

The use of dentures is becoming common even among Africans. So also is the problem of swallowed and impacted dentures. Their radiolucence makes radiological localization almost impossible, and because of their rigidity, large size, irregular and unyielding edges, impacted dentures are apt to produce lacerations during endoscopic removal from gullets rendered friable by impaction. Three patients with impacted radiolucent dentures are described in order to illustrate the problems of removal. It is suggested that the safest and most effective method of removing impacted dentures in the esophagus is through an elective open esophagotomy.
Course and Contents of the Paravestibular Canaliculus
Authors: Sando Isamu , Egami Tetsuya , Hasada Takehiko
Published: October 2014

The purpose of this study is to describe the anatomy of the paravestibular canaliculus (PVC) in detail, specially its course in relation to the vestibular aqueduct (VA) and its vascular contents. Serial horizontal sections of 20 normal human temporal bones were stained either with hematoxylin and eosin, by Verhoeff-van Gieson's method, or by Mallory's method, and studied under the light microscope. Graphic reconstruction of the VA and the PVC was performed in some of the cases. In this study, the following new anatomical information on the common course and vascular contents of the PVC was obtained: 1) two PVC are present in the area near the vestibular orifice of the VA; 2) the PVC merges with the VA in the area near its cranial orifice without any particular branching, and does not enter the posterior cranial fossa; 3) veins course through the entire length of the PVC whereas arteries course only through the posterior cranial fossa side of the PVC. It appears that veins are the major contents of the PVC and that these veins represent the main venous drainage system from the vestibule. It also appears that arteries in the PVC supply the blood from the posterior cranial fossa mainly to the PVC itself.
Management of Vallecular Pseudodiverticulum
Authors: Gacek Richard R.
Published: October 2014

Vallecular pseudodiverticulum following laryngectomy may be responsible for dysphagia if large enough to compress the cervical esophagus. The pouch probably represents a defect caused by the antagonistic action of tongue and inferior constrictor muscles in laryngectomy repair. Initially, the pocket may remain limited or may form a pharyngocutaneous fistulous tract. Two laryngectomy patients who developed a large vallecular pseudodiverticulum were sufficiently symptomatic to require surgical management. An external approach was used successfully to resect the party wall between the diverticulum and the cervical esophagus.
Treatment of Maxillary Cysts
Authors: Merwin Gerald E. , Boies Lawrence R. , Tilsner Thomas , Shrewsbury Donald S.
Published: October 2014

Differing classification systems for cysts of the maxilla have resulted in confusion in the literature regarding these cysts. We feel that proper evaluation and treatment is essentially the same regardless of the classificatory system employed. The hallmark of proper treatment of these cysts is meticulous removal of all cyst lining to prevent recurrence. Three case reports are presented and discussed.
Cochlear Fluid Balance
Authors: Duvall Arndt J. , Santi Peter A. , Hukee Margaret J.
Published: October 2014

Stria edema, and in some cases atrophy, follows osmotic agents, loop-inhibiting diuretics, acoustic trauma, and rupture of Reissner's membrane. All have in common an imbalance of fluid and electrolytes in the cochlear duct. The glycerol test causes temporary improvement in hearing in Menière's disease. Glycerol causes stria edema and collapse of Reissner's membrane in the chinchilla. Stria edema, as well as stria atrophy, are found in Menière's disease. Metabolic manipulation of the stria might be the best approach in the search for successful treatment of Menière's disease.
Congenital Malformations of the Ear Analysis of 94 Operations
Authors: Jahrsdoerfer Robert
Published: October 2014

The 94 operations analyzed were performed on 80 ears in 73 patients with congenital malformation of the ear. Operative findings included 13 patients with a congenital absence of the oval window, 5 patients with vascular anomaly of the middle ear, and 6 patients with congenital cholesteatoma. Six of 13 patients with congenital absence of the oval window had a labyrinthotomy performed to create a new opening into the vestibule. The method of surgical repair in atresia was a canalplasty with fascia graft overlay for the substitute tympanic membrane. A Silastic® button was placed over the substitute tympanic membrane to lessen blunting and to anchor the center-hole skin graft in place. A modified face lift procedure was done if necessary to align the external ear with the new ear canal. At present no ear canals are stenosed and no ears are actively discharging. One patient sustained a temporary facial paralysis. The hearing results are discussed.
Acute Cochlear Disorders: The Combination of Hearing Loss, Recruitment, Poor Speech Discrimination, and Tinnitus
Authors: Tonndorf Juergen
Published: October 2014

