bluuebunny/crossref_metadata_2025 huggingface dataset:
Endoscopic Endonasal Surgery—Concepts in Treatment of Recurring Rhinosinusitis. Part I. Anatomic and Pathophysiologic Considerations
Authors: Stammberger H.
Published: November 2015

Many years of endoscopic investigation and observation proved that most infections of the paranasal sinus are rhinogenic, spreading from the nose into the sinuses. The common focus of infection in cases of recurring sinusitis is the stenotic areas of the anterior ethmoid, with infection recurring in the larger sinuses. The anterior ethmoid, especially its infundibulum, is thus a key location for infection or cure, and maxillary as well as frontal sinuses are fully dependent on the pathophysiologic conditions there. Histologic examination demonstrates that massive changes of the nasal glands are the reason for permanent mucosal thickening. Retention cysts, highly viscous mucus, mucus extravasations, and metaplastic epithelial changes add to the vicious cycle of blockage of the ostium‐meatus unit.
Ultrasound Screening for Sinus Disease
Authors: Landman Michael D.
Published: November 2015

The A‐mode ultrasound is an inexpensive and efficacious screening modality for sinus pathology. A comparison of 690 ultrasound patterns from 200 cases was made with sinus x‐ray films and case histories. Excellent correlation was found between the ultrasound patterns and the subsequent diagnosis of a normal sinus or a pathologic sinus containing fluid, thickened mucosa, or a mass. Future areas of potential clinical usefulness and current limitations of this instrument are discussed.
Venous Outflow Obstruction in Myocutaneous Flaps: Changes in Microcirculation Detected by the Perfusion Fluorometer and Laser Doppler
Authors: Liu Alfred J. , Cummings Charles W. , Trachy Ronald E.
Published: November 2015

The effects of venous occlusion on the perfusion of porcine myocutaneous groin flaps were studied by means of the laser Doppler and the dermofluorometer. A consistent decrease in fluorometer readings following venous clamping with rebound to original or greater levels after unclamping was noted. A similar pattern was noted in laser Doppler studies. However, flow as measured by the Doppler remained significant (>100 mV) even with venous outflow occlusion. It is hypothesized that the Doppler is more prone than the dermofluorometer to reflect non‐nutritive flow in the flap during the early period following flap construction and, therefore, may be less accurate in the evaluation of actual flap microperfusion. The fluorometer was determined to be the more desirable instrument in monitoring the microcirculatory status of myocutaneous flaps during the immediate period after flap elevation and transposition.
Chin Reconstruction with Pectoralis Myocutaneous Flap
Authors: Berktold Robert E. , Ossoff Robert H. , Sisson George A. , Wurster Carl F.
Published: November 2015

Chin reconstruction after radical surgery for carcinoma of the oral cavity is a complex and controversial problem. We have developed a simple, single‐stage, primary procedure for chin reconstruction. It is easily mastered and is based on a simple modification of the pectoralis major myocutaneous flap. Our experience includes seven cases, including two with total chin reconstructions. The number and type of complication is low and consistent with the magnitude of the surgical procedure. This operation provides acceptable aesthetic and functional results to patients undergoing partial or total resection of the chin.
Sensorineural Hearing Loss Associated with Systemic Lupus Erythematosus
Authors: Bowman Carol A. , Linthicum Fred H. , Nelson Ralph A. , Mikami Karen , Quismorio Francisco
Published: November 2015

Because our recent clinical experiences suggested a possible association between hearing loss and systemic lupus erythematosus (SLE), we prospectively studied the hearing of 30 patients hospitalized because of exacerbation of SLE. Twenty‐nine of the 30 patients were receiving immunosuppressive therapy at the time of testing. We found an 8% incidence of substantial, previously undetected hearing loss without attributable cause. Hearing loss could not be correlated to age, sex, disease activity, organ‐system involvement, laboratory test abnormalities, or duration of symptoms of SLE. Otolaryngologists treating patients with unexplainable hearing loss—particularly if it is sudden, fluctuating, or rapidly progressive—are alerted to the possibility of underlying systemic autoimmunity. We advise physicians who frequently treat patients with SLE to include questions on hearing in the review of systems and to refer the patient with hearing complaints for thorough otologic evaluation.
Sjögren's Syndrome in Children
Authors: Franklin Daniel J. , Smith Richard J.H. , Person Donald A. , Pflugfelder Stephen C.
Published: November 2015

Sjögren's syndrome (SS) is a chronic autoimmune disease characterized by lymphocytic infiltration of the lacrimal and salivary glands; it eventually leads to keratoconjunctivitis sicca and xerostomia. The disease usually affects middle‐aged women and is second to rheumatoid arthritis as the most commonly diagnosed connective tissue disorder. Surprisingly, only 31 cases have been reported in the pediatric population. The diagnosis should be considered, however, in children with a foreign body sensation in the eyes, chronic dryness of the eyes or mouth, or recurrent salivary gland enlargement. This has prompted us to describe our experience in treating five children with SS at Texas Children's Hospital, Houston. One 5‐year‐old child with no other evidence of connective tissue disease was diagnosed as having primary SS. The remaining four children either had juvenile rheumatoid arthritis or systemic lupus erythematosus in addition to SS, and the diagnosis of secondary SS was made. Other autoimmune disorders associated with SS include polyarteritis nodosa, scleroderma, and polymyositis. Interestingly, one child with secondary SS and chronic lymphocytic thyroiditis developed papillary carcinoma of the thyroid. Both forms of SS are probably more prevalent than the literature would suggest. Recognition of this fact is important if the immediate complications of corneal damage and severe dental decay are to be prevented. Symptomatic treatment with steroids, eyedrops, artificial saliva, and prophylactic fluoride treatments is available. With an adequate follow‐up program the late morbidity associated with SS, such as malignant disease, can be minimized.
The Extended Pectoralis Major Flap in Head and Neck Reconstruction
Authors: Sasaki Clarence T. , Gardiner Linda J. , Carlson Roy D. , Vris Thomas
Published: November 2015

