bluuebunny/crossref_metadata_2025 huggingface dataset:
1. Effect of Different Conditions of Ocular Fixation
Authors: Baloh Robert W. , Sills Andrew W. , Solingen Leda , Honrubia Vicente
Published: January 2017

Twelve normal subjects received standard caloric testing under the following conditions: 1) fixation, 2) Frenzel glasses in a dimly lit room, 3) eyes open in total darkness, and 4) eyes closed. Multiple nystagmus response parameters were evaluated and statistically compared for each condition. Fixation markedly diminished induced nystagmus and produced the largest coefficient of variation for each response parameter. Caloric testing with eyes closed resulted in periodic nystagmus suppression and a less distinct saw-toothed pattern. As with fixation, the coefficient of variation was consistently higher with eyes closed compared to eyes open in darkness or Frenzel glasses. It is concluded that caloric testing of the vestibulo-ocular reflex are should be performed with eyes open in darkness or with Frenzel glasses.
3. Patients with Peripheral and Central Vestibular Lesions
Authors: Baloh Robert W. , Sills Andrew W. , Honrubia Vicente
Published: January 2017

Results of bithermal caloric testing in 83 patients with unilateral peripheral vestibular disease, cerebellopontine angle tumors and vertebrobasilar insufficiency were compared in order to find which response measurements identified the most abnormal responses in each disease category. A laboratory digital computer was used to quantitatively assess each caloric response and a large digital computer was used to statistically compare 110 measurements generated from each caloric test. Of the commonly used response parameters maximum slow component velocity (SVM*) and sum of slow amplitudes (SSA) were most sensitive in each category and duration of response (TDUR) was least sensitive. This order was maintained for the vestibular paresis (VP), directional preponderance (DP) and temperature effect (TE) formulas. The magnitude of DP was significantly correlated with the magnitude of spontaneous vestibular nystagmus and both occurred with approximately the same frequency in peripheral and central disorders. There was no reliable way of separating end-organ from VIII nerve or peripheral from central disorders on the basis of the caloric responses.
Crista Neglecta in Man
Authors: Okano Yasumasa , Sando Isamu , Myers Eugene N.
Published: January 2017

— The prevalence, location, and size of the crista neglecta in man were investigated by examining the histological sections of 223 human temporal bones (137 cases). The relationship between the crista neglecta and the singular nerve was also described. The crista neglecta was observed in 17 cases, ranging in age from 15-week fetal life to 76 years. This structure was located on the wall of the anterolateral quadrant of the posterior canal ampulla, close to the cribriform area of the singular nerve in the area between the utriculoampullar duct and the intermediate portion of the posterior canal crista. The average width, length, and height of the crista neglecta were described. The crista neglecta had a mound-like shape and contained nerve fibers, transitional epithelium, sensory hair cells, and a cupula. The nerve fibers from the crista neglecta were joined to a small branch of the singular nerve at the cribriform area in 5 of 17 crista neglecta cases, and to the main trunk of the singular nerve in the remaining 12 cases.
Neurilemoma of the Jugular Foramen Trans Mastoid Removal
Authors: Call William H. , Pulec Jack L.
Published: January 2017

— The authors present two cases in which the palsies of the IX, X, XI and XII nerves heralded the presence of a neurilemoma within the jugular foramen. Temporal bone polytomography, retrograde jugular venography, and pantopaque posterior fossa myelography allowed the nature and extent of the tumor to be predicted accurately prior to the operation. The tumors were completely removed using a transmastoid-extended facial recess approach without labyrinthectomy, supplemented in one case by exploration of the upper cervical portion of the internal jugular vein. This technique has avoided the complications which attend removal by way of the posterior fossa. We feel that transmastoid removal merits more extensive clinical trial.
Flexible Bronchoscopy in Nonvisualized Carcinoma of the Lung
Authors: Teirstein Alvin S. , Chuang Ming T. , Miller Albert , Choy A. Rogelio , Nieburgs Herbert E.
Published: January 2017

— Of 1,000 consecutive patients undergoing fiberoptic bronchoscopy, 331 eventually were proven to have primary lung cancer. Of the 331 carcinomas, 253 were beyond the visual range of the flexible bronchoscope. However, under fluoroscopic guidance, the diagnosis of carcinoma was established in 194 (76.7%) of these nonvisualized tumors. Cytologic analysis of brush specimens was more often positive for malignancy than specimens obtained by forceps biopsy. An expert cytologist and experienced bronchoscopy team are essential for a high percentage of reliable positive diagnoses in bronchogenic carcinoma.
Head and Neck Manifestations of Scleroderma
Authors: Weisman Robert A. , Calcaterra Thomas C.
Published: January 2017

— Scleroderma has rarely been discussed in the otolaryngologic literature. A review of the records of 71 scleroderma patients admitted to UCLA Hospital during the past five years indicates that head and neck manifestations are common, occurring in 80% of these patients. The initial symptoms in 30% among them were related to the head and neck. It is the purpose of this paper to familiarize otolaryngologists with scleroderma. Although it has not been emphasized in the past, this is a disease whose early symptoms and findings may require otolaryngologic consultation and whose later course is characterized by head and neck symptoms and findings in the overwhelming majority of patients.
Combined Flap-Wire Reconstruction of the Oral Cavity
Authors: Lowell Seth H. , Mathog Robert H. , Maisel Robert H.
Published: January 2017

