bluuebunny/crossref_metadata_2025 huggingface dataset:
The Evaluation of Auditory Function in Homozygous Sickle Cell Disease
Authors: Forman‐Franco Bonnie , Karayalcin Gungor , Mandel Debra D. , Abramson Allan L.
Published: November 2015

The most significant clinical manifestations of sickle cell disease (SCD) are those associated with CNS involvement. This disease is systemic in character, with the tissues of the CNS being the most sensitive to even temporary anoxia. For this reason, the incidence of peripheral and central auditory dysfunction in patients with SCD may be greater than in the “normal” population. We examined the peripheral auditory function of 54 patients with homozygous sickle cell disease and the central auditory function of 28 of these patients. Results were compared with a control population. Peripheral hearing loss was found in 11% (6) of the SCD population. Central auditory testing indicated that 46% (13) of the sickle cell population had mild central auditory dysfunction not involving Heschl's gyrus. This study suggests a higher than usual incidence of peripheral and central auditory impairment in sickle cell disease.
The Acoustic Stapedial Reflex as Aprognostic Indicator in Sudden Onset Sensorineural Hearing Loss
Authors: Gerwin John M. , LaCoste Pat
Published: November 2015

Forty consecutive patients with sudden onset sensorineural hearing loss treated similarly over a four‐year period were studied retrospectively to determine a correlation between presence or absence of the acoustic stapedial reflex (ASR) and recovery of hearing. Six patients were dropped from the study because of incomplete data. There were 42 affected ears in the remaining 34 patients. The ASR was present in 28 (67%) of the 42 affected ears that had either full or partial recovery. The ASR was not present in 11 ears (26%) in which there was no recovery. The ASR was present in three ears (7%) in which there was no recovery. There was a statistically significant association (P<.001) between presence of the ASR and eventual full or partial recovery of hearing in this series. The ASR would have been an effective prognostic indicator for 32 (94%) of our 34 patients (39 [93%] of 42 affected ears).
Superior ultra‐audiometric hearing associated with genetic hearing loss
Authors: Bergstrom Lavonne , Morgan Donald
Published: November 2015

In 1978 Berlin et al.1 described several severely congenially deaf persons having extraordinarily good speech and better hearing at high and ultra‐audiometric frequencies than in the usual speech range. We have identified two families in whom this pattern occurs. Petrous pyramid polytomograms were normal in one family. Two sporadic cases are also described. Inheritance of this audiometric pattern has not been reported previously.
Serial Excision and Advancement Flaps in the Management of Facial Lesions
Authors: Ford Charles N.
Published: November 2015

Large facial lesions may be irradicated and replaced with anatomically normal‐appearing adjacent skin by serial excision. The same properties that allow skin flaps to move and expand may cause undesirable spreading of lesion‐bearing skin. Since scar contracture does not induce physiologic stretching of adjacent normal skin, it is more difficult to resolve third‐degree burn deformities by serial excision. Certain anatomic regions present difficulties because of the relative immobility of skin and the risk of conspicuous deformity resulting from the secondary motion induced by advancement of the local flap. Discrete undermining and differential tissue approximation afford effective utilization of serial excision in these situations.
Primary Adenocarcinoma of the Middle Ear
Authors: Schuller David E. , Conley John J. , Goodman Joseph H. , Clausen Kathryn P. , Miller William J.
Published: November 2015

Adenocarcinoma arising from the mucosa of the middle ear is a rare tumor. This report adds four new cases to the 13 cases that have been previously reported in the literature. These neoplasms tend to have a rather slow growth pattern and have an infrequent incidence of distant metastases. The observations that local recurrence is the major problem with adenocarcinoma of the middle ear suggest that aggressive locoregional treatment should be strongly considered.
Arteriovenous Malformations of the Mandible
Authors: Babin Richard W. , Osbon Donald B. , Khangure Markhan S.
Published: November 2015

Arteriovenous malformations of the mandible may present with pulsatile tinnitus, pain, a bruit, loosening of teeth, or intraoral or facial deformation or discoloration. In the absence of these classic symptoms and signs, the unwary surgeon might attempt a limited excision, leading to massive intraoperative hemorrhage. Management includes external carotid as well as selective branch arteriography and preoperative arterial embolization with polyvinyl alcohol sponges and absorbable gelatin. Vessel ligation, mandibular resection, lesion excision, mandibular autografting, and intermaxillary fixation complete surgical treatment.
Cerebrospinal Fluid Dynamics and Rhinorrhea: The Role of Shunting in Repair
Authors: Komisar Arnold , Weitz Stephen , Ruben Robert J.
Published: November 2015

CSF rhinorrhea can have many causes: traumatic, neoplastic, and iatrogenic origins are common. Most traumatic rhinorrhea ceases after a trial of conservative management. While obvious erosion or traumatic destruction of vital structures may be the underlying cause, other pathophysiologic mechanisms may be working in the formation of CSF rhinorrhea, which may require the combined skills of the otolaryngologist and the neurosurgeon. Leakage of CSF is seen in “high‐pressure rhinorrhea,” a pathophysiologic state wherein the underlying problem is poor CSF resorption. The result is increased intracranial pressure and eventual rhinorrhea or otorrhea. Areas of CSF leakage correspond to sites of congenital weakness in the cribriform plate region, the parasellar region, or the temporal bone. Weak areas in old base‐of‐skull fracture sites may leak with increased intracranial pressure. The initial management should stress correction of the deranged pathophysiology, namely shunting. Surgical repair is secondary to controlling the abnormal CSF dynamics.
Comparison of Two Voice Prostheses for Vocal Restoration Following Laryngectomy
Authors: Stuart Dennis R. , Kotsanis Constantine A. , Borkenhagen Robert
Published: November 2015