The combination of hearing loss, recruitment, poor speech discrimination and tinnitus, which is characteristic of acute cochlear disorders, can be accounted for on the basis of a decoupling of hair cells from their drive system, the tectorial membrane. Decoupling may either be caused by a temporary reduction of ciliary stiffness (shown to occur during periods of noise-induced temporary threshold shifts) or by temporary and/or chronic ciliary pathology (demonstrated to exist in cases of antibiotic ototoxicity and in endolymphatic hydrops). Since ciliary coupling is elastic in nature, the decoupling is only partial. The hearing loss and the tinnitus are manifestations of the reduced coupling per se, the magnitude of the loss depending on the degree of decoupling and the number of hair cells involved. Recruitment and poor speech discrimination result from center-clipping of the signal waveform applied to an involved hair cell, the direct corollary of partial, ciliary decoupling.
Comparative Preoperative Evaluation of Eustachian Tube Function in Pathological Ears
Authors: Virtanen H. , Palva T. , Jauhiainen T.
Published: October 2014

On 100 pathological ears with tympanic membrane perforation, eustachian tube function was measured by using sonotubometry and the negative pressure equalization test in an attempt to compare these two methods. The pressure equalization test did not appear to be a reliable tool for preoperative clinical determination of tube function because sonotubometry showed tubal opening in 85 % (myringoplasty group) and in 49 % (radical surgery group) of pathological ears, which were not able to equalize negative middle ear pressure at all during swallowing. The negative pressure equalization test is considered to be unphysiological and may produce a locking phenomenon of the tube. Even a small negative pressure can act like a valve, producing an obstruction that muscle activity of the tube is no longer able to overcome particularly when mucosal changes are present in the tubal orifice. Sonotubometry is a physiological test and as such gives a reliable picture of the opening of the tube during swallowing. Data on tympanic aeration postoperatively will be reported later.
Characteristics of Capillary Permeability in Nasal Mucosa
Authors: Watanabe Kensuke , Saito Yozo , Watanabe Isamu , Mizuhira Vinci
Published: October 2014

The transendothelial passage of horseradish peroxidase (HRP) and colloidal carbon and diffusion of HRP in pericapillary space, injected intravenously into rats, was studied at the light microscopic and ultrastructural level in the nasal mucosa. In the lamina propria of the mucosa in the middle third of the nasal septum of rats, the capillaries directly beneath the epithelium were mostly with fenestrae, while the capillaries around the nasal gland were without the fenestrae. The permeability of the capillaries in the lamina propria of the nasal mucosa was very high and some of the endothelial cells were wide open, like liver sinusoid, allowing free passage of carbon particles. Marked transendothelial passage was also noted at ten seconds after HRP infusion through the capillaries without fenestrae located around the nasal gland. On the other hand, no extracapillary leakage of HRP was noted even at 150 seconds after its infusion in the capillaries without fenestrae located in the muscles. The permeability of small venules located in the lamina propria of nasal mucosa also was extremely high. The reasons for the greater permeation of HRP through capillaries of nasal mucosa are as follows. First, the endothelial cell junction was loose in the nasal mucosa and in some capillaries endothelium had holes like liver sinusoid. Second, interstitium surrounding the capillary was loose in nasal mucosa.
Innominate Artery Compression of the Trachea in Infants with Reflex Apnea
Authors: Ardito Joseph M. , Ossoff Robert H. , Tucker Gabriel F. , deLeon Serafin Y.
Published: October 2014