Historically, major extirpative surgery for control of head and neck cancer developed well in advance of reconstructive procedures that could provide acceptable functional and cosmetic rehabilitation. Introduction of cutaneous axial and random flaps— followed more recently by the description of musculocutaneous flaps—represented major advances in reconstructive techniques.
Preliminary Observations after Facial Rehabilitation with the Ansa Hypoglossi Pedicle Transfer
Authors: Anonsen C.K. , Duckert L.G. , Cummings C.W.
Published: November 2015

Facial paralysis is a very disabling condition, both functionally and cosmetically. Despite the different methods of facial reanimation that have been described, there is no single method that will restore normal facial tone and motion. Of the methods available, primary neurorrhaphy is probably the most effective. The recovery period, however, is prolonged and, as a result, muscle tone and bulk may be lost. The hypoglossal‐facial anastomosis7–12 is also a very reliable and effective technique but requires necessary interruption of both major cranial nerve trunks. Transfer of a neuromuscular pedicle (based on the ansa hypoglossi) has been offered as a method of facial reanimation that involves neither prolonged recovery nor interruption of the major cranial nerve functions. The application of this technique for reinnervation of a paralyzed larynx was first described by Tucker in 1970, and the technique was applied to facial muscle (in animal models) in 1977. The effectiveness of this technique—and its application in the management of facial paralysis in the human patient—remains controversial. We report our experience with a series of six patients who underwent neuromuscular pedicle transfer in conjunction with other more conventional methods of facial reanimation. The function of the pedicle and its contribution to the overall facial rehabilitation were assessed clinically and electromyographically. Factors influencing the success of the procedure and clinical and experimental evidence to support its application are discussed. While our experience with this technique is limited, it would appear that the neuromuscular pedicle transfer may play a useful adjunctive role in reanimation of the face in selective cases of facial paralysis.
Cholesteatoma vs. Cholesterol Granuloma of the Petrous Apex
Authors: Rosenberg Richard A. , Hammerschlag Paul E. , Cohen Noel L. , Bergeron R. Thomas , Reede Deborah L.
Published: November 2015

Lesions involving the petrous apex are rarely encountered in clinical practice. This directly affects the ability of the otolaryngologist to diagnose and effectively treat these lesions. Greater physician awareness and increased technologic capability are leading to more effective management of pathologic conditions involving this area of the temporal bone.
Defective Immunoregulation in Children with Chronic Otitis Media with Effusion
Authors: Bernstein Joel M. , Park Byung H.
Published: November 2015

Otitis media and middle ear effusions (MEE) are most common clinical problems in early childhood, for which an estimated one million tympanostomies are performed each year in the United States. Although many factors have been associated with MEE (age, sex, genetics, otitis media, socioeconomic status, feeding style, atopy or hypersensitivity, certain bacteria and viruses), a defective immunoregulatory mechanism in the host may also contribute to the pathogenesis. During the past 2 years, we have evaluated immune function in 90 randomly selected children who underwent repeated tympanostomy for persistent MEE. The T‐cell subset ratio (OKT‐4/OKT‐8) was reduced (below 1.25) In 16%. In 33 children, generation of T‐cell growth factor (IL‐2) by peripheral blood lymphocytes (PBL) was evaluated and found to be decreased in 11. The mitogenic response of PBL to phytohemaglutinin (PHA) and pokeweed mitogen (PWM) stimulation was abnormal in almost half of the cases. Imbalance of T‐cell subsets and decreased production of IL‐2 indicate defective immunoregulatory function in some of these children, which may play a role in the pathogenesis of persistent MEE.
Evaluation and Treatment of Frontal Sinus Fractures
Authors: Levine Steven B. , Rowe Lee D. , Keane William M. , Atkins Joseph P.
Published: November 2015

We treated twenty‐three patients with blunt or penetrating wounds of the frontal sinus from 1978 through 1983. Nondisplaced anterior wall fractures were observed or explored. Posterior table fractures—with displacement confirmed by computed tomography or polycycloidal tomography—were explored. Either obliteration of the sinus or nasofrontal duct reconstruction with a Sewall‐Boyden‐McKnaught flap was selected, depending on the magnitude of duct injury. In all cases, the anterior wall was primarily reconstructed. All penetrating wounds with posterior table involvement were treated by cranialization of the frontal sinus and temporalis muscle obliteration of the nasofrontal ducts. Only one case of meningitis occurred, resulting in prolonged hospitalization.
The Degree to Which Accuracy of Preoperative Staging of Laryngeal Carcinoma has been Enhanced by Computed Tomography
Authors: Katsantonis George P. , Archer Carol R. , Rosenblum Barry N. , Yeager Vernon L. , Friedman William H.
Published: November 2015

