bluuebunny/crossref_metadata_2025 huggingface dataset:
Properties of Acoustic Reflex Adaptation
Authors: Kaplan Harold , Gilman Samuel , Dirks Donald D.
Published: October 2014

The dynamic behavior of the acoustic reflex to continuous sinusoidal stimuli was investigated. The major purpose was to determine the temporal characteristics of reflex adaptation as frequency (0.5, 1.0, 2.0, 3.0, 4.0 kHz) and suprathreshold level (6, +12, +18 dB re reflex threshold) were systematically varied. Repeated measurements were made with an impedance bridge on six normal listeners. Both relative and absolute impedance changes were analyzed. The results revealed large intersubject variability. Four general conclusions were reached regarding the effect of stimulus frequency and suprathreshold level on adaptation: 1) as the stimulus frequency increases, the rate of adaptation increases; 2) the adaptation curves appear to form distinct groups, at the low frequencies adaptation rates are significantly slower than those at 2.0 kHz and above; 3) the onset of adaptation occurs at an earlier time for the higher frequencies; and 4) the rate of adaptation was found to be independent of suprathreshold level. The changes in adaptation with frequency of the stimulus may be expressed by an equation involving inter-related time constants for the growth and adaptation portions of the reflex curve in accordance with a descriptive model suggested by Tietze.
Chronic Tympanomastoiditis with Formation of Calculi
Authors: Gapany-Gapanavicius Boris , Sela Jona , Levij Itzhak S.
Published: October 2014

Numerous calculi of varying sizes and shapes were discovered in the mastoid, antrum, and attic during mastoid surgery for persistent chronic suppurative inflammation of the middle ear cleft with retroauricular and external meatal fistulas in an 8-year-old boy. Light microscopic and scanning electron microscopic examinations and x-ray microanalysis revealed the calculi to consist of masses of crystals containing calcium-oxalate and calcium-and magnesium-phosphate. No signs of tuberculosis were found. Since the patient had multiple dysplasias, including ipsilateral macrotia, in addition to chronic otitis media and mastoiditis, it is suggested that the formation of the calculi may have been due to congenital predisposition.
Proplast® Tracheal Prosthesis
Authors: Kosoy Jerome , Homsy Charles A. , Greenberg S. Donald , Prewitt John M.
Published: October 2014

Proplast®, a recently developed biologically acceptable synthetic polymer, has been utilized in replacement of the cervical tracheas of five dogs. The results of this initial study are encouraging and, in the opinion of the authors, justify further experimentation with this refined prosthetic model.
Effect on Hearing Thresholds of Surgical Modification of the External Ear
Authors: Goode Richard L. , Friedrichs Robert , Falk Stephen
Published: October 2014

Modifications of external ear anatomy following tympanomastoid surgery can have significant effects on the hearing threshold. Experiments are described that demonstrate the acoustical effect of changes in the dimensions of the concha and ear canal on external ear sound pressure gain. An attempt is made to correlate these findings with results in 30 post-tympanomastoidectomy ears and develop some basic principles of external ear surgery that might be clinically useful.
Endoscopy and Tracheotomy in the Neonatal Period
Authors: Cohen Seymour R. , Desmond M. Sheila , Eavey Roland D. , May Bruce C.
Published: October 2014

The charts of 124 patients who underwent endoscopy as neonates during the period from 1967 to 1976 were reviewed. Twenty-nine of these patients (23.4%) had tracheotomies performed during the first month of life; analysis of this group also is included. Three hundred and ninety-two otolaryngological procedures were performed and included direct laryngoscopy (175), bronchoscopy (91), esophagoscopy (37), tracheotomy (29), bronchial lavage (14), change of tracheotomy tube (14), esophageal dilatation (13), incision and drainage of cyst (14), removal of tracheal granuloma (3), laryngeal dilatation (1), and bronchial dilatation (1). Two hundred and forty-nine lesions were found of which 146 were laryngeal, 44 tracheobronchial, 33 esophageal, 16 craniofacial, and 10 were orohypopharyngeal. Procedures were performed under general anesthesia and no anesthetic complications occurred. Surgical complications in the neonatal period were few and never life-threatening. In the nontracheotomized group two complications were found; 38% of this group was discharged within one day of endoscopy. In the tracheotomized group eight complications occurred; none were fatal. In many cases endoscopy proved to be essential in making the specific diagnosis.
Manometric Studies of the Upper Esophageal Sphincter
Authors: Berlin Barry P. , Tedesco Francis , Fierstein Jeffrey T. , Ogura Joseph H.
Published: October 2014

The pharyngoesophageal sphincter (PES) has been studied extensively using the standard three lumen esophageal catheter. Studies using this catheter are nonreproduciible because intraluminal pressure in the PES is dependent on the orientation of the catheter. This difficulty was overcome when a multiluminal catheter was developed by Winans. In this work we used a modification of this multiluminal catheter to study the PES in 6 normal patients and in 13 patients who had undergone partial laryngeal surgery. Pressure profiles in the six normal patients revealed a marked increase in intraluminal pressure in the anterior-posterior direction. This is explained by the anatomy of the cricopharyngeal muscle which does not insert in a median raphe. These readings were reliable and reproducible. The operative patients included nine subtotal supraglottic laryngectomies and four partial laryngopharyngectomies. Eight patients had a cricopharyngeal myotomy and five did not. Pre- and postoperative measurements in this series revealed a marked decrease in PES pressure in those patients who had a myotomy; however, all patients were decannulated and swallowed postoperatively without clinical evidence of aspiration. All future manometric studies of the PES should employ a multilumined catheter in order that the differential pressures in the upper esophagus are recorded.
Congenital Cricopharyngeal Achalasia
Authors: Reichert Timothy J. , Bluestone Charles D. , Sieber William K. , Stool Sylvan E. , Sieber Anne M.
Published: October 2014

