bluuebunny/crossref_metadata_2025 huggingface dataset:
Tympanosclerosis of the Stapes: Hearing Results for Various Surgical Treatments
Authors: Giddings Neil A. , House John W.
Published: November 2015

When tympanosclerosis involves the tympanic membrane or the lateral ossicles, treatment is usually straightforward and uncomplicated. When the stapes is involved, therapy Is more controversial and may be more difficult. We report our results in 154 patients who underwent different surgical procedures for tympanosclerosis of the stapes. Followup was up to 10 years. Pure‐tone average threshold was significantly improved (P < 0.05) in patients who underwent mobilization procedures or stapedectomy for definitive treatment. The air‐bone gap was less than 20 dB at 6 months postoperative in 72% of patients and less than 30 dB in 90%. At 6 months, 2 years, and 5 years there were no statistically significant differences in hearing results between stapedectomy and mobilization patients, some of whom were followed for up to 10 years. No patient had a profound hearing loss after surgery. Surgical treatment for tympanosclerosis of the stapes is a safe procedure, with hearing results similar to those of surgery for other chronic ear diseases involving the ossicular chain.
An Evaluation of Laryngeal Muscle Activation in Patients with Voice Tremor
Authors: Koda Junji , Ludlow Christy L.
Published: November 2015

Eight patients with voice tremor were studied to characterize laryngeal muscle involvement. Electromyographic (EMG) recordings were made from intrinsic laryngeal muscles, simultaneously with some extrinsic laryngeal muscles, respiratory movement, and voice recordings during respiration, whisper, and phonation. Spectral measures were used to determine the tremor frequency and the prominence of spectral peaks in the EMG, respiratory and acoustic signals, while correlation coefficients were computed between pairs of tremulous EMG signals to measure the synchrony of tremor between muscles. The intrinsic laryngeal muscles were tremulous during respiration and speech, with the thyroarytenoid most often involved. Tremor was also detected in some of the extrinsic muscle recordings and the percentage of muscles with tremor was higher during phonation than during whisper or respiration. Time delays were found between tremor oscillations in laryngeal muscles. Because the thyroarytenoid was affected in all the patients studied, botulinum toxin injections may be beneficial in treatment of this voice disorder.
An Algorithm for the Management of Acoustic Neuromas regarding Age, Hearing, Tumor Size, and Symptoms
Authors: Silverstein Herbert , Rosenberg Seth I. , Flanzer John M. , Wanamaker Hayes H. , Seidman Michael D.
Published: November 2015

An algorithm has evolved for the management of patients with acoustic neuroma. Decisions as to surgery vs. observation, surgical approach, and whether hearing preservation should be attempted depend on age, patient symptoms, size of the tumor, residual hearing, and degree of facial nerve involvement at the time of surgery. Conservative management is used for patients over 65 years of age. This consists of observation or subtotal resection through a translabyrinthine approach, depending on the absence or presence of brainstem signs or symptoms. In patients under 65 years of age, hearing preservation is attempted through the retrosigmoid approach in tumors 1.5 cm or less if pure‐tone average is less than 30 dB and the discrimination score is greater than 70%. The translabyrinthine approach is our preferred approach for tumors of any size when hearing is not serviceable. A near‐total excision is performed when the facial nerve cannot be separated from the tumor. The rationale for this algorithm in the management of 130 cases of acoustic neuroma over the past 17 years is presented.
Intramuscular Hemangioma of the Head and Neck
Authors: Rossiter James L. , Hendrix Robert A. , Tom Lawrence W.C. , Potsic William P.
Published: November 2015

Intramuscular hemangiomas (IMH) are uncommon tumors in the head and neck region, occurring most often in the trunk and extremities. Preoperative misdiagnosis is common because of the deep location of these tumors. Ten recent cases of head and neck IMH are presented, five of which involve the masseter muscle‐the most frequent site of involvement in the head and neck. Masseter IMH occurred almost exclusively in the pediatric age group. The clinical presentation, radiographic and histologic findings, treatment, complications, and outcome of these patients are presented. The vital role of preoperative diagnosis using magnetic resonance imaging (MRI) is discussed, as well as a review of the natural history of IMH and indications for surgical intervention.
Pathology of Labial Salivary Gland Cellular Aggregates in Sjögren's Syndrome
Authors: Cleland‐Zamudio Suzanne , Demuth Melissa , Trune Dennis R.
Published: November 2015

Sjögren's syndrome (SS) is a chronic autoimmune inflammatory disease in which lymphocytic infiltration of the lacrimal and salivary glands is the hallmark of disease diagnosis. The present study was conducted to identify developmental features of labial salivary gland histopathology to permit earlier diagnosis of SS patients with borderline biopsies. Control subjects were chosen on the basis of clinical presentation consistent with SS, but whose biopsies did not meet current focus score criteria. Intraglandular connective tissue and diffuse cellular infiltration were significantly greater in SS patients than in controls. Glands in both groups had small cellular aggregates (10 to 50 cells/100 μm2), but those in SS patients were more numerous, larger, and contained more lymphocytes, plasma cells, and active fibroblasts. The large inflammatory foci characteristic of SS appeared to be formed by the enlargement and merging of these aggregates. This suggested aggregate formation was the earliest stage of pathology. Therefore, a comprehensive analysis of these cellular aggregates in borderline or negative biopsies could identify at‐risk patients and lead to earlier diagnosis and intervention in the disease.
Lateral Division of the Rabbit Cricoid Cartilage: Its Effect on Cartilage Growth
Authors: Silver Frederick M. , Myer Charles M. , Cotton Robin T.
Published: November 2015