— The concept of immediate reconstruction for head and neck defects following tumor resection provides the impetus for the development of new reconstructive techniques. In this article, the authors describe the evolution of local and regional flaps and the more recent use of composite tissues. The application of a combined forehead-deltopectoral flap and Kirschner wire for the reconstruction of a large defect involving the oral cavity, mandible and facial-cervical skin is presented in a case report and evaluated as to its efficacy in the treatment of head and neck cancer.
Surgical Treatment of Congenital Choanal Atresia
Authors: Freng Atle
Published: January 2017

— In a follow-up, 2 to 27 years postoperatively, of 43 patients with unilateral choanal atresia a high frequency of relapses was observed. In 47% of the cases, preoperative symptoms had reappeared, and in 84% scar tissue had reduced the choanal opening to less than half of normal size. In most of the patients a transpalatinal approach was used, either ad modum Ruddy, Wilson or Owens. In order to improve the results, the surgical method and the postoperative treatment were changed in a new series of 15 patients with unilateral atresia. These patients, 6 to 26 years of age, were operated on by a transpalatinal approach during two months in the autumn of 1974. After removal of the atresia, the posterior part of the nasal cavity was modeled, with a dental drill, to increasing diameter towards epipharynx. To keep the opening patent a PVC tube was left in the choana for six weeks postoperatively. The results were encouraging. Two and a half years after the operation there were no relapses.
Synovial Sarcoma of the Hypopharynx
Authors: Gapany-Gapanavičius Boris , Behar Albert J. , Chisin Roland
Published: January 2017

— Primary synovial sarcoma of the hypopharynx is an extremely rare neoplasm. Only 16 cases could be traced in the literature so far. An additional case, in a 29-year-old male patient, is presented. Progressive disturbance of deglutition and speech, choking sensation, and mild respiratory distress were his original complaints. Our case differs from those previously reported in that a) the tumor was pedunculated, and the site of its attachment could be very well-defined, and b) unusual intratumoral destructive hemorrhage turned the case into an emergency. The pedicle was radically excised together with part of the grossly uninvolved underlying tissue, and the tumor was removed in toto. The histological findings are described. The patient is under observation. No recurrence has been noticed 11 months after surgery, and there are no signs of metastasis. The origin of the tumor and its treatment are discussed.
Hemangioma of the Nasal Bones: Radiographic Appearance
Authors: Zizmor Judah , Robbett William F. , Spiro Ronald H. , Ganz Andrew , Tawfik Bernard
Published: January 2017

—- Four additional cases of hemangioma involving the nasal bones are presented, bringing the reported cases to 15. The radiographic findings of nasal bone hemangioma are distinctive, permitting easy diagnosis. Hemangioma involving the nasal bones may result in a reticular or “soap bubble” osteoporosis, spiculation, bone thickening, or a channelled appearance of the nasal bone. Treatment is by local excision.
Quantitative Evaluation of Postnatal Bone Growth in the Auditory Ossicles of the Dog
Authors: Roberto Michele
Published: January 2017

— The postnatal bone growth (appositional and internal) in the auditory ossicles and in the tibia of three mongrel dogs was studied by means of tetracycline and alizarin labeling. The appositional growth is characterized by an increase in the external dimensions of the auditory ossicles within the first month of postnatal life. No trace of bone deposition was found after this period of time. The patterns of internal growth are: 1) the rate of primary osteon formation shows the same value in the incus and malleus; 2) these values are always less than those in the primary osteons of the diaphysis of the tibia of the same dog; 3) the time required for the formation of these osteons in the auditory ossicles, like in the other parts of the skeleton, increases significantly with age.
Estimate of Vitamin a in the Guinea Pig Cochlea
Authors: Chole Richard A. , Quick Cedric A.
Published: January 2017

— Microfluorometric estimates of the membranous structures of the freeze-dried guinea pig cochlea have demonstrated that vitamin A is present in these tissues at a concentration of 21.2 μg/gm (SD ± 4.77 μg) which is approximately ten times the vitamin A concentration in most other tissues.
Alcohol and the Oculomotor System
Authors: Umeda Yoshio , Sakata Eiji
Published: January 2017

— The influence of alcohol on the oculomotor system was observed by means of the caloric eye tracking pattern (CETP) test, the visual suppression test on caloric nystagmus, and the positional nystagmus, eye tracking and gaze nystagmus tests. In Group A (nine cases whose CETP before the intake of alcohol was normal), the influence of alcohol consumption appeared regularly and consistently in the following order: abnormality of CETP ≥ positional alcohol nystagmus ≥ abnormality of the eye tracking pattern ≥ alcohol gaze nystagmus. On the contrary, in Group B (eight cases whose CETP before the consumption of alcohol was already abnormal), with one exception, the regularity noted in Group A was not observed. This phenomenon may be attributable to the presence of latent disorders of the oculomotor system. In both groups, the duration of the caloric nystagmus itself was slightly shortened and its amplitude somewhat suppressed after the consumption of alcohol. The results were confirmed by experiments in which the subjects kept their eyes open in darkness. On the other hand, when the eyes were kept open in light surroundings, the duration and amplitude of the caloric nystagmus were exaggerated in appearance because the mechanism of visual suppression was disturbed by alcohol.
Study of 100 Patients with Bilateral Sensorineural Hearing Loss for Lipid Abnormalities
Authors: Lowry Louis D. , Isaacson Steven R.
Published: January 2017