Fifteen infants with congenital cricopharyngeal achalasia are reviewed. Although most of the patients had symptoms at birth, the diagnosis was frequently not confirmed until later in the first year of life. While four of the infants had only cricopharyngeal achalasia, 11 had associated diseases related to the central nervous system. Those patients without associated diseases improved spontaneously with conservative management; most of the infants with other abnormalities also improved, although their clinical progress was slower and more complicated. In three of the patients, the symptoms were persistent and there were two deaths related to associated diseases. Cricopharyngeal myotomy was performed on two children with only moderate improvement in symptoms. Congenital cricopharyngeal achalasia is more common than formerly recognized. When suspected, an esophagram with tele- or cineradiography is essential to confirm the diagnosis. Esophageal motility studies will quantify changes and also evaluate lower esophageal dysfunction not easily identified on esophagrams.
Fatal Complication from an Alkaline Battery Foreign Body in the Esophagus
Authors: Blatnik Donald S. , Toohill Robert J. , Lehman Roger H.
Published: October 2014

Foreign bodies and alkali burns in the trachea and esophagus are potentially fatal. Some camera batteries contain 45% potassium hydroxide electrolyte which can leak and cause liquification necrosis upon tissue contact. This report describes a case of an alkali battery foreign body in the esophagus with a subsequent fatal course which was masked by steroid therapy. A discussion of corrosive burns of the esophagus, their etiology, clinical course and pathology is presented.
Permanent Tracheostomy
Authors: Fee Willard E. , Ward Paul H.
Published: October 2014

A new method of permanent tracheal fenestration is reported, utilizing cervical skin and tracheal flaps. It has been performed on four patients without complications and has the advantage of being a quick, simple, one-stage operation that is reversible should conditions change. The procedure is utilized in patients with posttraumatic or postirradiation fibrosis of the larynx, chronic obstructive pulmonary disease and patients with sleep apnea.
Coccidioidomycosis of the Larynx in Infants and Adults
Authors: Ward Paul H. , Morledge David , Berci George , Schwartz Harmon
Published: October 2014

Coccidioidomycosis is a fungal disease endemic to the southwestern United States. The primary form of the disease is relatively benign and many patients, after exposure by inhalation of the sapyrophytic form of the organism, convert from negative to positive skin testing without significant clinical symptoms. The less common disseminated form represents a serious life-threatening disease and can present with granulomatous changes in the larynx. The authors' experience with disseminated coccidioidomycosis presenting in the larynx of adults and infants successfully treated with amphotericin B are presented and discussed.
Tumor Fluorescence with Hematoporphyrin Derivative
Authors: Carpenter Robert J. , Ryan Robert J. , Neel H. Bryan , Sanderson David R.
Published: October 2014

Hematoporphyrin derivative (HpD) is one of several photodynamically active dyes that accumulate in tumor cells and can be used to differentiate neoplastic from normal tissue by violet light activation. Degree of tumor fluorescence was studied in relation to the nature of the hematoporphyrin compound, dose of HpD injected, route of injection, and intensity of activating light. Our studies indicate that HpD is not a chromatographically homogeneous material. Four components of HpD have been identified by thin-layer chromatography; their nature is not presently known. Pure HpD is the best agent for tumor fluorescence as compared with the components studied. Intravenous injection of HpD resulted in a more intense red-orange fluorescence than that after intraperitoneal injection. Fluorescence was more intense at the tumor periphery where tumor invaded normal tissues and around blood vessels. HpD injection of 0.002 mg/gm body weight induced more selective fluorescence of tumor than did 0.01 mg/gm. Microscopic examination of tumor showed fluorescence distributed throughout the cytoplasm. A fiberoptic bronchoscope attached to the Mayo-Baldes activating light source made possible induction of slight tumor fluorescence, but the intensity of activating light would not be adequate for clinical examination of the bronchial tree and detection of tumor.
Neck Dissection: Radical or Conservative
Authors: Lingeman Raleigh E. , Helmus Christian , Stephens Robert , Ulm James
Published: October 2014

Four hundred and forty-five neck dissections for epidermoid carcinoma over a 10-year period are reviewed as to local recurrence of neck disease. Three hundred and fortyseven dissections were radical en bloc procedures and in 98 a modified conservative technique was utilized. Cervical lymph node classification was applied and a comparison made of the two techniques. A review of the anatomy of cervical fascias and the technique of conservative neck dissection is given. Evaluation of this series of cases indicate that the control of local disease in the neck in the N0 and N1 groups is accomplished as well with conservative dissection as with radical neck dissection. The number of conservative neck dissections for N2 disease was too limited for accurate comparison. There were no conservative neck dissections done for N3 disease. We suggest that conservative neck dissection be utilized for subclinical and N1 disease and that the classic en bloc dissection be reserved for N2 and N3 situations.
Histopathological Observations on the Cochlear Changes in Otosclerosis
Authors: Antoli-Candela F. , McGill T. , Peron D.
Published: October 2014

