bluuebunny/crossref_metadata_2025 huggingface dataset:
Studies of inner ear blood flow in animals and human beings
Authors: Miller Josef M. , Ren Tian‐Ying , Nuttall Alfred L.
Published: September 2022

This article reviews current studies on inner ear blood flow, discusses their relevance to the maintenance of normal homeostasis of the inner ear, reports for the first time clear changes in fundamental properties of cochlear blood flow in the chronic hydropic ear, and describes the potential of applying laser Doppler flowmetry technology to the measurement of inner ear blood flow in human beings. Studies of the guinea pig in which perfusion pressure is varied demonstrate a broad range of autoregulatory capabilities of the inner ear vasculature. Gain factors range from 0.76 and higher for recovery for less than 1 minute of modified perfusion pressure. This is significantly greater than reports obtained for brain autoregulation. In a series of four investigations of cochlear blood flow in the hydropic ear in guinea pigs, a decreased responsiveness to electrical stimulation and direct stimulation of the superior cervical ganglia was found, indicating a change in sympathetic control of cochlear tone. Reduced vasomotion was observed, and autoregulatory capabilities were reduced. In human investigations, changes in cochlear blood flow were demonstrated with direct electrical stimulation of the round window and warm water irrigation of the ear canal, but not with carbogen breathing. Increased cochlear blood flow was observed with increased systemic blood pressure, and a remarkable decrease in cochlear blood flow was observed with the application of 1:10,000 epinephrine to the round window. These observations indicate the potential for development of laser Doppler flowmetry technology in the diagnosis and treatment of inner ear vascular disorders, and the animal Investigations suggest that changes may occur in the chronic hydropic ear that compromise autoregulation and thus increase the sensitivity of the hydropic ear to other stress factors. Treatments can be found to modify such changes in vascular tone.
Vertebrobasilar insufficiency and stroke
Authors: Baloh Robert W.
Published: September 2022

Vertigo is the most common symptom of transient ischemia within the vertebrobasilar system. Episodes typically come on abruptly and last minutes. Although there are usually associated symptoms, isolated attacks of vertigo can occur. Vertigo is also a common symptom with brain stem and cerebellar strokes. Isolated cerebellar infarction can mimic peripheral vestibular disorders because vertigo and imbalance are the main symptoms with both disorders. Modern neuroimaging techniques have markedly improved diagnostic capabilities.
Vascular compression syndrome of the vestibular nerve: A critical analysis
Authors: Bergsneider Marvin , Becker Donald P.
Published: September 2022

The rationale, indications, and surgical results of microvascular decompression for the treatment of vertigo are reviewed, and a critical analysis is made. The syndrome of disabling positional vertigo is discussed. It is concluded that (1) vascular compressive vestibular neuropathy may exist, (2) the current published diagnostic criteria for this disorder are insufficient to firmly establish the diagnosis, and (3) further work delineating this syndrome should be undertaken.
Programmatic vestibular rehabilitation
Authors: Shepard Neil T. , Telian Steven A.
Published: September 2022

Although the use of vestibular exercises for patients with persistent vertigo and dysequilibrium has received some attention for many years, organized vestibular rehabilitation therapy programs have only recently been introduced. The benefits of such programs are becoming widely accepted. They typically involve a three‐pronged approach: habituation exercises designed to facilitate central nervous system compensation by extinguishing pathologic responses to head motion, postural control exercises, and general conditioning activities. This article will describe the programmatic approach to vestibular rehabilitation, emphasizing selection criteria and reviewing results that may be anticipated when this treatment modality is used in a variety of patient populations.
Dural Closure with Laser Tissue Welding
Authors: Foyt David , Johnson Jeffrey P. , Kirsch Andrew J. , Bruce Jeffrey N. , Wazen Jack J.
Published: September 2022

This study investigates the use of tissue‐soldering techniques to substitute or reinforce traditional suture closure of dural incisions. Fresh human cadaveric dura was incised and subsequently closed by use of three techniques: (1) conventional interrupted suture with 4–0 silk (n = 25), (2) laser solder reinforced suture closure (n = 25), and (3) laser solder closure alone (n = 25). Anastomosis tensile strength and hydrostatic leak pressures were measured. Dural repair was also performed in 15 live Lewis rats. Dural closure was accomplished with 9–0 Prolene sutures (n = 5), laser‐reinforced suture closure (n = 5), and laser solder closure alone (n = 5). Histologic examination of the closure immediately after soldering and 2 weeks later was performed. Suture closure alone had the lowest leak pressure, 9.4 ± 1.7 mm Hg, and an intermediate break point, 13.3 ± 2.1 Kgf/cm2. Measurements with laser solder alone revealed a mean leak pressure of 26.2 ± 3.7 mm Hg and a break point of 4.6 ± 1.4 Kgf/cm2. Solder‐reinforced suture closure leak pressure measured 64.0 ± 6.7 mm Hg and 21.4 ± 2.4 Kgf/cm2. There was a statistically significant increase in leak pressure and tensile strength in the closures performed with laser weld reinforcement of traditional suture technique (p = 0.0001). Dural closure with laser tissue welding alone provided an immediate leak‐free closure, but with poor tensile strength. Histologic examination of welded dura and underlying brain tissue showed no evidence of thermal injury in four of five animals studied. Laser welding may significantly decrease the incidence of cerebrospinal fluid leak after dural closure. In addition, laser tissue welding also makes dural closure possible where space constraints make traditional suture closure difficult.
Repair of Chronic Tympanic Membrane Perforations with Fibroblast Growth Factor
Authors: Kato Maya , Jackler Robert K.
Published: September 2022