— One hundred persons were selected from our audiology records who showed at least 20 dB bilateral sensorineural hearing loss. The number 100 was picked for an adequate statistical analysis. The patients were taken from the chart files which are filed in chronological order. Letters were mailed with instructions for fasting 14 hours prior to testing except for the consumption of water. On presentation, a history was taken for diabetes, height and weight, and the blood pressure was recorded. The blood samples were drawn in clot tubes and taken to a commercial laboratory for overnight refrigeration and testing of the serum. Testing included observation of serum for massive chylomicronemia, triglycerides, cholesterol and lipoprotein electrophoresis (by the cellulose acetate method). Lipoprotein testing results showed 12 patients with Type II A or II B and 8 patients with Type IV abnormalities. No Types I, III or V were found. These 20 patients represent a lower number of hyperlipoproteinemic patients than would be expected in the general population.
Major Immunoglobulin Ratios in Carcinoma of the Head and Neck
Authors: Katz Arnold E. , Nysather John O. , Harker Lee A.
Published: January 2017

— Serum immunoglobulin A (IgA), immunoglobulin G (IgG), and immunoglobulin M (IgM) levels were determined on 245 patients with carcinoma of the head and neck and on 92 controls. Ratios of these levels were calculated for each subject. The patients with cancer demonstrated elevated serum IgA levels ( P <.0001) and elevated IgA/IgM and IgA/IgG ratios ( P <.05). No differences were noted when the IgM/IgG ratios were compared between the cancer and the control groups. These observations are offered as evidence that previously reported elevations of serum IgA levels in patients with carcinoma of the head and neck are not merely an index of nonspecific increased immunoglobulin production in these patients.
Lymphocyte Morphology in Mucoid Middle Ear Effusions
Authors: Palva Tauno , Häyry Pekka , Ylikoski Jukka
Published: January 2017

—Cytologically, the mucoid middle ear effusions could be divided into a lymphocyte-monocyte type and a type where the granulocytes predominated. By α-naphthyl-acetate esterase (ANAE) staining procedure the T lymphocytes were found to make up the majority of lymphocytes in the first type, often accompanied by large numbers of ANAE-positive macrophages. In the second type the relative and particularly the absolute numbers of T cells were smaller. The T lymphocytes in aural effusions, distributed in agreement with their normal distribution in blood, could be the basis of possible delayed hypersensitivity immune mechanisms in the middle ear, but definite proof, either demonstrating receptor molecules directed to antigens or a specific response by T cells, is still lacking.
Eighteen Years Experience in Stapedectomy
Authors: Smyth G. D. L. , Hassard T. H.
Published: January 2017

The postoperative findings in almost 800 stapedectomized ears were analyzed to evaluate the proposition that complication rates in stapedectomy were affected by the size of the footplate fenestration. It was concluded that small fenestra stapedectomy (diameter 0.4 mm) provided similar hearing gains to those achieved with standard techniques, that articulation problems occurred to a similar extent as with wire loop prostheses, and that there was a significantly lower incidence of a) fistula and b) immediate and delayed severe sensorineural hearing loss than with any other technique. There was also significantly less deterioration in bone conduction thresholds at 4 kHz after three years postoperatively. The incidence of severe immediate sensorineural loss in large fenestra stapedectomy (half or more of footplate removed) was significantly influenced by factors such as age, preoperative bone conduction thresholds and oval window pathology. A retrospective analysis provided no information which might predict oval window pathology. Additional information gained from the analysis indicated that with all types of stapedectomy, bone conduction did not deteriorate significantly more rapidly in the operated as compared to the unoperated ear, whereas in unoperated ears, deterioration in bone conduction was significantly greater in ears with mixed hearing losses than when the loss was purely sensorineural. It was concluded that small fenestra stapedectomy was currently the operation of choice because with it, the threat of cochlear dysfunction both immediately, and in the long term, was significantly less.
Solitary Plasmacytoma of the Larynx and Upper Trachea Associated with Systemic Lupus Erythematosus
Authors: Cohen Seymour R. , Landing Benjamin H. , King Karen Koster , Isaacs Hart , Hanson Virgil
Published: January 2017

Solitary plasmacytoma rarely involves the larynx and trachea. This tumor caused severe laryngeal and tracheal obstruction in an adolescent female with systemic lupus erythematosus of nine years' duration. Her systemic disease had been in remission at the time she developed symptoms of laryngeal and tracheal obstruction by plasmacytoma invasion. A complete survey failed to reveal any other focus of tumor. Because steroid therapy failed to clear the plamsa cell infiltrate, she was treated with irradiation after the tumor was surgically debulked endoscopically. Postirradiation biopsy showed no evidence of tumor, but the patient continued to experience moderate airway obstruction from fibrosis in the irradiated trachea. The patient has been followed, and is free of disease nine years after establishing the diagnosis.
Primary Lymphosarcoma of the Larynx in a Child
Authors: Cohen Seymour R. , Landing Benjamin H. , Feig Stephen , Byrne William J. , Isaacs Hart
Published: January 2017