Alterations in the dimensions of the basilar membrane and spiral ligament have been implicated in the pathogenesis of sensorineural hearing loss in otosclerosis. The histopathological findings in nineteen temporal bones with otosclerotic involvement of the cochlear endosteum are reviewed. Hyalinization and decrease in the width of the spiral ligament are the only consistent findings related to the otosclerotic focus in these temporal bones. The width of the basilar membrane is normal. The hair cell population and the stria vascularis are normal for the age group.
Temporary Threshold Shift following 24-Hour Noise Exposure
Authors: Melnick William
Published: October 2014

Nine men were exposed to 24 hours of continuous noise in a sound field. The noise was an octave band centered at 4 kHz at levels 80 and 85 dB. Hearing thresholds were measured monaurally at 11 test frequencies ranging from 250 to 10000 Hz before, during, and after exposure. Temporary threshold shift (TTS) reached maximum levels at 8 to 12 hours of exposure. Maximum TTS occurred at 4 and 6 kHz. Mean asymptomtic threshold shifts (ATS) resulting from the 80 dB exposure level were 9.3 dB for 4 kHz and 7.2 dB for 6 kHz. For the 85 dB noise level, these threshold shifts were 17.8 dB and 14.6 dB respectively. The increase in ATS with increase of noise level for these two frequencies could be fitted with a straight line having a slope of 1.6.
Late Recurrence of a Frontal Sinus Cholesteatoma
Authors: Holt G. Richard , Holt Jean Edwards , Davis William E.
Published: October 2014

The longest recorded recurrence of a frontal sinus cholesteatoma with involvement of the orbit, frontal bone, and floor of the anterior cranial fossa is presented. Radical surgery is required and often craniotomy is necessary. Bony reconstruction of defects should not be undertaken until recurrence has not been present for at least a year. A review of the literature and a discussion of the origin of cholesteatomas is given.
Current Concepts of Tumor Immunology II. Tumor Immunodetection
Authors: Krause Charles J. , Nysather John O.
Published: October 2014

A great deal of investigation is presently underway to develop methods of effectively assessing the status of an individual patient's immune system. Such methods might provide a means of early detection of tumor or of indicating prognosis so that treatment modalities may be tailored to individual patient needs. The cell-mediated response may be monitored using intradermal skin tests and in vitro lymphocyte stimulation and cytotoxicity tests. Humoral responses have been monitored using assays for antibodies against tumor specific as well as tumor associated antigens. Assays have been developed which are capable of detecting circulating fetal antigens in very small concentrations. Thus far no one assay technique has proven to be sufficiently sensitive nor specific to be clinically useful. However, by utilizing a battery of tests before, during and after treatment, it is possible to determine a great deal about individual patient response to treatment and prognosis. With so many investigators focusing upon this problem, it seems likely that more effective methods of immunodetection will soon be developed.
Ear Anomalies Associated with Renal Dysplasia and Immunodeficiency Disease
Authors: Lindsay John R. , hinojosa Raúl
Published: October 2014

The histopathologic study of the temporal bones of a case with low-set rudimentary auricles, without preauricular pits or cervical fistula is presented. Abnormalities of the middle and inner ear, fusion of the kidneys, hydrocephalus, short-limbed dwarfism and immunodeficiency are described. An abnormally low position of the middle cranial fossa in relation to the petrous pyramid was observed. The cochlea was of normal length. The modiolus was poorly developed with apparently normal population of ganglion cells and moderate diffuse hydrops of the cochlear duct and saccule. The stria vascularis was partially degenerated in the upper apical coil. Vestibular abnormalities included bilateral absence of common crus of the vertical canals and unusually high origin of endolymphatic aqueduct with no medial dilation present, the convoluted portion of the sac located beneath the dura.
Experimental Diabetes and the Inner Ear a Proposed Biologic Model
Authors: Gladney John H.
Published: October 2014

Experimental diabetes was induced in 28 healthy chinchillas by the intravenous injection of Streptozotocin.® Five chinchillas were used as controls. It was noted that a dose of 60 mg/kg body weight produced a noninsulin-dependent diabetes in adult chinchillas of mean weights of 393 gm. The chinchilla is proposed as a suitable animal model for the study of experimental diabetes because of the many attributes it possesses. A method of producing experimental diabetes is described. A method of anatomical display was utilized that allowed a detailed longitudinal study of the entire cochlear partition without sacrificing the stria vascularis and Reissner's membrane. The study did not yield any new histopathologic data concerning the nature of diabetes in the inner ear. In all likelihood this is, among other things, a factor of the mild severity of diabetes induced and the short duration of this study.
Melanocyte System of the Endolymphatic Duct and Sac
Authors: Gussen Ruth
Published: October 2014