In this retrospective study, the accuracy of preoperative staging by high‐resolution CT and clinical evaluation (indirect‐direct laryngoscopy) is compared to the postsurgical pathologic staging of laryngeal cancer. Forty‐two patients who were admitted to St. Louis University Hospital between the years of 1978 to 1985 with diagnoses of laryngeal cancer were included. All patients received high‐resolution CT scan of the larynx preoperatively and subsequently underwent total or partial laryngectomy. None of these patients received preoperative radiotherapy. The accuracy of the clinical vs. CT staging—as well as the accuracy of the staging by combination of the two modalities—was determined by comparison with the postsurgical pathologic staging. The accuracy was assessed separately for glottic, supraglottic, and transglottic carcinoma. The accuracy of CT staging for glottic carcinoma was 75%. However, clinical evaluation in this group of lesions was very reliable, offering 92.9% accuracy. The accuracy of CT staging increased in the supraglottic and transglottic lesions, to become superior to the clinical staging. With combined information gained by both examinations, the preoperative staging accuracy was 91.4% for supraglottic carcinoma and 87.5% for transglottic carcinoma. It is, therefore, recommended that high‐resolution CT should be included in the preoperative staging of laryngeal cancer.
Oral steroid therapy for chronic middle ear perfusion: A double‐blind crossover study
Authors: Lambert Paul R.
Published: November 2015

A prospective, double‐blind crossover study design was used in the evaluation of the role of prednisone in the treatment of a chronic middle ear effusion. Sixty children with an effusion—of at least 2 months’ duration—randomly received either prednisone or placebo for 2 weeks. One week later they were re‐evaluated. If the effusion had resolved, they were followed periodically; if the effusion persisted, they were given the crossover regimen and reevaluated. Sixty percent of the patients’ effusions cleared, but there was no statistical difference between the prednisone and placebo groups. The amount of hearing recovery was also the same for both treatment regimens. Subdividing the patients on the basis of effusion duration, unilateral vs. bilateral effusions, or history of ventilation tubes or antibiotics failed to identify a subgroup of individuals who might benefit from a short‐term course of oral steroids.
The ossicle‐cup prosthesis: Five years later
Authors: Schuring Arnold G. , Lippy William H.
Published: November 2015

The osslcle‐cup prosthesis is a semibiologic prosthesis that incorporates a synthetic portion into the remaining (or transplant) ossicle. This assembly is positioned on the stapes capitulum, with the synthetic cup forming a dynamic joint. During 1978, 114 patients underwent surgical procedures in which an ossicle cup prosthesis was used. After I year 84% of these patients were within 20 dB of their preoperative bone hearing levels. Patients with a concurrent mastoidectomy did worse than those who underwent only a tympanoossiculoplasty. Five years later, 74% of the successful cases were still within 20 dB of the preoperative hearing levels. Eighteen patients underwent a revision surgical procedure to regain hearing. The postoperative hearing results at 1 year were 50% within 20 dB. The causes of failure included further ossicle necrosis (28%), a laterally healed tympanic membrane (39%), and fixation of the prosthesis (33%). Extrusion of the prosthesis during the 5‐year period was between 1% and 2%. Overall, the ossicle cup prosthesis has proved to be a stable assembly, easy to revise, and longlasting. Once successful, three of four cases will retain successful hearing for more than 5 years.
Fibrous dysplasia of the paranasal sinuses
Authors: Feldman Marc D. , Rao Vijay M. , Lowry Louis D. , Kelly Mark
Published: November 2015

Fibrous dysplasia (FD) of the paranasal sinuses is rare and often presents a diagnostic challenge. It is usually secondary to extension of disease from adjacent bones and is rarely limited to the sinuses. We have described three cases of FD involving the paranasal sinuses, including the first reported case of FD isolated to the sphenoid sinus. A brief update of the clinical aspects, radiographic appearance, diagnosis, and management of cranlofacial FD is provided.
Instantaneous “video photography” with a low‐cost black‐and‐white video printer: Its value in otolaryngology and head and neck surgery
Authors: Yanagisawa Eljl , Walker Rondi K.
Published: November 2015

Despite its shortcomings in black‐and‐white imagery and its print quality, the video printer described here is an inexpensive and convenient video image‐printing instrument and is useful for documentation of anatomy and pathologic conditions of otolaryngologic structures. It is of great value in patient counselling and in development of a permanent pictorial record.
Congenital Conductive Hearing Loss in Apert Syndrome
Authors: Phillips Susan G. , Miyamoto Richard T.
Published: November 2015

Acrocephalosyndactyly (Apert syndrome) is a rare cranlosynostotic syndrome characterized by acrocephaly, syndactyly of the hands and feet, and—occasionally—‐conductive hearing loss. We report three cases of conductive hearing loss in Apert syndrome. One patient was found to have bilateral stapes fixation. His daughter (the second case) had chronic bilateral otitis media with effusion. The third case involved a fixed Incus and hypomobile stapes. The management of these patients and a review of the literature are presented.
Facial Nerve Dissection by use of Acoustic (Loudspeaker) Facial EMG Monitoring
Authors: Kinney Sam E. , Prass Richard
Published: November 2015

