bluuebunny/crossref_metadata_2025 huggingface dataset:
Auditory Processing Abilities in Children with Previous Middle Ear Effusion
Authors: Hoffman-Lawless Kimberly , Keith Robert W. , Cotton Robin T.
Published: October 2014

The present study was designed to determine whether auditory processing disorders are present in children with documented middle ear effusion (MEE) that required surgical treatment. Children with previous MEE and control subjects, in two age groups, were studied using five tests of auditory processing abilities: low-pass filtered speech, staggered spondaic word test, speech in noise, auditory sequential memory, and sound blending. Results found differences in groups at mean age 7 on the filtered speech test, but no statistical differences were found on any other test at age 7 or on any test at mean age 9. The results indicate that well-managed MEE appears to have no long-term effects on children acquiring this disease.
Early Decompression of the Facial Nerve in Bell's Palsy
Authors: Pulec Jack L.
Published: October 2014

Decompression of the facial nerve for 200 patients with Bell's palsy has been performed by the author during the past 17 years. These procedures were accomplished without injury to the facial nerve or inner ear. In no case was the incus removed nor the tympanic membrane or posterior bony canal wall disturbed with the exception of two translabyrinthine procedures in which the incus and inner ear were removed. Of 34 patients with normal nerve excitability preoperatively all had 100% recovery of facial motion. In 147 others followed for one year or more and whose nerve excitability was absent preoperatively, there was obtained an average of 80% recovery of motion and usually some degree of synkinesis. One patient who had a missing segment of nerve and a nerve graft performed failed to obtain any facial motion. Biopsy of facial nerve fibers during surgery has been found to be a feasible and useful technique. There is still no way to establish a prognosis when one still has a chance to avoid a bad result. The best one can do is to carefully follow serial electrical tests and perform surgery at the time when electrical studies begin to deteriorate. It is hoped that deterioration will develop slowly enough that a third degree injury will not have developed by the time that surgery is performed. Considering the results of this series of cases it would seem that the best results can be obtained by early surgical decompression for Bell's palsy. The patient must be informed of the possibility and the decision regarding the nature and timing of treatment should be a subjective one made after a careful analysis of the available facts and each patient's own circumstances. The availability of a promptly accomplished and precisely performed facial nerve decompression allows every patient to have a minimal risk of disabling permanent facial deformity.
Total Energy and Critical Intensity Concepts in Noise Damage
Authors: Ward W. Dixon , Duvall Arndt J. , Santi Peter A. , Turner Christopher W.
Published: October 2014

Groups of chinchillas were given a series of noise exposures of approximately equal energy ranging from 22 minutes at 120 dB SPL to 150 days at 82 dB. For all exposures involving levels of 112 dB or less, the same average permanent hearing losses (15–20 dB) and degree of outer hair cell destruction (8–10%) resulted, thus confirming the validity of the total energy principle for assessing the hazard associated with single continuous exposures at moderate levels. The 22-minute, 120-dB exposure, however, produced a 60-dB hearing loss and massive hair cell destruction (70–80%), indicating that some critical level had been exceeded, thus producing acoustic trauma. Further histological study suggests that the massive destruction is a result of breaks in the organ of Corti, produced by severe mechanical stress, that permit the mixture of endolymph with perilymph, thus creating a hostile environment for the hair cells.
Medical Treatment of Tinnitus
Authors: Shea John J. , Emmett John R. , Orchik Daniel J. , Mays Kit , Webb William
Published: October 2014

Medical treatment is presented as the best hope of the various treatment methods available for the management of tinnitus. A test dose of 100 mg lidocaine given rapidly intravenously will give good or partial temporary relief to approximately 80% of patients with tinnitus. More permanent relief can then be achieved by the oral anticonvulsants carbamazepine or primidone but the side effects of these drugs are occasionally too severe to justify their use. Three preliminary clinical studies of the oral amide of lidocaine, tocainide hydrochloride, were conducted and results with 600 mg four times daily are very promising. Further long-term clinical trials with tocainide will be started soon. It would appear that local anesthetics when given intravenously block the multisynaptic slow pathways in tinnitus as well as in chronic pain, with which there are many other similarities. The delay in wave V in the BSER and the sudden sleep induced in patients with a good response to intravenous lidocaine further confirm the site of action of these drugs in the brainstem and reticular formation. Until tocainide is available for general use it is possible to control tinnitus with large doses of intravenous lidocaine, 100 mg given rapidly and 400 mg slowly with EKG monitoring each day for several days, and then at weekly intervals, as in the treatment of clausalgia. Because patients with disabling tinnitus, as with chronic intractable pain, are rigid, insecure, chronically depressed and fatigued, a mood-elevating tranquilizer drug combination such as perphenazine-amitriptyline is of great value in maintaining these patients. While medical treatment is not the final answer it is the best treatment available and it offers a promising direction for further study.
Central Vestibular Signs, Posterior Fossa Pathology and Computerized Tomography-Regional Blood Brain Circulation
Authors: Kumar Arvind , Torok Nicholas , Valvassori Galdino
Published: October 2014