One hundred fourteen human temporal bones from 64 individuals were studied for the presence of melanized melanocytes about the endolymphatic duct and sac. Specimens were from Caucasians (104), Orientals (6) and Negroes (4). Of the specimens from people above nine years of age 79% demonstrated melanized melanocytes about the endolymphatic duct and sac, as well as occasionally about blood vessels in the adjacent bone. These represented 74% of the Caucasian and 75% of the Negro and Oriental individuals. Pigment granules were noted in occasional epithelial lining cells and in macrophage-type cells within the lumen. Heavily melanized melanocytes were noted in five of six specimens of Ménière's disease (all from Caucasian individuals), five of five specimens with previous labyrinthitis (two of which were from a Negro woman), and in occasional specimens from patients with presbycusis, metastatic carcinoma (three of the four adult Oriental patients), chronic otitis media, otosclerosis and lymphoma, as well as in several apparently normal specimens. No clear cut correlation of degree of melanization with specific disease processes can be discerned.
Neoglottic Reconstruction after Total Laryngectomy
Authors: Griffiths Ceri M. , Love J. Thom
Published: October 2014

This paper is a preliminary report on neoglottic reconstruction of the larynx after total laryngectomy following the techniques described by Staffieri. Also included are general observations on the criteria for selecting candidates for this procedure. At the University of Texas Medical Branch in Galveston, this procedure has been attempted on eight candidates. Reconstruction was accomplished in six, of whom five achieved satisfactory speech, providing an 80% success rate. One of the five did not like the quality of his voice and refused to use it. The sixth produced speech with difficulty and is still undergoing speech therapy. One patient died from recurrence before a second stage could be carried out, and another patient did not have sufficient tissue for neoglottic reconstruction after total laryngectomy. Three patients developed salivary fistulas at the drain site, but all closed spontaneously with the application of pressure. From this data, one may conclude that this technique offers much potential and warrants further study.
Neomycin Ototoxicity
Authors: Ward K. M. , Rounthwaite F. J.
Published: October 2014

A case of oral neomycin ototoxicity is presented, followed by a summary of known cases in the English literature. While it is known that neomycin is concentrated in the inner ear fluids, at the present time the biochemical basis of its ototoxic effect has not been definitively elucidated. High frequency audiometry can aid in the early detection of the onset of neomycin-induced deafness. Dialysis has a limited but useful role in preventing neomycin ototoxicity.
Masticator Space Abscess Complicating Removal of Suspension Wires
Authors: Caruso Vincent G.
Published: October 2014

Masticator space abscesses have been reported more frequently in recent years. They are usually secondary to extractions of the first and second mandibular molar teeth. The use of antibiotics has changed the presentation and clinical course of these abscesses, masking the symptoms and resulting in secondary infection by resistant organisms. Therefore, selection of appropriate antibiotics is important, but surgical intervention remains the cornerstone of treatment. Suspension wires are being used widely in the treatment of midface fractures. These wires may extend from the zygomatic arch or frontal bone through the masticator space into the oral cavity to attach to arch bars. A case of masticator space abscess resulting from the removal of suspension wires is reported, and the relevant literature is reviewed. Suggestions are made for preventing and treating this complication.
Dermoid of the Nasopharynx
Authors: Lloyd Ricardo , Chuprevich Thomas , Gilbert Enid
Published: October 2014

A case of a cystic polyp of the nasopharynx in a three-year-old Caucasian female is presented. Although cases of teratomas of the nasopharynx have been reported, our literature search revealed only one prior report of a hamartoma. To our knowledge, a lesion with these histological features occurring in the nasopharynx has not been previously reported.
Effects of Adenoidectomy
Authors: Rynnel-Dagöö Britta , Ahlbom Anders , Schiratzki Helge
Published: October 2014

A prospective controlled study was made on the effect of adenoidectomy performed on 105 children. For various reasons, mainly severe long-standing nasal obstruction, 29 children were omitted from the study. The remaining 76 children were randomly divided into two groups, one adenoidectomy, and one control. Both groups were slightly reduced in number due to drop out. Thus 36 adenoidectomized children were followed during one year and 35 children during two years. The corresponding numbers for the children in the control group were 37 and 33. The incidence of common cold, purulent and serous otitis media and moderate nasal obstruction was compared in the two groups. A considerable reduction in the incidence of these variables was observed in both groups. The occurrence of moderate nasal obstruction was reduced more among the operated than among the unoperated children. The difference was only slightly significant during the first and not at all during the second year. Regarding the other variables, the differences were not significant, implying that adenoidectomy seems to have no effect on the incidence of common cold, serous and purulent otitis media.
Sputum Cytologic Diagnosis of Upper Respiratory Tract Cancer
Authors: Neel H. Bryan , Woolner Lewis B. , Sanderson David R.
Published: October 2014

Sputum cytologic testing has been applied in the screening of high-risk individuals for presymptomatic lung cancer. This same screening procedure sometimes identifies patients with upper respiratory tract cancers and thereby may permit earlier treatment. Patients enrolled in the Mayo Lung Project undergo sputum cytologic and chest roentgenographic screening at four-month intervals and are compared with matched controls who are not intensively screened. Experience to date indicates an incidence rate of approximately 1 per 1,000 per year of cancer in the upper respiratory and alimentary passages among males more than 45 years old who are heavy cigarette smokers. This compares with a rate of approximately 4 per 1,000 per year of lung cancer. Recognition of early cancer of the upper respiratory tract is an additional benefit of screening for lung cancer. Since cigarette smoking represents an etiologic agent common to both upper and lower respiratory tract cancers, tumors should be searched for in both sites in this high-risk population.
Functional Diseases of the Esophagus: Role of Endoscopy
Authors: Swamy Nanjunda , Rayl John E.
Published: October 2014