Two prostheses for voice rehabilitation after laryngectomy were compared. A comparison was also made to evaluate the interchangeability of the two prostheses (Panje button and Blom‐Singer duckbill) when only a single tracheoesophageal fistula was made. Fourteen laryngectomized patients were included in the study. Factors taken into account were voice quality, intelligibility, surgical technique, ease of insertion of the prostheses, patient preference, and care of each device. It was concluded that the Panje button in a Blom‐Singer fistula offered better results when voice quality was compared. Patient selectivity is a factor important to the high success rate reported for voice restoration when either prosthesis is used. The development and success of these new prostheses is highlighted in a brief review of the literature.
Perilymph Fistulas in Infants and Children
Authors: Supance John S. , Bluestone Charles D.
Published: November 2015

During the years 1975 through 1981 we performed exploratory tympanotomies on 33 infants and children (44 ears) to verify the presumptive diagnosis of perilymph fistula (PLF). A PLF was identified at the round window, oval window, or both in 29 (66%) of the 44 ears explored. After surgery hearing was unchanged in 86%, improved in 5%, and worsened in 9% of the ears in which PLFs had been observed. Complaints of vertigo subsided in all children in whom a PLF was repaired. Preoperative factors determined to be highly suggestive of the presence of a PLF included the following: sudden onset of sensorineural hearing loss (SNHL), congenital deformities of the head, and abnormal findings on tomograms of the temporal bones, especially Mondini‐like inner ear dysplasias. Middle ear abnormalities (primarily congenital) were observed in 20 of the 44 ears. Abnormal results of preoperative vestibular function studies, which included a fistula test, and sex were not consistently found to be associated with an observed PLF at tympanotomy.
The Role of Digital Subtraction Angiography in Diagnosis of Skull‐Base Lesions
Authors: Kinney Sam E. , Modic Michael T.
Published: November 2015

Advances in radiographic diagnosis of skull‐base lesions have made it possible to approach lesions formerly considered unresectable. The most important of these are the high‐resolution computerized tomographic (CT) scanners with bone algorithms. In conjunction with their evaluations it is important to know in detail the vascular structures involved with the skull base. These include not only the jugular vein and bulb and lateral sinus associated with glomus tumor surgery but often the carotid artery associated with lesions of the jugular foramen and petrous apex. Conventional arteriograms have been the best way to evaluate the vascular system but were occasionally associated with some risk and much patient discomfort. New digital subtraction techniques (digital subtraction angiography [DSA] using an intravenous bolus injection of dye) are now yielding x‐ray studies equal to or better than conventional arteriography. DSA will be described and the results of these studies of various lesions of the skull base will be presented in conjunction with the results of high‐resolution CT scanning to show the complete workup of the skull‐base lesion possible for an outpatient.
Objective Evaluation of Anterior Septal Surgical Reconstruction
Authors: Mertz Janet S. , McCaffrey Thomas V. , Kern Eugene B.
Published: November 2015

Fifty patients who underwent nasal septal reconstruction for anterior septal deformities were examined preoperatively and postoperatively with anterior mask rhinomanography. A high degree of correlation was found between the reduction in nasal resistance after operation and the patients' subjective assessment of improvement. Those patients who improved subjectively had a mean decrease in nasal resistance of 1.2 cm H2O/L/sec, whereas those patients who indicated no improvement had a mean increase in nasal resistance of 0.2 cm H2O/L/sec.
Bone Resorption Factors in Chronic Otitis Media
Authors: Moriyama Hiroshi , Chun Cheng Huang , Abramson Maxwell , Kato Michimasa
Published: November 2015

Collagenase was identified within naturally occurring rat chronic otitis media by the use of an immunohistochemical technique with peroxidase‐antiperoxidase to stain the paraffin. Collagenase was found in fibroblasts, mononuclear cells, and osteoclast cells in the bone‐resorbing area. Collagenase was found only in fibroblasts in contact with epithelial basal cells. Macrophages from rat peritoneum were cultured with different concentrations of a lipopolysaccharide. The prostaglandin E2 level reached a maximum during the 12‐to 24‐hour period in the presence of endotoxin. This prostaglandin E2 was confirmed by immunofluorescent staining. The endotoxin‐activated macrophage produced an insignificant amount of collagenase. These findings suggest that activated macrophages may be able to stimulate fibroblast collagenase production through the chemical mediator prostaglandin E2. Also, the interaction between fibroblasts and epidermal cells appears to encourage and enhance the biochemical events resulting in bone resorption in chronic otitis media.
Failures with Plasti‐Pore Ossicular Replacement Prostheses
Authors: Sanna Mario , Gamoletti Roberto , Magnani Massimo , Bacciu Salvatore , Zini Carlo
Published: November 2015