A number of angiogenic growth factors have been shown to accelerate wound healing. Previous work has demonstrated that topical application of epidermal growth factor is effective in healing chronic tympanic membrane perforations in an animal model. Theoretically, fibroblast growth factor may result in a superior healed membrane through preferential stimulation of the fibroblasts within the middle layer of the tympanic membrane. To test this hypothesis, the effects of exogenously applied fibroblast growth factor on the chronically perforated tympanic membrane were evaluated. A buffered solution of fibroblast growth factor (25 μl of fibroblast growth factor, 0.2 mg/ml) was administered to a Gelfoam pledget placed over chronic tympanic membrane perforations in chinchillas. Control ears were treated with Gelfoam and the buffer solution only. Complete closure of the tympanic membrane perforation was observed in 81% (13 of 16) of the fibroblast growth factor‐treated ears, but in only 41% (7 of 17) of the controls (p= 0.05). Healing took place gradually, requiring an average of 4 weeks for the fibroblast growth factor‐treated and 6.5 weeks for the control ears that healed. The relatively high healing rate for the control group does not imply that the pretreatment perforations were not chronic, rather there appears to be some efficacy to the control protocol of repeated applications of Gelfoam and buffer. A histologic analysis of the fibroblast growth factor‐healed eardrums immediately after closure demonstrated hypertrophy of the squamous and fibrous layers of the tympanic membrane. Over time, the eardrum thinned to reach proportions similar to those of the normal tympanic membrane, including the presence of a substantial middle fibrous layer. A screening ototoxicity study revealed no structural damage to the organ of Corti after growth factor treatment. To assess the potential for systemic toxicity, blood and peripheral tissues were analyzed for radioactivity at time points during a 48‐hour period after application of 25 μl of125l‐fibroblast growth factor to the perforated tympanic membrane. More than 78% of the radioactivity remained at the application site. Given the tiny original dosage, the small fraction absorbed systemically is minuscule and highly unlikely to induce adverse effects in light of published toxicity data. On the basis of these promising safety and efficacy data in the chinchilla model, clinical trials of fibroblast growth factor in repair of chronic tympanic membrane perforations in human beings are being initiated.
Otology Through the Ages
Authors: Pappas Dennis G.
Published: September 2022

Recounted are some, not all, of the most significant contributions to otology. The history of otology has, for the most part, followed the history of medicine: Little was known of otology by the ancient physicians, but their work must be reviewed to appreciate the progress that has been made. Most of the otology produced during the Middle Ages was limited to those structures that were readily accessible; otologic surgery was confined to trauma and removal of foreign bodies from the external auditory canals. Examination of the ear began after studies of the ear by Italian anatomists during the seventeenth century. It was not until the end of the eighteenth century that magnification was used so that the minute anatomic details could be observed. The clinical specialty of otology started in France (1850s), emerged as a scientific specialty in England, and received explosive progress from the German‐speaking countries at the end of the nineteenth century. Otology has a remarkable background.
Blood and Air Pollution; State of Knowledge and Research Needs
Authors: Badman David G. , Jaffé Ernst R.
Published: September 2022

The ready access to blood (plasma and formed cellular elements) makes it unusually susceptible to the deleterious effects of pollutants whose origins may be in the air. The red blood cells' hemoglobin may be rendered useless for oxygen transport by combination with carbon monoxide or conversion to methemoglobin or sulfhemoglobin. Lead and arsine can damage the erythrocytes' membranes, resulting in anemia. Metabolites of benzene and other volatile polycyclic hydrocarbons are implicated in the causation of leukemias. The extensive use of pesticides and herbicides may be associated with the development of Hodgkin's disease, non‐Hodgkin's lymphoma, and aplastic anemia. The carcinogenic risks from ionizing radiation, especially for leukemia, are well known. More information is needed concerning the epidemiology of environmental factors responsible for damage to blood. Enhanced knowledge about the molecular biology of toxins' effects on the hematopoietic system and improved detection and prevention technologies are needed to answer environmentally related health questions.
Direct and Indirect Exposure to Air Pollution
Authors: Thron Raymond W.
Published: September 2022

Hazardous substances that originally are discharged as air pollutants may find their pathway to human exposure through multiple routes, including ingestion and dermal contact, as well as direct inhalation. The mechanisms for modeling and understanding the fate of air pollutants through atmospheric transport, deposition into water and soil, bioaccumulation, and ultimate uptake to receptor organs and systems in the human body are complex. Pollution prevention programs can be better engineered, pollution priorities can be identified, and greater environmental public health gains (attributable to pollution prevention) can be achieved by evaluating the multiple pathways to human exposure and through improved dosage calculations. A single contaminant source often may represent only a fraction of a total body pollutant burden. Further research is needed on source culpability and attributable risk, long‐range transport of air pollutants, human dose contributions by various pathways, better techniques for health risk assessment, and an identification of human behavior patterns that affect exposure and dose.
Future of Environmental Pollution
Authors: Barnes Donald G.
Published: September 2022