The use of endoscopic procedures in the evaluation of primary motor disorders, or functional diseases, of the esophagus is filled with both risks and benefits. Since both flexible and open-tube esophagoscopy carry a significant risk factor, it is necessary to have a clear concept of the indications and value of endoscopy in the management of functional diseases of the esophagus. A review of the literature reveals very little documentation on the value of endoscopy in diagnosing esophageal functional diseases other than Zenker's diverticulum and achalasia. Based on the current literature and the experience of the authors, observations and recommendations concerning the role of endoscopy in functional diseases of the esophagus are presented. These are: 1) In Phase I or upper esophageal sphincter dysfunctions, endoscopy contributes little to their understanding, is difficult to perform, and may be hazardous. In this group, esophagoscopy should be reserved for indications beyond the dysfunction itself. If endoscopy has to be performed, open-tube esophagoscopy should be performed by an experienced endoscopist. 2) In functional diseases of the esophageal body or Phase II dysfunction, endoscopy is frequently valuable. In spastic disorders, it helps to differentiate between primary spasm of neuromuscular origin and spasm secondary to esophagitis or an obstructive process. In scleroderma and pulsion diverticulum, endoscopy helps to identify such unsuspected complications as esophagitis, hiatal hernia, and carcinoma. 3) In Phase III or lower esophageal sphincter dysfunctions, endoscopic examination is essential both to rule out organic lesions that simulate functional disorders, and to determine the presence and extent of esophagitis.
Effect of Topical Anesthetics on Ciliary Activity of Chicken Embryo Tracheal Organ Cultures
Authors: Dudley James P. , Cherry James D.
Published: October 2014

Because of conflicting reports concerning the effect of topical anesthetics on cilia, testing of four different agents was undertaken. The agents were hexylcaine 5% (Cyclaine®), tetracaine 2% (Pontocaine®), cocaine 5% and 10%, and lidocaine 4% (Xylocaine®). Tracheas were removed from 19 to 20 day old chicken embryos. Ciliary activity was graded as to extent and vigor. Two methods of testing were used. In the first, dilutions of each agent were made, and tracheal rings were placed in the wells of microtiter plates and completely covered with the test drug. In the second method of testing, 0.8 ml of the test drug was injected in vivo into the exposed trachea of the embryo. In immersion testing, cilia stopping effect (CSE) in tracheal rings was noted in all drug dilutions tested within 1 to 20 minutes. When the drug was injected directly into the trachea, a complete CSE was noted the next day in the rings from the tetracine and hexylcaine injected tracheas. Three days following in vivo transtracheal injection of lidocaine and cocaine, ciliary activity in these and the control rings was similar. Although cilia did not tolerate total immersion in any of the agents tested, ciliary activity in tracheas injected with lidocaine and cocaine did not differ significantly from the control tracheal rings. Physicians who use topical anesthetics should be aware of this.
Electrocochleographic Study of Sudden Deafness
Authors: Nishida Hiroaki , Kumagami Hidehaku
Published: October 2014

By performing electrocochleography (AP, SP and CM) on 34 patients with sudden deafness, it was thought that the pathophysiology of this disease could be deduced. The various waveform patterns of AP and SP responses obtained in cases of sudden deafness were classified into the following types: 1) AP high response; 2) decreased AP high response; 3) AP low response; 4) dominant — SP; 5) — SP or + SP; and 6) AP, SP no response. The cases showing the type of dominant — SP and AP high response had satisfactory prognoses. In these cases the sensory epithelium and the cochlear nerve seemed to indicate a reversible condition being affected by the temporary functional block. Furthermore, it seemed to indicate that the neural regions related to the source of AP(N1) response were impaired in cases in which CM were recorded at normal response threshold in spite of the absence of AP(N1) response. In the unsatisfactory prognosis cases with decreased AP high response, AP low response and AP, SP no response in which only the extremely low or depressed CM responses could be recorded, it seemed that the sensory epithelium and the cochlear nerve were affected permanently, although the degree of impairment varied.
Juvenile Nasopharyngeal Angiofibroma
Authors: Biller Hugh F.
Published: October 2014

The diagnosis of angiofibroma can be suspected in most cases by clinical examination, supplemented by routine x-rays and tomograms and is confirmed by angiography. Adjunctive therapy including embolization, estrogens, cryotherapy and arterial ligation is discussed. Surgical resection is the preferred treatment. Radiotherapy as the primary treatment modality is contra-indicated except in select cases.
Hypersensitivity Problems in Otorhinolaryngology
Authors: Williams Russell I.
Published: October 2014

The average otolaryngologist is confronted with allergic problems in well over 50% of his patients. It would seem imperative that he either recognize the problem and be able to instigate appropriate therapy himself or refer the patient to someone who can. In the latter case, he should have a basic knowledge which would allow him to evaluate adequately the therapy provided.
Laryngocele and Saccular Cysts
Authors: Holinger Lauren D. , Barnes David R. , Smid Lojze J. , Holinger Paul H.
Published: October 2014