Plasti‐Pore ossicular prosthesis failures found in our series of 246 patients with regular follow‐up are reported and analyzed. Extrusions as well as poor functional results (postoperative air‐bone gap greater than 25 dB) of the prostheses with and without cartilage on top have been reviewed. The overall extrusion rate was 9.3%: a higher extrusion rate occurred with prostheses without cartilage (18.4%) than with cartilage (4.4%). Thirty‐six patients among those with poor postoperative hearing improvement have undergone revision surgery: the main causes of failure were a short prosthesis, a fixed stapes or footplate, adhesions of the prosthesis to surrounding structures, and the displacement of the prosthesis.
The Use of Autogenous Vein for Nerve Grafting
Authors: Rice Dale H. , Berstein Fernando D.
Published: November 2015

The use of autogenous femoral vein to graft a resected segment of sciatic nerve in 10 rats suggests that autogenous vein can serve as a satisfactory nerve graft conduit. Scar tissue within the vein or distal nerve was minimal.
The Effect of Cooling on the Photodynamic Action of Hematoporphyrin Derivative during Interstitial Phototherapy of Solid Tumors: 1983 Second‐Place Resident Research Award: Basic Category*
Authors: Jones Gregory C. , Kinsey James H. , Neel H. Bryan , Cortese Denis A.
Published: November 2015

Hematoporphyrin derivative (HpD), a mixture of compounds chemically prepared from naturally occurring crude hematoporphyrin, is preferentially concentrated in neoplastic cells and produces red fluorescence when irradiated with blue‐violet light. In addition, HpD exhibits other photodynamic properties, which, in the presence of oxygen and visible light, result in cytotoxicity. Preliminary reports indicate that early, superficial carcinomas of the upper aerodigestive tract and tracheobronchial tree can be localized and treated successfully with HpD phototherapy (HpD‐PT), in which a fiberoptic bundle transmits laser light to the tumors. To assess this modality's potential for treating solid tumors, the cytotoxic effect of HpD‐PT was measured in a murine tumor model. We specifically assessed the effect of cooling on the pure photodynamic action of HpD‐PT. Adult female mice with typical mammary tumors received interstitial phototherapy 24 hours after HpD was given intraperitoneally. Light from an argon‐dye laser was delivered through an optical fiber, along with simultaneous cooling from a cryosurgical probe, for 15 minutes. After being cooled with a cryosurgical probe, tumors were excised 48 hours after treatment and the necrotic area was measured. The results indicate that cooling enhances the tumoricidal action of HpD‐PT.
Prognostication of Myocutaneous Flap Viability using Laser Doppler Velocimetry and Fluorescein Microfluorometry
Authors: Cummings Charles W. , Trachy Ronald E. , Richardson Mark A. , Patterson H. Clifton
Published: November 2015

Formerly, flap perfusion was assessed clinically by gross evaluation of the amount of fluorescein in the developed flap prior to transfer. Recently the laser Doppler velocimeter and the perfusion microfluorometer have been developed as aids in perfusion assessment. We have used each instrument in a series of reconstructive procedures employing pectoralis or trapezius myocutaneous flaps and a series of pig groin myocutaneous flaps to assess the contribution of each to the prognostication of flap viability. While the laser Doppler does provide useful information, we have found that the microfluorometer is more selective in representing the hemodynamics of the developed flap.
Electrical Stimulation of the Auditory System in Children Deafened by Meningitis
Authors: Eisenberg Laurie S. , Luxford William M. , Becker Terry S. , House William F.
Published: November 2015

Twenty‐five children deafened by meningitis were compared with 10 congenitally deaf children on cochlear implant performance. All subjects had met the audiologic criterion of profound deafness as required for implant surgery. Twenty subjects in the meningitis group had some degree of ossification at the round window, and drilling was required for electrode insertion into the scala tympani. In six of these subjects, bone completely filled the scala. There was a significant relationship between extensive ossification and the etiologic pathogen Diplococcus pneumoniae, as determined by radiologic and surgical reports. Postoperative results revealed that all subjects could be electrically stimulated, except for one with extensive bone formation. On implant performance, the meningitis group demonstrated sound‐field thresholds comparable to those of the group with congenital deafness but required significantly higher voltage settings. These findings suggest that even with extensive labyrinthine ossification caused by meningitic deafness, neural elements are present and can be stimulated if enough power can be safely provided.
Development of an Implantable Hearing aid Using a Piezoelectric Vibrator of Bimorph Design: State of the Art
Authors: Yanagihara Naoaki , Suzuki Junichi , Gyo Kiyofumi , Syono Hisao , Ikeda Hironosuke
Published: November 2015

A new, implantable hearing aid has been developed. An ultraminiature electret microphone placed under the skin of the external ear canal transduces sound waves into electrical impulses that are amplified with battery power. The amplified electrical impulses are fed into a piezoelectric vibrator directly in contact with the stapes. The vibrator transduces the electrical impulses into mechanical vibration with minimal consumption of electrical energy. Direct coupling of the vibrator to the stapes allows a high degree of fidelity in the perception of sound. The developmental process and the structure and function of each component are described together with clinical problems. Preliminary and tentative implantation of this new device during middle ear surgery indicated that it would be beneficial to patients who have suffered hearing loss from middle ear disease and whose condition does not lend itself to surgical correction.
Gunshot Injuries of the Temporal Bone
Authors: Duncan Newton O. , Coker Newton J. , Jenkins Herman A. , Canalis Rinaldo F.
Published: November 2015