Compression of the trachea by an anomalous innominate artery in association with reflex apnea is a frequent cause of respiratory arrest in infants. Once considered, tracheoscopy is mandatory to rule out this disorder. Surgical correction of this condition by innominate arteriopexy has proven to be a very effective method of management. Seventy-eight patients with tracheal compression by an anomalous innominate artery managed by the authors at The Children's Memorial Hospital in Chicago between January 1977 and December 1979 are presented. In this series, 28 patients had a history of one or more episodes of reflex apnea; all of these patients underwent an innominate arteriopexy. A complete review of this syndrome and methods of its diagnosis are scrutinized. We agree with previous authors that reflex apnea is a definite indication for surgical correction of this vascular anomaly causing tracheal compression, but other indications are delineated.
Congenital Tracheal Diverticulum
Authors: Frenkiel Saul , Assimes Irene K. , Rosales Jose K.
Published: October 2014

A six-month-old female with a history of recurrent bronchopulmonary infections was admitted to the Montreal Children's Hospital in severe respiratory distress. Cardiac arrest ensued and although ventilation by mask was always possible during the resuscitation procedure, there was a confusing inability to aerate the lungs after successful intubation. A right-sided tracheal diverticulum was identified at autopsy. It was assumed, in retrospect, that the intubating tube entered and abutted against the wall of the diverticulum, thus obstructing its distal lumen. The embryology, morphology and pathophysiology of congenital tracheal diverticuli are discussed. This rare diagnosis should be entertained when successful intubation leads to ineffectual ventilation.
Laryngeal Stenosis from Endotracheal Intubation
Authors: Hawkins Donald B. , Luxford William M.
Published: October 2014

During the decade of the 1970s, the Department of Otolaryngology at the Los Angeles County - University of Southern California Medical Center encountered 58 patients who required tracheotomy for laryngeal stenosis secondary to endotracheal intubation. This included 19 children and 39 adults. We treated 50 of these patients, of whom 35 (70%) were decannulated after endoscopic management alone. One other patient could have been decannulated but needed the tracheotomy for medical reasons. Two others will probably be decannulated in the near future. Eight patients underwent open reconstructive procedures.
Double-Barreled (Diversionary)Tracheostomy in the Management of Juvenile Laryngeal Papillomatosis
Authors: Tucker Harvey M.
Published: October 2014

A two-year-old female presented to the author with a 1½ year history of multiple recurrences of juvenile laryngeal papillomatosis which when first seen had progressed to and below the tracheotomy site. The entire supraglottic larynx, glottis, and subglottic area were completely filled with exuberant papillomata. There was active growth of papilloma at and below the tracheotomy site and the tube had to be inserted through papilloma in order to reach a clear area in the trachea. In hopes of preventing further spread of papilloma below the area already involved and in order to control the airway and provide access to the subglottic area for laser removal, a double-barreled tracheostomy was performed. Laser treatment and/or spontaneous resolution ultimately resulted in complete clearing of all papillomata from the upper and lower tracheal segments. Four years and nine months after the initial procedure it was felt safe to attempt reconstruction. Her postoperative course was uneventful and she was successfully extubated three months later. Both vocal cords are normally mobile and her voice is quite clear although slightly hoarse as a result probably of slight changes in the edges of the cords because of the repeated surgical interventions. There has been no recurrence of papilloma now, over one year since reconstruction of the trachea. This somewhat radical approach to a life-threatening growth of endotracheal papilloma was successful in preventing further spread below the level of tracheostomy and ultimately permitted total reconstruction of an intact tracheal bronchial tree in the case reported.
Management of the Extubation Problem in the Premature Child
Authors: Cotton Robin T. , Seid Allan B.
Published: October 2014

Long-term endotracheal intubation is a widely established means of giving ventilatory support in the newborn period. Though such long-term intubation is well tolerated by the premature infant, laryngeal complications do occur and extubation may be impossible even though the initial disease process for which the intubation was performed has resolved. In such a situation, careful endoscopic evaluation of the upper respiratory tract is advocated to identify the site of the problem. If subglottic edema or mucosal ulceration in the subglottic area is the site of the damage and if, during endoscopic evaluation immediately following removal of the endotracheal tube, the subglottic area starts to narrow because of edema formation or edema fluid filling up compressed granulation tissue, then a split of the cricoid in the midline anteriorly, leaving the endotracheal tube in as a stent, appears to be a preferable alternative to performing a tracheotomy. Of 12 consecutive patients, 9 have been successfully extubated.
Neoglottic Reconstruction following Total Laryngectomy
Authors: Leipzig Bruce
Published: October 2014