In recent years, the concept of pollution prevention has overtaken end‐of‐pipe controls as the paradigm of choice for effecting environmental protection. Through cooperative mechanisms, significant progress Is being made to reduce or eliminate upstream processes and practices that can lead to downstream pollution. These efforts, coupled with productive interactions with the public, are making an impact. The Science Advisory Board released a report in January that described the “next wave” of pollution prevention. Specifically, the report described approaches for anticipating environmental problems of tomorrow so that preventive actions can be taken today. The potential of air pollution problems figures prominently in the Board's vision of the future.
Ambulatory vs. In‐Patient Stapedectomy: A Randomized Twenty‐Patient Pilot Study
Authors: Corvera Gonzalo , Céspedes Boris , Ysunza Antonio , Arrieta José
Published: September 2022

A prospective study was undertaken to determine whether stapedectomy can safely be performed in an outpatient setting. Twenty patients with otosclerosis amenable to surgical treatment were divided into two groups; those in the hospitalized group were admitted the day before surgery and discharged 24 hours after the procedure. The patients in the ambulatory group were admitted on the day surgery was scheduled and released 1 or 2 hours after the procedure. We analyzed the intensity and duration of postoperative vertigo, and the hearing gain obtained, studying the speech frequencies (500 to 2000 Hz) separately from the high frequencies (4000 to 8000 Hz). No significant difference was found at 4, 3, and 6 months of follow‐up in any of the parameters studied, concluding that small‐fenestra stapedectomy can safely be performed as an outpatient procedure.
Tympanic Membrane Reconstruction using Formaldehyde‐Formed Autogenous Temporalis Fascia: Twenty Years' Experience
Authors: Perkins Rodney , Bui Hana T.
Published: September 2022

This study describes 20 years' experience with autogenous temporalis fascia that is formed and shaped by formaldehyde cross‐linking with special Fasciaform (Hear America, Palo Alto, Calif.) molds in the repair of large tympanic membrane perforations. One hundred twenty operations in 113 patients were performed between 1973 and 1993 to close large perforations in patients with intact ossicular chains. All perforations were successfully closed by this technique. Audiometric studies indicated that the postoperative air‐bone gap was closed to within 0 to 10 dB in 63% and to within 0 to 20 dB in 97%. One patient had a 15‐dB sensorineural hearing impairment. Graft lateralization requiring revision occurred in three patients, two of whom had previous unsuccessful tympanoplasties. Comparisons of adult vs. pediatric groups and primary vs. revision groups were made. The technique ensures the removal of any ectopic epithelium on the medial surface of the tympanic membrane remnant and provides for easy graft placement and stability during healing without the use of middle ear Gelfoam (Upjohn Co., Kalamazoo, Mich.). The formaldehyde‐formed fascia graft or Fasciaform graft technique provides an effective method of closing large perforations with excellent functional results and minimal complications.
Positional Nystagmus in Asymptomatic Human Subjects
Authors: McAuley James R. , Dickman J. David , Mustain William , Anand Vinod K.
Published: September 2022

Nystagmus produced by static placement of the head in different orientations is termed positional nystagmus and is known to occur In human subjects who are free of vestibular sympitoms. This study provides quantitative data for horizontal positional nystagmus occurrence in 49 normal human subjects, in whom the number of nystagmus beats, the slow‐phase velocity of each beat, and distribution statistics were determined. A metric for the possible differentiation of physiologic positional nystagmus from pathologic positional nystagmus is described.
Assessment of the Infant Airway with Videorecorded Flexible Laryngoscopy and the Objective Analysis of Vocal Fold Abduction
Authors: Waters Kurtis A. , Woo Peak , Mortelliti Anthony J. , Colton Ray
Published: September 2022

Accurate diagnosis of upper airway abnormalities by flexible laryngoscopy in infants is hampered by rapid laryngeal motion and lack of patient cooperation. This study evaluates the added role of videorecorded flexible laryngoscopy and the objective measurement of vocal fold abduction in improving the diagnosis of upper airway abnormalities in infants. Seventy‐eight infants had videorecorded flexible laryngoscopy performed as part of their evaluation of a suspected airway disorder. These recordings were reviewed by three otolaryngologists for confirmation of the clinical diagnosis. From the video image, the maximum angle of vocal fold abduction was measured with image analysis software. Of 78 patients 40 had supraglottic or glottic abnormalities, 9 had nasal or nasopharyngeal obstruction, 9 had subglottic abnormalities (diagnosed subsequent to videolaryngoscopy), and 15 patients had normal findings on examination. Of those with laryngeal abnormalities, laryngomalacia was the most common diagnosis (23 of 78). Vocal fold paralysis was present in 4 patients. A separate group (9 of 78) of patients was identified as having symmetric bilateral limitation of vocal fold abduction. Laryngeal dyskinesia was diagnosed in these 9 patients. The mean values of maximal vocal fold abduction were as follows: (1) normals, 59.5 degrees; (2) laryngomalacia, 57.0 degrees; (3) paralysis, 26.6 degrees; and (4) incomplete abduction with laryngeal dyskinesia, 27.6 degrees. Videolaryngoscopy is a valuable tool for documentation, parent education, and analysis of infant laryngeal abnormalities. Repeat viewing of the video examination and frame‐by‐frame analysis improve the diagnostic accuracy. Using this approach, we have calculated the anterior glottic abduction angle in the normal and abnormal Infant larynx. In addition, we have identified a group of infants with incomplete abduction of the vocal folds that appears to be different from that found in vocal cord paralysis.
Vocal fold Paralysis in Infants Twelve Months of Age and Younger
Authors: Zbar Ross I. S. , Smith Richard J. H.
Published: September 2022