The symptoms, endoscopic findings, treatment and results of 46 patients with laryngoceles and saccular cysts are presented. Thirty-four were adults; 12 were infants and children under three years of age. Twenty-two adults had anterior saccular cysts, nine had lateral saccular cysts; three had laryngoceles. Ten infants and children had saccular cysts; two had laryngoceles. A laryngocele is an abnormal dilatation of the saccule which communicates with the lumen of the larynx, fills with air but on occasion may be temporarily distended with mucus; laryngoceles may be congenital or acquired. A saccular cyst is a mucus-filled dilatation of the saccule which does not communicate with the laryngeal lumen; saccular cysts are classified as lateral or anterior. Laryngoceles and saccular cysts represent abnormalities of the laryngeal saccule; a developmental spectrum exists among the normal saccule, large saccule, laryngocele and saccular cyst. The treatment of saccular cysts in infants and children is primarily repeated aspiration. In adults, symptomatic laryngoceles and large lateral saccular cysts are treated by an external approach; endoscopic aspiration and unroofing of small lateral saccular cysts is sometimes adequate and is attempted first. Anterior saccular cysts are treated by endoscopic excision biopsy. Carcinoma of the larynx may be found in association with a laryngocele or saccular cyst and must be diligently searched for by biopsies in the region of the saccular orifice. A smooth mass involving the area of the false vocal cord and aryepiglottic fold cannot be assumed to be a lateral saccular cyst; biopsies of the ventricle and saccule and deep incisional biopsies of the mass are indicated to rule out a carcinoma originating in the ventricle or saccule.
Thorotrast® Induced Pharyngeal Necrosis
Authors: Miglets Andrew W. , Letson James A. , Speigel Jerome C.
Published: October 2014

Thorotrast®, a radioactive contrast material used between 1930 and 1950, is often permanently retained within the patient. Individuals who have had diagnostic studies with Thorotrast® may develop serious complications many years later. These complications fall into two major categories, desmoplastic and neoplastic. The inadvertent infiltration of Thorotrast® into soft tissue, usually the neck during carotid arteriography, may later result in severe fibrosis with constriction of the surrounding vessels and nerves. Malignancies, the second major problem, have occurred at the site of previous Thorotrast® instillations throughout the body. The following report describes the clinical course of an 82-year-old woman who presented with a Thorotrast® induced desmoplastic reaction of her neck, complicated by pharyngeal necrosis and the development of a pharyngeal cutaneous fistula. The latter problem is quite rare, having been previously reported only once. Despite extensive tissue destruction conservative management prevailed. Repetitive debridement, controlling the intermittent infections, maintaining her nutritional status, and relieving her pain allowed spontaneous healing to occur.
Otosclerosis: Vestibular Symptoms and Sensorineural Hearing Loss
Authors: Cody D. Thane R. , Baker Hillier L.
Published: October 2014

Of 546 patients with otosclerosis, 500 who had not had ear surgery were divided into four groups according to the relative and absolute amounts of sensorineural hearing loss in the hearing-impaired ears. The first three groups of patients had progressively less of a conductive component and progressively more of a sensorineural component to their hearing losses. The fourth group of patients had pure sensorineural hearing impairments. The remaining 46 patients were placed in group V. They had bilateral hearing losses and had had a prior unilateral stapedectomy for otosclerosis and they had received medical therapy for otosclerosis. The following conclusions were reached: 1 Further clinical evidence was obtained supporting the existence of the entity “pure labyrinthine otosclerosis.” However, there can be difficulties in the diagnosis of this condition. 2 The incidence of vestibular symptoms in patients with otosclerosis increased as the relative and absolute amounts of sensorineural hearing loss increased and was much higher than one would expect in the normal population. In addition, with increasing sensorineural hearing loss, the severity of vestibular symptoms increased along with the incidence of depression in vestibular function determined by the bithermal caloric test in patients with vestibular Symptoms. 3 A preliminary study on the administration of a combination of calcium gluconate, sodium fluoride, and vitamin D to patients with otosclerosis who had vestibular symptoms indicated that the therapy controlled vestibular symptoms in a high percentage of these patients. 4 A preliminary study on the administration of calcium gluconate, sodium fluoride, and vitamin D to patients with otosclerosis indicated that in a high percentage of patients the deterioration in hearing was stopped. A small but significant number of patients had reversal of their hearing loss. 5 Side effects of treatment with a combination of calcium gluconate, sodium fluoride, and vitamin D were not serious and were reversible, and there appears to be no contraindication to this therapy for healthy adults.
Vestibular Responses to Bithermal Caloric and Harmonic Acceleration
Authors: Wolfe James W. , Engelken Edward J. , Olson James W. , Kos C. M.
Published: October 2014

Vestibulo-oculomotor responses from 33 patients with either peripheral labyrinthine or central pathology were compared using the standardized Fitzgerald-Hallpike bithermal caloric and harmonic accelerations. In numerous cases (40%), patients with normal caloric responses reflected abnormalities in either their phase relationships or labyrinthine preponderance to sinusoidal acceleration. Results clearly indicate that harmonic acceleration provides additional information to the clinician in the evaluation of vestibulo-oculomotor pathology that is not reflected in the responses to standard caloric tests.
Gentamicin Vestibulotoxicity: Long Term Disability
Authors: Dayal Vijay S. , Chait Gordon E. , Fenton Stanley S. A.
Published: October 2014

Vestibular toxicity is known to occur from gentamicin. Over a five-year period seven patients with severe and prolonged ataxia from gentamicin vestibular toxicity were seen. Two of these patients were not in renal failure. Case reports of five of these are presented. The possible explanations for prolonged disability are discussed.
Impedance Screening for Preschool Children: State of the Art
Authors: Paradise Jack L. , Smith Clyde G.
Published: October 2014