A 4 7/12-year-old Caucasian female with a history of “croup-like symptoms” and persistent airway obstruction, was found to have a primary lymphosarcoma by biopsy at the time of laryngoscopy and bronchoscopy. No metastatic disease was found. After an induction course of vincristine, prednisone and local irradiation, she received CNS prophylaxis with intrathecal methotrexate and cranial irradiation. Maintenance therapy, administered over a 2¾ year period, consisted of cyclophosphamide, methotrexate, and 6-mercaptopurine. Excluding the diagnostic evaluation, she was hospitalized only once for the management of suspected sepsis, gastrointestinal ulceration and severe bone marrow depression. Since discontinuing treatment 27 months ago, she has remained free of disease.
Neurofibroma of the Larynx in a Child
Authors: Cohen Seymour R. , Landing Benjamin H. , Isaacs Hart
Published: January 2017

Laryngeal obstruction due to neurofibromatosis in a girl with von Recklinghausen's disease first occurred in the neonatal period, and recurred by age seven years. She has done well for four years following laryngofissure surgery. Pharyngeal and laryngeal neurofibromatosis are rare manifestations of von Recklinghausen's disease. The dominant hereditary pattern of this disease requires that the condition be considered when respiratory distress occurs in the child of an affected parent, whether or not skin tumors or other features are present.
Cochlear and Vestibular Lesions in Capsular Otosclerosis as Seen in Microdissection
Authors: Johnsson Lars-Göran , Hawkins Joseph E. , Linthicum Fred H.
Published: January 2017

In 24 temporal bones from patients with otosclerosis prepared by the method of microdissection and surface preparations, otosclerotic foci could be clearly seen during removal of the otic capsule. The state of activity of each focus was estimated on the basis of its consistency and vascularity. Small anterior foci constituted the most common form of involvement of the otic capsule. All were judged to be inactive, and none of them appeared to have caused obvious sensorineural degeneration. No cases of “pure cochlear otosclerosis” were seen. Sensorineural degeneration was associated with large anterior foci which reached the upper basal turn. One specimen displayed a circumscribed sensorineural degeneration in the upper basal turn, with an almost exact correspondence between the location and extent of the cochlear lesion and the site of invasion by the otosclerotic process in the bone and endosteum bordering on scala media and scala tympani. It is postulated that a toxic factor had diffused from the focus and acted directly on the organ of Corti. When multiple foci were present they were usually poorly defined. The otosclerotic process involved the round window, with new lamellar bone formation in the scala tympani of the lower half of the basal turn. The most extensive sensorineural degeneration in the entire material was seen in this group. One specimen also had severe cochlear hydrops. In three specimens large shunts were observed to connect the otosclerotic foci with the cochlear vasculature, which was severely dilated. Where otosclerosis involved the endosteum of the scala tympani, loss of vessels was observed. One specimen with extensive active capsular otosclerosis had severe sensorineural degeneration of the vestibular system. Vestibular pathology in fenestrated ears is also described. In a specimen from a patient with no caloric reaction, numerous hair cells were present in the macular organs.
Experimental Observations of Canine Mandibular Regeneration following Segmental Removal, Freezing, and Reimplantation
Authors: Cummings Charles W.
Published: January 2017

Mandibular replacement subsequent to major extirpative head and neck surgery is predisposed to complications in the best of hands. The most suitable prosthesis appears to be the previously resected mandible, both from the standpoint of antigenicity and configuration. This study establishes that in the canine mandible a healthy, revitalized osseous network is reestablished subsequent to resection, freezing and replacement of the mandibular body when the graft is immobilized. The neoosteogenesis is borne out by in vivo (technetium 99, methylene diphosphonate scanning) and histopathological (tetracycline fluorescence and polarizing microscopy) studies. This early work in the canine suggests the potential for application in the human when the procedure is further refined and perfected.
Design of the Cochlear Prosthesis: Effects of the Flow of Current in the Implanted Ear
Authors: Spelman Francis A. , Clopton Ben M. , Pfingst Bryan E. , Miller Josef M.
Published: January 2017

When structures within the temporal bone are stimulated electrically it is desirable to maximize the dynamic range of the stimulus. The maximum dynamic range of electrical stimulus seems to be found when the threshold of stimulation is minimum. The minimum threshold of stimulus is likely to be reached when the electrical current that flows through regions containing excitable cells is maximized. By implanting electrodes throughout the temporal bone, it is possible to apply electrical currents to the ear and to measure the distributions of current flowing within the ear. The results of these measurements demonstrate that when current flow is directed outside the scala tympani, lower thresholds can be obtained. Frequency dependence of the paths of current flow canot be used to explain the frequency dependence of the frequency-threshold functions measured in animals.
Comparison of Cochlear Histopathology following Two Implant Designs for Use in Scala Tympani
Authors: Sutton Dwight , Miller Josef M. , Pfingst Bryan E.
Published: January 2017

