bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of Alternative Goal Structures within Curriculum-Based Measurement
Authors: Fuchs Lynn S. , Fuchs Douglas , Hamlett Carol L.
Published: January 2017

This study assessed the effects of alternative goal structures within curriculum-based measurement (CBM) in the area of math. Subjects were 30 special education teachers, assigned randomly to a dynamic goal CBM, static goal CBM, or control group for 15 weeks. Each teacher selected two mildly or moderately handicapped pupils for participation. Analyses of variance conducted on fidelity of treatment measures indicated that dynamic goal teachers increased goals more frequently and, by the study's completion, employed more ambitious goals. Multivariate analyses of covariance indicated that students in the dynamic goal group had better content mastery than did control students, whereas students in the static goal group did not. Content coverage for the three groups was comparable. Implications for special education goal-setting practice are discussed.
Initiating and Fading Self-Management Interventions to Increase Math Fluency in General Education Classes
Authors: McDougall Dennis , Brady Michael. P.
Published: January 2017

This study investigated the effects of multiple-component behavioral self-management (BSM) interventions on math fluency and engaged time of five 4th-grade students with and without disabilities in general education classrooms. A multiple-baseline across subjects design demonstrated that the students (a) increased their math fluency and engaged time after being trained to use self-management components, (b) further improved their math fluency and engaged time when components of the self-management interventions were faded, (c) matched or exceeded normative levels of math fluency of 4th-grade peers, (d) generalized improvements in math fluency when they answered math word problems, and (e) self monitored accurately and punctually when they computed answers to calculation problems during daily warm-up sessions.
Whose Job is it Anyway? Educational Roles in Inclusion
Authors: Wood Michelle
Published: January 2017

Qualitative research methods were used to investigate teachers' perceptions of their educational roles and collaborative teaching efforts in the inclusion of children with severe disabilities in general education classrooms of one school district. Individual interviews were conducted with three educational teams; each consisted of a general education teacher and a special education teacher of an included student. Results indicated that in the initial stages of inclusion, teachers maintained discrete role boundaries through a relatively clear, albeit informal, division of labor. As the school year progressed, role perceptions became less rigid as the teaming became more cooperative. Implications relate to special education reform and effective strategies to facilitate collaboration among teachers who work within and to promote inclusive environments.
Academic Achievement Effects of an in-Class Service Model on Students with and without Disabilities
Authors: Saint-Laurent Lise , Dionne Jean , Giasson Jocelyne , Royer Éagide , Simard Claude , Piéarard Brigitte
Published: January 2017

This article presents the results of a study designed to evaluate the impact of an in-class service model on the achievement of students at risk of school failure. The model, which included collaborative consultation, cooperative teaching, parent involvement, and strategic and adapted instruction was implemented for 1 school year in 13 different schools. Significant effects were found on writing scores for students at risk and on reading and mathematics scores for general education students. No significant treatment effects were detected for students with learning disabilities. The findings confirm the benefits of the in-class service model for some students and the need to pursue further research in order to achieve better results for the lowest achievers in the classroom.
A Close Look at the Cognitive Play of Preschoolers with Visual Impairments in the Home
Authors: Hughes Margaret , Dote-Kwan Jamie , Dolendo Janet
Published: January 2017

The cognitive play of 13 children with visual impairments approximately 40 months of age was observed while playing alone in their homes. Three play categories adapted from Belsky and Most's (1981) hypothesized sequence of development of exploration and play for typical children and nonplay were coded for frequency and duration. The findings revealed that children with visual impairments showed significant differences in play compared to the earlier documented play schemes for sighted children in the Belsky and Most's study (1981). Over half of the play behaviors were in the category of exploration and sensorimotor play, and symbolic play accounted for less than 4% of play. These findings are discussed in terms of interventions at home and in school.
The Scientific Knowledge Base of Special Education: Do We Know What We Think We Know?
Authors: Gallagher Deborah J.
Published: January 2017

Leading scholars in special education acknowledge that the field has recently come under intense public criticism. Various defenses have been offered, including the lack of appropriate conditions under which to implement the knowledge base of special education. The nature of this knowledge base is examined, in particular the claim that special education possesses scientifically derived technologies. Specifically, a case is made that the term “science” is misused, and that the methods of empiricist science are inappropriately applied to study of special education. It is concluded that many, if not most, of the criticisms leveled at special education can be traced back to this misunderstanding of science. As a result, the field would do well to reconsider its philosophical ancestry.
The State Complaint Procedure under the Individuals with Disabilities Education Act
Authors: Suchey Nicole , Huefner Dixie Snow
Published: January 2017

IDEA complaint managers in 35 states responded to a survey asking how their state interprets and implements the state complaint procedure under the Individuals with Disabilities Education Act (IDEA). Although complaints increased as a percent of the special education population during the years surveyed, most respondents believed that neither educator nor parental awareness of the complaint procedure had increased since its reinsertion in the 1992 IDEA regulations. Although respondents preferred mediation over other dispute resolution options, nonetheless, a majority concluded that the complaint procedure had reduced the number of due process hearings in their state. Although continuing study of the efficacy of the state complaint procedure is needed, greater awareness of its utility should be fostered.
Socio-Forensic Studies: A Promising Field for Future Development
Authors: Prins Herschel A.
Published: January 2017