The purpose of this paper is to analyze the problems and complications which have resulted from neoglottic reconstruction at the University of Texas Medical Branch in Galveston. It has been performed as a primary procedure at the time of laryngectomy on 50 patients. Over 40 % of these patients have required a second operative procedure to control major complications of their neoglottis. Aspiration is a nearly constant feature of the procedure, and a significant number of patients do not tolerate it well. Radiation therapy does not appear to increase the number of problems, but the complications are more severe when they do occur, and they are more difficult to control. The indications for surgical neoglottic reconstruction cannot be extended beyond those tumors which are within the confines of the larynx without an increased incidence of major complications. Other relative contraindications to this surgery are poor patient pulmonary reserve, reflux esophageal incompetence, and a “hyperactive” gag reflex. Nine patients with prior treatment which included a total laryngectomy underwent secondary neoglottic reconstruction. In our experience, all have had significant aspiration. About one half of these patients developed speech. The procedure of neoglottic reconstruction must be reviewed critically prior to popular introduction into the surgical armamentarium. A plea for careful study by a small number of experienced surgeons is now in order.
Vocal Cord Positioning by Selective Denervation Old Territory Revisited
Authors: Sasaki Clarence T. , Horiuchi Masatoshi , Ikari Takestugu , Kirchner John A.
Published: October 2014

Vocal cord positioning produced by selective laryngeal denervation remains a controversial issue in clinical laryngology. Previous studies fail to arrive at uniform conclusions for two important reasons: 1) failure to mark a reference sagittal plane from which to assess the degree of vocal cord lateralization, and 2) failure to recognize the influence of tracheostomy and respiratory positioning of the vocal cords. The present study makes use of photographic and electromyographic documentation in the assessment of the paralyzed cord. Physiologic inactivation of the cricothyroid muscle by tracheostomy is a key determinant of the lateralized cord observed in acute low vagal and recurrent nerve paralysis. Tracheostomy-related cricothyroid inactivation cannot be ignored as a major determinant of cord positioning in paralysis and should not be overlooked in determining the neuroanatomic site of injury.
Acute Cricoarytenoid Arthritis: Local Periarticular Steroid Injection
Authors: Simpson George T. , Javaheri Ahmad , Janfaza Parviz
Published: October 2014

Acute cricoarytenoid arthritis is a frequent complication of rheumatoid arthritis and the most frequent otolaryngologic manifestation of the disease. Over 25% of rheumatoid arthritis cases have discomfort from this problem. Other etiologies can produce cricoarytenoid arthritis. Symptoms range from mild discomfort through hoarseness to complete airway obstruction requiring emergency tracheotomy. Chronic cricoarytenoid arthritis may result in joint ankylosis and vocal fold fixation. Single periarticular triamcinolone injections may bring rapid and dramatic relief of the symptomatology of nonankylosed acute cricoarytenoid arthritis for periods of up to one year if other medical management is adequate. Six cases illustrate the problem and the efficacy of this treatment methodology. Findings, pathology and pertinent literature are discussed. Specific criteria for considering this technique are outlined. This form of therapy has not been described previously.
Repair of Supraglottic Laryngeal Stenosis with Postcricoid Involvement
Authors: Doyle Patrick J.
Published: October 2014

A supraglottic stenosis with postcricoid stenosis was successfully corrected in a single stage procedure by excising the scar tissue and the arytenoid cartilage and the use of mucosal flaps to recover the right side of the larynx and postcricoid area. By obtaining good mucosal approximation without tension the need for a free skin graft or mucosal graft was avoided.
Destruction and Regeneration of Jawbone after Cryogenic Application
Authors: Kuylenstierna Richard , Lundquist Per-Gotthard , Nathanson Arthur
Published: October 2014