The development of the surgical microscope in 1953, and the subsequent development of microsurgical instrumentation, signaled the beginning of modern‐day acoustic neuroma surgery. Preservation of facial nerve function and total tumor removal is the goal of all acoustic neuroma surgery. The refinement of the translabyrinthine removal of acoustic neuromas by Dr. William House’ significantly improved preservation of facial nerve function. This is made possible by the anatomic identification of the facial nerve at the lateral end of the internal auditory canal. When the surgery is accomplished from a suboccipital or retrosigmoid approach, the facial nerve may be identified at the brain stem or within the internal auditory canal. Identifying the facial nerve from the posterior approach is not as anatomically precise as from the lateral approach through the labyrinth. The use of a facial nerve stimulator can greatly facilitate Identification of the facial nerve in these procedures.
Pediatric Vestibular Evaluation with Harmonic Acceleration
Authors: Staller Steven J. , Goin Donald W. , Hildebrandt Martha
Published: November 2015

A group of 101 otologically normal infants and children were evaluated with low‐frequency harmonic acceleration (HA) to determine the feasibility of use of this procedure in evaluation of vestibular function in a pediatric population. Ninety‐six of the subjects were successfully tested and normative data are presented. A maturational trend was noted (in the presence of nystagmus) in subjects up to 10 months of age and in the phase‐lag measurement up to approximately 4 years of age.
Intractable Vertigo—When not to Operate
Authors: Konrad Horst R.
Published: November 2015

Patients with episodic vertigo—or one severe episode of vertigo—may respond to vestibulosuppressive medications or operations on the labyrinth. In patients with constant incapacitating vertigo or disequilibrium, the clinician should suspect nonlabyrin‐thine disease. A careful history and physical and neurologic examinations will provide clues to underlying disease and direct the selection of further objective tests.
Lethal Cholesteatoma
Authors: Jahrsdoerfer Robert A. , Gardner Gale , Yeakley Joel W. , Karam Charles R.
Published: November 2015

Aural cholesteatoma Is a disease entity well known to the otologic community. Complications of cholesteatoma, although uncommon, are not usually life threatening. We present two cases in which a unique and hitherto unreported pathway of spread of a cholesteatoma is noted. The cholesteatoma, after originating in the ear, entered the diploe and spread insidiously between the inner and outer tables to distal parts of the skull. Osteomyelitis, in concert with the cholesteatoma, destroyed large areas of the skull in both patients. One patient died of his disease. The other patient was operated on and is alive but has unresectable disease and purulent drainage from three separate cranial fistulas.
Real‐Time Monitoring of Brainstem Auditory Evoked Response (BAER) during Cerebellopontine Angle (CPA) Surgery
Authors: Hammerschlag Paul E. , Berg H.M. , Prichep L.S. , John E.R. , Cohen N.L. , Ransohoff J.
Published: November 2015

The signal‐to‐noise ratio of brainstem auditory evoked responses (BAER) can be greatly enhanced by use of optimal digital filtering before averaging. This permits accurate assessment of auditory nerve status every 5 to 10 seconds, making real‐time intraoperative monitoring possible. The major advantages yielded by real‐time monitoring—in our experience thus far—have been (1) identification of potentially adverse functional consequences of apparently uneventful surgical maneuvers, reducing postoperative dysfunction, (2) early indication of potential for improved clinical function, and (3) potential identification and localization of neural tissue in the face of absent surgical landmarks. Examples of these advantages will be provided from case studies, and the possibility that real‐time monitoring may improve ability to preserve hearing will be discussed.
Non‐Epidermoid Carcinoma of the Larynx: The Thomas Jefferson University experience
Authors: Gadomski Stephen P. , Zwillenberg David , Choi Hong Y
Published: November 2015

Nonepidermoid cancers of the larynx appear with consistency in large series of laryngeal tumors. We reviewed 1135 laryngeal cancers seen over a 24‐year period at Thomas Jefferson University Hospital and found a 1.7% incidence. This is similar to several other large series. These patients are presented in terms of their sex, age, race, clinical presentations, therapies, and outcomes, and a review of these unusual tumors is given. The recognition of such lesions is important because many require different therapies and have different prognoses than their squamous cell counterparts. The relatively infrequent occurrence of these tumors makes the availability of controlled clinical studies extremely difficult.
Immune Reactivity in Bell's Palsy
Authors: Hughes Gordon B. , Barna Barbara P. , Kinney Sam E. , Goren Hershel , Sweeney Patrick J. , Valenzuela Rafael , Calabrese Leonard H. , Tucker Harvey M.
Published: November 2015

Although the pathogenesis of acute facial (Bell's) palsy is probably multifactorial, some investigators believe that the disorder results from autoimmune demyelination and is perhaps related to previous viral infection. The purpose of this study was to identify immune mechanisms which might contribute to Bell's palsy. The lymphocyte transformation test and immunofluorescence were evaluated with a soluble homogenate of unrefined peripheral nerve antigens. Three antigen‐nonspecific tests were also studied. Results in 14 patients with Bell's palsy were compared with those in 21 controls. To be eligible for study, patients with Bell's palsy had to be seen within 10 days of onset of weakness. The control group included 5 patients with facial nerve dysfunction from other causes and 16 normal volunteers. No patient or control had previously received steroids. Five patients with Bell's palsy and one normal volunteer had abnormal lymphocyte transformation (p <.05). Virtually all other tests were normal. These results suggest that some instances of Bell's palsy result from cell‐mediated immunity against peripheral nerve antigens. They also encourage further research in steroid and other immunotherapy.
A Technique for the Placement of a Long‐Term Hyperalimentation Catheter in the Head and Neck Oncology Patient
Authors: Wells James R. , Jaindl Michael A. , Gernon William H.
Published: November 2015