Concurrent with the increase in handgun crime in the United States is a rising incidence of gunshot wounds to the temporal bone. These injuries present challenging diagnostic and management problems to the otolaryngologist. A timely multicenter review of this entity revealed 22 cases evaluated and treated by the authors between 1975 and 1984. A wide variety of injuries were encountered, involving anatomic structures within or contiguous with the temporal bone. These included: eight intracranial injuries; 11 traumatized facial nerves; seven vascular wounds; 19 mastoid, middle, or inner ear injuries; and 11 cases of damage to the external auditory canals. A rational scheme for immediate and long‐term management of each type of injury is outlined. Illustrative cases representing vascular, neural, temporal bone, and central nervous system injury are presented.
Posttraumatic Enophthalmos and Diplopia
Authors: Mathog Robert H. , Archer Kathleen F. , Nesi Frank A.
Published: November 2015

Malposition of the globe and failure to fuse visual images are late‐developing complications of orbital injury. This article reviews the causes of specific sequelae, such as enophthalmos, hypophthalmos, and diplopia, and describes a procedure of strategic implantation of autogenous bone grafts to correct the condition(s). Using quantifiable methods of assessing globe position and motility, the authors demonstrate improvement in 18 of 19 patients. Vision is reported unchanged or improved in 13 sighted patients. Several cases are presented with analyses of preoperative and postoperative photographs. Indications, contraindications, advantages, and disadvantages of the surgical procedure are described and compared to others.
Dizziness and the Autonomic Dysfunction Syndrome
Authors: Pappas Dennis G. , Crawford Wynne , Coghlan H. Cecil
Published: November 2015

Dizziness resulting from inner ear or CNS disease has been well described. However, there is a large number of patients for whom dizziness does not seem to be related to either the ears or the CNS. We postulate an abnormality in the autonomic nervous system of such patients and have used standard tilt testing and Valsalva methods to assess the abnormality. Based on the results of these tests, we can suggest therapeutic options.
Neuro‐Otologic Evaluation of the Patient with Acute, Severe Head Injuries: Correlations among Physical Findings, Auditory Evoked Responses, and Computerized Tomography
Authors: Aguilar Eugenio A. , Hall James W. , Mackey‐Hargadine Judy
Published: November 2015

Long‐term clinical neurologic and otologic sequelae of traumatic head injury are well recognized. In this article, we describe the relationship among neurophysiologic, neuro‐otologic, and neuroradiologic findings in a series of fifty patients with acute, severe head injury. Seventy percent of the patients had one or more otologic abnormalities, of which hemotympanum was most common. Outcome of computerized tomography (CT), auditory brainstem response (ABR), and otologic examination findings were not mutually dependent. For example, otologic disease was found in 50% of the patients with normal ABR. All but one patient in the series showed brain damage by CT; yet only 14% of the series had evidence of temporal bone fracture and, unexpectedly, one third of this group yielded normal otologic findings and a normal ABR. We conclude that combined application of otologic examination, CT scanning, and auditory evoked response assessment provides complementary information on structural and functional neuro‐otologic status in persons with acute, severe head injury.
The Mechanical Spread of Viable Tumor during Surgery
Authors: Atiyah Raja A. , Krespi Yosef P. , Hidvegi Denise , Sisson George A.
Published: November 2015

The “mechanical” spread of tumor is that which occurs through physical trauma, such as during surgical resection. There has been a waxing and waning of interest in this concept over the past 70 years. We have collected the blood that comes off the surgical field during major head and neck resections and separated and plated all nucleated cells in the tumor stem cell assay of Hamburger and Salmon. In one of six such preparations, we demonstrated the presence of viable, colony‐forming tumor cells. Two were contaminated and three did not grow. We demonstrated, therefore, that the blood that bathes the raw open surgical field contains tumor cells that are viable and potentially capable of producing new foci of tumor.
The Relationship of Lateral Osteotomies in Rhinoplasty to the Lacrimal Drainage System
Authors: Thomas J. Regan , Griner Nancy
Published: November 2015

Damage to the lacrimal drainage system is a potentially complicating factor in rhinoplasty utilizing lateral osteotomies. The authors present data from osteotomies performed on a series of fresh cadavers. Following completion of the osteotomies, the lacrimal sac and nasal lacrimal ducts were Identified and cannulated. Soft tissue was dissected to demonstrate the osteotomy site. The specimen was inspected to delineate involvement (if any) of the lacrimal duct or sac. The proximity of the osteotomy site to the lacrimal drainage apparatus components was measured in each specimen. Various parameters were observed, including the effect of curved vs. straight osteotomes, guarded vs. unguarded osteotomes, and the effect of various widths of osteotomes. Likewise, the degree of risk to the lacrimal system was evaluated, and the technique of the novice and resident surgeon was compared to that of the experienced rhinoplastic surgeon. A low, curved osteotomy, performed with a sharp osteotome without subperiosteal tunnels, provides the safest maneuver. Lateral osteotomies, properly performed, prove to be an unusual cause of lacrimal drainage dysfunction.
Presentation of Wegener's Granulomatosis in Young Patients
Authors: Halstead Lucinda A. , Karmody Collin S. , Wolff Sheldon M.
Published: November 2015