Central vestibular signs are sensitive indicators of lesions in the posterior fossa. With the availability of computerized tomography and computerized tomography-regional blood brain circulation, the identification of suspected retrolabyrinthine lesions has improved considerably. This is a report about the reliability of central vestibular signs in predicting posterior fossa lesions.
Total Footplate Extraction in Stapedectomy
Authors: Robinson Mendell
Published: October 2014

The concept of total footplate removal in stapedectomy surgery is recommended as the preferred technique providing that the surgery is atraumatic. Only that part of the footplate which can be removed easily should be removed; in 4,761 consecutive stapedectomies a total footplate removal could be accomplished in 74%. Total and partial footplate removal necessitates a connective tissue graft to seal the oval window and must be coordinated with a suitable prosthesis which is efficient, functional and self-centering. The successful results between total and partial footplate removal are not statistically significant when employing the criteria of air-bone gap closure to within 10 dB but when comparing the complete air-bone gap closure rate there is a statistically significant difference with total footplate removal providing a more favorable hearing result.
Comparison of Small Fenestra and Total Stapedectomy
Authors: McGee T. Manford
Published: October 2014

A biostatistical study of the results of 280 consecutive operations for clinical otospongiosis are analyzed over a seven-year period. One hundred forty-one (141) operations were done utilizing the “total stapedectomy” technique, and 139 were done utilizing the “small fenestra” technique. The auditory acuity of the two groups is compared with reference to conductive and sensorineural performance. All the surgery was performed by the authors, the data was collected by a third party and analyzed by a statistician. All audiograms were performed by the same audiologist under the same conditions. The data indicates that the preferred operation for this clinical disease is the small fenestra technique.
Contraindications to the Small Hole Stapedectomy
Authors: Farrior Brown
Published: October 2014

A small hole stapedectomy with an unprotected piston is contraindicated in an ear subjected to excessive pressure changes whether these are excessive fluid pressure changes which occur in the inner ear or excessive air pressure changes in the middle ear. Excessive fluid pressure changes in the inner ear may be the result of an overly patent aqueduct of the cochlea or a permeable internal auditory canal. These excessive fluid pressure changes may produce fistulas or a dilated blister around the piston called a tented piston. Excessive air pressure changes in the middle ear will produce excessive excursions of the tympanic membrane which may result in vertigo or a dislocated piston.
Cochlear Hydrops in Association with Collapsed Saccule and Ductus Reuniens
Authors: KitamurA Ken , Schuknecht Harold F. , Kimura Robert S.
Published: October 2014

Histopathological evidence from five human temporal bones with endolymphatic hydrops limited to the cochlea shows pathological obliteration of their saccules and/or ductus reunientes. We suggest that this finding supports the theory of longitudinal flow of endolymph. The anatomical distribution of endolymphatic hydrops is related to the location of the blockage which may occur anywhere from the ductus reuniens to the endolymphatic sac. Atrophy of sensorineural structures of the cochlea is severe in these five temporal bones and is presumed to be caused by the original disorders rather than occurring secondary to the endolymphatic hydrops.
Argon Laser Stapedotomy
Authors: Gantz Bruce J. , Kishimoto Seiji , Jenkins Herman A. , Fisch Ugo
Published: October 2014

The argon laser has been used clinically to perform stapedotomies in patients with otosclerosis. In order to determine if this device induces histologic changes in the inner ear, stapedotomies were performed in cats. Saccular membrane fistulas, in line with the path of the laser beam, were found in 3 of 8 ears. The unpredictable nature of the argon laser in the ear is discussed.
Acute Morphological Changes in Guinea Pig Cochlea following Electrical Stimulation
Authors: Duckert Larry G. , Miller Josef M.
Published: October 2014

A major area of concern in the development of the cochlear prosthesis involves the effects of the implant on inner ear anatomy and function. This study examined one aspect of host-implant interaction — the effects of cochlear implantation with and without electrical stimulation on cochlear morphology in the guinea pig. To accomplish this, a series of normal guinea pigs were acutely implanted bilaterally with a scala tympani multiple electrode prosthesis. One ear was stimulated with continuous 1 kHz sinusoidal current of constant intensity for a period of three hours. The contralateral control ear was not stimulated. Current intensities tested ranged from 0.1 mA to 1 mA rms. After stimulation the animals were sacrificed, perfused with fixative and the temporal bones were microdissected for examination using the scanning electron microscope. Morphological changes observed in the stimulated ear ranged from hair cell and supporting cell degeneration to complete destruction of the basilar membrane and organ of Corti overlying the electrode. These changes occurred at current intensities ranging from 0.4 mA to 1 mA and were conspicuously absent in the implanted but unstimulated control ears. The current intensities employed in this experiment were within operating ranges presently used in long-term behavioral studies in other animal models. To what degree the morphological changes observed in this study may effect the function of the prosthesis or host responses on a long-term basis cannot be determined from this experiment. However, our observations do demonstrate that electrical stimulation of the cochlea is not benign and point out the need for further evaluation to help define safe standards for use of the prosthesis.
Intracranial Complications of Sinusitis in Children
Authors: Brook Itzhak , Friedman Ellen M.
Published: October 2014