Laryngotracheoplasty often includes bilateral lateral division of the cricoid cartilage, despite the theoretical risk that cartilage growth centers might be located in the lateral cricoid. To investigate the effect of lateral cricoid cartilage division on subsequent cartilage growth, 60 five‐week‐old New Zealand white rabbits were divided into four groups of 15 animals each. Group I was comprised of unoperated controls. The remaining animals underwent anterior (group II), anterior and posterior (group III), and anterior, posterior, and bilateral lateral (group IV) division of the cricoid cartilage. Animals were killed 20 weeks after surgery, and the cross‐sectional area of each animal's cricoid cartilage and of each animal's airway was determined. There was no statistically significant difference in mean cartilage cross‐sectional area between any of the four groups; the group IV mean was larger than that of any other group, though the difference was not significant. There was no significant difference in airway cross‐sectional area between any of the groups operated on. From these results, lateral cricoid division in the growing animal does not appear to interfere with subsequent normal growth of the larynx.
Leukocyte Esterase Activity in Effusion Fluid of Patients with Otitis Media
Authors: Lebovics Robert S. , Murthy Vadiraja V. , Karmen Arthur
Published: November 2015

Fluid obtained during myringotomy and tube placement in 20 patients with middle ear effusions was assayed for leukocyte esterase activity using a quantitative spectrophotometric assay. This quantitative assay used the synthetic substrate, N‐tosyl indoxyl alaninate. Seven of the 20 samples showed no measurable enzyme activity (8 U/ml or less). The remaining samples demonstrated activity ranging from 20 to 1600 units. Although enzyme activity did not correlate well with the physical appearance of the fluid, it did correlate with clinical history, suggesting the presence of a purulent exudate rather than serous effusion. Leukocyte esterase activity in the fluid appears to hold promise as an indicator for the presence of chronic middle ear infection. The enzyme can be assayed by a simple and fast diagnostic strip test, with results available almost immediately.
Subtotal Petrosectomy in the Management of Advanced Parotid Neoplasms
Authors: Leonetti John P. , Smith Peter G. , Anand Vinod K. , Kletzker G. Robert , Hartman James M.
Published: November 2015

Circumferential growth of parotid neoplasms may involve the external auditory meatus posteriorly, the floor of the middle cranial fossa superiorly, and the neurovascular structures of the jugular foramen medially. Inadequate tumor resection in these anatomically complex regions will result in local disease recurrence at the lateral skull base. A subtotal petrosectomy approach has been combined with a standard total parotidectomy in the management of 27 patients with aggressive parotid tumors. Twenty‐two patients had malignant lesions and 10 individuals had recurrent disease. The resultant conductive hearing loss is outweighed by the following advantages of this technique: (1) the ability to obtain tumor‐free bony margins, (2) proximal intratemporal facial nerve identification, (3) vascular control of the jugular bulb and petrous carotid artery, and (4) the dissection and protection of cranial nerves IX through XII. Our series of 27 patients will be detailed with an emphasis on surgical technique and overall patient results.
Indications and Results of Cordectomy for Early Glottic Carcinoma
Authors: Olsen Kerry D. , Thomas Jon V. , Desanto Lawrence W. , Suman Vera J.
Published: November 2015

Select early glottic carcinomas in patients with normal vocal cord mobility can be successfully treated with cordectomy, performed either endoscopicaliy or by means of an open operation (laryngofissure‐cordectomy). From 1976 to 1986, 95 patients underwent cordectomy at our institution. There were 88 men and 7 women, with an age range at the time of surgery of 27 to 84 years. A laryngofissure was used to perform a cordectomy in 61 patients and an endoscopic approach was used in 34. The median number of days in the hospital for the endoscopic group was 2, and for the laryngofissure group it was 6. The Kaplan‐Meier product‐limit method showed the probability of no recurrence in the first 3 years after an endoscopic cordectomy was 0.9099, and in the laryngofissure‐cordectomy group it was 0.9502. To date, there have been four recurrences (11.8%) in the endoscopic group and three (4.9%) in the laryngofissure group. Only one patient with recurrent tumor is known to have died of the cancer. Laryngectomy was necessary for ultimate control in three patients. The Kaplan‐Meier survival curve for the 95 patients was the same as that for a sex‐ and age‐matched control group. Cordectomy is an effective treatment option that results in minimal morbidity for select early glottic carcinomas.
The Benefits of Cochlear Implantation in the Geriatric Population
Authors: Waltzman Susan B. , Cohen Noel L. , Shapiro William H.
Published: November 2015