As a test for detecting middle ear disease among preschool children, tympanometry — as opposed to audiometry — has three advantageous attributes: a high degree of sensitivity, minimal need for subject cooperation, and total objectivity. For these reasons interest has arisen in tympanometry as a method for screening, i.e., identifying children with previously undetected middle ear disease. However, uncertainty persists concerning the importance of detecting apparently asymptomatic middle ear effusions, and concerning optimal methods, or even the advisability, of treating them. Further, the sensitivity and specificity of tympanometry depend on how the pass-fail cutoff point is defined. Defining this cutoff point so as to achieve high sensitivity may result in excessively low specificity, with the production of large numbers of false-positives who then become overreferrals. Data are presented to show how the validity of the test may be increased to some extent by attention to the gradient of “negative-pressure” tympanograms. At the present time, given the various aforementioned uncertainties, and with adequate validation as to the presence or absence of disease often lacking in reported studies of impedance screening in preschool populations, the cumulative results of these studies do not warrant embarking on large-scale screening programs. What is needed instead is additional research to explore the issue further.
Optokinetic Suppression of Aberrant Vestibular Reactions: An Observation
Authors: Karlan Marc S. , Todd John , Adams Calvin K. , Stein Gerald H. , Goldstein Mark K.
Published: October 2014

It has long been known that optokinetic nystagmus may be modified by vestibular inputs. We have suppressed an aberrant vestibular response and associated gastrointestinal sensations by use of an optokinetic stimulus simultaneous to the positional stimulus in a patient with paroxysmal positional vertigo. This single subject study utilized several optokinetic conditions, and patterned its stimulus presentations to control for visual fixation and vestibular habituation. Objective recordings of eye movements (ENG) were made simultaneously with subjective evaluation of “dizziness” on a simple magnitude estimation scale.
Cefazolin Prophylaxis in Head and Neck Cancer Surgery
Authors: Becker Gary D. , Parell G. Joseph
Published: October 2014

This study evaluated the prophylactic use of cefazolin in reducing the incidence of infection in patients undergoing cancer surgery where the upper aerodigestive tract was entered from the neck. A prospective, randomized, double-blind design was conducted in a single hospital. The patient was given placebo or cefazolin, 1 gm intramuscularly with the preoperative medications, then 0.5 gm every six hours for four doses. Of 55 determinate patients, 32 received antibiotics and 23 placebo. Infection rate was 38% (12/32) and 87% (20/23) respectively, representing a statistically significant reduction in infection ( P < 0.001). There were 30 wound and two nonwound (sinusitis and pneumonia) infections. In conclusion, the perioperative use of cefazolin in patients undergoing cancer surgery where the oral cavity or pharynx has been entered from the neck is useful in reducing the incidence of wound infection.
Experimental Viral Infections of the Inner Ear II. Simian Virus 40 Induced Tumors of the Temporal Bone
Authors: Davis Larry E. , Nager George T. , Johnson Richard T.
Published: October 2014

Pathological and virological studies were performed on temporal bones of 23 hamsters which developed tumors subsequent to neonatal inoculation of simian virus 40 (SV40). Four to five months after viral inoculation, 22 hamsters developed undifferentiated sarcomas in the subcutaneous space adjacent to the temporal bone. Nine tumors invaded the temporal bone, occasionally extending to the subarachnoid space but not to the inner ear. Choroid plexus papillomas developed in four animals, with one tumor demonstrating invasion of the cochlear aqueduct, internal auditory canal, and cochlear modiolus. Cells grown from a sarcoma and a choroid plexus papilloma contained tumor antigen and established that the tumors were SV40 virus induced.
Effect of Ammonia on Nasal Resistance in Atopic and Nonatopic Subjects
Authors: McLean J. A. , Mathews K. P. , Solomon W. R. , Brayton P. R. , Bayne N. K.
Published: October 2014

Nasal airway resistance (NAR) was assessed from the slope of pressure-flow curves obtained during normal nasal breathing. Volunteers were classified as atopic or nonatopic according to strict criteria. 100 ppm NH3 was introduced into each nostril for periods ranging from 5 to 30 seconds with frequent NAR monitoring. A progressive increase in NAR responses was obtained with incremental NH3 exposures, but no significant difference was noted between the mean response of atopic and nonatopic subjects. Control exposures to compressed air under the same pressure generally produced only a small change in NAR, while aerosolized buffered saline increased NAR more than compressed air. The nasal response to NH3 was effectively inhibited by intranasal atropine administration but not by chlorpheniramine. The described procedure provides a safe and simple method for studying semiquantitatively the short-term effects of inhaled irritants on the nose.
Hypernephroma Metastatic to the Palatine Tonsils
Authors: Brownson Richmond J. , Jaques William E. , LaMonte Samuel E. , Zollinger William K.
Published: October 2014