The cases of two children with periapical abscess in the upper incisors, sinusitis, and intracranial abscess are described. The ethmoid and maxillary sinuses were involved in both patients. Subdural empyema occurred in both, and one of the children had also cerebritis and brain abscess. Anaerobic bacteria were isolated from the infected subdural empyemas. Peptostreptococcus intermedius and microaerophilic streptococci were recovered in one patient and Fusobacterium sp in the other. Surgical drainage and appropriate antimicrobial therapy resulted in complete eradication of the infection in both patients. The role of anaerobic bacteria and the therapy directed against them in periapical abscess and the sinusitis and intracranial abscess which follow are discussed.
Vestibular Ganglion of the Squirrel Monkey
Authors: Fermin César D. , Igarashi Makoto
Published: October 2014

The vestibular ganglia of adult squirrel monkeys (Saimiri sciureus) were studied with the aid of light and electron microscopy. The vestibular ganglia are formed by small and large neurons (perikarya). The perikarya's outermost surface is surrounded by 2–20 lamellae of compact myelin. The compact myelin sheath varies its thickness around one perikaryon. The sheath generally thins out in the vicinity of the axon hillock. Occasionally, the compact myelin transforms completely into loose myelin for a length of 2–5 μ. Two to eight lamellae of loose myelin usually face the cytoplasm of the neurons. This myelin arrangement is constant in the majority of the cells examined regardless of shape and/or size. Large myelinated perikarya form the majority of the ganglion cells. There are, however, a few neurons that lack a true compact myelin sheath. Others are surrounded by very few lamellae of loose myelin. The general morphology of the neurons was compared to the available literature on other species. Possible variation on the myelination pattern due to fixation differences, and variation on perikaryal size due to the angle of cut and irregular shape of the cells are also discussed.
Fluorescence Bronchoscopy
Authors: Hürzeler Dietrich
Published: October 2014

A new method of fluorescence bronchoscopy is presented which uses a standard light source and a special filter combination to permit the carrying out of fluorescence bronchoscopy with a surface marking method by means of inhaling a fluorescein solution. Normal mucous membrane, or mucous membrane with no histological change other than inflammation, which is cleansed by ciliary activity, does not usually fluoresce for a period longer than about two hours after the inhalation. There were, it is true, 13 false positive fluorescences out of 52 fluorescing areas in the mucous membrane. Correctly recorded were 39 cases of positive, ie, visible tumors, metaplasias, accumulation of mucous glands in the epithelium, and mucous membrane which had undergone a neoplastic change in the sense of a lymphangitis carcinomatosa or a mucous membrane carcinosis; these all caused fluorescence. The false negative results amounted to only two nonfluorescing tumors and one metaplasia. These diagnoses arise from the first 100 patients examined by this method. The fact must be especially emphasized that out of the 58 carcinoma cases, there were 7 where neoplastic changes in the mucous membrane were diagnosed by the fluorescence technique, although they had not been recognized macroscopically either by the naked eye or by the Hopkins optical technique.
Granulocyte Proteases in Middle Ear Effusions
Authors: Carlsson Britt , Lundberg Christer , Ohlsson Kjell
Published: October 2014

Analyses of 20 middle ear effusions and plasma from 15 patients with serous otitis media demonstrated a marked local release of the granulocyte proteases, elastase, and collagenolytic neutral protease in the effusions. Furthermore, activation of C3 and complexes with antiplasmin were demonstrated. Complex formations between the granulocyte proteases and the protease inhibitors, α1-antitrypsin, α2-macroglobulin, and antileukoprotease were shown. A residual inhibitory capacity for α1-antitrypsin and antileukoprotease was also demonstrated in the middle ear effusions.
Comparative Anatomy of Eustachian Tube and Middle Ear Cavity in Animal Models for Otitis Media
Authors: Daniel Hal J. , Brinn Jack E. , Fulghum Robert S. , Barrett Kathryn A.
Published: October 2014

The comparative anatomy of the normal eustachian tube (ET) and normal middle ear cavity of three animal species (rat, gerbil, and chinchilla) is described relating to the usefulness of these animals as models for otitis media (OM). Routine histological and anatomical techniques and procedures were used. The gerbil and chinchilla, although of different sizes, are quite similar, having hypertrophied middle ear bullae, nearly vertical ET, and similar histology including seromucous glands draining directly into the ET. In contrast, the rat has a small bulla, a nearly horizontal ET, and a large concentration of goblet cells but few mucous glands in the ET. It appears that the chinchilla and the gerbil may serve as alternative models for OM research. Chinchillas and gerbils are relatively free of naturally occurring OM, while the rat has a high incidence of naturally occurring OM.
Carcinoma of the Anterior Tongue
Authors: Leipzig Bruce , Cummings Charles W. , Johnson Jonas T. , Chung Chung T. , Sagerman Robert H.
Published: October 2014