The deterioration of speech‐understanding abilities in the aged that results from factors such as reduced speed and accuracy in processing has been well documented. The purpose of this study was to evaluate whether the geriatric population could benefit from a cochlear implant, despite the possibility of reduced processing abilities. Twenty patients, ages 65 to 85 years, with bilateral profound sensorineural hearing loss received the Nucleus multichannel cochlear prosthesis at NYU Medical Center. All patients underwent extensive preoperative medical and audiologic assessments to determine candidacy. The surgical procedure was well‐tolerated by all patients. Mean postoperative test results revealed significant improvements in both auditory performance and quality of life as a result of implant usage. These data support the concept that although a reduction in the processing of sensory stimulation might exist, the elderly can process a new auditory code delivered by means of a cochlear implant.
Bone‐Anchored Reconstruction of the Irradiated Head and Neck Cancer Patient
Authors: Granströ GÖ , Tjellströ Anders , Brånemark Per‐Ingvar , Fornander Jörgen
Published: November 2015

Titanium implants in facial bones for retention of epitheses or dental bridges were used for reconstruction in cancer patients after tumor surgery. Even heavily irradiated bones could integrate the implants and bear the load from the epithesis. No major complications, such as wound infection, fistulation, or osteoradionecrosis, occurred after implant surgery. There was, however, an increased loss of implants with time after irradiation, especially in the orbital region. When hyperbaric oxygen was used as adjunctive treatment, implant losses were reduced.
Auditory Brainstem Implant: I. Issues in Surgical Implantation
Authors: Brackmann Derald E. , Hitselberger William E. , Nelson Ralph A. , Moore Jean , Waring Michael D. , Portillo Franco , Shannon Robert V. , Telischi Fred F.
Published: November 2015

Most patients with neurofibromatosis type 2 (NF2) are totally deaf after removal of their bilateral acoustic neuromas. Twenty‐five patients with neurofibromatosis type 2 have been implanted with a brainstem electrode during surgery to remove an acoustic neuroma. The electrode is positioned in the lateral recess of the fourth ventricle, adjacent to the cochlear nuclei. The present electrode consists of three platinum plates mounted on a Dacron mesh backing, a design that has been demonstrated to be biocompatible and positionally stable in an animal model. Correct electrode placement depends on accurate identification of anatomic landmarks from the translabyrinthine surgical approach and also on Intrasurglcal electrophysiologic monitoring. Some tumors and their removal can result in significant distortion of the brainstem and surrounding structures. Even in the absence of Identifiable anatomic landmarks, electrode location can be adjusted during surgical placement to find the location that maximizes the auditory evoked response and minimizes activation of other monitored cranial nerves. Stimulation of the electrodes produces auditory sensations in most patients, with results similar to those of single‐channel cochlear Implants. A coordinated multldlscipllnary team is essential for successful application of an auditory brainstem implant.
The Presence of Eosinophil Cationic Protein in Middle Ear Effusion
Authors: Hurst David S. , Venge Per
Published: November 2015

Eosinophil cationic protein (ECP) is probably responsible for the underlying Inflammatory mechanisms seen in asthma. It can be modulated in vivo by immunotherapy or steroids, with an appropriate reduction in symptoms of respiratory tract diseases. ECP is an identifiable mediator in additional target organs involved in allergic reactions, making it of potential interest in the study of otitis media with effusion. A qualitative prospective study was designed to discover the relationship of ECP and serum IgE in patients with middle ear effusion and allergy, as demonstrated by RAST and skin testing. The concentrations of ECP in the middle ear fluid from 23 consecutive patients with otitis media with effusion undergoing the placement of tympanostomy tubes ranged from 2 to 1248 μg (normal serum ECP, 5 to 15 μg), with 87% being abnormally elevated. There was no correlation between an individual's ear and serum levels of ECP (r= 0.1672;p= 0.6232), suggesting a more localized process. There was no relation between effusion ECP and serum IgE (p= 0.0040). ECP from middle ear effusion did correlate with a patient's having allergy, as confirmed by RAST and skin testing (p= 0.0095). Mechanisms involving Immune mediated disease in the middle ear, of which the eosinophil may be one participant, are presented.
DNA Content and Tumor Response to Induction Chemotherapy in Patients with Advanced Laryngeal Squamous Cell Carcinoma
Authors: Gregg Cynthia M. , Beals Theodore E. , McClatchy Kenneth M. , Fisher Susan G. , Wolf Gregory T.
Published: November 2015

Recent results indicate that the adjusted DNA Index (aDI), a measure of nuclear DNA content, is a significant prognostic factor for patients with advanced laryngeal cancer treated with surgery and radiation therapy. Because DNA aneuploidy is an indirect measure of the proliferative activity of a cell population, a study was conducted to examine differences in tumor response to induction chemotherapy based on aDI values. Pretreatment tumor specimens were obtained from 50 patients with stage III and IV laryngeal squamous cell carcinoma who underwent Induction chemotherapy (cis‐platin/5‐FU). With the use of computerized cytomorphometry, DNA content and nuclear area were measured and associations with tumor site, stage, chemotherapy response, tumor recurrence, and survival were examined. An elevated aDI was more frequent in patients with a chemotherapeutic response (p = 0.08), and mean aDI was higher among the complete responders. There were no complete responders among patients with a low aDI value (< 0.024). Neither aDI nor nuclear area correlated significantly with organ preservation or patient survival. Our results indicate that a complete response is more likely for patients with tumors with an elevated aDI and that pretreatment aDI may be useful in selecting high‐risk patients who might benefit from chemotherapy.
An Animal Model for Pharyngocutaneous Fistulas
Authors: Weiss Lawrence S. , Miller Robert H. , Bates Melissa L. , Fisher Elizabeth , Weiner Ned , Shepard Dennis
Published: November 2015