Seventeen cases of unilateral or bilateral vocal fold paralysis were diagnosed in infants younger than 12 months from 1991 to 1994 at the University of Iowa Hospitals and Clinics. Eight (47%) children with left vocal fold paralysis had a history of prior thoracic surgery –‐ two to repair complex congenital anomalies and six to ligate a patent ductus arteriosus. During the study period, a total of 81 patent ductus arteriosus ligations were performed, yielding a 7.4% postoperative incidence of vocal fold paralysis. Seven (41%) children had idiopathic vocal fold paralysis (3 right, 1 left, 3 bilateral). Two (12%) children had VFP caused by central nervous system pathology (1 right, 1 bilateral). Tracheotomy was not required in any case. Prognosis for vocal fold paralysis varied with cause. With left vocal fold paralysis caused by thoracic surgery, no improvement was noted after an average follow‐up of 6 months; with idiopathic vocal fold paralysis infants improved within an average of 6 weeks of diagnosis; with vocal fold paralysis caused by central nervous system pathology, treatment of the underlying condition was followed by return of vocal cord function. Irrespective of cause, the morbidity associated with vocal fold paralysis is minimal. Although tracheotomy is not required, careful airway observation is important. Differences and similarities of these results with other studies are discussed.
Morphogenesis of the Lateral Nasal wall from 6 to 36 weeks
Authors: de Arreola Guadalupe Arredondo , Serna Norberto López , de Hoyos Parra Ricardo , Salinas Miguel Angel Arreola
Published: September 2022

This research describes the development of the lateral nasal wall, the description of which will allow a better comprehension of its anatomic complexity. One hundred embryos and fetuses from the sixth to thirty‐sixth weeks of morphologic age were studied. The seventh week shows the first buds of the three turbinates. At the ninth week the precartilaginous nucleus of the inferior turbinate is observed. Likewise, at the tenth week the uncinate process appears, and the invagination of the epithelium begins the formation of the infundibulum and the maxillar sinus. At the fourteenth week the cartilaginous nasal capsule is present. The epithelium is invaginated, starting the formation of the ethmoid cells. During the seventeenth week of development the invagination of the mucus has invaded the maxillar bone, which constitutes the maxillar sinus. At the thirty‐sixth week the lateral nasal wall is well developed. In 23 fetuses the supreme turbinate (fourth) was found. Although the length of the lower three turbinates increased progressively and proportionally in intrauterine life without differences between the sexes, the fourth remains invariably at an average length of 5 mm from the fourteenth to the thirty‐sixth and was present in 65% of male fetuses.
Comparison of the Canalith Repositioning Procedure and Vestibular Habituation Training in Forty Patients with Benign Paroxysmal Positional Vertigo
Authors: Steenerson Ronald L , Cronin Gaye W.
Published: September 2022

Forty patients with benign paroxysmal positional vertigo were treated with either the canalith repositioning procedure or vestibular habituation exercises to determine which treatment approach would be most effective. Twenty additional patients with benign paroxysmal positional vertigo were not treated and served as a control group. The intensity and duration of symptoms were monitored during a 3‐month period. All patients had symptomatic relief in the treated groups. The canalith repositioning procedure seemed to give resolution of symptoms with fewer treatments, but long‐term results show either treatment approach is effective in relieving positional vertigo. A significant number of patients in the control group (75%) continued to have vertigo. Advantages and disadvantages of the canalith repositioning procedure and vestibular habituation exercises are discussed.
Heat Shock Proteins in Middle ear Cholesteatoma
Authors: Shinoda Hideo , Huang Cheng‐Chun
Published: September 2022

Heat shock proteins (HSPs), particularly HSP60 and HSP70, may have integral roles in several aspects of the pathogenesis of acquired cholesteatoma. Cholesteatoma is usually associated with an inflammatory reaction occurring in the middle ear cavity, leading to proliferation, differentiation, and programmed cell death of keratinocytes. The presence of HSP60 and HSP70 in cholesteatoma was demonstrated by the immunoblotting assay with specific anti‐HSP60 and anti‐HSP70 antibodies after protein extraction. The distribution of HSP60 and HSP70 in the cholesteatoma tissues was studied immunohistochemically with paraffin‐embedded sections. HSP60 and HSP70 appeared to be localized in the cytoplasm of keratinocytes in all layers of the epithelium of cholesteatoma. Moreover, HSP70 was found in the nucleus of keratinocytes. Both HSPs were not labeled in the epidermis of the external ear canal skin or normal facial skin, except for significant staining on keratinocytes of hair follicles in facial skin. High density of HSP60 and HSP70 may be induced by the inflammatory reaction and immune responses in the middle ear cavity during the clinical development of cholesteatoma. Induction of HSP60 and HSP70 in cholesteatoma epithelium may also be related to hyperproliferation and active differentiation of basal keratinocytes, which cause the accumulation of keratin debris, a characteristic feature of cholesteatoma. In the nucleus of keratinocytes, HSP70 may act to stabilize p53 protein, which functions as a negative regulator of cellular proliferation and is crucial to apoptosis of keratinocytes. This study demonstrates HSPs in cholesteatoma and suggests important roles for HSPs in the clinical development of cholesteatoma.
The Medical Management of Rhinosinusitis
Authors: Benninger Michael S. , Anon Jack , Mabry Richard L.
Published: September 2022