We have reviewed 126 patients with squamous cell carcinoma of the anterior tongue. Our experience suggests that carcinoma of the anterior tongue is a highly aggressive disease. It is no less aggressive and dangerous than carcinoma of the posterior tongue. The clinically negative neck is a problem. Many clinical stage I and II cancers are, in fact, stage III when analyzed by the pathologist. This difficulty in clinical staging results in a significant management problem when stage III carcinomas are treated as stage I and stage II disease. Management, if it is to cure, must be aggressive. An adequate, wide surgical resection will control early carcinoma of the anterior tongue. Advanced cancers of the anterior tongue, clinical stages III and IV, should be widely excised; the cervical lymph nodes on the side of the primary lesion must be treated by surgery and radiation therapy. Treatment of the opposite side of the neck is indicated based on a high rate of metastases to contralateral lymph nodes in this series. Those patients treated with irradiation who had recurrence did so predominantly at the primary site of disease. Patients treated surgically tended to have recurrence in the regional cervical lymphatics.
Characteristics of Tissue Plasminogen Activator from Paranasal Mucous Membrane in Chronic Sinusitis
Authors: Kosugi T. , Matsuo O. , Mihara H. , Hirano K. , Hamaya M.
Published: October 2014

Tissue extract of paranasal mucous membrane from patients with chronic sinusitis was found to show a large lysis area on plasminogen-rich fibrin plates, but not on plasminogen-free fibrin plates. This indicates the existence of tissue plasminogen activator in the tissue extract. Further studies by the gel filtration technique showed that two plasminogen activators of different molecular weights were present in the tissue extract. The existence of tissue plasminogen activator with a low molecular weight has not previously been reported. This activator is labile at neutral pH at 37°C, but stable on fibrin under the above conditions. The molecular weight of this compound is lower than that of cytochrome c. It may be a compound which is proteolytically modified by proteases, ie, trypsin-like enzymes, existing in the paranasal mucous membrane tissue of patients with chronic sinusitis.
Nasal Decongestant Effect of Propylhexedrine
Authors: Hamilton Lyle H.
Published: October 2014

Propylhexedrine was evaluated for its objective and subjective effectiveness and duration of action as an inhaled topical nasal decongestant. It was studied with and without aromatic oils in subjects with nasal congestion due to acute upper respiratory infection (URI) or to allergic rhinitis. A logarithmic transformation of nasal airway resistance (R n) was performed to allow the application of standard statistical tests to R n changes. Subjective rating scales for congestion and symptoms were analyzed by nonparametric statistical procedures. R n was statistically decreased from control values for 120 minutes after propylhexedrine vapors, Responses were the same for subjects with URI and allergic rhinitis, and no effect of the aromatic oils could be demonstrated. A comparison of the relationship between objective and subjective assessments of congestion demonstrated that the subjective rating scale had reduced sensitivity and poor reliability when compared with the objective measurement of R n.
Vocal Symptoms in Parkinson Disease Treated with Levodopa
Authors: Schley W. Shain , Fenton Elaine , Niimi Seiji
Published: October 2014

This is a report of a patient with unusually severe hoarseness in the absence of vocal fold pathology demonstrating Parkinson disease as one of the neurological diseases in which vocal symptoms occur. Although it is classifiably a severe, progressive, degenerative disorder, the popularity of pharmacotherapy for Parkinson disease during the past decade has resulted in improved functionality for an undetermined course of time in most patients- The classically described deterioration of speech and voice may develop in a variant manner difficult to distinguish as disease-related, as this case report illustrates. An explanation of the hoarseness based on dyssynchronous vocal fold motion related to the disease is suggested by the acoustic methods (spectrography, waveform analysis) used in this study, and supported by strobe light laryngoscopy. This conclusion is important because of the extremely high incidences of varying degrees of hoarseness reported in recent studies of Parkinson disease.
Bacteriology of the Maxillary Sinus of Rhesus Monkeys
Authors: Shapiro Eugene D. , Doyle William , Wald Ellen R. , Rohn Dale
Published: October 2014

Quantitative cultures of transantral aspirates of the maxillary sinuses of rhesus monkeys were performed to determine whether the sinuses have a normal bacterial flora. Of 13 sinus aspirate cultures 11 (85%) were sterile. The two positive sinus aspirate cultures had extremely low colony counts of the same bacteria present on the nasal mucosa prior to the sinus puncture. The maxillary sinuses of rhesus monkeys are sterile.
Head and Neck Carcinoma in Patients under 40 Years of Age
Authors: Carniol Paul J. , Fried Marvin P.
Published: October 2014

From 1965–1978 over 2,700 patients were admitted to the Massachusetts Eye and Ear Infirmary or the Massachusetts General Hospital with carcinoma of the oropharynx, larynx or nasopharynx; only 36 of these patients were less than 40 years of age. Twelve patients had oropharyngeal carcinoma, 13 patients had laryngeal or hypopharyngeal carcinoma, and 11 patients had nasopharyngeal carcinoma. Analysis of these patients indicates an increased incidence of head and neck cancer in younger females. In patients less than age 31 there was no significant social history which contributed to early onset of disease. The younger patients with nasopharyngeal carcinoma survived longer than patients of all ages with comparable neoplasms. The survival of patients with oropharyngeal, laryngeal and hypopharyngeal carcinoma is comparable to survival in patients of all ages with similar lesions.
Oxatomide in the Treatment of Chronic Allergic Rhinitis
Authors: Vannieuwenhuyse E. , Degreef F. , De Proost W. , Callier J.
Published: October 2014