Postoperative pharyngocutaneous fistula is not an uncommon complication. Although the frequency of postoperative flstulae has decreased with the use of perioperative broad‐spectrum antibiotics, It remains a complication with significant morbidity and expense. We present an animal model for postoperative pharyngocutaneous flstulae based on Increasing wound tension. The New Zealand white rabbit was used to assess the rate of wound breakdown in the thyrohyoid membrane. The animals were assigned to one of seven groups according to the width of tissue resected. After tissue resection, the pharyngeal wounds were repaired, as were the overlying skin wounds. Animals were monitored postoperatively up to 14 days, at which time they were killed and underwent autopsy. Statistically significant results were achieved that demonstrate an Increasing incidence of pharyngeal wound breakdown associated with Increasing width of tissue resected and, therefore, closure tension. The procedure and results will be presented in detail. We propose that this model may be used to assess postoperative wounds as well as substances or methods touted as promoters of wound healing.
Mycobacterial infections of the head and neck
Authors: Manolidis Spiro , Frenkiel Saul , Yoskovitch Adi , Black Martin
Published: November 2015

Despite the decline of pulmonary tuberculosis in the Western world, the incidence of cervical mycobacterial infections has remained relatively unaffected. A retrospective review was conducted of 20 patients treated for head and neck tuberculosis from 1984 to 1991. They were mostly an immigrant group coming from underdeveloped countries close to the equator. All cases were treated with antituberculous chemotherapy; 18 patients also underwent surgical excision of their lymphadenopathy. Sixteen patients showed complete response to combined treatment and one relapse was successfully retreated with antituberculous medication. Three patients died from unrelated causes‐two from human immunodeficiency virus infection and one from nasopharyngeal carcinoma. The most reliable indicator of mycobacterial infection was the pathologic specimen, making the need for surgical intervention an important diagnostic consideration. As with other reports, most patients in our series had negative chest x‐ray films, variable responses to skin testing, and negative cultures. The epidemiology, pathogenesis, and management of this disease are discussed. (OTOLARYNGOL HEAD NECK SURG 1993;109:427‐33.)
Acute laryngeal trauma: A review of 77 patients
Authors: Bent John P. , Silver John R. , Porubsky Edward S.
Published: November 2015

Acute laryngeal trauma is a rare injury. In the past 18 years, 77 patients with acute laryngeal trauma have been evaluated at our institution. Each patient's care was overseen by the senior author (E.S.P.). The 61 patients who were seen within 48 hours of their accident are compared with those treated after 48 hours. All patients are classified by both injury (groups 1 through 5) and treatment (types I through III). Results are reported for voice, airway, and swallowing. Our methods of evaluation and treatment are outlined, and controversial aspects of patient management are addressed. We conclude that conservative treatment of group 1 and 2 injuries is 100% effective, expeditious repair of laryngeal injuries greatly reduces poor outcome, and the type of injury can be used to roughly predict patient outcome. Further, with use of current methods of diagnosis and management, almost all patients will be decannulated (98%) with functional speech (100%) and normal deglutition (100%). (OTOLARYNGOL HEAD NECK SURG 1993;109:441‐9.)
Acute epiglottitis: Changing epidemiologic patterns
Authors: Frantz Timothy D. , Rasgon Barry M.
Published: November 2015

We determined incidence of acute epiglottitis in the Northern California Region of the Kaiser Permanente Medical Care Program during an 11‐year period, from 1980 through 1990. The health plan membership is representative of the ethnicity, age, sex, and occupation of the Northern California population. The study included 135 children and 258 adults. Annual incidence in adults was relatively stable, ranging from 1.16 to 2.12 cases per 100,000. Annual incidence in children, however, decreased from 3.47 cases per 100,000 in 1980 to 0.63 cases per 100,000 in 1990. The ratio of annual incidence in children to that in adults decreased from 2.6 in 1980 to 0.4 in 1990. This changing epidemiologic pattern may be the effect of the Hemophilus influenzae type b vaccine (Hib), which was first given to children in 1985. Acute epiglottitis, classically considered a disease of children, is now becoming a disease of adults. (OTOLARYNGOL HEAD NECK SURG (1993;109:457‐60.)
Teflon vocal fold augmentation: Failures and management in 28 cases
Authors: Nakayama Meijin , Ford Charles N. , Bless Diane M.
Published: November 2015

Although vocal fold augmentation by Teflon injection has been the mainstay of treatment for glottic insufficiency for three decades, the success and safety of this treatment have been overstated. Twenty‐eight patients who manifested poor or complicated Teflon results between 1984 and 1991 were evaluated using acoustic, aerodynamic, videostroboscopic, perceptual, and subjective patient self‐evaluation of voice, both before and after our management of these complications. Most of these had Teflon granulomas; subglottic overfilling was the most common condition. In most instances such management included microsurgical removal of the Teflon granuloma. Voice measures that were abnormal before correction tended to improve and move into the normal range, although the resultant voices were not totally normal. Degree of improvement varied depending on the Teflon‐induced tissue changes and the methods of correction subsequently used. The worst results were in patients with scarring, atrophy, and bilaterally mobile vocal folds, for whom Teflon should never have been injected. Teflon injection should be reserved for those instances in which it is clearly indicated and the surgeon is skilled in the technique of intrafold injection. (OTOLARYNGOL HEAD NECK SURG 1993;109:493‐8.)
Facial sensibility in patients with unilateral facial nerve paresis
Authors: Novak Christine B. , Ross Brenda , Mackinnon Susan E. , Nedzelski Julian M.
Published: November 2015