The management of rhinosinusitis depends on a number of variables related to the duration and severity of symptoms in the individual patient. Furthermore acute rhinosinusitis is managed differently than chronic rhinosinusitis. Because a variety of conservative and pharmacologic interventions are available, the physician can find it difficult to develop a cohesive and logical approach to treatment. An understanding of the pathophysiology, microbiology, and natural history of rhinosinusitis is necessary to formulate the best treatment plan for the individual patient.
Effect of Radiotherapy on the Levels of Secretory Immunoglobulin A Against Indigenous and Virulent Streptococci
Authors: Himi Tetsuo , Kukuminato Yasushi , Kita Hideaki , Yoshioka Iwao , Kataura Akikatsu
Published: September 2022

If is well known that the frequency of upper respiratory infection is clinically increased after radiotherapy of the head and neck region. This study found higher antibacterial secretory immunoglobulin A (S‐IgA) activity against three indigenous streptococci (Streptococcus mitis, S. salivarius, and S. sanguis I) and S. pneumoniae in patients who had undergone radiation therapy of the head and neck region than in control subjects. This showed no relation to the extent of the radiation field. Compared with before radiotherapy, the S‐IgA titer against S. pneumoniae and its ratio to the activities against the indigenous streptococci were significantly higher in patients with fully irradiated major salivary glands. These results indicated that the radiotherapy promoted the antigen‐specific S‐IgA production of virulent streptococci in most patients with head and neck cancer, even more than 6 months after radiotherapy. The resulting altered balance in the S‐IgA system of normal indigenous streptococci may also impair the ability to maintain the stable bacterial interference between normal indigenous and virulent streptococci in the oropharyngeal cavity.
Surgical Anatomy of the Rat Middle Ear
Authors: Judkins Richard F. , Li Hongyan
Published: September 2022

This study was designed to aid experimental otologic studies of the rat middle ear. The topographic anatomy of the albino rat middle ear is described. A set of microphotographs with matching illustrations presents the structural details at several surgical exposures. Anatomic differences between the rat, guinea pig, and cat are noted.
Interleukin‐8 Expression in Human Nasal Polyps
Authors: Allen Jerilyn S. , Eisma Roselle , Leonard Gerald , Lafreniere Denis , Kreutzer Donald
Published: September 2022

The cytokine Interleukin 8 (IL‐8) has been shown to be a potent mediator of leukocyte recruitment and neovascularization in inflammatory and neoplastic diseases. In this study we hypothesize that IL‐8 produced in the nasal polyp microenvironment is responsible for the leukocyte recruitment seen in nasal polyposis. To test this hypothesis we evaluated nasal polyps for distribution and content of IL‐8 antigen with immunohistochemical techniques and radioimmunoassay to determine tissue levels of IL‐8. The immunohistochemical results demonstrated that IL‐8 antigen staining occurred predominantly within inflammatory cells and epithelium. IL‐8 was detected in all nasal polyp tissue homogenates (a mean value of 1767 ± 1633 pg/mg total protein (TP) with a range of 134 to 3668 pg/mg TP vs control specimens with a mean value of 77 pg/mg TP with a range of 0.09 to 255 pg/mg TP). These data demonstrate the presence and distribution and levels of IL‐8 antigen in nasal polyps in vivo, supporting our hypothesis that local production of IL‐8 could be an important factor in the sustained recruitment of leukocytes in nasal polyposis. Thus IL‐8 likely plays a significant role in the pathogenesis of this disease process and therefore is a potential target for therapeutic intervention.
Drill‐Induced Hearing Loss in the Nonoperated Ear
Authors: da Cruz Melville J. , Fagan Paul , Atlas Marcus , Mcneill Celene
Published: September 2022

The reversible hearing loss in the nonoperated ear noted by patients after ear surgery remains unexplained. This study proposes that this hearing loss is caused by drill noise conducted to the nonoperated ear by vibrations of the intact skull. This noise exposure results in dysfunction of the outer hair cells, which may produce a temporary hearing loss. Estimations of outer hair cell function in the nonoperated ear were made by recording the change in amplitude of the distortion‐product otoacoustic emissions before and during ear surgery. Reversible drill‐related outer hair cell dysfunction was seen in 2 of 12 cases. The changes In outer hair cell function and their clinical implications are discussed.
Clinical Observations on Coexistence of Sudden Hearing Loss and Vestibular Schwannoma
Authors: Aslan Asim , de Donato Giuseppe , Balyan Fatih ridvan , Falcioni Maurizio , Russo Alessandra , Taibah Abdelkader , Sanna Mario
Published: September 2022