It is suggested that the important Field of socio-forensic studies has been neglected although it is one that provides a viable area for development at social work post-professional qualification level. An indication of the manner in which this might be achieved is given on the basis of some exploratory work undertaken by the author at the University of Leicester.
Fatal Masochism—Accident or Suicide?
Authors: Knight Bernard
Published: January 2017

The motivation of some cases of fatal masochistic asphyxia is discussed, with particular reference to four specific deaths. In these instances, it would appear that the expectation of a fatal outcome was apparent to the victims and this has medicolegal significance in deciding whether the deaths should be classified as accidents or suicides.
The Police and Government
Authors: Welsh Laurence
Published: January 2017

Our Government Correspondent comments on a matter about which we can expect to hear more.
Estimates of Smoking before and during Pregnancy, and Smoking Cessation during Pregnancy: Comparing Two Population-Based Data Sources
Authors: Tong Van T. , Dietz Patricia M. , Farr Sherry L. , D'Angelo Denise V. , England Lucinda J.
Published: January 2017

Objectives.

We compared three measures of maternal smoking status—prepregnancy, during pregnancy, and smoking cessation during pregnancy—between the Pregnancy Risk Assessment Monitoring System (PRAMS) questionnaire and the 2003 revised birth certificate (BC).

Methods.

We analyzed data from 10,485 women with live births in eight states from the 2008 PRAMS survey, a confidential, anonymous survey administered in the postpartum period that is linked to select BC variables. We calculated self-reported prepregnancy and prenatal smoking (last trimester only) prevalence based on the BC, the PRAMS survey, and the two data sources combined, and the percentage of smoking cessation during pregnancy based on the BC and PRAMS survey. We used two-sided t-tests to compare BC and PRAMS estimates.

Results.

Prepregnancy smoking prevalence estimates were 17.3% from the BC, 24.4% from PRAMS, and 25.4% on one or both data sources. Prenatal smoking prevalence estimates were 11.3% from the BC, 14.0% from PRAMS, and 15.2% on one or both data sources. The percentages of prepregnancy smokers who indicated that they quit smoking by the last trimester were 35.1% from the BC and 42.6% from PRAMS. The PRAMS estimates of prepregnancy and prenatal smoking, and smoking cessation during pregnancy were statistically higher than the corresponding BC estimates (t-tests, p<0.05).

Conclusions.

PRAMS captured more women who smoked before and during the last trimester than the revised BC. States implementing PRAMS and the revised BC should consider information from both sources when developing population-based estimates of smoking before pregnancy and during the last trimester of pregnancy.
Correlation between Aerial Insecticide Spraying to Interrupt West Nile Virus Transmission and Emergency Department Visits in Sacramento County, California
Authors: Geraghty Estella M. , Margolis Helene G. , Kjemtrup Anne , Reisen William , Franks Peter
Published: January 2017

Objectives.

Insecticides reduce vector-borne pathogen transmission but also pose health risks. In August 2005, Sacramento County, California, underwent emergency aerial ultralow-volume (ULV) application of pyrethrin insecticide to reduce the population of West Nile virus (WNV)-infected mosquitoes and thereby interrupt enzootic and tangential transmission. We assessed the association between aerially applied pyrethrin insecticide and patterns of emergency department (ED) visit diagnoses.

Methods.

We used geographic information systems software to determine ZIP Code-level exposure to pyrethrin. We used logistic regression models to examine the relationship between exposure status and three-digit International Classification of Diseases, Ninth Edition, Clinical Modification (ICD-9-CM) codes (785 in total) for all ED visits ( n=253,648) within Sacramento County in 2005 and for specific diagnostic clusters (e.g., respiratory, gastrointestinal, skin, eye, and neurologic). All models were adjusted for age, gender, race/ethnicity (individual level), median income, ozone, and temperature (ZIP Code level).

Results.

Exposure to aerially applied insecticide was not associated with clusters of respiratory, gastrointestinal, skin, eye, and neurologic complaints in adjusted models but was inversely associated with ICD-9-CM code 799 (“other ill-defined morbidity and mortality”), with adjusted odds ratios (AORs) ranging from 0.31 to 0.36 for 0–3 lag days (95% confidence interval 0.17, 0.68). Spraying was also directly associated with ICD-9-CM code 553 (“other abdominal hernia”), with AORs ranging from 2.34 to 2.96 for 2–3 lag days.

Conclusions.