Fifty-six patients with chronic allergic rhinitis were selected for a randomized double-blind study comparing oxatomide with a placebo. At the end of the 1-month treatment period symptoms had disappeared or were markedly improved in 81% of the oxatomide-treated patients compared with only 17% of the placebo group. Therapeutic control was achieved in most patients with a dose of 30 mg bid. Improvements were characterized by a reduction in the number, duration and severity of episodes of rhinitis. Oxatomide also significantly reduced the requirements of patients for additional antiallergic medication. No significant side effects were reported.
Vaterite Otoconia in Two Cases of Otoconial Membrane Dysplasia
Authors: Wright Charles G. , Rouse Roland C. , Johnsson Lars-G. , Weinberg Arthur G. , Hubbard David G.
Published: October 2014

Scanning electron microscopy, electron microprobe analysis, and x-ray powder diffraction were used to study temporal bone specimens obtained at autopsy from an infant with Potter syndrome and from a second trimester fetus, which was the product of an elective abortion. The mothers of both the infant and fetus were juvenile-onset rheumatoid arthritis patients who took prostaglandin inhibitors during pregnancy. The infant's external ears were low set and the left ear canal was stenotic. The vestibular maculae on the left were covered by aberrant otoconia composed of vaterite. In the right inner ear, otoconia were entirely absent, although the gelatinous otoconial membranes were intact. Only the left saccule and right utricle from the fetus were studied; both contained vaterite crystals similar to those in the infant. In addition, apatite was present in the fetal utricle, apparently lying on the macula beneath the vaterite otoconia.
An Inexpensive Effective Cryoprobe for Palliative Care
Authors: Pashley Nigel R. T.
Published: October 2014

Cryotherapy has been shown to be an effective method of palliation for recurrent head and neck tumors. Commercially produced cryotherapy units, however, are extremely expensive; a factor that is significant for otolaryngologists in other than large academic centers where utilization justifies such an expenditure. A simply constructed, effective, and inexpensive cryoprobe is described which can be used by any practitioner in the care of recurrent head and neck tumors.
Functional Patency of the Cochlear Aqueduct
Authors: Carlborg Björn , Densert Barbara , Densert Ove
Published: October 2014

The perilymphatic (P P) and cerebrospinal fluid (P CSF) pressures were investigated in relation to pressure variations in the ear canal, middle ear and intracranial compartment before and after occlusion of the cochlear aqueduct (CA). Experiments using intracranial infusion showed that the CA was responsible for a perfect hydrodynamic balance between the CSF and the perilymph. There are indications of additional pressure release factors but their capacities were not sufficient to prevent the appearance of a longstanding and substantial pressure gradient following occlusion of the CA. A gradual P P build-up, from zero to its original level after the CA was opened and occluded, indicated perilymph production within the labyrinth. Investigation of pressure transfer from the ear canal and middle ear to the perilymph showed that the CA was the major pressure release route from the cochlea. Occlusion of the CA reduced the compliance of the inner ear and severely reduced the pressure release capacity. In such a situation the inner ear is almost incapable of equilibrating ambient pressure changes.
Evidence for Presynaptic Parasympathetic Receptors on Nasal Blood Vessels
Authors: Jackson Richard T.
Published: October 2014

Noradrenergic synapses in the heart and several blood vessels have been shown to possess prejunctional receptors that modulate the release of norepinephrine from the synapse. The present experiment attempted to find evidence for presynaptic receptors for acetylcholine that modulated norepinephrine release. From the evidence obtained, it appears that the acetylcholine released from nasal parasympathetic fibers does not directly affect the smooth muscle of nasal blood vessels. Acetylcholine does, however, appear to inhibit the release of norepinephrine from nasal sympathetic nerve terminals. It appears that any nasal vasodilation produced by nasal parasympathetic fibers is caused by acetylcholine acting on an inhibitory, presynaptic, muscarinic receptor on the sympathetic nerve terminals. Acetylcholine would exert its control over nasal vessels by regulating the degree of sympathetic neurotransmitter release.
Binocular Counterrolling during Sustained Body Tilt in Normal Humans and in a Patient with Unilateral Vestibular Nerve Section
Authors: Diamond Shirley G. , Markham Charles H. , Furuya Nobuhiko
Published: October 2014

Two normal persons and a patient with unilateral vestibular nerve section were held motionless for ten minutes in the upright position, at 60° tilt right ear down, and at 60° tilt left ear down. In addition, one normal subject was held for ten minutes at each of 30, 60, and 90° tilt left ear down. Photographs were taken of both eyes every ten seconds. Measurements of ocular counterrolling during these trials revealed torsional eye movements in all positions, including the upright, even though the head and body were stationary. Variations in torsion in the upright position ranged up to 2.75°. At the tilt positions, variations ranged up to 4°. Disconjugate movements were seen in all subjects in all positions. There were no significant differences in measurements of ocular counterrolling during static tilt between the normal subjects and the patient with the vestibular nerve section, in contrast to measures obtained during slow velocity dynamic testing.
Deafness in Cryoglobulinemia
Authors: Nomura Yasuya , Mori Shigeo , Tsuchida Mineko , Sakurai Teruhisa
Published: October 2014