It has long been recognized that sudden hearing loss (SHL) may be a harbinger of vestibular schwannoma (VS). Among 192 VS patients who underwent operation in the Gruppo Otologico, Piacenza, Italy, from April 1987 to October 1995, the charts of 14 (7.3%) cases with a history of SHL were examined. SHL was the first symptom in 8 (4.2%) patients. Eight (57.1%) of 14 VS cases with SHL anamnesis had reported recovery of their previous hearing either totally or partially before establishment of tumor diagnosis. Five (35.7%) cases had recurrent bouts of SHL. SHL was observed less frequently in cases with large tumors (<3 cm). However, the frequency of SHL in patients with small tumors did not differ from that of medium‐sized tumors. Awareness about coexistence of SHL and VS, as well as concomitant use of auditory brain stem response and magnetic resonance imaging, is crucial to rule out the diagnosis of VS in a patient with SHL.
Bone Graft Incorporation after Cortical Perforations of the Host Bed
Authors: Gordh Monica , Alberius Per , Lindberg Lisbeth , Johnell Olof
Published: September 2022

A fundamental issue in onlay bone graft persistence is the unpredictable extent of incorporation and volumetric maintenance of the graft. The purpose of this study was to evaluate the effects on integration of onlays, with either their cancellous or cortical portion facing toward the host bed, positioned over cortical perforations at the recipient site. Tibial or femoral unicortical bone grafts were harvested from isogeneic donors and positioned sub‐periostally on each tibia of 22 adult Lewis rats. On the experimental side, the recipient outer cortical bone surface received multiple perforations, 0.25 mm in diameter. The contralateral side served as a control (no cortical perforations). The findings were assessed after 4 and 20 weeks using routine histologic and immunohistochemistry techniques. Cortical perforations induced a migration of the recipient bone marrow info the graft as well as a reduced size diminution. More cortical bone remodeling and marginal lamellar bone apposition were observed after orientating the cortical portion of the graft toward the recipient site. These observations may be useful clinically to improve long‐term success after autogeneic bone grafting.
Epistaxis: A retrospective review of hospitalized patients
Authors: Pollice Philip A. , Yoder Milton G.
Published: September 2022

A 2‐year retrospective study (August 1, 1992, to July 31, 1994) reviews medical records of 249 hospitalized epistaxis patients at seven Baltimore‐area hospitals. This review represents the first multihospital study of patients hospitalized with epistaxis. The study evaluates multiple factors associated with epistaxis: demographics, underlying medical diseases, use of anticoagulation medication, site of epistaxis, and month of hospital admission. Blood transfusion requirement, hematocrit level, length of stay, treatment, and local/systemic complications are studied as well. The month of hospital admission was evenly distributed without a wintertime predominance, and the mean length of stay was 4 days. Treatment and outcome were similar in all hospitals, and more than 83% of patients responded to packing, balloon placement, local cautery, or a combination thereof. Of the 249 patients reviewed, 30 underwent surgical endoscopic cautery, 3 required formal surgical arterial ligation, and 1 underwent arterial embolization. All 30 endoscopic cauterizations successfully stopped the epistaxis, and this technique proved to be a useful adjunct for patients who required multiple interventions. The review identified a 3% complication rate of epistaxis and its treatment, including synechiae, aspiration, angina, myocardial infarction, and hypovolemia. No deaths were directly attributable to epistaxis or its treatment. (Otolaryngol Head Neck Surg 1997;117:49–53.)
Negative‐pressure pulmonary edema in the otolaryngology patient
Authors: Goldenberg John D. , Portugal Louis G. , Wenig Barry L. , Weingarten Randall T.
Published: September 2022

It is estimated that 11% of all patients requiring active intervention for acute upper airway obstruction develop negative‐pressure pulmonary edema. This pathologic process typically has a benign and rapidly resolving clinical course with the prompt use of mechanical ventilation and positive end expiratory pressure. A review of the literature, however, has revealed a morbidity and mortality rate of 11% to 40% in reported series. During the years 1991 through 1993, six patients were identified in whom negative‐pressure pulmonary edema developed after various otolaryngologic procedures. Five (84%) of the six patients had complete resolution of the pulmonary edema within 24 hours, and the sixth patient progressed to prolonged mechanical ventilation and eventual death. In an effort to further understand the pathophysiology of this disease, a cardiac evaluation was performed by use of echocardiography on all six patients. In three of the six patients, studies revealed an underlying cardiac anomaly not previously identified by history or physical examination. Findings included one case of hypertrophic cardiomyopathy and two cases of pulmonary and tricuspid valvular insufficiency. This 50% incidence of cardiac anomalies is striking, in contrast to the less than 1% incidence of these anomalies in the general adult population. To our knowledge, this is the first study to implicate an underlying cardiac cause for the generation of negative‐pressure pulmonary edema. On the basis of this study, we recommend that echocardiography be a part of the routine evaluation of all patients who manifest negative‐pressure pulmonary edema. (Otolaryngol Head Neck Surg 1997;117:62–6.)
Treatment of massive or life‐threatening hemangiomas with recombinant α2a‐interferon
Authors: Bauman Nancy M. , Burke Diane K. , Smith Richard J. H.
Published: September 2022

OBJECTIVE

To assess the response of massive, life‐threatening, or function‐impairing hemangiomas in pediatric patients receiving daily α2a‐interferon subcutaneously.