The observed significant ICD-9-CM code associations likely represented chance findings. Aerial ULV pyrethrin applications were not associated with ED visits for specific diagnoses or clusters of diagnoses.
Evaluation of New Jersey's Sex Offender Treatment Program at the Adult Diagnostic and Treatment Center: Preliminary Results
Authors: Zgoba Kristen M. , Sager Wayne R. , Witt Philip H.
Published: January 2017

This study examined 10-year sexual and non-sexual offense recidivism for sex offenders released from New Jersey's general prison system and from the Adult Diagnostic and Treatment Center (ADTC), New Jersey's correctional facility and treatment center for repetitive-compulsive sexual offenders. The study found that sexual offenders released from the ADTC had significantly lower rates of committing both non-sexual offenses and any offense, compared with the general prison population of sex offenders. For both groups, the 10-year sexual offense reconviction rates were relatively low, 8.6% for the ADTC offenders and 12.7% for the general prison sexual offenders, while reoffense rates for non-sexual offenses were 25.8% and 44.1% for ADTC and general prison sex offenders, respectively.
Yes, I Did it, but Don't Blame Me: Perceptions of Excuse Defenses
Authors: Heath Wendy P. , Stone Jeff , Darley John M. , Grannemann Bruce D.
Published: January 2017

According to some, it is increasingly common for defendants to admit they committed an offense but to argue that they shouldn't be held legally responsible because they have an excuse. The present study was conducted to investigate views of excuse defenses. Forty-three participants rated 15 different excuse defenses (e.g., steroid use) on a number of characteristics (e.g., persuasiveness of defense). Participants also indicated whether they would be willing to change an assigned sentence (increase or decrease sentence, recommend treatment or probation) in the presence of each excuse defense. Ratings revealed that excuses vary in persuasiveness, with the persuasiveness of an excuse associated with the defendant's perceived amount of responsibility for the act and control over the criminal act and excusing condition. Defendants providing excuses seen as more persuasive tended to receive shorter sentences and more treatment recommendations. Possible factors influencing judgments are discussed.
Whole Blood Serotonin Levels among Pretrial Murder Defendants
Authors: Lande R. Gregory
Published: January 2017

A growing body of literature increasingly supports the notion that serotonergic dysfunction may play a role in violent behavior. These findings come from animal and clinical research that probes serotonin activity through selective animal breeding techniques, central nervous system measures of serotonin, and now the indirect assessment of central serotonin function by using whole blood serotonin. In this study, 20 men arrested for murder and referred for a mental evaluation provided blood samples to measure their whole blood serotonin. The results from these men were compared with those of a 93-person reference group. Statistical analysis confirmed an increased level of whole blood serotonin in the pretrial murder defendants. The murder defendants' mean blood serotonin level was 0.41 SD higher than the reference group's. This study also found elevated whole blood serotonin among men who self-reported at least one episode of fire setting or juvenile arrest.
Toward a Two-Stage Model for Assessing Adjudicative Competence
Authors: DeClue Gregory
Published: January 2017

Important points emerge from a review of two new books on assessment of competency, Evaluating Competencies and Adjudicative Competence, leading toward a two-stage model for assessment. In stage one, evaluators should conduct a screening assessment and should routinely use a structured forensic assessment instrument. The second stage is a more comprehensive assessment of those subjects who may have competency deficits.
A Psychobiographical Approach to the Evaluation for Sentence Mitigation
Authors: Connell Mary A.
Published: January 2017

Most state and the federal sentencing guidelines include a “catchall” category of potential mitigators, allowing the capital defendant to put forth evidence, at sentencing, of any issue that might bear on the question of moral culpability. This broad category of potentially mitigating information is sometimes given short shrift, in favor of traditional diagnostic findings. Because death is different from all other punishments in its finality, the mental health evaluator bears a special burden, under the Lockett doctrine, to explore all factors that shaped the defendant's developments. A psychobiographical approach to evaluation is described.
How Academically Gifted Elementary, Urban Students Respond to Challenge in an Enriched, Differentiated Reading Program
Authors: Reis Sally M. , Boeve Hope
Published: January 2017

This mixed-methods study combined the use of qualitative, comparative case study methods with other data analysis procedures to investigate an afterschool enriched reading program for academically gifted students who had also been identified as talented readers. The Schoolwide Enrichment Model-Reading Framework (SEM-R) was used to provide challenging reading experiences for 2 days each week in a 6-week afterschool program. Although their reading fluency scores improved, each academically gifted student initially encountered frustration when asked to read content that was either at or slightly above his or her current independent reading level. With encouragement, these academically gifted students began to be able to read texts that were slightly above their current instructional level for short periods of time. Without encountering more challenging content, as these students become older, they may become frustrated with more advanced material in honors or advanced classes in subsequent years, despite their identification as gifted.
Vestibular Meniere's Disease
Authors: Paparella Michael M. , Mancini Fernando
Published: January 2017

The clinical entity of vestibular Meniere's disease (VMD) is assessed and described. Twenty percent of cases eventuating in typical Meniere's disease presented with VMD first, in other patients VMD alone persisted for many years (30 or more). VMD, usually unilateral, is characterized by recurrent episodes of vertigo typical of classical Meniere's disease. Positional vertigo can occur between or during episodes. Aural pressure is second to vertigo in importance, and electronystagmographic findings are third. Although hearing is normal, tinnitus or loudness intolerance may be present. Concepts of pathogenesis are discussed.
Preoperative and Postoperative Growth Rates in Acoustic Neuromas Documented with CT Scanning
Authors: Wazen Jack , Silverstein Herbert , Norrell Horace , Besse Byron
Published: January 2017