We present a histopathological study of a 44-year-old female with essential cryoglobulinemia. She had suffered from purpura and ulcer in winter, bilateral tinnitus and progressive hearing loss. An audiogram taken a week before her death showed bilateral total deafness. In the cochlea of the left temporal bone, the organ of Corti was either missing or present as a mound. The stria vascularis was atrophic throughout the cochlea. The tectorial membrane showed drooping and encapsulation. Reissner membrane was in the normal position. Eosinophilic precipitate was noted in the scala media at the site where Reissner membrane bulged. The spiral ganglion cells were well preserved. In the lower basal turn, there was fibrosis and ossification intermingled in the scala tympani. Ossification was most marked near the basal end. The semicircular canals and vestibule were almost totally ossified and fused with surrounding bone. There was a small, cyst-like structure in the vestibule containing eosinophilic fluid. Our findings indicate that the deafness was the result of circulatory disturbance due to cryoglobulinemia. To our knowledge, this is the first cryoglobulinemia case in which temporal bone findings are reported.
Occurrence of Additional Primary Neoplasms in Patients with Laryngeal Carcinoma in Israel (1960–1976)
Authors: Deviri Ehud , Eliachar Isaac , Bartal Arie , Steinitz Ruth , Goldsher Moshe , Robinson Eliezer
Published: October 2014

One thousand-six-hundred and sixty cases of laryngeal cancer were diagnosed in Israel during the years 1960–1976. In 98 of these cases another primary cancer accompanied the laryngeal carcinoma. Patients whose second primary cancer was basal or squamous cell carcinoma of the skin were not included in this study. Therefore, the results reported here deal with 84 patients. The prevalence of multiple primary cancer in patients with laryngeal carcinoma was found to be 5%. Lung cancer is the other primary tumor accompanying laryngeal carcinoma most frequently (29% of the additional tumors) followed by colorectal and bladder cancers. Most of the additional tumors (83%) appeared in a metachronic form with an average time interval of six years. In most metachronic tumors laryngeal carcinoma appeared as the first tumor (86%). Eighty percent of the patients were dead by August 1978. The majority (74%) succumbed due to the additional tumor and only 4% died of laryngeal carcinoma.
Distribution of Antileukoprotease in Upper Respiratory Mucosa
Authors: Fryksmark Ulla , Ohlsson Kjell , Polling Åsa , Tegner Hans
Published: October 2014

Human respiratory tract secretions contain enzyme inhibitors derived from plasma and a low molecular weight, acid-stable protease inhibitor, antileukoprotease. The distribution of antileukoprotease in normal upper respiratory tract mucosa has been studied using an immunohistologic technique. The inhibitor was localized to the serous parts of the submucosal glands of the maxillary sinus and the trachea but was not demonstrable in mucous glands and goblet cells. It is concluded that the antileukoprotease found in respiratory tract secretions is produced locally in the submucosal serous glands.
Effectiveness of Middle Ear Electrical Stimulation for Activating Central Auditory Pathways
Authors: Clopton Ben M. , Bosma Martha M.
Published: October 2014

Electrical stimulation of afferent auditory elements through electrodes placed in the middle ear was investigated in acute guinea pig preparations. Thresholds for auditory activation were current-dependent for low frequencies (<1 kHz) and charge-dependent at higher frequencies. Threshold currents were 3–5 times those for intracochlear stimulation. Mechanisms of activation were examined with removal of cochlear fluids and injection of neomycin, Xylocaine, saline, and artificial perilymph with different calcium concentrations. Neurons of the spiral ganglion are indicated as mediators of this stimulation.
Hair-Clip Type Piston Artificial Stapes and the Safety Auger
Authors: Min-Sheng Tung
Published: October 2014

A hair-clip artificial stapes prosthesis was used in the surgical treatment of otosclerosis in 22 ears. In nine patients followed an average of 15 months the air-bone gap stabilized at 6–7 dB. Further advantages of the prosthesis design and technique are that they minimize the risk of ischemic necrosis and perilymphatic fistula formation.
Bilateral Middle Ear Carcinomas Associated with Waldenström's Macroglobulinemia
Authors: Brookes Gerald B.
Published: October 2014

A case of bilateral middle ear squamous cell carcinomas with concurrent Waldenström's macroglobulinemia is described. An increased incidence of malignant tumors occurring in patients with this potentially fatal, chronic lymphoproliferative disorder is well recognized, but the association with an otological tumor has not previously been reported. The relationship between the two conditions is discussed.
Tracheoesophageal Fistula
Authors: Obiako M. N.
Published: October 2014

The case presented is one in which a coin in the esophagus resulted in a tracheoesophageal fistula. It is of interest not only because the occurrence is unusual, but also because the coin remained in the esophagus for an extraordinarily long period before the condition became symptomatic. The various factors responsible for the delay in getting medical help, including the nonavailability of medical services in many parts of Nigeria, are discussed.
Otitis Media Secondary to Ampicillin-Resistant Hemophilus Influenzae
Authors: Schwartz Richard H. , Rodriguez William J. , Khan Waheed N.
Published: October 2014