The relative safety of silicone rubber catheters allows use of the deep brachial vein for long‐term central venous access when other vascular access sites are unavailable or undesirable. After local infiltration, a small incision is made across the medial edge of the brachial biceps and the vein is isolated from the artery and median nerve. An introducer is used to aid in insertion of the catheter. Catheter position is checked with a postoperative radiograph of the chest. Sixty of our patients have had catheters in place from 14 to 200 days, with few complications. There was one catheter‐related death from acute bacterial endocarditis and one case of clinical thrombosis. The surgical approach to the deep brachial vein provides a simple and safe method of long‐term central venous access in the head and neck oncology patient, whereas regional therapy and treatment planning often preclude use of other more conventional access sites.
Sensorineural Hearing Loss in Cordless Telephone Injury
Authors: Orchik Daniel J. , Schmaier Daniel R. , Shea John J. , Emmett John R. , Moretz William H. , Shea John J.
Published: November 2015

Audiometric data from 19 cases of cordless telephone injury are reviewed, including three cases with pre‐insult and post‐insult audiograms. In addition, data are presented from analyses of intensity and frequency for the ring signal of three telephones involved in injury cases. The most severe hearing loss was found at 500 Hz and 1000 Hz, where the mean threshold difference in the injured ear was 20 dB and 29 dB, respectively. The three cases for which pre‐insult and post‐insult data were available exhibited similar audiometric patterns, although the degree of threshold shift varied. Spectral analysis of the ring signal indicated sound‐pressure levels of approximately 140 dB, with a fundamental frequency near 750 Hz.
Surfactant in Middle Ear Effusions
Authors: Grace Andrew , Kwok Peter , Kawke Michael
Published: November 2015

Evidence from animal studies suggests that substances that lower surface tension are present in the middle ear cleft, where they may facilitate opening of the eustachian tube. The purpose of this study was to investigate whether or not surface‐tension‐lowering substances are present in middle ear effusions. Aspirates from children and adults with secretory otitis media—both serous otitis media and mucoid otitis media—were analyzed by means of two‐dimensional thin‐layer chromatography. Phospholipids, the major components of pulmonary surfactant, were present in appreciable quantities in all aspirates. Differences in total phosphate content and phospholipid composition were found when effusions from adults and children were compared.
Traumatic Infratemporal Facial Nerve Injury: Management Rationale for Preservation of Function
Authors: Coker Newton J. , Kendall Katherine A. , Jenkins Herman A. , Alford Bobby R.
Published: November 2015

A retrospective review of 29 cases of infratemporal facial nerve injuries included 18 temporal bone fractures, 7 gunshot wounds, and 4 iatrogenic complications. Surgical exploration confirmed involvement of the fallopian canal in the perigeniculate region in 14 longitudinal and 3 transverse or mixed fractures of the petrous pyramid. Gunshot and iatrogenic injuries usually occurred within the tympanic and vertical segments of the facial canal and at the stylomastoid foramen. When hearing is salvageable, the middle fossa approach provides the best access to the perigeniculate region of the facial nerve. In the presence of severe sensorineural hearing loss, the transmastold‐translabyrinthine approach is the most appropriate for total facial nerve exploration. Grade I to III results can be anticipated in timely decompression of lesions caused by edema or intraneural hemorrhage. Undetectable at the time of surgery, stretch and compression injuries with disruption of the endoneural tubules often lead to suboptimal results. Moderate‐to‐severe dysfunction (Grade IV), with slight weakness and synkinesis, is the outcome to be expected from the use of interpositional grafts.
Epithelial Membrane Antigen Expression in Benign and Malignant Squamous Epithelium of the Head and Neck
Authors: Fernandez Bruce , Lund Judi , Meyers Frederick
Published: November 2015

A distinction between benign, preneoplastic, and malignant tissue, based upon the expression of surface antigens, would provide useful clinical information. Epithelial membrane antigen (EMA) has been reported in squamous cell carcinomas, but not in normal squamous epithelium. Twenty‐nine specimens from 15 patients, representative of the spectra of changes seen in squamous cell epithelium from normal through dysplasia to squamous cell carcinoma, were fixed in B‐5 and examined with anti‐EMA monoclonal antibody in an immunoperoxidase technique. Normal squamous epithelium does express EMA. Squamous cell carcinoma also expresses EMA. Well‐differentiated tumors stain more intensely and in greater numbers of cells than less‐differentiated tumors. The presence or absence of EMA expression does not distinguish normal squamous epithelium from carcinoma. Investigations of membrane antigen content in fixed tissue must use methods of fixation that preserve antigenicity. While strict quantitation of immunoperoxidase preparations is not possible, quantitative differences in expression may be important.
Free Jejunal Autograft Reconstruction of the Pharyngoesophagus: Review of a 10‐year experience
Authors: Biel Merrill A. , Maisel Robert H.
Published: November 2015