We have reviewed 50 cases of Wegener's granulomatosis, seen at the New England Medical Center Hospital between 1970 and 1984, and were impressed that 10 (20%) of these patients were under 25 years of age, with ages ranging from 13 to 23 years. Closer examination of this younger group revealed striking differences in their presenting symptoms and organ Involvement when compared to the older group of patients. The presentation of these young patients was varied, with no single predominant symptom. Patients presented with otalgia and otitis media or hearing loss, fulminant sinusitis, arthralgias, and even corneal ulcers. Only one patient had “typical” rhinitis and nasal congestion. This group also had a disproportionate number of patients with involvement of the oral cavity, skin, and trachea. Biopsy of these sites frequently demonstrated necrotizing vasculitis. Three of our 50 patients had intracranial involvement, leading to transient hemiplegia in the first, permanent hemiplegia in the second, and a seizure disorder in the third. Two of these patients were in the younger age group. The proportion of patients with limited and generalized Wegener's granulomatosis was the same in both the younger and older age groups. All the younger patients, however, had manifestations of the disease in the head and neck, while four of the older patients had no symptoms in the upper respiratory tract. The number of young patients in our study emphasizes the fact that Wegener's granulomatosis, indeed, occurs in the younger patient and with a greater frequency than previously supposed. This study suggests that in the teenager and young adult, with an unusual constellation of symptoms of the head and neck and accompanying systemic problems, a diagnosis of Wegener's granulomatosis should be seriously considered.
Pneumomediastinum and Cervical Emphysema from the Inhalation of “Free Based” Cocaine: Report of Three Cases
Authors: Aroesty David J. , Stanley Robert B. , Crockett Dennis M.
Published: November 2015

As the recreational use of cocaine increases, media coverage and medical literature dealing with symptoms and treatment of complications proliferate. What follows is a report of three cases of complications from inhalation of “free based” cocaine.
Thyroid Nodules in Children
Authors: White Ann K. , Smith Richard J.H.
Published: November 2015

Thyroid nodules are infrequently encountered in children. During the era of low‐dose therapeutic irradiation, the incidence of malignancy in these lesions was 40% to 70%. Recent studies suggest that this incidence is declining, resulting in a concomitant relative increase in the proportion of benign nodular conditions. There is also a heightened awareness that secondary thyroid neoplasms may occur in children surviving primary malignant diseases. Records of 38 children treated surgically at Texas Children's Hospital between 1972 and 1984 have been reviewed to determine the incidence of benign vs. malignant pathosis and to study the role of prior irradiation or chemotherapy in the pathogenesis of thyroid disease. Benign conditions were diagnosed in 27 children (71%), with diffuse hyperplasia (10 children, 26%) and follicular adenoma (8 children, 21%) occurring most frequently. Thyroid carcinoma was diagnosed in the remaining 11 children (29%). All of these patients were euthyroid at presentation, none had received multimodal therapy for a prior malignant condition, and only one had a history of head and neck irradiation in infancy for a treatment of a benign condition (a congenital hemangioma). The clinical presentation, diagnostic evaluation, and surgical management of these patients are reviewed and closely parallel those of patients in other recently published series. No conclusions can be drawn regarding the development of thyroid neoplasia following multimodal therapy for primary disease; however, this incidence must be very low.
Fluorescein elimination as a measure of island flap perfusion
Authors: Denneny James C. , Weisman Robert A. , Silverman David G. , Brousseau David A.
Published: November 2015

The fluorescein test has been used as a means of assessing flap viability for almost 40 years. This study was performed in an attempt to determine if recording of the elirnination of dye—combined with dye uptake measurement—could provide reliable and consistent monitoring of island flap perfusion.
A Technique to Model the Nasal Airway for Aerodynamic Study
Authors: Levine Samuel C. , Levine Howard , Jacobs Gordon , Kasick Jerry
Published: November 2015

This article presents a new technique for creation of a model that can be used to study the aerodynamics of the nasal airway. The model is employed to determine parameters used to calculate nasal resistance and modified to compare various types of nasal obstruction. It quantitatively compares the importance of septal deviation, turbinate size, and nasopharyngeal port size to airflow. A new parameter of nasal resistance is introduced.
Neck Node Immunoreactivity in Head and Neck Carcinoma
Authors: Mandell‐Brown Mark , Johnson Jonas T. , Rabin Bruce S. , Hamill Ellen , Wagner Robin L.
Published: November 2015

T‐lymphocyte subpopulations were quantitated in lymph nodes that contained metastatic tumor—or no metastasis—from patients who had squamous cell carcinoma of the upper aerodigestive tract. In addition, the lymphocyte subpopulations in peripheral blood were quantitated. The content of prostaglandin E2 within each node that was evaluated was also determined. Lymph nodes containing metastatic tumor had significantly higher helper/suppressor ratio than lymph nodes that were not involved. Quantification of the T‐lymphocyte subpopulations in peripheral blood did not indicate the presence of metastatic disease. Significantly more prostaglandin E2 was present in lymph nodes containing metastatic disease, in comparison to lymph nodes without metastatic disease. Thus, both the lymphocyte subpopulations and prostaglandin levels were found to differentiate lymph nodes with metastasis from those without.
Treatment of Vascular Lesions with a CW Yellow Dye Laser—Initial Trials
Authors: Keller Gregory S. , Doiron Daniel R. , Keller Richard S.
Published: November 2015