During a 2-year period ending December 1978, we encountered 27 cases of otitis media secondary to ampicillin-resistant Hemophilus influenzae. This represents 19% of the 139 Hemophilus isolates obtained by tympanocentesis. In agreement with data from Huntsville, Alabama, Boston, and Pittsburgh, we estimate that as of 1978, approximately 4% of all cases of acute otitis media are caused by this pathogen.
Intrinsic Malignant Schwannoma of the Larynx
Authors: DeLozier Howard L.
Published: October 2014

The first case of an intrinsic laryngeal malignant schwannoma is reported. The diagnosis of a malignant schwannoma is difficult to establish without gross evidence of its origination in a nerve. Although surgery remains the mainstay of treatment, a combination of surgery and radiotherapy appears promising. The prognosis in most cases is poor, with death usually resulting from persistent or locally recurrent disease.
Aneurysmal Bone Cyst of the Sphenoid in a Child
Authors: Kimmelman Charles P. , Potsic William P. , Schut Luis
Published: October 2014

The aneurysmal bone cyst is a vascular lesion which destroys and expands bone. We report a case of an aneurysmal bone cyst of the sphenoid sinus which resulted in loss of vision due to compression of the optic chiasm. Staged intracranial and extracranial procedures were used to remove the lesion. Aneurysmal bone cysts are very rare in the sphenoid sinus, and this is the first reported case occurring at that site in a child.
Office Telescopic Photography of the Larynx
Authors: Yanagisawa Eiji
Published: October 2014

After testing many different procedures for photographing the larynx in the office, the author found that telescopic photography is a most effective and reliable method. Four currently available right-angle laryngeal telescopes were reviewed and are discussed with regard to their results, along with the author's method of office telescopic photography.
Chondrosarcoma of the Larynx: Excision of Massive Recurrence
Authors: LeJeune Francis E. , Van Horn Herbert W. , Farr Gist H.
Published: October 2014

Chondrosarcoma of the larynx is an uncommon, slow-growing malignant tumor of the larynx which tends to metastasize late. This paper adds to the literature a case which was followed for 18 years. During the first three years is was thought to be a benign chondroma. Conservative management by limiting surgical resection, at the patient's direction, allowed observation of the disease for this unusual length of time. Massive enlargement finally necessitated laryngectomy. The lesion, though unquestionably malignant, had not infiltrated adjacent neck structures and appears to have been totally excised, with the patient now being free of disease six months after surgery. This supports the view of conservative surgical management.
Assessment of Intubation in Croup and Epiglottitis
Authors: Zulliger John J. , Schuller David E. , Beach Thomas P. , Garvin John P. , Birck Herbert G. , Frank John E.
Published: October 2014

Nasotracheal intubation for the management of airway obstruction in acute epiglottitis has become a well-received practice. However, the same technique has not received widespread support in laryngotracheobronchitis. The purpose of this study was to update the series of nasotracheal intubations in croup and epiglottitis from Columbus Children's Hospital with the specific intent to evaluate its effectiveness. All patients were evaluated for any immediate and delayed complications. Delayed complications were evaluated using parent interviews and measuring expiratory flow rates. This study of 45 children intubated for epiglottitis and 83 intubations for croup reconfirms the earlier report from this institution about its safety in both conditions. However, it has identified a subset of the croup patients who are definitely at risk to develop complications of the technique. In those children under 1 year of age, a disturbingly high incidence of subglottic stenosis was identified and this appeared to be related to the patient's age, tube size, serial intubations (dilatations), and duration of intubation. Suggested guidelines for airway management in the light of the new information are presented.
Cricothyroidotomy: The Impact of Antecedent Endotracheal Intubation
Authors: Weymuller Ernest A. , Cummings Charles W.
Published: October 2014

In light of the current debate regarding cricothyroidotomy, we elected to study the procedure at our institution. Cricothyroidotomy was instituted whenever tracheotomy was necessary for airway management. After a fairly short period of time, some significant complications of cricothyroidotomy were apparent and the study was aborted prior to achieving statistically significant results. The report reviews 15 consecutive cricothyroidotomies. Five (33%) developed significant complications requiring surgical intervention. Of the five, two had life-threatening airway obstruction. The major underlying factor in patients who developed complications was prolonged intubation prior to the institution of cricothyroidotomy. The study suggests that cricothyroidotomy should not be performed after prolonged intubation. The issue of primary cricothyroidotomy for short-term airway control remains unanswered.
Nerve-Muscle Pedicle Reinnervation of the Larynx: Avoiding Pitfalls and Complications
Authors: Tucker Harvey M.
Published: October 2014