This study evaluated facial sensibility in 29 patients with unilateral lower motorneuron facial nerve paresis using standard clinical tests of sensory evaluation used at other anatomic sites, most commonly the hand. Vibratory and cutaneous pressure thresholds and moving and static two‐point discrimination were measured. Statistically significant differences were found between the affected and unaffected sides of the face, with vibration threshold, cutaneous pressure threshold, and static two‐point discrimination being greater on the affected side. Vibration thresholds and two‐point discrimination (moving and static) progressively decreased, moving down the face from the forehead to the cheek, chin, and then the lip. Sensibility thresholds are altered in patients with unilateral lower motor neuron facial nerve paresis. These findings document a relationship between sensory disturbance and lower motorneuron facial nerve paresis. The potential functional significance of this relationship has clinical significance for patients undergoing rehabilitation training. (OTOLARYNGOL HEAD NECK SURG 1993;109:506‐13.)
A practical methodology to analyze facial deformities
Authors: Hom David B. , Marentette Lawrence J.
Published: November 2015

Despite much information about various methods to analyze the face, a practical stepwise methodology has not been firmly established in otolaryngology teaching programs. A general guideline for facial analysis would be helpful to individuals not totally familiar with facial analysis for assessing facial deformities resulting from to traumatic, neoplastic, or developmental causes. This article attempts to distill and integrate previously established guidelines for facial analysis into eight major steps to provide a preliminary and practical methodology for initial facial assessment.
The role of ktp laser in revision stapedectomy
Authors: McGee T. Manford , Diaz‐Ordaz Ernesto A. , Kartush Jack M.
Published: November 2015

In recent years, the safety and efficacy of revision stapedectomy has come under scrutiny. Experienced surgeons report that the results of such surgery are often worse than the results after primary surgery and that the risks of sensorineural hearing loss, tinnitus, and vertigo are increased. With the addition of laser technology to revision stapes surgery, the procedure to open the neomembrane over the oval window and gain access to the inner ear can now be performed safely. This allows positive identification of the oval window and assures placement of the prosthesis through the fenestra rather than on an intermediate segment of scar or bone in the region of the footplate. Our studies have shown the laser to be an important tool that enhances the safety and efficacy of revision stapedectomy.
Petrous jugular malposition (diverticulum)
Authors: Pappas Dennis G. , Hoffman Ronald A. , Cohen Noel L. , Holliday Roy A. , Pappas Dennis. G.
Published: November 2015

Jugular bulb anatomy is variable. A “high‐riding” bulb extending into the tympanic cavity is a well‐described anomaly. Petrous jugular malposition (diverticulum) (PJMD), however, is rare. The relationship between PJMD and clinical symptoms is questionable because the differentiation between PJMD as an anatomic variant and pathologic process is unproved. A literature review reveals 14 previously documented cases. We report an additional four cases. Diagnostic and management dilemmas are discussed, with the importance of high‐resolution CT Stressed.
An education model for otitis media care field‐tested in latin america
Authors: Eavey Roland D. , Santos Jose Ignacio , Arriaga Moises A. , Gliklich Richard , Odio Carla , Desmond M. Sheila , Villasenor Alberto , Beltran Sandra , Orloff Lisa , Stool Sylyan E.
Published: November 2015

The World Health Organization has designated the teaching of otitis media management skills a “priority” status. Effective treatment of ear disease requires that the physician be both informationally educated as well as physically trained to use otoscopy. Little is known about how well this education can be provided in a short time and in a foreign country. To more objectively assess teaching effect, results of an education session for rural Mexican pediatric primary‐care providers who were given an intensive otitis media lecture and otoscopy skills workshop in 1990 were evaluated. To test immediate cognitive impact, an anonymous written examination was given both before and after the teaching session. Average test scores after the educational sessions improved 24% (p > 0.001) over baseline scores before the sessions. To evaluate long‐term impact on clinical practice, a follow‐up telephone survey 2 years later was conducted. The use of an otoscope to diagnose otitis media had increased from 40% to 93% of respondents. We conclude that pediatric primary‐care providers In rural Mexico possess a baseline level of knowledge about otitis media that can be significantly enhanced with one educational session. Further, this teaching effort produces an impact on practice pattern that lasts at least 2 years.
Assessment of survival and microscopic changes in porcine skin flaps undergoing immediate intraoperative tissue expansion
Authors: Guida Roberta , Cohen James I. , Cook Ted A. , Swanson Neil A. , Burgeson Robert , Johnson Timothy M.
Published: November 2015