Sequential computerized tomography (CT) allows us to determine the growth rate of acoustic neuromas. Prior to CT scanning, a variability in tumor growth rates was recognized on the basis of clinical signs. After incomplete tumor removal, some patients experienced rapid recurrence, whereas others lived many years without recurrence. We used CT scanning to study tumor growth rates in a heterogeneous group of 21 patients. Thirteen elderly patients were given annual scans after incomplete tumor removal, while eight patients who had not had surgery are likewise being followed up. Early detection and complete tumor removal with preservation of hearing and facial function remain the goal in vigorous and healthy patients. However, a large number of older, infirm patients with acoustic neuromas may not require surgery or be candidates for incomplete tumor removal. Because rapid tumor growth may necessitate total tumor removal even in older patients, a better understanding of the growth rates may permit us to take a more scientific approach in planning these patients' management.
Meningiomas of the Cerebellopontine Angle
Authors: Laird Frank J. , Harner Stephen G. , Laws Edward R. , Reese David F.
Published: January 2017

The majority of cerebellopontine angle tumors are acoustic neurinomas; however, 10% to 15% are meningiomas. Meningiomas are benign lesions that must be removed but may require surgical approaches different from those used for acoustic neurinomas. To determine if meningiomas could be distinguished from acoustic neurinomas clinically, findings in 20 patients who underwent removal of a meningioma were compared to those in 131 patients who had an acoustic neurinoma removed during the same period. We found that in patients with meningiomas the tumors frequently are large at presentation, the otologic symptoms and audiometric findings are less dramatic, and roentgenograms of the skull and tomograms of the petrous apex rarely show erosion of the internal auditory canal. Computerized tomography is the most useful method for differentiating a meningioma from a neurinoma: when a meningioma is present the characteristic finding is a broad‐based mass aligned with the petrous ridge, not centered over the internal auditory canal.
Analysis of Complete Responders after Initial Treatment with Chemotherapy in Head and Neck Cancer
Authors: Kies Merrill S. , Gordon Leo I. , Hauck Walter W. , Krespi Yosef , Ossoff Robert H. , Pecaro Bernard C. , Yuska Connie , Lamut Christine H. , Brand William N. , Chang Sung K. , Shetty Ramananda , Sisson George A.
Published: January 2017

We treated 60 patients with cisplatin‐based combination chemotherapy before definitive surgery and/or radiation. All had squamous cell tumors of the head and neck, stages II to IV, M0. Twelve patients (20%) achieved a complete remission after chemotherapy. Eight of these patients showed no histologic evidence of residual disease after biopsy or surgery. Definitive local therapy with surgery and/or radiation was carried out on almost all patients regardless of the extent of the response to preceding chemotherapy. Chemotherapy‐induced complete responders have had an improved survival rate in comparison with patients achieving a partial response or less. The extent of primary tumor correlates inversely with a complete response to chemotherapy.
Investigations into the Cause of Vertigo in Sudden Sensorineural Hearing Loss
Authors: Khetarpal Umang
Published: January 2017

In this light microscopic study of the temporal bone, an attempt has been made to find a morphologic correlate of vertigo associated with idiopathic sudden sensorineural hearing loss (ISSHL). Hair cell densities of the three cristae and both maculae, as well as vestibular ganglion cell (neuronal) count estimation, was done in nine ears that had documented histories of ISSHL. There were five ears with vertigo and four without. These quantitative data—i.e., hair cell densities and neuronal counts, of the vertiginous ears (group I) and nonvertiginous ears (group II)—was compared by histograms and statistically. Additionally, in each of the two groups, the data from three opposite normal hearing ears were taken as a control and used for comparison with the ISSHL ears. The differences between the vertiginous, nonvertiginous, and control ears were not significant at the 0.01 level, indicating that the vertigo was not caused by hair cell or neuronal degeneration. Gross morphologic alterations in the vestibular system, such as membrane ruptures, endolymphatic hydrops, etc., were also assessed, but no clear‐cut pathology was identified in the vertiginous and nonvertiginous ears. The absence of a light microscopic morphologic correlate for vestibular disturbances associated with ISSHL suggests that the symptoms could result from ultrastructural changes in the hair cells and their synapses or from biochemical alterations in their environment.
Intraoperative Recurrent Laryngeal Nerve Monitoring
Authors: Rice Dale H. , Cone‐Wesson Barbara
Published: January 2017

Intraoperative nerve monitoring has become common for surgical procedures in which cranial or peripheral nerves may be compromised. Intraoperative monitoring of recurrent laryngeal nerve function can be accomplished by recording electromyographic activity from fine‐wire electrodes placed in the vocalls muscle. The technique and instrumentation for this are adapted from those used In intraoperative facial nerve monitoring for acoustic neuroma excision. Specifically, a commercially available instrument, the XOMED‐NIM provides the capability for monitoring the vocalls muscle electromyogram by means of visual and auditory display. It also provides the capability for performing evoked electromyographic tests of nerve integrity. Intraoperative monitoring of the recurrent laryngeal nerve during thyroidectomy may assist in the more precise dissection of the nerve as well as in verification of nerve integrity during the operative procedure, thus reducing the risk of injury.
Obstructive Sleep Apnea: A Comparison of Continuous Positive Airway Pressure and Surgical Treatment
Authors: Anand Vinod K. , Ferguson Patric W. , Schoen Lawrence S.
Published: January 2017