On 13 rabbits part of the lateral aspect of the jawbone was frozen with liquid nitrogen in two sessions. The animals were sacrificed 2, 4, 12, and 24 weeks after the cryosurgery. The specimens were analyzed with microangiography according to the Spalteholz technique and with light microscopy. The whole width of the lateral cortex, measuring around 3 mm, was subject to bone destruction two weeks after cryosurgery. New bone formation, on the other hand, was evident in the frozen area and on the undamaged periosteum some distance from the lesion. The same area, 12 weeks after the injury, was completely restored. Bone destruction and regeneration are discussed with special reference to the vascular response to the injury.
Vasculature of the Anterior Commissure
Authors: Andrea Mario
Published: October 2014

Results of a study of the vasculature of the anterior commissure, part of a larger study of the larynx, are presented. The vasculature of the anterior commissure is dependent on the medial branch of the anteroinferior laryngeal artery. The techniques used, postmortem angiography, dissection, cleared method, microangiography and histological sections, made it possible to follow the course of the artery and determine its configuration. The results reveal separation of the supraglottis and the glottis between the thyroepiglottic ligament and the anterior commissure; the study also establishes that a separation does not exist between the glottis and the subglottis in the anterior larynx. Particular emphasis is placed on ossification of the thyroid cartilage and the relationship between the vascular network of the glottic and subglottic mucosa and the tissues immediately in front of the larynx.
Electronystagmography in Congenital and Acquired Syphilitic Otitis
Authors: Wilson William R. , Zoller Michael
Published: October 2014

This study is an analysis of the electronystagmogram (ENG) changes in 17 patients with luetic vestibular disease with early and late acquired syphilis and congenital syphilis. Vestibular disturbances occurred in 80% of patients with luetic otitis. Among these patients the ENG gives signs of peripheral rather than central vestibular injury, and reduced vestibular response to caloric stimulation is the most common finding. Congenital syphilis patients have the greatest dysfunction, both in degree of ENG changes and incidence of bilaterality. We found no correlation between FTA-ABS levels and the amount of hearing impairment or vestibular injury. Treatment with penicillin and steroids had a beneficial subjective effect upon the symptoms of vertigo in over half the patients.
Quantitative Histology of the Mucous Membrane of the Accessory Nasal Sinus and Mastoid Cavities
Authors: Harris Michael J. , Schlenker Robert A.
Published: October 2014

The mucous membranes of the accessory nasal sinuses and of the mastoid labyrinth were measured in undecalcified, plastic-embedded specimens from nonpathologic postmortem cases. Epithelial thicknesses, lamina propria thicknesses and the ratio of nuclear to total cell area of the epithelia are presented for these organs to provide a quantitative basis for dosimetric calculations of alpha-emitting radionuclides. These data will be of value for studies in populations at risk for head carcinomas from the intake of radium and related nuclides.
Carcinoid Tumor of the Larynx
Authors: Gapany-Gapanaviĉius Boris , Kenan Samuel
Published: October 2014

Primary carcinoid of the larynx is an unusual neoplasm. Only one case could be traced in the literature so far. Another case, a 55-year-old male patient, is presented and discussed. The tumor proved to be malignant, showing histological, histochemical and electron microscopical characteristics of a carcinoid. Initially there was a striking discrepancy between the scanty findings in the larynx and the wide metastatic spread of the tumor into the cervical lymph nodes along the internal jugular vein, and the progression of the process was markedly slower than that of laryngeal carcinoma. Despite the massive dose of radiotherapy that had been administered after radical neck dissection in an attempt to preserve the larynx, the tumor continued to expand, infiltrating the laryngeal tissues and causing stenosis that necessitated total laryngectomy, thus again proving that the treatment of choice in laryngeal carcinoid should be wide surgical excision.
Parotolymphatic Backflow: A New Sign of Malignancy
Authors: Som Peter M. , Shugar Joel M. A.
Published: October 2014

The embryology and anatomy of the parotid lymphatics are reviewed. Instances where intraparotid adenopathy can be confused with a parotid tumor are cited. Added to the roentgen signs of parotid malignancy, a new finding, parotolymphatic backflow, is described for what we believe is the first time. Its pathogenesis is discussed.
Prosthetic Vocal Rehabilitation following Laryngectomy
Authors: Panje William R.
Published: October 2014