Two designs of intracochlear implants were evaluated for their histopathologic effects in the monkey ear. A molded electrode designed to fit the contour of the basal turn of the scala tympani tended to create basilar membrane fistulas and osseous spiral lamina fracture, along with relatively extensive loss of spiral ganglion cells in sites adjacent to the implant. A delicate, free-fit electrode induced local encapsulation but little or no mechanical damage and limited degeneration of spiral ganglion cells. Both electrode types occasionally induced changes in stria vascularis.
Brainstem Histopathology following Chronic Scala Tympani Implantation in Monkeys
Authors: Miller Josef M. , Sutton Dwight , Webster Douglas B.
Published: January 2017

Degeneration in brainstem auditory nuclei was studied in monkeys following chronic implantation with scala tympani multielectrode systems. Nauta and Fink/Heimer-stained material from animals with survival × to 16 months were studied. The density and distribution of degeneration in the cochlear nuclei were consistent with observed patterns of spiral ganglion cell degeneration. Transneuronal degeneration was seen up to the level of the inferior colliculus. The density and form of the degeneration material in animals of varying survival times was consistent with the interpretation that a process of continuing degeneration occurred in these implanted ears.
Epidemiology of Otitis Media in Children
Authors: Teele David W. , Klein Jerome O. , Rosner Bernard A.
Published: January 2017

To determine the epidemiology of otitis media (OM) during the first three years of life, physicians participating in the Greater Boston Collaborative Otitis Media Program followed prospectively from birth 2,565 children. At every visit we recorded results of pneumatic otoscopy and epidemiology data. By three years of age 71% of the children had had one or more episodes of acute otitis media including 33% who had three or more episodes. Features associated significantly with first episode of OM were: sibling with recurrent OM, race (white > black), and sex (male > female). Having a sibling with allergy disposed propositi to first episode. Features associated significantly with recurrent OM (≥ three episodes) were those noted above. A parent with recurrent OM disposed propositi to recurrent OM. Middle ear effusion (MEE) persisted for prolonged periods after OM; after the first episode of OM, 70% of children still had MEE at two weeks, 40% had fluid at one month, 20% had fluid at two months, and 10% had fluid at three months. The sole feature associated significantly with persistent effusion in the middle ear after the first episode of OM was the practice of giving a child a bottle in bed.
Prevalence of Secretory Otitis Media in Seven to Eight Year Old School Children
Authors: Virolainen Erkki , Tuohimaa Pekka , Puhakka Heikki , Ruuskanen Olli , Aantaa Eero , Meurman Otto H.
Published: January 2017

One thousand two hundred and seven school children aged seven to eight years were examined in the spring of 1978 in order to determine the frequence of undiagnosed secretory otitis media (SOM). All children were without any subjective ear symptoms. Two and eight tenths percent of the children were found to have SOM. The relation between SOM and the appearance of allergy, the occurrence of earlier otitis media, the occurrence of repeated upper respiratory tract infections and the treatment of earlier middle ear infections are discussed.
Comparison of Eustachian Tube Function in Children and Adults with Normal Ears
Authors: Bylander Anita
Published: January 2017

The eustachian tube function was studied in 53 children and 55 adults, all otologically healthy, by means of tympanometry in a pressure chamber. The ability to equilibrate applied overpressures and underpressures in the middle ear by deglutition or jaw movements, ie, muscular opening function was significantly poorer in children than in adults, and also significantly poorer in younger children than in older ones. The pressure opening function of the tube was determined during reduction of the pressure in the chamber, ie, deflation test. The relative positive pressure persisting in the middle ear after the deflation test, ie, closing pressure, was also measured. No significant difference was found between children and adults. The ability to create a negative middle ear pressure by sniffing (positive sniffing test) was correlated with low closing pressures of the tube. Children with negative middle ear pressures had poor muscular opening function rather than positive sniffing tests. Judging from serial tympanometric measurements for up to two months, also performed in ten sniffing positive and ten sniffing negative children, it seems that the results obtained in the pressure chamber tests reflect a “mean tubal function.”
Opening Mechanism of the Eustachian Tube
Authors: Honjo Iwao , Okazaki Nobuhiro , Kumazawa Tadami
Published: January 2017

In order to examine the mechanism of tubal opening in detail, the following three experiments were conducted. Experiment 1: The tensor and the levator muscle were selectively stimulated in four monkeys. Tensor stimulation produced constant tubal opening, while levator stimulation had no effect on the opening. This result indicates that the tube opens by the tensor alone. Experiment 2: Cineradiographic studies of the tube during swallowing were conducted in three patients. Motion of the tube, made visible by means of contrast medium, was filmed at a vertical angle. Frame by frame analysis of the film revealed a marked difference between movement of the tube at its pharyngeal orifice and at its cartilaginous part. The result suggested that there are two muscles which dilate two different parts of the tube. Experiment 3: Cineradiography of the tube during selective stimulation of the tensor and the levator muscles was carried out on three monkeys. Levator stimulation produced dilation of the pharyngeal orifice, but no tubal opening. On the other hand, tensor stimulation produced opening of the tube as a whole, by outward displacement of the lateral wall of the tube. It is concluded that almost the entire cartilaginous part of the eustachian tube opens by contraction of the tensor muscle, while the distal end of the tube increases in diameter by contraction of the levator, but the tube never opens as a whole by its contraction.
Eustachian Tube Function in Cleft Palate Children
Authors: Doyle William J. , Cantekin Erdem I. , Bluestone Charles D.
Published: January 2017