Seventeen patients underwent free jejunal autograft reconstruction of the pharyngoesophagus after ablative surgery for Stage III and IV squamous cell carcinoma of the cervical esophagus and hypopharynx. Postoperative complications included three perioperative deaths, three graft failures, six transient fistulas, and two early and one late fistula. The 5‐year survival rate of patients with Stage III and IV hypopharyngeal carcinoma was 20% (one of five). The 4‐year survival rate for patients with cervical esophageal carcinoma was 33% (one of three). This method of reconstruction is advocated as a reliable palliative procedure for patients with a dismal long‐term survival.
Evaluation of a “Shotgun” Regimen for Sudden Hearing Loss
Authors: Wilkins Stanley A. , Mattox Douglas E. , Lyles Alan
Published: November 2015

One hundred nine patients with idiopathic sudden hearing loss were treated with a “shotgun” regimen that included dextran, histamine, Hypaque, diuretics, steroids, vasodilators, and carbogen inhalation. Thirty‐three patients received the entire protocol and 76 patients received most, but not all, of the protocol drugs. Some improvement of hearing (>10 dB in pure‐tone average) was seen in 52% of patients treated with the complete protocol and in 54% of patients who received the partial protocol. All patients were analyzed for potential prognostic indicators. Patients with thresholds at 8000 Hz better than at 4000 Hz fared better than the group as a whole. Vertigo at the time of onset of hearing loss was a sign of poor prognosis. There was no correlation between hearing improvement and the age of the patient or the sedimentation rate. Most importantly, there was no statistically significant difference in outcome between patients treated with the complete protocol and those who received only part of the protocol. Furthermore, when the effect of each drug was examined individually, there was no significant difference between those patients receiving and not receiving treatment. The results suggest that this “shotgun” approach for treatment of sudden hearing loss offers no better outcome than is reported in the literature for spontaneous recovery.
Three‐Dimensional CT Reconstruction in Midfacial Surgery
Authors: Marentette Lawrence J. , Maisel Robert H.
Published: November 2015

Correct preoperative planning is an essential aspect of any surgical procedure and it is equally important when midfacial reconstruction is contemplated. Conventional methods include standard radiographic views, plain tomography, photography, and computerized tomography. All of these methods produce a two‐dimensional image of the patient. Three‐dimensional computerized tomographic reconstruction allows the surgeon to visualize the entire facial skeletal deformity. The three‐dimensional image produced also allows comparison of the deformity to surrounding normal structures, and thus makes the correction of facial asymmetries more precise. This new modality is particularly useful in the preoperative planning for patients with zygomaticomaxillary defects that result from either trauma or maxillectomy. Illustrative examples of patients in whom autogenous bone graft zygomaticomaxillary reconstruction was performed, after trauma and subsequent to subtotal maxillectomy, are presented. The amount and exact placement of the grafts was determined preoperatively from the analysis of the three‐dimensional CT reconstruction, and the surgical planning was thereby simplified.
An Objective Assessment of Voice Production after Radiation Therapy for Stage I Squamous Cell Carcinoma of the Glottis
Authors: Lehman Jeffrey J. , Bless Diane M. , Brandenburg James H.
Published: November 2015

Radiation therapy has been the primary treatment for early glottic carcinoma, especially when restoration of normal voice is essential; yet objective evidence of the status of vocal function after treatment is lacking. The purpose of this study was to assess vocal characteristics of patients with glottic carcinoma after they had undergone radiation therapy. Twenty males, who had previously been treated with external beam irradiation for T1NOMO squamous cell carcinoma with no subsequent evidence of recurrence, volunteered for this study. Laryngovideostroboscopic, acoustic, aerodynamic, and perceptual measures of vocal function were used to determine the characteristics of voice production. Acoustic indices were compared to those of a normal group of 30 age‐matched volunteers, and the other measures were compared to established values reported in the literature. On acoustic analysis, the study group was characterized by significantly worse voice production than their counterparts. A high degree of intersubject variability was noted that could not be accounted for in terms of variables in treatment and medical history. The aerodynamic, spectral, and video‐stroboscopic findings correlated well; this indicated a poor vibratory source, characterized by diffuse stiffness. Further work is necessary in order to compare vocal function after endoscopic laser and conventional conservative excision.
The Singular Canal: A Valuable Landmark in Surgery of the Internal Auditory Canal
Authors: Silverstein Herbert , Norrell Horace , Smouha Eric , Haberkamp Thomas
Published: November 2015

The singular canal transmits the posterior ampullary nerve between the inferior part of the internal auditory canal (IAC) and ampulla of the posterior semicircular canal. The anatomy of the singular canal was studied in temporal bone dissections, in surgical dissections, and in high‐resolution computerized tomography scans. Measurements were taken for distances between the origin of the singular canal in the IAC, the porus acousticus, the vestibule, and posterior canal ampulla. The location and importance of the singular canal are demonstrated for retrosigmoid‐IAC vestibular neurectomy, retrosigmoid acoustic neuroma surgery, and transcochlear cochleovestibular neurectomy. The main purpose for the use of the retrosigmoid approach to the internal auditory canal during vestibular neurectomy and excision of acoustic neuromas is preservation of hearing. A major concern when the contents of the internal auditory canal are exposed through this approach is fenestration of the labyrinth, which results in sensorineural hearing loss. In the retrosigmoid approach, the singular canal has been found to be a vital landmark in prevention of fenestration during surgery of the internal auditory canal.
Auditory Brainstem Response and Audiologic Findings in Adrenoleukodystrophy: Its Variant and Carrier
Authors: Shimizu Hiroshi , Moser Hugo W. , Naidu Sakkubai
Published: November 2015