The Voice Button is a simple biflanged silicone device placed in the tracheoesophageal wall which has been found to enable speech without aspiration in approximately 80% of unselected laryngectomy patients. A simple surgical outpatient procedure provides the necessary tracheoesophageal fistula for insertion of the Voice Button. Indications, results, advantages, disadvantages and complications are discussed.
Lysosomal Hydrolases in Middle Ear Effusions
Authors: Diven Warren F. , Glew Robert H. , Bluestone Charles D.
Published: October 2014

Biochemical studies of middle ear effusions have demonstrated generally higher levels of certain hydrolytic and oxidative enzymes in mucoid fluids when compared to serous. We have extended these studies by analyzing middle ear effusions for the content of a large number of lysosomal hydrolases. The mean specific activity for α-glucosidase in mucoid fluids was found to be ten times that for serous fluids while α-mannosidase, β-glucuronidase, hexosaminidase, acid phosphatase, β-galactosidase, alkaline phosphatase, and lactate dehydrogenase were found to be three to five times greater in mucoid than serous effusions. In this study the specific enzyme activities for lysosomal hydrolases from purulent effusions were found to be intermediate between the activities in serous and mucoid effusions. No significant correlation was found between the specific activities of lysosomal hydrolases and the presence or absence of bacteria in mucoid or serous middle ear effusions. The hexosaminidase isozyme distribution was found to be identical for serous and mucoid fluids and similar to that found in human serum. However, the isozyme pattern of β-glucuronidase in mucoid effusions was significantly different than that in normal human serum as mucoid fluids contain a large amount of an anionic isoenzyme of β-glucuronidase that is barely detectable in human serum.
Ear Deformities Associated with the Klippel-Feil Syndrome
Authors: Windle-Taylor Paul C. , Emery Pauline J. , Phelps Peter D.
Published: October 2014

Congenital spinal fusion, constituting the Klippel-Feil anomaly, has long been known to be associated with severe deafness in many patients. Ten such cases are described, with audiometric and tomographic assessment of the ear lesions. Of the 20 ears examined, 12 showed evidence of severe hearing loss and of these, 11 had evidence of significant inner ear dysplasia on tomography. Middle and external ear abnormalities were also demonstrated. The significance of these findings and the relation to other syndromes is discussed.
Auditory Brainstem and Middle Latency Evoked Response Sensitivity near Threshold
Authors: Musiek Frank E. , Geurkink Nathan A.
Published: October 2014

Auditory brainstem response (ABR) and middle latency evoked response (MLER) testing have been used successfully for assessing hearing sensitivity electrophysiologically. Though both procedures have their proponents, ABR seems to be the more popular of the two. However, this study shows that overall, MLER waves occur with greater frequency at low sensation levels than ABR waves. Specifically, MLER wave Pa was the most sensitive wave, followed by ABR wave V, MLER wave Pb, ABR wave III, MLER wave Pc, and ABR wave I. Latencies were more consistent and predictable for ABR than MLER. However, as expected, amplitudes for MLER waves were greater than those for ABR. Given these results, those involved in measuring hearing sensitivity electrophysiologically are encouraged to consider the potential of the MLER measure and not limit their scope of assessment to ABR.
Common Migraine and Vestibular Function
Authors: Toglia Joseph U. , Thomas David , Kuritzky Arieh
Published: October 2014

Even though “classic migraine” and “complicated migraine” may be diagnosed readily, “common migraine” may be easily confused with other types of vascular headaches. This differential diagnosis is of great importance for the appropriate choice of drug therapy. It is frequently stated that family history of migraine and history of motion sickness in childhood suggest that a periodic vascular headache is most likely of migrainous origin; although this statement applies to ophthalmoplegic and hemiplegic migraine, it is doubtful that it applies to common migraine. In fact, in a pilot study of patients with common migraine, we have observed that family history and history of motion sickness in childhood did not contribute to the diagnosis. Vestibular dysfunctions are frequently associated with migraine including the common type. Utilizing labyrinthine tests with the aid of electronystagmography, abnormalities of labyrinth function were demonstrated in 80% of patients with common migraine who had no history of vertigo or of other otological and neurological disorders.
New Neurotological Test for Detecting Cerebellar Dysfunction
Authors: Yagi Toshiaki , Sekine Shuji , Shimizu Motohiro , Kamio Tomokazu
Published: October 2014