The technique of rapid Intraoperative tissue expansion has been used with increasing frequency in the clinical setting over the last several years. This technique takes advantage of the skin's ability to immediately stretch and increase in surface area when expanded under a constant load. Sixteen random‐pattern, rapidly expanded skin flaps on 10 domestic male pigs were studied to assess the predictive value of the fluorescein test for flap viability after rapid intraoperative tissue expansion. Partial fluorescence was found to be a more accurate predictor of flap survival in the experimental rapidly expanded flaps when compared to full fluorescence. Partial fluorescence was found to under‐predict flap survival by 0.3 to 0.5 cm, whereas full fluorescence was found to under‐predict flap survival by 2.5 cm. Additionally, histologic and ultrastructural changes were examined in rapidly expanded skin from the hip region in three pigs. The only microscopic change noted between control and experimental flaps was dilated capillaries in the dermis of expanded skin, which was noted by electron microscopy. Collagen and elastic tissue changes were not demonstrated in rapidly expanded pig skin by electron microscopy, direct immunoflurescence, collagen, and elastic tissue stains.
Variations in maximum amplitude of facial expressions between and within normal subjects
Authors: Neely J. Gail , Jekel James F. , Cheung John Y.
Published: November 2015

Definitive proof of efficacy of preventions and therapeutic interventions, and of risk factors in lower motor neuron facial paralyses continue to be confounded by the lack of repeatable quantitative measures of outcome. Clinical and research experience with human facial expression repeatedly demonstrates wide variations between subjects. To our knowledge, little information is available to isolate and describe the differences in dynamic facial expression between and within normal subjects. The purpose of this study is to use a statistical model to analyze the components of the observed variations of maximum amplitude measurement of image change during normal human subject facial expressions. Seventeen consecutive normal adult human subjects with no current or past evidence of facial nerve or ear disease were studied. Videotapes of command facial expressions were taken using specific and standardized conditions. The tapes were analyzed using a new computer‐assisted image‐change analysis program capable of generating dimensional data for the maximum amplitude of expression. These data were statistically analyzed using a General Linear Model with Nested variables to isolate and define component variations and errors. The General Linear Model predicted 88% of the observed total variation (p < 0.05).* A model performance this high suggests that most of the important independent variables were being studied. The major component of the variations was the difference among (between) subjects. Seventy‐seven percent of the predicted variation was due to this difference (p < 0.05). Little of the variation (1%) seemed to be within‐subjects. Test‐retest agreement was acceptable. Most of the data were tightly clustered about the mean and there was no stochasticly significant difference between test‐retest (p = 0.1187). We are encouraged by these results. They suggest the potential value of this and other dimensional techniques applied to facial expression. This study demonstrates that a computer‐assisted image‐change analysis program is capable of generating dimensional data that can be statistically analyzed in order to isolate and define component variations and errors.
Effects of probe insertion depth on real ear measurements
Authors: Dirks Donald D. , Ahlstrom Jayne B. , Eisenberg Laurie S.
Published: November 2015

The purpose of this article is to provide an overall summary of the role probe insertion depth has on real ear measurements, and to compare the real ear sound pressure level measured by a probe microphone system, using three methods for positioning the probe in an ear canal. The probe insertion techniques that were compared included: (1) an acoustic method that incorporates use of the quarter‐wave antiresonance property of the ear to determine acoustically the location of the probe tube relative to the eardrum in an individual ear; (2) a constant insertion depth method (25 mm from the intratragal notch); and (3) the earmold + 5 mm method, which places the probe 5 mm beyond the tip of the individual's earmold in the canal, thereby avoiding problems associated with the transition region, where sound exits from the bore of the earmold into the larger ear canal. Measurements were obtained for each method at 32 frequencies in the unoccluded ears of 17 subjects. Results indicated that the sound pressure levels measured by the acoustic method were significantly larger than those measured by the other two methods. This result was most evident in subjects with long ear canals (> 25 mm) and at high test frequencies (4.0 to 6.3 kHz). For subjects with short or average length ear canals, the three methods provided essentially equivalent results.
Kanamycin depletes cochlear polyamines in the developing rat
Authors: Henley Charles M.
Published: November 2015

Developing mammals are more sensitive to aminoglycoside antibiotics and other ototoxic agents than adults, with maximum sensitivity occurring during the period of anatomic and functional maturation of the cochlea. For the aminoglycoside antibiotics, the hypersensitive period in rats occurs during the second and third postnatal weeks. Toxicity is initially expressed as outer hair cell (OHC) damage in the high‐frequency, basal region of the cochlea. Distortion‐product otoacoustic emissions (DPOAEs), physiologic measures of OHC function, are particularly sensitive to aminoglycoside exposure during the period of rapid cochlear physiologic development. Toxicity is characterized by increased DPOAE thresholds and decreased amplitudes. The mechanism of developmental sensitivity to aminoglycosides is unknown. A potential biochemical target of aminoglycosides is the ornithine decarboxylase (ODC)‐polyamine pathway. ODC activity is elevated in the developing rat cochlea, aminoglycosides inhibit cochlear ODC in developing rats, and α‐difluoromethylornithine (a specific ODC inhibitor) impairs development of cochlear function. In the present study we demonstrate an incomplete polyamnine response to aminoglycoside damage, characterized by inhibition of the polyamines spermidine and spermine and accumulation of putrescine in the organ of Corti. Aminoglycoside inhibition of polyamine synthesis may mediate developmental ototoxic hypersensitivity by interfering with developmental and repair processes.
Acute otitis media increases middle ear susceptibility to nasal injection of Pseudomonas Aeruginosa
Authors: Antonelli Patrick J. , Juhn Steven K. , Le Chap T. , Giebink G. Scott
Published: November 2015