Auditory brain stem response, auditory sensitivity, speech discrimination function, acoustic reflex threshold, and reflex decay were studied in seven children with adrenoleukodystrophy (ALD), nine adults with adrenomyeloneuropathy (AMN), one child with neonatal ALD, and two carriers of ALD. Significant auditory dysfunctions were found in only two patients; a retrocochlear type auditory disorder in one child with ALD, and a profound deafness in a child with neonatal ALD. None of the patients showed significant abnormality in acoustic reflex threshold and reflex decay except for one patient with ALD who showed a slightly elevated reflex threshold. All but two ALD patients showed significantly prolonged wave latencies and interwave intervals. The latency values revealed the highest incidence of abnormality in the I to III interval; this was followed by the III to V interval, then by wave I. Significantly, one child with asymptomatic ALD and both heterozygous female relatives showed abnormal ABRs, demonstrating the high sensitivity of ABR in detection of the existence of pathophysiological condition in subclinical or presymptomatic ALD.
Autoimmune Endolymphatic Hydrops: Five‐Year Review
Authors: Hughes Gordon B. , Barna Barbara P. , Kinney Sam E. , Calabrese Leonard H. , Hamid Mohamed A. , Nalepa Nancy J.
Published: November 2015

This article reviews the authors' experience with autoimmune endolymphatic hydrops over the past 5 years. Twenty‐seven of 52 patients with diagnosed autoimmune inner ear disease (52%) manifested endolymphatic hydrops, usually bilateral. Treatment consisted of low salt diet, diuretic, vestibular suppressant, and usually prednisone. Cytotoxic drugs and lymphocytoplasmapheresis were reserved for refractory cases. Audiometric followup (average, 23 months) was available in 12 patients. Using American Academy of Otolaryngology‐Head and Neck Surgery guidelines, hearing improved or stabilized in at least one ear in nine patients and deteriorated bilaterally in three patients. Vestibular treatment results paralleled auditory treatment results. Autoimmune endolymphatic hydrops should be considered in the differential diagnosis when symptoms are bilateral and do not respond to conventional therapy or when immune laboratory tests are positive. In suspect patients, medical therapy with prednisone, and rarely cytotoxic drugs and lymphocytoplasmapheresis, should be recommended. Further research is needed to determine whether surgery should be performed in medically unresponsive cases.
The Role of Pars Flaccida in Human Middle Ear Sound Transmission
Authors: Aritomo Hiroshi , Goode Richard L. , Gonzalez James
Published: November 2015

The role of the pars flaccida in middle ear sound transmission was studied with the use of twelve otoscopically normal, fresh, human temporal bones. Peak‐to‐peak umbo displacement in response to a constant sound pressure level at the tympanic membrane was measured with a noncontacting video measuring system capable of repeatable measurements down to 0.2 micron. Measurements were made before and after pars flaccida modifications at 18 frequencies between 100 and 4000 Hz. Four pars flaccida modifications were studied: (1) acoustic insulation of the pars flaccida to the ear canal with a silicone rubber baffle, (2) stiffening the pars flaccida with cyanoacrylate cement, (3) decreasing the tension of the pars flaccida with a nonperforating incision, and (4) perforation of the pars flaccida. All of the modifications (except the perforation) had a minimal effect on umbo displacement; this seems to imply that the pars flaccida has a minor acoustic role in human beings.
The Lateral Facial Approach to the Nasopharynx and Infratemporal Fossa
Authors: Gates George A.
Published: November 2015

Surgical access to the nasopharynx and infratemporal fossa is restricted by the bony structures that support and define these areas. Traditional surgical approaches to the nasopharynx for removal of benign neoplasms follow three directions: (1) the anterior route via the nasal cavity and the maxillary and, if necessary, the ethmoid sinuses; (2) the inferior route through the palate; and (3) the anterolateral retromaxillary pathway via the gingivobuccal sulcus into the pterygoid space. These approaches provide fair access, but limited visibility and little technical control of the neurovascular supply. For the small‐ to medium‐sized tumor, the experienced surgeon is able to successfully manage the majority of cases using these approaches, singly or in combination. However, in patients with larger tumors—when recurrence is more common—approaches offering greater visualization have been developed, such as Panje's facial bifiap,1 Mann's transmaxillary,2 and Fisch's transtemporal.3 These provide better access and control at the cost of increased locoregional morbidity, long operating time, and considerable technical complexity. I have developed a simpler, more direct surgical approach that combines the exposure concepts of the head and neck surgeon with the microsurgical techniques of the otosurgeon. It has been applied to eight cases, with minimal morbidity and excellent results, and appears to be the procedure of choice for cases of angiofibroma with early intracranial extension. Subsequently, a similar approach, developed previously by Holliday,4 has been published in which access into the anterior temporal lobe, petrous apex, and clivus are gained. In this report, I describe and illustrate the anatomic and technical considerations of this approach and report a single case in which it was first applied.
Repair of Severed Peripheral Nerve: A Superior Anatomic and Functional Recovery with a New “Reconnection” Technique
Authors: Wikholm Richard P. , Swett John E. , Torigoe Yasuhiro , Blanks Robert H. I.
Published: November 2015