Adaptation of the vestibule-ocular reflex (VOR) was studied in 26 normal subjects and 15 patients with cerebellar lesions, using horizontal vision-reversal prisms. In normal subjects, adaptation of gain after wearing prisms for one hour was approximately 50% of the VOR value in the dark. In contrast to this, patients with cerebellar lesions showed less adaptation, approximately 20% after a one-hour forced adaptation task. These cases showed three different types of abnormalities: 1) high gain before wearing prisms and normal adaptation, 2) high gain before wearing prisms and reduction of adaptation, 3) normal gain and reduction of adaptation. From these results, it is suggested that observation of the effect of vision-reversal prisms on the VOR may permit the detection of cerebellar lesions of a type or subtlety which escape established tests.
Surgical and Radiological Effects upon the Development of Speech after Total Laryngectomy
Authors: Richardson Jean L.
Published: October 2014

The data presented examine the relationship between postlaryngectomy communication method, and the extent of total laryngectomy and the use of radiation therapy. The expectations of speech therapy providers were also examined. The author interviewed 60 laryngectomy patients who were six months to 3½ years postsurgery. Surgeries were grouped into four categories and correlated with communication method. The relationship was statistically significant with the most apparent deterrent effect exhibited only for the most extreme surgical excisions. There was no relationship with the use of radiation therapy. In many cases speech therapy providers' expectations were not supported by the data.
Flexible Fiberoptic Endoscopy in Difficult Intubations
Authors: Edens Enje Th. , Sia Roberto L.
Published: October 2014

Intubation problems sometimes occur very suddenly and can be divided into two groups. The expected ones include the patients with a short neck and long teeth, cellulitis of the tongue, large oropharyngeal tumors, obstructing laryngeal tumors, congenital and acquired maxillofacial deformities, ankylosis of the temporomandibular joints, fractures or ankylosing spondylitis of the cervical spine, and all patients with a history of previous intubation problems. Unexpected problems can arise in patients who combine large incisors and canines with an inability to open the mouth wide, or when the glottis is invisible because the epiglottis is immobile. The first concern in these cases is to restore consciousness, for the conscious patient shows tonus and this facilitates identification of anatomical landmarks. A 60 cm bronchofiberscope provided with a tube and a freely movable end of 30 cm is suitable. Shorter flexible scopes are not adequate.
Sputum Cytologic Diagnosis of Upper Respiratory Tract Cancer Second Report
Authors: Neel H. Bryan , Sanderson David R. , Taylor William F. , Fontana Robert S. , Woolner Lewis B.
Published: October 2014

Screening for cancer is a popular issue for debate because few, if any, evaluations of the screening process have been conducted on a long-term prospective basis with use of concomitant, unscreened controls. We have found that screening of high-risk persons for presymptomatic lung cancer will identify patients with cancer in the upper and lower respiratory passages. Randomly selected patients enrolled in the Mayo Lung Project have undergone sputum cytologic and chest roentgenographic screening at four-month intervals and were compared with randomly selected matched control subjects who were not intensively screened. The search for upper airway tumors in the head and neck region was instigated by abnormal findings on sputum cytology in 12 screened patients. In the same period, 12 other screened patients with abnormal results of sputum cytology were found to have roentgenographically “occult” lung cancer. This finding emphasizes the importance of the otorhinolaryngologic examination in screening programs for airway cancer. It is also important to emphasize that sputum-negative patients may have obvious, symptomatic tumors of the upper aerodigestive tract that can be easily diagnosed by those who are skilled in examining this area. Contrary to our expectation, there is no definitive evidence that screening has reduced mortality from either upper or lower airway cancer.
Unusual Presentations and Problems Created by Mismanagement of Foreign Bodies in the Aerodigestive Tract of the Pediatric Patient
Authors: Cohen Seymour R.
Published: October 2014