Pseudomonas aeruginosa was injected intranasally into four groups of chinchillas to determine if these bacteria can invade the middle ear by way of the eustachian tube. One group completed penicillin treatment of bilateral penumococcal otitis media (POM), and the second group started penicillin treatment of bilateral POM at the time of P. aeruginosa injection. A third group had no POM, but completed a course of penicillin treatment before P. aeruginosa injection, and a fourth group had no POM and received no penicillin. Middle ear susceptibility to nasally injected P. aeruginosa was significantly higher in animals with POM (61%) than in animals without POM (32%, p = 0.001). Forced eustachian tube opening pressures did not correlate with P. aeruginosa susceptibility. Thus, P. aeruginosa, the principle pathogen of chronic suppurative otitis media, can invade the middle ear by way of the eustachian tube, and acute otitis media predisposes to middle ear infection by P. aeurginosa.
The nottingham system: Objective assessment of facial nerve function in the clinic
Authors: Murty George E. , Diver Joseph P. , Kelly Peter J. , O'Donoghue G. M. , Bradley Patrick J.
Published: November 2015

The House‐Brackmann is the most widely accepted system for the clinical assessment of facial nerve function. It is, however, being subjective and discontinuous, prone to interobserver variation. The need for an objective system persists. The Nottingham System is described and compared to the Burres‐Fisch system in a study of 29 subjects with varying degrees of facial nerve function, ranging from normal to total paralysis. Within‐group component of variance analysis was 7% for the Nottingham System compared to 26% for the Burres‐Fisch system. Bland and Altmans' analysis showed the Burres‐Fisch system to be biased, overestimating small percentage scores, and underestimating large ones. The Nottingham System proved unbiased. The Nottingham System is recommended as an accurate objective continuous grading system for the rapid assessment of facial nerve function in the clinic.
Quantitative pathology of the intraepithelial laryngeal neoplasia
Authors: Sampedro Andres , Alvarez Cesar A. , Suarez Carlos , Nistal Angel M.
Published: November 2015

A clinical‐histologic and morphometric study on 32 patients with precancerous laryngeal lesions was carried out. Two biopsies taken at different times were studied, and the cases in which carcinoma developed were compared with those cases in which it did not. The only clinical‐histologic variable with prognostic value, related with evolution to carcinoma, was severe dysplasia. The Malignancy Grading System, which grouped together 13 clinical‐histologic variables, had both high sensitivity and high specificity. On the other hand, quantitative microscopy was a more sensitive and objective method. Through the relationship between the parameters of orientation/nuclearity and Histometric Progression Index, we could separate those cases in which invasive carcinoma developed from those cases in which it did not with a sensitivity of 100% and a specificity of 82%.
The management of blunt fractures of the thyroid cartilage
Authors: Bent John P. , Porubsky Edward S.
Published: November 2015

Our experience with 20 cases of blunt fractures of the thyroid cartilage encountered over the last 15 years were reviewed. These injuries were classified into one of three categories: nondisplaced with minimal associated laryngeal injuries (four cases), moderately displaced with intralaryngeal defects (12 cases), and severe fractures with intralaryngeal avulsion injuries (four cases). Treatment consisted of either surgical reduction of fracture (and associated intralaryngeal injuries) or conservative, nonsurgical management. Results were graded subjectively as good, fair, or poor for airway and voice.
Autorotation test abnormalities of the horizontal and vertical vestibulo‐ocular reflexes in panic disorder
Authors: Hoffman Donna L. , O'Leary Dennis P. , Munjack Dennis J.
Published: November 2015

Patients with panic disorder often describe dizziness as a disturbing symptom, with more severe episodes reported than in other psychiatric populations. Nineteen patients diagnosed as having a panic disorder were tested for vestibulo‐ocular (VOR) abnormalities with the Vestibular Autorotation Test (VAT), a computerized test of the high‐frequency (2 to 6 Hz) VOR. The patients were unselected for the presence or absence of balance disorders. Results showed VOR abnormalities, relative to a normal population, in the horizontal and/or vertical VORs of all 19 patients. Vestibulo‐ocular reflex asymmetries were commonly present. Because the VAT tested the VOR over a frequency range encountered during common daily activities, the observed abnormalities could result in a perceptually moving visual field (oscillopsia). We hypothesize that the resulting experience of a visual‐vestibular disturbance—perhaps in a biologically or psychologically predisposed individual—is catastrophically misinterpreted, leading to more bodily symptoms and anxiety. These could then contribute to more misinterpretation in a positive feedback sense, ultimately leading to a panic attack.
β2‐transferrin confirms perilymphatic fistula in children
Authors: Weber Peter C. , Kelly Robert H. , Bluestone Charles D. , Bassiouny Mohamed
Published: November 2015