Since earlier descriptions of the syndrome of obstructive sleep apnea (OSA), various treatment alternatives have included a variety of medical regimens, continuous positive airway pressure (CPAP), tracheostomy, and other surgical options. A lack of acceptable criteria for surgical intervention remains an important concern for the surgeon. In an attempt to resolve some of the controversies pertaining to various therapeutic modalities, we performed a retrospective analysis—from 1983 to the present—of post‐treatment results in patients who underwent surgical therapy and those who were treated primarily with CPAP at this institution. Of 400 patients diagnosed with OSA, only 66 underwent surgical treatment, including uvulopalatopharyngoplasty. CPAP was the mainstay of treatment in the majority of our patients. Post‐treatment data were available for 50 patients treated with CPAP and for 45 patients treated surgically. A comparative analysis of polysomnographic studies revealed superior cures with CPAP, although long‐term compliance remains a significant problem. We advocate CPAP as initial therapy in patients with no clinically apparent causes for obstruction (e.g., nasal polyps, deviated nasal septum, or obstructive tonsillar hypertrophy) because of the predictability of success, and lower costs and complication rates. Long‐term followup of OSA patients is indicated, regardless of treatment modality.
Advanced Microspot Microslad for the CO2 Laser
Authors: Ossoff Robert H. , Werkhaven Jay A. , Raif Joshua , Abraham Martin
Published: January 2017

New advances in instrumentation have facilitated the development of a second generation carbon dioxide (CO2) laser microspot micromanipulator. The 710 Acuspot has unique advantages over the previous generation of microspots. The compact design is easier to handle and has attachment points for sterile draping. The unit produces a spot size of 250 microns at a 400‐mm focal length and 160 microns at 250 mm; the maximum de‐focus is 3.2 mm at all focal lengths. An innovative dichrolc mirror allows use of the laser unit's own HeNe laser as the aiming beam, eliminating possible aiming error introduced with a virtual image‐aiming system. The dichrolc mirror also allows better light transmission, resulting in a brighter field of view. As with first generation microspots, the laser beam path is coincident with the microscope optical path, eliminating parallax; this feature has been especially advantageous in pediatric and otologic cases. Having used this unit for 6 months on more than 50 patients, we now consider the use of a microspot to be our delivery system of choice for most microlaryngeal laser surgical applications.
Functional Staging for Vocal Cord Paralysis
Authors: Woo Peak , Colton Raymond , Brewer David , Casper Janina
Published: January 2017

Phonatory function can be reliably tested after vocal paralysis. After a review of 116 cases, 55 patients underwent objective testing. The clinical history of vocal ability and aspiration were found to be significantly correlated with measurements of phonatory mean flow rate (MFR), maximum phonation time (MPT), and maximum decibel output (SPL). A four‐stage classification system, based on clinical and objective measurements, has been formulated. In stage I, measures of vocal parameters approached those of normals with MFR = 155 cc/sec, MPT = 12 sec, and SPL = 92 dB. Patients with stage IV disability have high MFR (480 cc/sec), but low MPTs (<3 sec) and low SPL values (76 dB). Factors such as sex, age, weight loss, and the presence of malignancy affect the degree of vocal function deficit. Post‐therapy recordings indicated an improvement in vocal function by an increase in MPT and SPL, with a decrease in MFR. Measurements of MFR, PT, and SPL are good objective indicators available to the clinician. Functional staging can be applied to assessment and treatment of vocal cord paralysis.
Bilateral Electrocochleographic Findings in Unilateral Meniere's Disease
Authors: Moffat David A. , Baguley David M. , Harries Meredydd Ll , Atlas Marcus , Lynch Catherine A.
Published: January 2017

At present, electrocochleography is the only proven investigation that can demonstrate objectively the presence of endolymphatic hydrops. The electrophysiologic recordings in response to sound stimuli show an enhancement of the negative summating potential in these cases. It is well established that patients with unilateral Meniere's disease have a high likelihood of development of the disease bilaterally in the fullness of time. Using transtympanic electrocochleography in 40 patients who manifested unilateral clinical Meniere's disease, we have recorded bilateral abnormalities indicative of endolymphatic hydrops in 35% of cases. The early recognition of incipient Meniere's disease in the asymptomatic contralateral ear of a patient with known unilateral disease has obvious profound implications for patient management.
Lipoma of Internal Auditory Canal
Authors: Wong Matthew L. , Larson Timothy I. , Brackmann Derald E. , Lo William W.M.
Published: January 2017

Lipoma of the internal auditory canal is a rare tumor. Clinically, it presents like an acoustic tumor. The diagnosis can be made with the use of a magnetic resonance imaging showing a high intensity on T1‐ and low intensity on T2‐weighted image with no enhancement. Pathologically, this is a soft, smooth, yellow tumor with some fat in it that can resemble grossly any acoustic tumor. The lipoma is intermixed with the eighth nerve and can be adherent to adjacent structures. The growth of a lipoma can be slower than an acoustic tumor. A patient diagnosed with lipoma of the internal auditory canal can often have quite good hearing. As an alternative to surgical removal, another therapeutic option is to watch the growth of the lipoma with periodic magnetic resonance imaging, probably on a yearly basis initially.
Prognostic Value of Evoked and Standard Electromyography in Acute Facial Paralysis
Authors: Sillman Jonathon S. , Niparko John K. , Lee Sharon S. , Kileny Paul R.
Published: January 2017