The cleft palate population has a high prevalence of chronic otitis media with effusion (OME). The present study attempts to relate this pathology to a functional obstruction of the eustachian tube (ET). Employing two methods, the forced-response test and the inflation-deflation test, various parameters of ET function were evaluated in 41 children and adolescents with cleft palates. The results indicated that cleft palate children have a limited ability to open the ET actively by swallowing, as evidenced by an inability to equilibrate applied positive or negative pressures. These children demonstrated little ability to alter pressure in the middle ear (ME) by either the Valsalva or Toynbee maneuver. Passive ET airflow resistance in these children is not different from that of a traumatic perforation group. However, in the majority of cases (73%), the resistance of the tube increased with swallowing, suggesting a constriction of the ET rather than a dilation. Further, for those individuals capable of tubal dilation, the efficiency of dilation as measured by the resistance ratio was significantly less than that reported for the traumatic perforation group. Eustachian tube function in this population was not demonstrably dependent on age, sex, or type of cleft. The cleft palate children of the present study had severe functional obstruction of the ET. This obstruction was primarily related to the inability of the tensor veli palatini (TVP) muscle to dilate the ET actively during swallowing and appears to be the major factor responsible for the pathogenesis of OME in this population.
Nonhuman Primate Model of Cleft Palate and its Implications for Middle Ear Pathology
Authors: Doyle William J. , Phillips David C. , Cantekin Erdem I. , Kimes Kyle K. , Bluestone Charles D. , Siegel Michael I.
Published: January 2017

The present study is a preliminary report on the development of a nonhuman primate model of cleft palate and middle ear (ME) disease. The causal relationship between a surgical cleft of the soft palate only or a cleft of the hard and soft palate and otitis media with effusion (OME) was investigated in rhesus monkeys. Prior to clefting, ME status was documented by pneumatic otoscopy or otomicroscopic examination and tympanometry over a period of at least five months. A minimum of four preoperative eustachian tube (ET) function evaluations were performed employing the inflation-deflation and the forced-response tests. These procedures were repeated following surgery and during a long-term follow-up. Seventeen of the 18 ears developed a recurrent OME. Postoperative ME pressures were initially high negative values. After the first two postoperative months, high positive ME pressures were recorded. The forced-response test showed little to no long-term changes in passive and active tubal resistances or in the efficiency of tubal dilation as a result of surgery. The inflation-deflation test showed higher opening and closing pressures and a limited and more variable ability to equilibrate applied positive and negative ME pressures following surgery. Both ME status and ET function appeared to improve with time. These findings indicated that the pathogenesis of recurrent OME in this animal model may have been due to changes in ET function associated with an abnormal nasopharynx rather than aberrant tensor veli palatini (TVP) muscle function.
Gas Absorption in the Middle Ear
Authors: Cantekin Erdem I. , Phillips David C. , Doyle William J. , Bluestone Charles D.
Published: January 2017

The middle ear (ME) pressure of alert and anesthetized rhesus monkeys was monitored by serial tympanograms in order to determine the gas absorption process in the ME cavity. During the four-hour observation period the ME pressure showed small, random fluctuations around zero pressure in the alert animals, whereas in the anesthetized animals, following an initial positive pressure phase, the ME pressure reached a plateau at an average pressure of − 60 mm H2O. The ME gas composition was changed by air or oxygen gas politzerization in anesthetized animals to determine the effect of different initial gas compositions on the rate of absorption of the gas and on the magnitude of ME pressure. Politzerization with air and with oxygen gas resulted in average maximum ME pressures of − 400 and − 730 mm H2O, respectively. The experimental evidence suggested that the physiological composition of ME gases is nearly that of the surrounding environment and that the rate of gas absorption is low. When the gas composition of the ME is changed, the ME pressure decreases considerably. Based on these findings, a possible mechanism for the development of negative ME pressure is proposed.
Oxygen Supply of Middle Ear Mucosa under Normal Conditions and after Eustachian Tube Occlusion
Authors: Morgenstern C.
Published: January 2017

The mucosa of the middle ear is not only supplied with oxygen from the blood but also from the air space of the middle ear. Under physiological conditions, the perilymph is supplied partially with oxygen from the tympanic cavity. When the Po2 in the middle ear falls below 57 mm Hg, a net diffusion flux of oxygen from the perilymph to the middle ear induces a loss of oxygen from the inner ear. A negative pressure of 25 mm Hg generated in the middle ear, causes a transudate. Subsequently, slight disturbances of microcirculation should occur in the mucosal membrane. More pronounced negative pressures lead to very distinct disturbances of microcirculation and local oxygen supply.
Auditory Tube and Middle Ear Mucosa in Nonpurulent Otitis Media
Authors: Zechner G.
Published: January 2017