The procedure for reinnervation of bilateral vocal cord paralysis using nerve-muscle pedicle technique has now been well established in the literature. Moreover, several other centers have reported success using this technique. Nevertheless, the author is aware that a significant number of well trained otolaryngology-head and neck surgery practitioners have found difficulty in making the procedure successful in their hands. It therefore seems appropriate to address those aspects of patient evaluation, technique and postoperative follow-up that have brought a satisfactory level of success in the author's hands. Preoperative evaluation of patients is the cornerstone of success in nerve-muscle pedicle reinnervation. It is imperative that the larynx be properly evaluated to be certain that there does not exist fixation or ankylosis of one or both arytenoids in addition to paralysis. Clearly if such fixation exists, nerve-muscle pedicle reinnervation cannot be successful. Several pertinent aspects of technique with special reference to the identification of the proper nerve-muscle pedicle, the design of the pedicle and proper identification of the posterior cricoarytenoid muscle will be discussed. Postoperative evaluation of patients may be difficult for inexperienced operators. The author has seen at least three patients who were operated on by other surgeons who were referred because of “failure” of the procedure only to find that all three of them were successfully reinnervated with satisfactory motion of the reinnervated cord for reasonable day-to-day activity. All aspects of postoperative evaluation and management will be discussed as well.
Surgery of the Inferior Nasal Turbinates
Authors: Saunders William H.
Published: October 2014

The inferior turbinates are responsible for nasal obstruction more often than commonly thought. When there is no other obvious cause for nasal obstruction, and when allergic disorder or other medical condition is not responsible, attention should be given to treatment of the inferior turbinates in many instances of nasal obstruction. Such treatment is usually surgical and may consist of submucous resection of the turbinate bone or excision of redundant hyperplastic turbinate tissue, or a combination of the two. Other treatments consist of electrocautery or cryotherapy. Injection of corticosteroids have produced blindness through embolism and, in general, this treatment is discouraged. The paper discusses in some detail which patients are best suited for submucous resection and which for excision of soft tissue. Techniques, which are simple, are also described.
Predicting Esophageal Speech
Authors: Gates George A. , Hearne Erwin M.
Published: October 2014

Patients undergoing laryngectomy in the 1980s have a low rate of acquisition of esophageal speech. The interaction of the factors of postoperative physical performance status, preoperative phonation duration, postoperative dysphagia, site of lesion, patient income, and postoperative radiation therapy correctly predict the acquisition of esophageal speech in 83% of cases and the failure to acquire esophageal speech in 96%. Such information may be helpful in selecting patients for alternative forms of postlaryngectomy speech rehabilitation.
Infratemporal Fossa Approach for Glomus Tumors of the Temporal Bone
Authors: Fisch Ugo
Published: October 2014

The surgical experience with 74 glomus tumors of the temporal bone is presented. The article proposes new refinements in the classification of types C and D tumors and describes in detail the technique of blind sack closure of the external auditory canal, double ligation of the sigmoid sinus and the use of a special infratemporal fossa retractor. The postoperative treatment and intraoperative management of the internal carotid artery, facial nerve and cranial nerves IX, X, XI and XII including the technique and results of a new type of V-VII anastomosis are discussed.
Normal Neonatal Brainstem Auditory Evoked Potentials
Authors: Zubick Howard H. , Fried Marvin P. , Epstein Michael F. , Feudo Peter , Strome Marshall
Published: October 2014

Brainstem auditory evoked potentials present a unique opportunity to assess the neuronal and auditory status of the newborn. To date, sample data have been few in number, thereby limiting their interpretive value. The present study was undertaken in an effort to accrue data generated from a large sample size. One hundred fifty-five normal neonates were tested within the first 36 hours of life. No subjects qualified for inclusion in the High Risk Register for Hearing Loss established by the American Academy of Pediatrics. Each ear was tested independently, using click stimuli at a rate of 30.1 per second at 65 dB HTL. Test runs were replicated for purposes of reliability. A run consisted of 2,000 sweeps of data, each being 10 ms in length. Identification of wave forms were assessed by two or more observers. Total agreement was required from all observers for inclusion of wave peaks for analysis. Latencies of onset of stimulus to peak were obtained. Descriptive as well as inferential statistics were computed. Results provide standardized data for comparison.
Harmonic Acceleration Tests as a Measure of Vestibular Compensation
Authors: Rubin Wallace
Published: October 2014

The material presented is excerpted from patient evaluations. The study was performed with the use of the Contraves rotary chair. This testing modality was used at each patient visit. All other conventional auditory and ENG tests were also performed. These patients have been selected to illustrate the value of the harmonic acceleration (HA) test as a modality for monitoring patient progress. The HA graphs produced were a result of the presence or absence of central vestibular compensation. The findings on these investigations further confirm that HA tests provide an objective monitor for vestibular abnormality.
Comparison of Vestibular Subjective Sensation and Nystagmus Responses during Computerized Harmonic Acceleration Tests
Authors: Honrubia Vicente , Jenkins Herman A. , Baloh Robert W. , Konrad Horst R. , Yee Robert D. , Ward Paul H.
Published: October 2014

A comparison was made between the phase of vestibulo-ocular reflex (VOR) responses to sinusoidal rotatory tests and the phase of the subjective sensation (SS) to rotation. A parallelism was found between the results of both sets of data such that they behaved in accordance with the prediction of the pendulum model of vestibular function. The time constant of the VOR (17.5 seconds) was longer, however, than that of the SS (13 seconds). Measurements in patients with unilateral labyrinthine pathology also showed comparable changes in both responses. One group of patients with complete unilateral labyrinthine paralysis showed an advance of the phase of the VOR and of the SS. However, phase measurements in the group of patients with only partial unilateral labyrinthine paralysis were not significantly different statistically from those of normal subjects.