Ninety‐one patients with idiopathic (n = 62) and traumatic (n = 29) facial paralyses were available for evaluation at least 1 year after the onset of paralysis. In nine cases of idiopathic paralysis and in 12 cases of traumatic paralysis, total intratemporal nerve decompression was performed. The remaining patients were treated with steroids alone. All patients underwent evoked electromyography (EEMG) testing within 2 weeks of the onset of paralysis. Facial nerve recovery was graded using the House‐Brackmann facial nerve recovery scale. Subjects were grouped according to maximal decline of compound muscle action potential (CAP), as determined by EEMG, and by level of recovery 1 year after onset of paralysis. Among patients who did not undergo surgical decompression of the facial nerve, incomplete clinical recovery (grade III or higher) was significantly associated with CAP decline of >90% (p < 0.05) for idiopathic paralysis. In contrast, there was no significant association between CAP decline of >90% and clinical outcome in traumatic paralysis. These findings support previous reports of the prognostic value of EEMG in idiopathic facial paralysis, but suggest that this test may have less predictive value in the evaluation of facial paralysis as a result of trauma.
Partial Endoscopic Middle Turbinectomy Augmenting Functional Endoscopic Sinus Surgery
Authors: Lamear William R. , Davis William E. , Templer Jerry W. , McKinsey Joel P. , Del Porto Herbierto
Published: January 2017

Endoscopic sinus surgery has gained acceptance in the otolaryngologic community as an effective and safe method of treating inflammatory disease of the paranasal sinuses. At our institution, partial endoscopic middle turbinectomy has become a standard component of the procedure and our experience is reported. Middle turbinectomy enhances surgical exposure, specific anatomic anomalies are more completely corrected, and subpopulations of patients at risk for failure because of their underlying disease enjoy decreased rates of synechiae formation and closure of the middle meatus antrostomy when followed over time. Photodocumentation of the surgical technique and a discussion regarding the impact of middle turbinectomy on normal nasal physiology are presented. It is reported that the procedure is safe, and no complications directly attributable to middle turbinectomy (including atrophic rhinitis) are reported in a series of 298 patients.
Cardiac Function in Obstructive Sleep Apnea Patients following Uvulopalatopharyngoplasty
Authors: Zohar Yuval , Talmi Yoav P. , Frenkel Haya , Finkelstein Yehuda , Rudnicki Carlos , Fried Menachem , Zahavi Yzhar
Published: January 2017

Obstructive sleep apnea syndrome (OSAS) is associated with severe cardiac arrhythmias and conduction abnormalities. Cor pulmonale and right‐sided heart failure may ensue. Uvulopalatopharyngoplasty (UPPP) is one of several treatment modalities suggested for OSAS. Tracheotomy and CPAP treatment in adult OSAS patients and adenotonsillectomy in children with OSAS were shown to lead to improvement in some cardiac parameters. Cardiac function was prospectively evaluated in 19 OSAS patients before and after UPPP. No significant changes after surgery were noted on electrocardiographic studies. Improvement in global and regional function of both ventricles was seen in 91% of the patients. A trend toward significant elevation in left ventricular ejection fraction and a statistically significant increase in right ventricular ejection fraction were observed (45% = 9% to 50% = 7% [p = 0.007]). Our results support performance of UPPP in selected OSAS patients for relief of potentially life‐threatening cardiac pathologies.
The Canalith Repositioning Procedure: For Treatment of Benign Paroxysmal Positional Vertigo
Authors: Epley John M.
Published: January 2017

The Canalith Repositioning Procedure (CRP) is designed to treat benign paroxysmal positional vertigo (BPPV) through induced out‐migration of free‐moving pathological densities in the endolymph of a semicircular canal, using timed head maneuvers and applied vibration. This article describes the procedure and its rationale, and reports the results in 30 patients who exhibited the classic nystagmus of BPPV with Hallpike maneuvers. CRP obtained timely resolution of the nystagmus and positional vertigo in 100%. Of these, 10% continued to have atypical symptoms, suggesting concomitant pathology; 30% experienced one or more recurrences, but responded well to retreatment with CRP. These results also support an alternative theory that the densities that impart gravity‐sensitivity to a semicircular canal in BPPV are free in the canal, rather than attached to the cupula. CRP offers significant advantages over invasive and other noninvasive treatment modalities in current use.
Computer‐Aided Three‐Dimensional Measurement of the Human Vestibular Apparatus
Authors: Sato Hiroaki , Sando Isamu , Takahashi Haruo
Published: January 2017

Using a computer‐aided three‐dimensional reconstruction and measurement method, 12 measurements were made to determine the dimensions of the maculae, cristae ampullares, and semicircular canals in 18 temporal bones from nine pairs of age‐matched male and female individuals (1 day to 76 years old). The surface areas of the utricular and saccular maculae were significantly larger in male than in female specimens (two‐way analysis of variance, F = 9.00, df = 1, p<0.01; F = 4.57, df = 1, p < 0.05, respectively). The width of the utricular macula and the length of the saccular macula were also significantly greater in male than in female specimens (two‐way analysis of variance, F = 5.17, df = 1, p < 0.05; F = 4.33, df = 1, p < 0.05, respectively). Finally, the three semicircular canals were larger in diameter in male vs. female specimens; this difference was statistically significant for the superior semicircular canal (two‐way analysis of variance, F = 10.74, df = 1, p < 0.01). By contrast, none of these dimensions of those vestibular structures showed any significant change in size with advancing postnatal age. We propose from these findings that there appears to be sexual dimorphism in the vestibular apparatus.
Surface Sensibility of the Floor of the Mouth and Tongue in Healthy Controls and in Radiated Patients
Authors: Aviv Jonathan E. , Hecht Craig , Weinberg Hubert , Dalton Jack F. , Urken Mark L.
Published: January 2017