Review of the literature discloses 76 cases of carcinoma metastatic to the palatine tonsil. Of these cases reported or mentioned, 51 were detailed sufficiently or occurred frequently enough to allow analysis. We add two new cases of hypernephroma, and also study the courses of patients with primaries of the stomach, breast, lung and melanoma and seminoma. Bilateral tonsillar involvement is found to be very common in melanoma and not uncommon in seminoma and adenocarcinomas of the stomach and breast. It is uncommon for bronchogenic carcinoma and hypernephroma to metastasize to both palatine tonsils. When laterality is present the left tonsil is more commonly involved than the right, except by melanoma. Regarding neoplastic involvement of the primary organ, the left side gives rise to malignancies more often than the right side. Only seminoma has a high incidence of cervical node involvement. Over 77% of patients have evidence of other metastases. The mean time interval between development of the primary and the tonsillar secondary is one year or less in seminomas, bronchogenic carcinomas and adenocarcinomas of the stomach, but 2½ years or more for adenocarcinomas of the breast and kidney and melanomas. The mean time of survival after appearance of the tonsillar metastasis is nine months or less, regardless of the cell type of the primary malignancy.
Role of the Vidian Nerve in Nasal Allergy
Authors: Konno Akiyoshi , Togawa Kiyoshi
Published: October 2014

Clinical studies were performed to evaluate the role of the vidian nerve at onset of symptoms in nasal allergy. A localized area of one side of the nasal cavity was stimulated with known allergen and 0.1% histamine chloride in patients with perennial nasal allergy. The effect of unilateral vidian neurectomy and sensory anesthesia on glandular and vascular response was evaluated. With localized nasal stimulation, hyperrhinorrhea was seen in both sides of the nasal cavity before vidian neurectomy. Unilateral vidian neurectomy blocked hyperrhinorrhea only in that nasal cavity in which the nerve was sectioned. However, hyperrhinorrhea from the contralateral side, with an intact vidian nerve, was blocked with sensory anesthesia of the opposite side of the nasal cavity where the stimulation was applied. Nasal hypersecretion in allergic rhinitis was assumed to be mostly due to stimulation of sensory receptors by a chemical mediator and reflexive stimulation of the nasal glands. Vidian neurectomy, however, did not have any apparent influence on the swelling of the nasal mucosa caused by localized stimulation of allergen and histamine.
Observations of Human Fetal Otoconial Membranes
Authors: Wright Charles G. , Hubbard David G. , Clark Geoffrey M.
Published: October 2014

Intact otoconial membranes from 31 human fetuses ranging in gestational age from 14 to 36 weeks were studied. At all stages of development specimens from different individuals showed marked variations in overall shape. During the course of the second and third trimesters, both saccular and utricular otoconial membranes were found to increase three to fourfold in surface area and more than twofold in weight. Near the end of gestation the fetal specimens were about equal in area and weight to otoconial membranes from children up to 13 years of age. However, the crystal layers of the fetal membranes had less prominently developed surface contours than usually observed in children and adults, indicating that maturational changes continue after the time of birth.
Juvenile Fibromatosis
Authors: Morioka Wilfred T. , Heath Victor C. , Cantrell Robert W.
Published: October 2014

Juvenile fibromatosis is a benign lesion with locally aggressive characteristics. Wide surgical excision is the treatment of choice. Radiation therapy can be used for inoperable cases or as adjunctive therapy. Steroid therapy has not been used extensively and deserves further evaluation. In the head and neck area, juvenile fibromatosis must be very carefully diagnosed and treated due to the serious consequences that result from inadequate control.
Coexisting Benign Mixed Tumor and Mucoepidermoid Carcinoma of the Parotid Gland
Authors: Pontilena Nicholas , Rankow Robin M.
Published: October 2014

Multiple unilateral parotid gland tumors are very rare. A review of the literature shows only seven cases of coexisting unilateral parotid tumors. This patient had a benign mixed tumor and a mucoepidermoid carcinoma of the right parotid gland. This is the eighth reported case of multiple unilateral parotid tumors and the first to show such a combination of tumors.
Fibrinolytic Activity in Patients with Acute Tonsillitis
Authors: Kosugi T. , Matsuo O. , Hamaya M. , Mihara H.
Published: October 2014

Three parameters in blood fibrinolysis, viz, the levels of fibrinogen, plasminogen, and fibrinogen and/or fibrin degradation products (FDP), were measured in patients with acute tonsillitis and the results were compared with those for healthy adults. The fibrinogen content in acute tonsillitis increased significantly ( P <.001), that of plasminogen decreased significantly ( P <.005), while FDP showed a higher value ( P <.01). The significance of the fibrinolytic system in acute tonsillitis is discussed.
Antibody Activity in Otitis Media with Effusion
Authors: Lewis Daniel M. , Birck Herbert G. , Schram James L. , Lim David J.
Published: October 2014

Bacteria were isolated from a high percentage of the effusions from patients with otitis media with effusion (OME, serous otitis media). In an attempt to determine if the isolated bacteria were involved in the disease process, we analyzed the serum and effusion of 25 OME patients for the presence of antibacterial antibodies by the indirect immunofluorescence antibody method. Specific antibody activity was detected in 20 of 25 effusions (80%) and 19 of 22 sera (86%). IgG antibodies were the most frequently found class of antibodies in both sera and effusions, but IgA antibodies were detected more frequently in the effusions than in the sera. Hemophilus influenzae, Streptococcus pneumoniae, and diphtheroids were the most frequently isolated organisms, and antibody activity to all bacterial species isolated was detected. The results support the concept that the isolated bacteria are not contaminants but are actively involved in the disease process.