METHODS

The effect of 3 or more months of subcutaneous α2a‐interferon (3 mU/m2) was prospectively evaluated in 10 patients with hemangiomas necessitating medical intervention. Hemangioma characteristics and extent were initially assessed by radiographic imaging in all but one patient. α2a‐interferon tolerance was monitored, and reduction in hemangioma size was recorded as marked (>50%), moderate (25% to 50%), or minimal (<25%).

RESULTS

Hemangiomas were apparent at birth in 8 of 10 patients, and α2a‐interferon was initiated at a median age of 4.5 months. Symptoms necessitating therapeutic intervention included congestive heart failure, airway obstruction, dysphagia, infection, failure to thrive, external auditory canal occlusion, visual axis impairment, and severe facial deformity. Four patients received treatment before referral that included systemic steroids (n = 2), intralesional steroids (n = 1), or surgical/taser excision (n = 2). α2a‐Interferon therapy was well tolerated. Most patients had a temporary elevation in body temperature during the first month of therapy. One patient with anorexia required nasogastric feedings and a temporary reduction in her α2a‐interferon dose. An additional patient with irritability was withdrawn from the study at his parents' request even though this symptom persisted after drug cessation. Hemangioma response to α2a‐interferon was marked in six patients, moderate in two, and minimal in one whose lesion had features suggestive of a vascular malformation. Early signs of involution were usually evident within 6 weeks and often heralded by cutaneous blanching. α2a‐Interferon therapy was concluded in four patients after a mean duration of 20 months.

CONCLUSIONS

Daily subcutaneous α2a‐interferon is well tolerated in pediatric patients and appears effective in hastening involution of symptomatic hemangiomas. A significant response is unlikely in lesions with features suggestive of a vascular malformation.
Cricopharyngeal Myotomy and Arytenoid Adduction in the Management of Combined Laryngeal and Pharyngeal Paralysis
Authors: Woodson Gayle
Published: September 2022

Aspiration caused by unilateral combined laryngeal and pharyngeal paralysis is a serious clinical problem. This article reviews the abnormal physiology, which includes glottal incompetence, impaired pharyngeal propulsion, and sensory loss, and reports the results of surgical treatment of, 13 patients who had significant dysphagia and aspiration caused by unilateral laryngeal and pharyngeal paralysis. In eight patients the cause was surgical resection or trauma of the tenth cranial nerve, with concomitant twelfth nerve injury in four. Four patients had central lesions. One patient had a surgical tenth cranial nerve injury as well as a stroke. Thyroplasty, alone in two patients, and combined with cricopharyngeal myotomy in a third, improved voice, but not swallowing. In all patients treated by arytenoid adduction plus cricopharyngeal myotomy, aspirationwas eliminated, and patients gained weight. Six of these patients had been dependent on enteral tube feedings. The results support the safety and efficacy of simultaneous arytenoid adduction and cricopharyngeal myotomy for dysphagia caused by combined laryngeal and pharyngeal paralysis.
Use of Manometry in the Evaluation of Dysphagia
Authors: Kelly James H.
Published: September 2022

Measurement of manometric pressures in the upper gastrointestinal tract has been done for the past 40 years. Although extensive amounts of data have been compiled for the lower esophageal sphincter and the esophageal body, technical problems have limited the usefulness of measurements of the upper esophageal sphincter and the pharynx. Newer equipment and methods may solve these technical problems, but more normative data and more widespread use of these technologies must be obtained before manometry is clinically useful in the diagnosis of pharyngeal dysphagia.
Anomalous Articulation of the First Rib Mimicking Supraclavicular Neoplasia
Authors: Zrada Stephen E. , Finkelstein Jeffrey M.
Published: September 2022

A hard, fixed mass in the supraclavicular fossa often suggests malignancy. However, a skeletal irregularity underlying the neck may also present as a hard mass, thereby simulating neoplasia. Recognition of a skeletal neck mass precludes the need for costly computed tomography (CT) scans and potentially dangerous diagnostic interventions such as fine‐needle aspiration (FNA) and open biopsy.

We report a case of a 15‐year‐old girl with a hard 3 × 3 cm mass in the supraclavicular fossa that was eventually diagnosed as an anomalous articulation of the first rib. This normal variant, which is usually asymptomatic and found incidentally during routine chest roentgenograms, has not been previously reported as simulating a neck mass. The various types of skeletal structures that may mimic a neck mass are also reviewed in an attempt to underscore the importance of the often overlooked skeletal neck mass.
Contemporary Management of Cerebrospinal Fluid Rhinorrhea
Authors: Wax Mark K. , Ramadan Hassan H. , Ortiz Orlando , Wetmore Stephen J.
Published: September 2022