Thirteen patients with vascular lesions were treated with a CW yellow dye laser. Most of these patients were either poor candidates for argon laser treatment (ALT) or had undergone unsuccessful argon laser treatment. Twelve patients responded with a “desirable”1,2 treatment result. One patient did not respond adequately to have his result classified as “desirable,” though all patients experienced fading of their lesions. None of the patients experienced scarring, epidermal thinning, or hypopigmentation. This lack of complications, associated with an incidence of desirable results in twelve of the thirteen patients, is noteworthy because all but one of the patients with port‐wine stain had difficult‐to‐treat lesions whose treatment is not attempted by many ALT centers. We believe that yellow light has certain advantages over blue‐green argon laser light for the treatment of vascular lesions and think that further study is warranted.
Vertical Nystagmus in Routine Caloric Testing
Authors: Barber Hugh O. , Stoyanoff Susan
Published: November 2015

Vertical nystagmus may occur in caloric testing when only horizontal is expected. We examined this occurrence in 112 normal subjects and in 339 patients with dizziness. Vertical nystagmus was found in 29 percent of normals and in 12 percent of patients with dizziness, more often with hot than cool caloric stimuli and it is always accompanied by horizontal nystagmus. The finding occurred with peripheral and central nervous system diagnoses as well as with patients whose dizziness was considered psychogenic or was undiagnosed. Maximum slow component velocity (SCV) of vertical nystagmus was usually half or less than that of the nystagmus in the horizontal lead. The SCV time profiles of the nystagmus in horizontal and vertical leads differed considerably. Possible origins of vertical nystagmus are discussed. Whatever the origin, it is clear that the finding of vertical nystagmus in routine caloric testing does not automatically denote disease of the central nervous system.
Primary Reconstruction of Palatal Defects
Authors: Shapiro Barry M. , Komisar Arnold , Silver Carl , Strauch Berish
Published: November 2015

Removal of the soft palate can cause marked functional deficit in deglutition and phonation. Most commonly, treatment of this deformity with prosthetic obturation has been less than ideal. Numerous reconstructive techniques have met with only partial success, while deforming distant structures. We will present a technique of reconstruction of the soft palate by use of a superiorly based pharyngeal flap. It has been used successfully in five patients who underwent soft palatectomy for malignant disease. The flaps have been the full width of the pharynx and extended down to the esophageal inlet. Viability of the flap is excellent, and the donor site is allowed to heal by secondary intention. Excellent function has been achieved in all cases with no compromise of oncological principles.
Study of Pursuit and Vestibulo‐Ocular Cancellation
Authors: Mai M. , Dayal V.S. , Tomlinson R.D. , Farkashidy J.
Published: November 2015

This present study, a follow‐up of our earlier investigation, further examines the time courses of recovery of oculomotor and vestibular function while patients are under the sedative effect of a single dose of secobarbital (Seconal). The assessment included tests for saccade and smooth pursuit, and the vestibulo‐ocular reflex and its cancellation, as evaluated by sinusoidal and pseudorandom rotation in a high‐frequency hydraulic chair (up to 5 Hz). Analysis of results showed that the vestibulo‐ocular reflex (VOR) gain, depressed soon after drug intake, recovered substantially after a few hours. Changes in VOR gain were more pronounced with higher frequencies of rotation at 2 and 3 Hz, and greater with pseudorandom than sinusoidal stimulation. Under barbiturate influence, pursuit and VOR cancellation followed distinctly different time courses of recovery. This dissociation between VOR cancellation and pursuit supports the theory that these two systems are subserved by different mechanisms. Saccadic hypermetria was also observed after drug intake.
The Treatment of Acoustic Neuroma and Meniere's Disease in the Same Patient
Authors: McDaniel Alan B. , Silverstein Herbert
Published: November 2015

Although total excision is accepted as the standard of care in the treatment of acoustic neuromas, for the elderly patient this approach is modified. Small tumors which cause only eighth nerve symptoms of hearing loss and tinnitus can be followed radiologically while larger tumors with brain stem compression may be subtotally excised through the translabyrinthine route. Our standard treatment for Meniere's disease—that is re‐factory to medical management—has been vestibular nerve section through a retro‐labyrinthine approach. In the event of bilateral Meniere's disease or Meniere's disease in an only hearing ear, treatment with low‐dose intramuscular injections of streptomycin sulfate is preferred. Two elderly patients are discussed, each of whom has an acoustic neuroma in one ear and Meniere's disease in the other. These patients' histories, diagnostic evaluations, treatment rationale, and follow‐up data are presented to illustrate the decision‐making process and the management of complicated and unusual cases.
Malignant Tumors of the Middle Ear and External Auditory Canal: A 20‐Year Review
Authors: Lesser Raymond W. , Spector Gershon J. , Devineni Venkata R.
Published: November 2015

Twenty‐four patients with malignant tumors of the external auditory canal and middle ear, originally seen between 1960 and 1980, were reviewed retrospectively. Seventeen patients had epidermoid carcinoma, one had adenocarcinoma, three had rhabdomyosarcoma, and one had osteosarcoma. At presentation, four had disease confined to the external auditory canal, three had superficial invasion of the bony canal, four had deeply invasive disease, and thirteen had disease that extended beyond the temporal bone. Treatment consisted of radiation, surgery, and combination therapy. Four patients with osteosarcoma or rhabdomyosarcoma received adjuvant chemotherapy. Five years after therapy, one of four patients with external auditory canal tumor died of disease, and two died of intercurrent disorders. One of three patients with superficial temporal bone invasion and two of four patients with deeply invasive tumor died of their disease; another died of intercurrent disorder. Twelve of 13 patients with tumor beyond the temporal bone died.
Airway Repair with Pedicled Composite Grafts—Clinical Experience
Authors: Lindholm Carl‐Eric , Löfgren Lennart
Published: November 2015