Most functional disturbances within the auditory tube can be shown and documented morphologically. In the case of a blocked tube we demonstrated changes on the tubal lining as well as in the adjacent salivary glands. Complete obliteration of the lumen is a very rare instance. A lack of ventilation already produces a vacuum within the tympanic cleft, followed by a typical effusion out of the altered mucosa. Anaerobic conditions favor hypertransformation and metaplastic transformation of the epithelium. The missing clearance makes the middle ear discharge a great challenge to the mucosa. Granulation tissue proliferates, an enzyme production starts, phagocytes help to eliminate the tympanic content. If the auditory tube is blocked long enough, the result is the atelectatic tympanum, filled by scar tissue, granulations with fatty degeneration or dystrophic calcification. The ossicular chain is fixed, if not destroyed or interrupted. A retraction pocket within the eardrum membrane, often a reason for secondary acquired cholesteatoma, is very dangerous.
Pathogenesis and Pathology of Chronic Secretory Otitis Media
Authors: Tos Mirko
Published: January 2017

Secretory otitis media is divided into three stages, and the pathogenesis and pathology of each stage are described on the basis of quantitative histopathological studies. In the initial stage, ie, the period before accumulation of mucus in the middle ear, metaplasia causes a transformation of the mucosa into a secretory mucosa and mucous glands are formed. These processes are described in detail. In the secretory stage, which is the period with accumulation of mucus in the middle ear, an enormous increase was found in the density of goblet cells and the density of active mucous glands was large. In the degenerative stage, the production of secretion abates owing to degeneration of the glands. These become inactive, and the mucosa gradually normalizes. The normalization process is slow and runs through several turnover periods of the epithelium by means of a gradually decreasing rate in the division of the basal cells.
Microbiology of Otitis Media
Authors: Klein Jerome O.
Published: January 2017

The microbiology of otitis media (OM) has been documented by cultures of middle ear fluid (MEF) obtained by needle aspiration. The results of studies of bacteriology of OM from Sweden, Finland and the United States are very similar: Streptococcus pneumoniae and Haemophilus influenzae are the most important pathogens: Gram-negative enteric bacilli are isolated from MEF of ≅ 20% of infants to six weeks of age but are rarely present in MEF of older children; group A beta hemolytic streptococcus and Staphylococcus aureus are infrequent causes of otitis. Preliminary results suggest that anaerobic bacteria are responsible for some episodes of OM. Although epidemiologic data suggest that virus infection is associated with OM, the results of ten studies indicate that these agents are infrequently isolated from MEF of children with OM. Viruses were isolated from 29 of 663 patients (4.4%). Respiratory syncytial virus and influenza virus were isolated most frequently. The results of seven studies of mycoplasma infection in 771 patients with OM included only one isolation of Mycoplasma pneumoniae from MEF. These results indicate that viruses and mycoplasmas are uncommonly found in MEF of patients with OM, but few studies have been attempted in recent years. Chlamydia trachomatosis is the etiologic agent of a mild but prolonged pneumonia in infants. OM may accompany the respiratory infection, and C. trachomatis has been isolated from MEF of some of these infants. Recent studies of asymptomatic children with persistent MEF indicate that bacterial pathogens are present in some of these fluids. Investigators in Columbus, Boston, and Pittsburgh obtained MEF for culture at the time of myringotomy or placement of tympanostomy tubes. Bacteria were isolated from MEF of 50% of these children; S. pneumoniae, H. influenzae, or group A streptococcus were isolated from 10% to 20% of cases. There were only minimal differences in the rates of isolation of bacteria from serous, mucoid, or purulent fluids. The significance of these results is uncertain, but they suggest that the persistent effusion may be a result of asymptomatic but prolonged infection or may be an immune response to a persisting antigen.
Antibody Coated Bacteria in Otitis Media with Effusions
Authors: Bernstein J. M. , Myers D. , Nisengard R. , Kosinski D. , Wicher K.
Published: January 2017

The significance of bacterial isolates of coagulase negative Staphylococcus epidermidis and Corynebacterium species in middle ear fluids remains controversial. This study was undertaken to evaluate the possible role of these organisms in different effusions. Cultures were obtained from the external cartilaginous ear, bony canal, tympanic membrane, middle ear fluids, tonsils and nasopharynx of 93 patients at the time of myringotomy for otitis media with effusion. Isolates of coagulase negative staphylococci from the middle ear, external ear and posterior aural skin were evaluated in regard to antibiotic sensitivity, biochemical tests and phage typing. Furthermore, in another series of patients in whom these organisms were isolated, specific antibody activity in both middle ear washings and corresponding sera were measured, using the technique of indirect immunofluorescence. The results suggest that the isolates from the middle ear and ear canal are not always identical. There is some evidence that specific IgM and IgG as well as IgA responses to these organisms are present in middle ear washings and not in corresponding serum. These results suggest that coagulase negative Staphylococcus and Corynebacterium species in middle ear effusions may not be contaminants from the external canal and that a local immune response may be produced by these organisms. Whether or not these organisms represent etiologic agents responsible for otitis media with effusion cannot be ascertained from this data. One very interesting point is the presence of IgE coating of organisms in some effusions.
Evaluation of Countercurrent Immunoelectrophoresis as a Diagnostic Tool in Bacterial Otitis Media
Authors: Ostfeld Ervin , Altmann Gideon
Published: January 2017