Increased areas of anesthesia in the oral cavity have been shown to significantly impair oral function in normal individuals. In patients who undergo oral cavity reconstruction, loss of sensation plays a major role in producing disturbances in postoperative oral function. Free tissue transfer techniques have permitted the problem of sensory loss to be addressed through the use of sensate cutaneous free flaps, in which microneural anastomoses are performed between a sensory nerve supplying the flap and a recipient nerve in the head and neck. To critically assess the results of such reconstructions, the effect of sensory restoration on oral cavity rehabilitation must be studied. As a first step toward this goal, normal values for sensory discrimination of the floor of mouth and tongue are needed. Previous studies of oral sensation failed to examine the ventral tongue and floor of mouth. The purpose of this study is to determine the surface sensibility of these regions in healthy patients and in patients who received radiation therapy to the oral cavity. Sensation was evaluated using static and moving two‐point discrimination in 90 healthy subjects divided equally into three age groups: 20 to 40 years, 41 to 60 years, and 61 to 80 years. In addition, 20 patients who received radiation therapy were studied. The mucosa of the dorsal and ventral aspects of the lateral tongue, tongue tip, and floor of mouth was examined. The tongue tip is the most sensitive area, followed by the dorsal lateral tongue, ventral lateral tongue, and floor of mouth. The effects of age and radiation therapy on sensory discrimination are discussed. We propose that patients undergoing reconstruction of the floor of mouth and tongue with sensate cutaneous free flaps undergo both preoperative and postoperative sensory testing. The control data obtained in this study can be applied for objective analysis of the results of the reconstruction. Current techniques for assessment of sensory discrimination are reviewed.
Intracordal Injection Increases Glottic Closing Force in Recurrent Laryngeal Nerve Paralysis
Authors: Iwanaga Yasunari , Maeyama Tadatsugu , Umezaki Toshiro , Shin Takemoto
Published: January 2017

Glottic closing pressure during swallowing was measured in the cat with a catheter pressure transducer to study the effectiveness of intracordal injection in increasing glottic pressure in unilateral recurrent laryngeal nerve paralysis. Swallows were elicited by pouring water into the pharynx while the animal was under light anesthesia with ketamine. Peak pressure of the glottic closure for the control group during deglutition was 68.0 ± 10.5 mm Hg (mean ± standard deviation). Peak pressure decreased to 22.0 ± 3.6 mm Hg just after sectioning of the unilateral recurrent laryngeal nerve, and rose to 39.8 ± 8.3 mm Hg by silicon injection into the paralyzed vocal fold. In a study of chronic cases 1 month or more after unilateral recurrent laryngeal nerve section, peak pressure was 49.1 ± 23.4 mm Hg, and varied widely from 21 to 92 mm Hg because of differences in the position of the paralyzed vocal fold and the degree of compensation by the unaffected vocal fold. In the group that had the paralyzed vocal fold fixed in the median position, peak pressure was almost the same as that of the control group. When the paralyzed vocal fold was fixed in either the paramedian or lateral position, peak pressure was 33.3 ± 7.0 mm Hg. This value was significantly elevated to 45.8 ± 10.4 mm Hg by injection of silicon, though it remained lower than that of the control. These results suggest that the decrease in glottic closing force during swallowing as a result of unilateral recurrent laryngeal nerve lesion is compensated for by the unaffected vocal fold to some degree and is improved by intracordal injection.
Mal de debarquement syndrome: A forgotten entity?
Authors: Murphy Terrence P.
Published: January 2017

Mal de debarquement syndrome is defined by a persistent sensation of rocking and swaying commonly felt with sea travel that is first noted on return to land. Mal de debarquement syndrome is not to be confused with seasickness, which causes nausea, vomiting, diaphoresis, and headache. Four female patients with mal de debarquement syndrome are reviewed. Mal de debarquement is normally a short‐lived phenomenon. The need for extensive evaluations may be avoided by an awareness of this entity.
Hearing results with clothespin ossiculoplasty: Preliminary report on the Kraus Modified Schuring Ossicle‐Cup Prosthesis (Clothespin Prosthesis)
Authors: Kraus Eric M.
Published: January 2017