The objective of this study was to use a quantitative functional and anatomic model to compare surgical repair of the rat sciatic nerve according to two techniques; standard epineurial repair and the recently reported “nerve reconnection technique” (“freeze‐trim technique”). Functional recovery was evaluated using a functional index based on the measurements of the rats' footprints. Neuroanatomic experiments were conducted on the same animals to correlate functional recovery with regeneration of known motoneuron populations. The results of surgical repairs were also compared to those obtained from untreated sciatic nerve crush injuries. Functional recovery after epineurial repairs typically averaged 18%, whereas the mean recovery from the “nerve reconnection technique” was 71%. Crush injuries recovered to normal and reached a plateau much earlier than the surgical repairs. Retrograde horseradish peroxidase (HRP) labeling of motoneurons of the common peroneal nerve, a branch of the sciatic, revealed that there was a complex relationship between functional recovery and the number and distribution of motoneurons that regenerated axons distal to the repair site. The “nerve reconnection technique” greatly reduced the probability of axonal misdirection into the wrong distal branches at the repair site and brought an improvement of 300% to 400% in functional recovery over that found with epineurial repair. This technique of nerve repair may prove to be a valuable tool in reconstructive surgery.
Computed Tomography and Magnetic Resonance Imaging of the Inner Ear
Authors: Jackler Robert K. , Dillon William P.
Published: November 2015

The majority of temporal bone radiographic studies are obtained either for middle ear and mastoid disease or in the evaluation of retrocochlear pathology. With recent technologic advances, diagnostic imaging of the inner ear has developed an increasing role in the evaluation and management of diseases that affect the cochlea, semicircular canals, and the vestibular and cochlear aqueducts. High‐resolution computed tomography (CT) provides excellent detail of the osseous labyrinth, whereas magnetic resonance imaging (MRI) generates images derived from the membranous labyrinth and its associated neural elements. Optimal techniques for obtaining high quality CT and MRI images of the normal and diseased inner ear are presented. CT has proved useful in the evaluation of inner ear malformations, cochlear otosclerosis, labyrinthine fistulization from cholesteatoma, translabyrinthine fractures, otic capsule osteodystrophies, in the assessment of cochlear patency before cochlear implantation, and in the localization of prosthetic devices such as stapes wires and cochlear implants. While MRI produces discernible images of the soft tissue and fluid components of the inner ear, it has yet to demonstrate any unique advantages in the evaluation of inner ear disease. However, MRI produces excellent and highly useful images of the audiovestibular and facial nerves, cerebellopontine angle, and brain.
Infratemporal Fossa and Lateral Skull Base Dissection: Long‐Term Results
Authors: Rosenblum Barry N. , Katsantonis George P. , Cooper Margaret H. , Friedman William H.
Published: November 2015

In 1981, we described a new surgical technique featuring en bloc removal of infratemporal fossa malignancies. This approach offered a systematic resection of cancers in this region and was designated “stylohamular dissection” because the medial boundary of the bloc is surgical plane between the styloid process and the hamulus of the pterygoid. All structures lateral to this plane are removed, sparing the internal carotid artery. Since 1977, twenty infratemporal fossa and lateral skull base dissections have been performed for palliation of metastatic or recurrent disease in the infratemporal fossa. Most patients obtained palliation of trismus, facial pain, or relief from an unmanageable ulcerating lesion. This technique offers improved average disease‐free intervals, as well as enhanced survival rates compared to non‐en bloc resections. A summary of the case presentations, survival statistics, and surgical technique with detailed cadaver dissections are presented.
Percutaneous Vs. Transcutaneous Transducers for Hearing by Direct Bone Conduction
Authors: Håkansson BO , Tjellström Anders , Carlsson Peder
Published: November 2015

There is a substantial need for improvement of the hearing situation for patients with chronic middle ear or ear canal disorders. To improve hearing for these patients, two different bone conduction hearing systems have been developed. The Nobelpharma Auditory System HC 200—the bone‐anchored hearing aid we present here—uses a percutaneous transducer; whereas the Audiant device, developed by Dr. Jack Hough, uses a transcutaneous transducer. In percutaneous transmission, the transducer is directly coupled to the bone by means of a permanent skin penetration, whereas in transcutaneous transmission one part of the transducer is implanted and the other part is kept outside the intact skin and soft tissue. Comprehensive audiologic assessments indicate great differences in performance between the two systems. These differences probably originate in differences in length of gap and in different suspension properties of the two transducer systems. This article will demonstrate that large gaps, such as in the transcutaneous transducer, can be devastating for power consumption, maximum output capability, and second harmonic distortion. Since the properties of the suspension in the transcutaneous transducer are not under adequate control and the complication risk of permanent skin penetration is low, we continue to concentrate our efforts on percutaneous transducer systems.
Split Calvarial Grafts in Maxillofacial Reconstruction
Authors: Hunter David , Baker Sterling , Sobol Steven M.
Published: November 2015

Experience with thirty‐seven patients demonstrating the versatility of the split calvarial graft in facial reconstruction is presented. A total of sixty grafts have been used with no evidence of significant clinical reabsorption, infection, or extrusion; advantages and limitations are discussed. We conclude that the split calvarium represents a readily available and reliable source of membranous bone for grafting maxillofacial defects with minimal limitations and low morbidity.