The diagnostic efficiency of countercurrent Immunoelectrophoresis (CIE) and correlation of clinical and bacteriological data were studied in 184 middle ear effusions (MEE) from 125 patients diagnosed as acute primary, acute recurrent otitis media, and chronic MEE. Significant differences between stage of otitis media (OM), patient age and type of MEE were found. Streptococcus pneumoniae was isolated in 22% of the overall MEE, 26% in the acute primary and 26% in acute recurrent OM. Among the S. pneumoniae isolates, 82.5% were detected by CIE and culture, 15% only by culture and 2.5% only by CIE. Most S. pneumoniae isolates identified by culture and CIE were in a purulent MEE (64%) while those identified by culture only were in a mucoid MEE (67%). Haemophilus influenzae overall incidence was 29%; 13% of them produced β-lactamase and only 4% were serotype b. The H. influenzae serotype b strains were detected by culture as well as CIE, so the overall effectiveness of CIE for S. pneumoniae and H. influenzae serotype b was 19.5% and 22 to 23% for acute primary and recurrent OM. Sterile cultures were obtained in 37.5% of the overall MEE. The CIE seems to be a useful screening test, culture remaining the method for definitive bacterial identification in MEE.
Cells Involved in the Middle Ear Defense System
Authors: Goycoolea Marcos M. , Juhn S. K. , Paparella Michael M. , Carpenter Anna-Mary
Published: January 2017

Despite the high incidence and prevalence of otitis media, its pathogenesis is not thoroughly understood. In the last decade, many efforts have been made to provide a better understanding, and abundant information has become available. At the same time the field of immunology has advanced at an extremely rapid pace. We have followed the gradual cellular events in the defense reaction of the middle ear, utilizing eustachian tube obstruction to induce otitis. Seventy-five cats were divided in groups and sacrificed at intervals between one day and six months, and their temporal bones were studied. During an initial phase of inflammation, polymorphonuclears appear at three days in connective tissue; at the same time active fibroblasts synthesize tropocollagen and ground substance while epithelial cells secrete mucus and lysozymes. These cells, together with those involved in the mucociliary transport system and a patent functional eustachian tube, constitute the nonspecific system of defense. The transition cells are the macrophages which appear at one week to interact with T and B cells to produce the specific immune response. Plasma cells appear at two weeks to peak at one month with synthesis of immunoglobulins A, G and M. A secretory immune system is observed. At three and six months, lymphocytes are the predominant cells and occasional accumulations of mononuclears are observed. The reaction involves the entire middle ear, including mucoperiosteum, middle ear muscles and round window membrane. We believe that a better understanding of the middle ear defense system will lead in time to a practical clinical assessment of the immunological status during the evolution of each particular process or disease involving the middle ear, and a more rational approach to the treatment and, hopefully, prevention of chronic ear disease.
Otitis Media in the Young Infant: An IgE-Mediated Disease?
Authors: Sloyer John L. , Ploussard John H. , Karr Laurel J.
Published: January 2017

IgE antibody directed against noncapsular antigens of mechanically disrupted Streptococcus pneumoniae, serotype 3 rough, was demonstrated in middle ear effusions (MEE) and serum of infants with and without prior evidence of pneumococcal otitis media with effusion (OME). The techniques employed included radioimmunoassay (RIA), passive skin testing, Prausnitz-Küstner (P/K), and enzyme-linked immunospecific assay (ELISA). Adsorption of MEE with ultrasonically disrupted crude pneumococcal antigen (CPA-U) resulted in a reduction of total IgE counts per minute and suggested bacteria-specific IgE antibody ranging from approximately 22 to 92% of the total IgE. The biological activity of the IgE antibody was confirmed by challenging skin passively sensitized with MEE IgE and CPA-U. Areas of induration appeared 20 minutes after challenge and continued to increase in size until 90 minutes. An ELISA procedure was developed as a tool to determine the nature of the antigen(s) and to determine the class(es) of antibody other than IgE. It appeared that CPA-U possesses free amino groups and that it can withstand the rigors of autoclaving. An analysis of 45 cord bloods revealed that high levels of IgG CPA-U antibody occur in this type of sample and that no correlation exists between the IgE and IgG levels. The mean IgG: IgE ratio, optical density at 420 nm (OD 420), for cord bloods was 2.49. In contrast, serum samples from nine infants without pneumococcal otitis media and from 14 infants with pneumococcal otitis media had lower levels of IgG antibody. There was no significant relationship between IgG and IgE OD 420 in infants who never had an episode of pneumococcal otitis media and the mean IgG: IgE was 1.88, whereas the ratio for those infants with pneumococcal otitis media was 1.56. In addition, there was a significant correlation between IgG and IgE levels in this latter group. The results suggest that it may be important to monitor the levels of at least these two classes of antibody to enhance our understanding of the pathogenesis and recovery from otitis media.