β2‐Transferrin is a protein that is unique to the cerebrospinal fluid and aqueous humor. on the basis of this Information and a recent study from our Institution that demonstrated that β2‐transferrin was also unique to human perilymph, a prospective, double‐blind study to evaluate perilymphatic fistula in children was performed. Attending otolaryngologists at Children's Hospital of Pittsburgh evaluated and recommended surgery for 10 children (10 ears) who were suspected of having a congenital perilymphatic fistula. During the operation, the surgeon decided whether a perilymphatic fistula existed, on the basis of otomicroscopic findings, and then separate pieces of gelatin sponge were placed on the oval and round windows, respectively, and sent to the immunopathology laboratory where they were analyzed for β2‐transferrin. Ten patients (10 ears) undergoing tympanoplasty or tympanomastoidectomy were used as controls and tested in a similar fashion. During the study, both the surgeons and patients were blinded from the results of the test. of the 10 control patients, none was observed to have a perilymphatic fistula, and all were negative for β2‐transferrin. of the 10 patients undergoing exploratory tympanotomy for perilymphatic fistula, 1 ear was thought to be negative for perilymphatic fistula on microscopic visual examination, whereas 9 were considered to be positive for perilymphatic fistula. No β2‐transferrin was identified from the ear that was considered not to have a perilymphatic fistula, whereas six of the nine ears that were thought to have perilymphatic fistula tested positive for β2‐transferrin. β2‐Transferrin, an objective test for perilymphatic fistula, agreed with the microscopic visual determinations in 66.7% of ears noted to have a perilymphatic fistula. This study confirms the existence of congenital perilymphatic fistula in children. Further investigation is needed to determine the true sensitivity and specificity of this new laboratory test for perilymphatic fistula.
Advanced giant cell granuloma: A twenty‐year study
Authors: Tallan Eric M. , Olsen Kerry D. , McCaffrey Thomas V. , Unni K. Krishnan , Lund Bruce A.
Published: November 2015

Giant cell granuloma is a benign lesion that generally involves the mandible and maxilla. It may be locally aggressive and result in extensive tissue destruction in advanced cases. A retrospective analysis of giant cell granuloma during the Interval 1970 to 1990 revealed 18 cases of advanced disease, as defined by bone destruction and a greatest dimension of 2.0 cm or more. Epidemiologic factors, physical findings, Imaging studies, pathologic specimens, treatment modalities, and outcome were reviewed for each case. Eight lesions were treated by local excision and curettage, and 10 were treated by partial mandibulectomy. Five mandibular defects were reconstructed with lilac bone grafts and one with a free flap. Only one patient with maxillary giant cell granuloma who underwent curettage had regrowth of what is suspected to have been residual disease. Individualized treatment, tailoring the extent of resection to the extent of disease, provided excellent results.
Pharyngoesophageal Reconstruction Using the Radial Forearm Fasciocutaneous Free Flap: Preliminary Results
Authors: Kelly Kevin E. , Anthony James P. , Singer Mark
Published: November 2015

Pharyngoesophageal reconstruction remains a challenge to the head and neck surgeon. The goals of pharyngoesophageal reconstruction include restoration, with minimal morbidity, of a person's ability to swallow and to speak. Myocutaneous flaps, gastric pull‐up, and the jejunal free flap are popular methods of pharyngoesophageal reconstruction; however, none of these modalities is clearly ideal. We have begun utilizing the radial forearm fasciocutaneous free flap for pharyngoesophageal reconstruction. Twelve patients have had reconstruction with this flap with follow‐up from 2 to 15 months. Seven defects were circumferential, and five were noncircumferential. Ten patients (83%) have had successful restoration of both swallowing ability and voice. Donor site morbidity was minimal. The leading complication was salivary leak, which was present in eight (67%) patients. Five of the leaks closed with nonsurgical intervention. No cases of flap necrosis occurred. The radial forearm free flap is a thin and pliable flap that closely approximates the tissue consistency of normal pharynx. Successful restoration of a patient's ability to swallow approximates that of enteral flaps and is superior to that of MC flaps. Successful speech restoration is superior to that of enteral and MC flaps. Donor site morbidity is less than that caused by enteral flaps because laparotomy is avoided. Salivary leak is higher than with enteral flaps. Part of this difference is accountable to the high number of secondary and technically challenging reconstructions in this series, and we have taken steps to lower this rate of leakage. These preliminary data show that the radial forearm fasciocutaneous free flap is well suited for pharyngoesophageal reconstruction. Additional experience with this flap for pharyngoesophageal reconstruction is necessary to fully evaluate its utility.
Obstructive Sleep Apnea Syndrome and Acromegaly
Authors: Mickelson Samuel A. , Rosenthal Leon D. , Rock Jack P. , Senior Brent A. , Friduss Michael E.
Published: November 2015

Obstructive sleep apnea syndrome is a complex disorder that has been associated with a variety of abnormalities of the upper airway, including tonsil and adenoid hypertrophy, nasal obstruction, retrognathia, and macroglossia. The cause of the airway obstruction in acromegaly is believed to be related to osseous and soft‐tissue changes surrounding the upper airway, which lead to narrowing and subsequent collapse during sleep. We describe the results of treatment in seven patients with both sleep apnea and acromegaly. Four patients were treated by transsphenoidal hypophysectomy alone with a resolution of sleep apnea syndrome. One underwent hypophysectomy followed by postoperative radiation therapy, which reduced his apnea. Three patients underwent unsuccessful uvulopalatopharyngoplasty. Successful treatment of the primary disorder, in this case acromegaly, resulted in improved breathing during sleep in five patients. This series would suggest that acromegalic patients with sleep apnea should be treated for their pituitary tumor to reduce growth hormone before consideration of surgery to enlarge or bypass the upper airway.