In particular surgical situations, part of the airway wall may have to be excised for different reasons, perhaps because of a large tumor or extensive scar tissue. The repair of large laryngotracheal defects, impossible to reconstruct with segmental resection and end‐to‐end anastomosis or to repair with existing adjacent tissue, is a challenge. A prerequisite for reconstruction of such defects is a graft composed of well‐vascularized mucosal lining and a supportive framework to keep the airway patent. A three‐stage procedure, based on the creation of an autogenous mucosal cyst, has been developed and used clinically in a series of patients. The three most recent patients who have undergone reconstruction with pedicled muscle Proplast mucosa grafts are presented. In two of the patients, large unilateral laryngeal tumors were removed and the third had a large patent tracheostoma.
Accuracy of Frozen Section Diagnosis of the Salivary Gland
Authors: Gnepp Douglas R. , Rader Willa Rae , Cramer Stewart F. , Cook Linda L. , Sciubba James
Published: November 2015

Three hundred and one salivary gland lesions (162 benign, 72 malignant, and 67 benign non‐neoplastic) of 677 cases were evaluated by use of intraoperative frozen sections by 66 pathologists. In seven patients, the diagnosis was deferred for permanent sections. In four cases (1.3%), the diagnosis at permanent section changed from one category of benign tumor to another, and in five cases (1.7%), from one category of malignant tumor to another. In four tumors, a frozen section diagnosis of benign was changed to malignant on permanent sectioning; all four involved acinic cell carcinomas. Only two tumors were incorrectly diagnosed as malignant. We conclude that diagnoses of most salivary gland lesions based on frozen section examination are reliable and accurate. However, the literature does indicate that caution should be exercised when malignant tumors are dealt with.
Microsphere Determination of Cochlear Blood Flow in Chickens
Authors: Zaluzec Daniel , Ramzy Joseph , Wotring Robert , Gray Lincoln
Published: November 2015

Chickens were injected with 9‐micron‐diameter radioactive microspheres. Cochleas were removed through the external auditory meatus, and the positions of all embedded microspheres were drawn under camera‐lucida. Constant measurements of arterial pressures and postinjection blood‐gas determinations confirmed that injections were made into normal circulatory systems. The averaged estimate of cochlear blood flow in chickens is 0.75 μl/min. Variability in these data from chickens is similar to that reported from mammals. A potentially important but puzzling observation is an inverse relationship between blood flow to the cochlea and to the brain. The ease of cochlear extraction makes chickens ideal models for study of cochlear blood flow.
The Audiologic Evaluation of Cerebellopontine Angle Tumor Suspects: A Review of Tumor and Non‐Tumor Suspects
Authors: Barrs David M. , Olsson James E.
Published: November 2015

In an initial study from January 1981 through December 1983, audiologic data were gathered on 41 patients with proven cerebellopontine angle (CPA) tumors and 82 tumor suspects who revealed no tumor on computed tomography with air cisternography of the internal auditory canal. The acoustic reflex threshold and decay, performance intensity function for phonetically balanced (PB) words, and several auditory brainstem response (ABR) variables were examined. Sensitivity, specificity, and diagnostic efficiency were calculated for each test. The ABR was better than the other tests. The interaural wave V latency difference (IT5) had a sensitivity of 100%, specificity of 80%, and diagnostic efficiency of 87%. In a subsequent study, from January 1984 to June 1985,52 patients with abnormal IT5 values were examined to determine the predictive value of a positive IT5 in detection of a CPA tumor. Nineteen of these patients had CPA tumors, for a detection rate of 36%. The high diagnostic efficiency of the ABR, coupled with the prevalence of a CPA tumor in a tumor suspect population, will translate into a yield of approximately one tumor for every three abnormal IT5 tests.
The Histologic Effect of Hypervitaminosis A on Laryngeal Cartilages
Authors: Schroeder Walter A. , Cooper Margaret H. , Friedman William H.
Published: November 2015

This study investigated the role of hypervitaminosis A on the developing larynx. Pregnant rats received a dose of 100,000 units of Vitamin A on either Day 8 or Day 11 of gestation. The hyaline laryngeal cartilages of the neonatal rats were studied. The cricoid and arytenoid cartilages appeared to be the most affected. There was a pronounced central disorganization of the structure of the cartilage, with numerous swollen lacunae devoid of chondrocytes. The thyroid cartilage was the least affected. The center of the cartilage displayed a minimal amount of disorganization, when compared to the control. The effect of hypervitaminosis A on cartilaginous tissue is discussed, as well as its possiible effect on the development of laryngeal cartilages.
Surgical Strategy in Hyperparathyroidism
Authors: Hoover Larry A. , Blacker Jonathan E. , Zuckerbraun Lionel , Lee Regina
Published: November 2015