Management of patients with cerebrospinal fluid rhinorrhea (CSF) remains controversial. Most studies recommend either an endoscopic or an external extracranial approach, depending on the surgeon's preference. Eighteen patients with CSF rhinorrhea have been managed at our institution since 1990. The causes of the CSF rhinorrhea consisted of functional endoscopic sinus surgery (7), lateral rhinotomy with excision of a benign nasal tumor (3), spontaneous rhinorrhea (7), and secondary repair after intranasal ethmoidectomy (1). In 11 patients the CSF leak was recognized at the time of surgery; in 10 of these patients it was repaired during the primary surgery, whereas one patient underwent secondary repair after failure of conservative management of his CSF fistula. Seven patients underwent exploration for spontaneous CSF rhinorrhea. Four patients had computer tomography scans that showed the leak, and two patients had cisternography to localize the leak. One patient underwent magnetic resonance cisternography. Both of these leaks were identified with cisternography and were then confirmed intraoperatively. Repair methods included a pedicled septal mucosal flap (4), a free mucosal graft from the septum (7), and a middle turbinate (5). Two patients had obliteration of the sinus with muscle/fascia and fibrin glue. Eight patients were repaired endoscopically. The remainder underwent repair through external approaches. Seventeen patients (at a minimum 1 year follow‐up) remain free from leakage. One patient required a second repair 8 months after surgery. Iatrogenic trauma remains the most common cause of CSF rhinorrhea. Management at the initial setting is the least morbid approach and is successful in 95% of cases. Whether an endoscopic or external approach is used depends on surgical expertise and experience.
Idiopathic Dandy's Syndrome
Authors: Syms Maj Charles A. , House John W.
Published: September 2022

In 1941 Dandy described patients in whom he had performed bilateral vestibular nerve sections who reported “jumbling” objects in their visual fields when in motion and difficulty walking in the dark. We use the term Dandy's syndrome to describe patients with bilateral vestibular loss as the cause of the above symptoms. The caloric response in these patients is either markedly reduced or absent when the cause is in the peripheral vestibular system. This study explored whether differences exist between those patients in whom the cause is known and those patients with no known cause. We reviewed our experience with 105 patients in whom Dandy's syndrome was diagnosed between 1984 and 1994. Information on their presenting symptoms, findings on physical examination, audiometric status, electronystagmographic findings, laboratory test results, symptom outcome, and cause was collected. Patients with known causes (Meniere's disease, ototoxicity, tumors, vascular disease, trauma, heredity, autoimmune disease, infection) were compared as a group with those with no known cause. Of the 105 patients 34 (32%) had no obvious cause for their symptoms despite an extensive evaluation. This group was similar to those with a known cause except for having a greater preponderance of women (68% vs. 41%, p = 0.018) and an increased likelihood to have normal audiogram findings (53% vs. 19%, p = 0.0009). All other variables, including age, duration of and age at onset of symptoms, physical examination, and electronystagmographic findings did not differ significantly between the two groups. Only 28% of patients with known causes and 40% (p < 0.05) of those with idiopathic Dandy's syndrome had improvement of their symptoms, underscoring the problem with rehabilitation. The results of this study are compared with earlier reports from our and other institutions.
Physiological Principles of Vestibular Function on Earth and in Space
Authors: Minor Lloyd B.
Published: September 2022

Physiological mechanisms underlying vestibular function have important implications for our ability to understand, predict, and modify balance processes during and after spaceflight. The microgravity environment of space provides many unique opportunities for studying the effects of changes in gravitoinertial force on structure and function of the vestibular system. Investigations of basic vestibular physiology and of changes in reflexes occurring as a consequence of exposure to microgravity have important implications for diagnosis and treatment of vestibular disorders in human beings. This report reviews physiological principles underlying control of vestibular processes on earth and in space. Information is presented from a functional perspective with emphasis on signals arising from labyrinthine receptors. Changes induced by microgravity in linear acceleration detected by the vestibulo‐ocular reflexes. Alterations of the functional requirements for postural control in space are described. Areas of direct correlation between studies of vestibular reflexes in microgravity and vestibular disorders in human beings are discussed. (Otolaryngol Head Neck Surg 1998;118:S5‐S15.)
Vestibulospinal Adaptation to Microgravity
Authors: Paloski William H.
Published: September 2022

Human balance control is known to be transiently disrupted after spaceflight; however, the mechanisms responsible for postflight postural ataxia are still under investigation. In this report, we propose a conceptual model of vestibulospinal adaptation based on theoretical adaptive control concepts and supported by the results from a comprehensive study of balance control recovery after spaceflight. The conceptual model predicts that immediately after spaceflight the balance control system of a returning astronaut does not expect to receive gravity‐induced afferent inputs and that descending vestibulospinal control of balance is disrupted until the central nervous system is able to cope with the newly available vestibular otolith information. Predictions of the model are tested using data from a study of the neurosensory control of balance in astronauts immediately after landing. In that study, the mechanisms of sensorimotor balance control were assessed under normal, reduced, and/or altered (sway‐referenced) visual and somatosensory input conditions. We conclude that the adaptive control model accurately describes the neurobehavioral responses to spaceflight and that similar models of altered sensory, motor, or environmental constraints are needed clinically to predict responses that patients with sensorimotor pathologies may have to various visual‐vestibular or changing stimulus environments. (Otolaryngol Head Neck Surg 1998;118:S39‐S44.)