The clothespin partial ossicular replacement prosthesis (PORP) is designed to Increase Joint stability during incus replacement ossiculoplasty. Fundamental modifications have been made in the Schuring ossicle‐cup, which include a forked well, increased well wall thickness and length, and a flexible tip disk added to the shaft. The forked well functions like a straight clothespin rather than an inverted cup. The forked well enables the clothespin prothesis to slide down over the stapes superstructure, between the facial nerve canal and the promontory, to form a stable, mortise‐and‐tenon prosthesis‐stapedial joint. Joint stability is enhanced because the inferior tine of the forked well is able to lever against the inferior surface of the stapes superstructure, creating a counterforce to gravity. This is in contrast to the more unstable ball‐and‐socket joint created by most partial ossicular replacement prostheses when they articulate with the stapes capitulum. The addition of a flexible disk to the shaft tip produces a tight, stable union between the prosthesis and the ossicular cap by increasing resistance at the shaft‐ossicle interface. Fluoroplastic composition maximizes Intraoperative versatility and reliability while the ossicle cap minimizes extrusions. One‐year hearing results for twelve chronic ear patients with mobile stapes undergoing clothespin ossiculoplasty during intact canal wall tympanomastoidectomy revealed postoperative air‐bone gaps within 20 dB in 92% of cases. The mean postoperative air‐bone gap was 8.9 dB, and the mean Improvement in air‐bone gap was 14.4 dB. These results are attributable to greater prosthesis stability provided by the time‐tested mortise‐and‐tenon joint concept rather than a ball‐and‐socket joint in a reconstructive situation in which stability is critical.
Long‐term efficacy of endolymphatic sac surgery for vertigo in meniere's disease
Authors: Telischi Fred F. , Luxford William M.
Published: January 2017

The long‐term efficacy of endolymphatic sac procedures for control of vertigo in Melnere's disease has been controversial. We evaluated results of sac shunt surgery for 234 patients having at least 10 years followup (mean, 13.5 years). All patients had persistent vestibular symptoms despite medical therapy. All underwent endolymphatic subarachnoid shunt as their original operation. Data were collected by chart review and questionnaire regarding: (1) the number of additional surgical procedures to control vertigo, (2) remaining dizziness, and (3) level of disability. One hundred forty‐seven of the patients (63%) did not undergo any further surgery to control vertigo, and an additional 17% had only revisions of the endolymphatic sac shunt. Thus, 80% never required a destructive procedure. Long‐term effectiveness of surgery in regard to dizziness and disability was determined from the questionnaire. Of the 147 patients with only the original sac shunt surgery, 93% reported no dizziness or mild to no disability. Of the group who underwent only revisions of the original shunt, 96% stated they had no more dizziness or mild to no disability. We conclude that endolymphatic sac shunt operations are effective as Initial surgical procedures for long‐term control of disabling vertigo of Meniere's disease.
The lateral arm free flap for head and neck reconstruction
Authors: Wenig Barry L.
Published: January 2017

The lateral arm free flap has proved to be both a versatile and successful method of reconstruction. Since its introduction a decade ago, however, its application in head and neck reconstruction has been fairly limited. Dissection of the flap, based on the posterior radial collateral branch of the profunda brachli artery, is relatively simple and provides a thin, dependable flap that has the potential to be used as a osteocutaneous flap or as a fasclocutaneous flap alone. The flap contains a sensory nerve that is readily anastomosed and donor site morbidity is limited. Although the pedicle is short, several modifications exist that allow its extension. This flap has been used successfully to reconstruct various defects in the head and neck. Pertinent anatomy, Indications, and guidelines for clinical application will be discussed.
Oscillopsia in patients with loss of vestibular function
Authors: Bhansali Sanjay A. , Stockwell Charles W. , Bojrab Dennis I.
Published: January 2017

Contrary to standard teaching, many patients with bilateral vestibular loss clearly deny oscillopsia or imbalance in darkness. In an attempt to characterize these patients within the larger population of all patients with bilateral vestibular loss, the rotation and posturography test results of 22 patients with bilateral vestibular loss were reviewed. In addition, dynamic visual acuity was assessed with an eye chart test. There was a poor relationship between oscillopsia and dynamic visual acuity or rotation testing. There were three patterns of response on rotation testing, and loss of high‐frequency gain was seen in as many patients who reported oscillopsia as did not. There were some patients with normal gain values at all frequencies tested who reported oscillopsia. It may be that the change in the VOR, rather than the absolute VOR loss, is responsible for the production of oscillopsia. On the basis of this and other studies, treatment strategies for patients with bilateral vestibular loss are suggested.
The Evolution and Demise of the Postwar Concept of Job Quality: an Analysis of Theories of Employment Segmentation
Authors: Beck Matthias
Published: January 2017

This article traces the evolution and demise of the postwar model of job quality. This model evolved in the context of theories of sheltered employment. It tied assumptions about job quality to the idea that the economy was separable into a stable and unstable segment. Jobs were typically described in terms of a dual structure, in which workers were either employed in the core sector with high employment security and high relative wages or the periphery, where jobs were low paying and unstable. Industrial jobs in large scale mass manufacturing enterprises, in this context, served as a benchmark for individual job quality. When the assumption of a stable sector of the economy became untenable, the concept of labour market shelters was modified and new models which accounted for flexibility in production were developed. This modification process progressively eroded the core of labour market segmentation theory. By the 1990s, both conceptual considerations and empirical evidence dismissed older simplistic concepts of stable demand, and suspended key assumptions about the cumulative nature of job quality. In terms of a Sociology of Knowledge, we witness the gestation and deterioration of an integrated set of economic propositions paralleling real and/or perceived changes in the economic environment.