The evaluation and surgical treatment of 39 patients with hyperparathyroidism has led to the development of a systematic strategy with excellent postoperative results. Successful planning requires an awareness of the limitations of histopathology. This strategy incorporates a knowledge of embryology, anatomy, and endocrinology, as well as the technologic advances of autotransplantation and the cryopreservation of parathyroid tissue. Our surgical procedure for exposing the parathyroid glands and our philosophy of conservative removal of enlarged tissues only are discussed.
The Folded Trapezius Flap for Through‐and‐through Cheek Defects
Authors: Guillamondegui Oscar M. , Campbell Bruce H.
Published: November 2015

A through‐and‐through defect of the cheek is a reconstructive challenge—functionally, technically, and cosmetically. The goal of reconstruction is to reliably and expediently bridge a poorly vascularized gap with healthy tissue. Since 1979, five patients have undergone folded trapezius flap reconstruction of the cheek. Despite a history of radiation In four of the five, all flaps have healed and complications have been minimal. The key to success seems to be careful attention to the venous drainage. This technique provides a one‐stage reconstruction of a difficult surgical defect.
Long‐term Hearing Preservation after Acoustic Neuroma Surgery
Authors: Rosenberg Richard A. , Cohen Noel L. , Ransohoff Joseph
Published: November 2015

The past two decades have evidenced a remarkable improvement in the capacity of otologic surgeons to treat cerebellopontine angle tumors. Advances in instrumentation because of technologic changes, coupled with better surgical training, have contributed to a highly successful rate of tumor removal. The capability to extirpate the tumor now permits the otologic surgeon to attempt simultaneous preservation of the facial and cochlear nerve functions. Just as middle ear surgery improved to the point in the 1950s that reconstruction as well as disease eradication became possible, so can surgeons now consider preservation of function of the inner ear. It is now technically feasible—in some instances—to attempt to preserve hearing in tumors of the eighth nerve. Several studies have provided evidence that the cochlear nerve can be anatomically and functionally preserved when neuromas involve either the inferior or superior vestibular nerves.1‐8 However, other studies assert that grossly intact nerves may contain microscopic islands of tumor cells intermingled with nerve fibers.9‐11 If viable tumor cells were allowed to remain behind, one would expect them to grow; this would result in loss of hearing function and tumor recurrence, as evidenced by computed tomography (CT) or magnetic resonance imaging (MRI). This article will discuss the issues of cochlear nerve preservation and tumor excision, and review our experience over the past decade.
Further Observations on the Effects of Head Position on Vertical OKN and OKAN in Normal Subjects
Authors: Leliever William C. , Correia Manning J.
Published: November 2015

Vertical optokinetic nystagmus (VOKN) and vertical optokinetic after‐nystagmus (VOKAN) were studied in three head positions (upright, lateral, and head‐hanging) in normal subjects by use of full‐field OKN stimulation. Mean vertical OKN gain asymmetry (downbeating > upbeating) was noted for the upright position at stripe velocities of 40, 50, and 60 deg/sec. In three subjects, mean VOKN gain asymmetry was eliminated in the head‐hanging position, but only slightly reduced in the lateral position. In one subject, mean gain asymmetry was reversed in the head‐hanging position. Down‐beating VOKAN (usually about 2 to 20 beats) was found in 11 of 21 subjects in the upright position, but was not generally affected by position change. Upbeating VOKAN never occurred following stripes‐down stimulation (appropriate stimulation). Inappropriately directed upbeating VOKAN did occur, however, after stripes‐up stimulation at 60 deg/sec for 2 of 21 subjects. Downbeating after‐nystagmus that was opposite to the direction of previously elicited optokinetic nystagmus (inappropriately directed after‐nystagmus), but which occurred from about 2 to 10 seconds after lights‐off, was seen in seven subjects.
Functional Assessment After Laryngotracheoplasty
Authors: Davidson Jean , Gullane Patrick , Havas Tom , Bryce D. P.
Published: November 2015

Laryngotracheal stenosis is a difficult problem to manage. Functional assessment is measured primarily on the ability to successfully decannulate the patient. In an effort to identify reliable, objective parameters for postoperative functional assessment, we present a retrospective study of 10 postlaryngotracheoplasty patients. All subjects underwent analysis with computerized tomography, translaryngeal manometry, acoustic reflection, flow volume loops (FVL). and voice analysis. Our results led us to conclude that accurate functional assessment is best provided by use of a combination of CT and spectral voice analysis.
Lack of Effect of Oral Acyclovir on Prevention of Aphthous Stomatitis
Authors: Wormser Gary P. , Mack Lynda , Lenox Theodore , Hewlett Dial , Goldfarb Johanna , Yarrish Robert L. , Reitano Michael
Published: November 2015

Aphthous stomatitis (canker sores) is a common cause of recurrent mouth ulceration. The effect of long‐term oral acyclovir therapy on aphthous stomatitis recurrences was evaluated in 44 patients who were in a double‐blind treatment trial for recurrent genital Herpes simplex infections. Twenty‐five subjects received oral acyclovir daily for one year, while 19 received the drug only during outbreaks of herpes. The number of patients who experienced recurrences of aphthous stomatitis and the frequency and duration of attacks per patient were not significantly different between groups. Furthermore, no consistent change in attack rate was observed in members of either group compared to that reported before they had entered the trial. We conclude that oral acyclovir is not effective for prevention of recurrent aphthous stomatitis in most patients.