Nine children who suffered unusual problems because of the mismanagement of ingested or inhaled foreign bodies are reported. The causes of mismanagement are discussed and the details of the histories, examinations and follow-up are given. The serious complications were pulmonary hemorrhage, tracheoesophageal fistulae, mediastinitis resembling a mediastinal tumor, periesophageal infection from perforation, loss of a Fogarty® catheter tip in a segmental bronchus, laryngeal stenosis from a cricothyrotomy in an infant, and the displacing of a foreign body into an almost inaccessible distal bronchus. All of these unusual problems, and the resultant morbidity and financial cost, could have been avoided with proper management and early diagnosis.
Effect of Total Laryngectomy on Esophageal Motility
Authors: Hanks John B. , Fisher Samuel R. , Postlethwait Raymond W. , Meyers William C. , Jones R. Scott , Christian Kenneth C.
Published: October 2014

Total laryngectomy for cancer can result in dysphagia and altered esophageal motility. Manometric changes in the upper esophageal sphincter (UES), and in proximal and distal esophageal function have been reported. However, most studies have failed to take into account radiation therapy and appropriate controls. We selected ten male patients (54.3± 1.9 yr) for longitudinal manometric evaluation prior to laryngectomy then at two weeks and again six months later. No patient received preoperative radiation therapy, had a previous history of esophageal surgery, or developed a postoperative wound infection or fistula. Seven of ten patients had positive nodes and received 6,000–6,600 rads postoperative radiation therapy. Preoperatively 4 of 10 patients complained of dysphagia which did not significantly change following surgery and radiation. Two of three patients who did not complain of dysphagia preoperatively and received radiation postoperatively developed dysphagia. No patient without dysphagia preoperatively who received no radiation therapy developed symptoms. Our studies show that laryngectomy causes alterations in the UES resting and peak pressures but not in the proximal or distal esophagus, or the lower esophageal sphincter. These data also imply radiation therapy may be associated with progressive alterations in motility and symptomatology. Further study regarding the effects of radiation on esophageal motility and function are urged.
Histopathology of Acquired Subglottic Stenosis
Authors: Tucker Gabriel F. , Newton Leonard , Ruben Robert J.
Published: October 2014

The history of a 2,900 g infant who had no stridor at birth and developed subglottic stenosis is presented in detail. The laryngeal lumen, which accepted a 3 mm endotracheal tube at one day of age, diminished to total occlusion at 15 months of age. There was an 8-day intubation and tracheotomy at nine months. At 19 months the patient expired from associated cardiac problems; the larynx was obtained at autopsy and was serially sectioned in the horizontal plane. A series (1mm-Tracer) of 12 sections through the stenotic area is presented. It demonstrates gross distortion of the cricoid cartilage with ossification extending into the right paraglottic larynx.
Abnormal Esophageal Manometry in Globus Hystericus
Authors: Flores Toribio C. , Cross Frederick S. , Jones Richard D.
Published: October 2014

Globus hystericus means the “hysterical ball or lump in the throat,” and is generally assumed to be of psychic origin. True dysphagia is usually absent. Twelve patients with the globus syndrome were studied at the Esophageal Motility Laboratory of the Saint Luke's Hospital of Cleveland. An organic cause for their symptomatology was ruled out by physical examination, laryngoscopy, esophagoscopy and cineesophagograms. Ten patients showed significant elevations in esophageal resting pressures and nine had evidence of disordered motor activity in the body of the esophagus. Knowing from previous investigations that a suprasternal discomfort may be elicited from stimulation of the esophagus at different levels, we propose that the globus sensation is a referred one coming from the hypertonic and frequently incoordinated body of the esophagus.
Horseradish Peroxidase Studies in Animals with Neuromuscular Transpositions
Authors: Neal G. David , Sutton Dwight , Duncan Gregory , Cummings Charles W.
Published: October 2014

Horseradish peroxidase (hrp) is used to trace axonal connections from the motor end-plate to the driving neuron. This technique has confirmed that the neurons activating the sternothyroid muscle are located in the cervical spinal cord, while those controlling the posterior cricoarytenoid (pca) are found in the nucleus ambiguus ipsilaterally. Eight rabbits underwent a sternothyroid ansa pedicle implantation to the pca at the time of sectioning the recurrent laryngeal nerve ipsilaterally. After two months, four of these animals received hrp injections into the previously implanted pca. Brainstem staining hrp did not reveal any retrograde transport to the motor neurons that were known to control the sternothyroid. Possible reasons for the failure of retrograde transport are discussed.