bluuebunny/crossref_metadata_2025 huggingface dataset:
Conchal Bowl and Postauricular Flaps for Reconstruction of the External Auditory Canal
Authors: Wolfensberger Markus , Hilger Peter A. , Hilger Jerome A.
Published: November 2015

Two techniques for reconstructing the external auditory canal are presented; to our knowledge they have not been described previously. The first technique can be used for disease that does not affect the conchal bowl. The canal is reconstructed with an inferiorly based conchal bowl flap. A second inferiorly based postauricular flap, tunneled through the conchal cartilage, resurfaces the conchal bowl. The postauricular defect is closed primarily. The second technique can be used for disease affecting the conchal bowl. A posteriorly based flap that includes skin overlying the mastoid and posterior surface of the pinna is tunneled through the conchal cartilage and resurfaces the conchal bowl and external auditory canal. The defect on the posterior surface of the pinna is closed with tissue advanced from the anterior surface of the pinna at the conchal bowl‐antihelical fold junction. The remainder of the retroauricular defect is closed primarily. The advantages of these techniques over current methods are described and illustrative cases presented.
Comparison of Geometric and “Real” Surface Areas of Cochlear Electrodes
Authors: Rizer Franklin M. , Duckert Larry G. , Spelman Francis A.
Published: November 2015

The destructive potential of the electrically active electrode is believed to be related to charge density at the electrode‐tissue surface. Charge density has been calculated with the use of both geometric and electrochemical “real” values for surface area. To further assess the accuracy of surface area measurements determined by means of the previously mentioned methods, an eight‐electrode modiolar array cochlear implant was examined. Electrode surface areas were measured first electrochemically, then by means of a light microscope, and finally with the use of the scanning electron microscope. Comparison of these measurements demonstrated a high correlation between the scanning and light microscopic values. However, there was no correlation between the surface areas determined by light and scanning electron microscopy and the electrochemical measurements.
Morphology of Inner Hair Cell Stereocilia in C57BL/6J Mice as Studied by Scanning Electron Microscopy
Authors: Garfinkle Terry J. , Saunders James C.
Published: November 2015

The observation that hair cell tuning curves exhibit frequency selectivity as sharply tuned as that seen in auditory nerve fibers has prompted closer examination of the sensory hairs or stereocilia. The present study was designed to examine the morphologic organization of inner hair cell stereocilia in a mammalian species, the neonatal C57BL/6J mouse. The cochleae of mice were fixed in OSO4, dehydrated, dissected, and prepared for scanning electron microscopy. An examination of the number of stereocilia per inner hair cell revealed an orderly decrease from base to apex. Conversely, there was a 300% increase in the height of the tallest stereocilia, a 100% increase in the height of the middle row stereocilia, and a 30% increase in shortest stereocilia from base to apex. The total surface area of the stereocilia, per hair cell, was shown to increase by approximately 250% from the base to the apex of the cochlea.
Varix of the Vocal Cord in the Professional Voice User
Authors: Feder Robert J.
Published: November 2015

Singers and actors who abuse their voices may develop either polyps, nodules, contact ulcers, and/or contact granuloma. Rarely a vascular lesion consisting of a hypertrophic vessel projecting above the medial or superior mucosal surface of the vocal cord is encountered that may contain a small knucklelike deformity. Clinically this is not dissimilar in appearance to a vessel found on the anterior nasal septum that is responsible for epistaxis. When the voice is strained, these vessels can rupture, causing recurrent submucosal hemorrhages in the professional voice user. The case described is that of a well‐known actress in whom vocal abuse did not produce a submucosal hemorrhage from the varix but rather an edematous change and symptoms identical to those of a soft, early vocal cord nodule.
A Trial of Biolite Ventilation Tubes in Children: Is Further Use Warranted?
Authors: Handler Steven D. , Potsic William P. , Marsh Roger R.
Published: November 2015

A prospective controlled pilot study was undertaken in which Biolite (carbon‐coated) ventilation tubes were placed in 44 ears and a conventional silicone tube in the contralateral ear. Long‐term follow‐up of these patients has revealed little difference in the incidence of tube occlusion or early extrusion. In addition, there were several disadvantages noted with the Biolite tubes: incomplete coating of the tube (especially within the lumen), shedding of the Biolite coating over time, “tattooing” of the tympanic membrane, poor otoscopic visibility, and the higher cost of these tubes. Since the Biolite tube has no documented advantages and, actually, several disadvantages, we believe its use in the treatment of middle ear disorders should be discontinued until significant benefits are demonstrated and present deficiencies are corrected.
Airway Obstruction in Aortic Arch Anomalies
Authors: Lima Jose A , Rosenblum Barry N , Reilly James S , Pennington D. Glenn , Nouri‐Moghaddam Soraya
Published: November 2015

Tracheoesophageal compression by aortic arch anomalies is rare. Nevertheless, one must keep this entity in mind because it is associated with significant morbidity. Although it is generally agreed that the barium swallow shows when an abnormal vessel is compressing the esophagus, the literature disagrees on whether a bronchoscopy is needed in the evaluation of these patients. Not uncommonly the symptoms of airway obstruction persist after surgery resolves the anatomic defect. To provide a basis for postoperative comparison, we propose that all patients with suspected aortic arch anomalies undergo endoscopy just before their operation. A series of 26 cases of aortic arch anomalies affecting the airway, seen over a period of 29 years, is presented. A discussion of the clinical presentation, the diagnostic and bronchoscopic findings, and the results of surgical treatment are presented in addition to a brief embryologic and anatomic discussion. A case illustrating the value of preoperative and postoperative bronchoscopy is presented.
Palliation of Airway Obstruction from Tracheobronchial Malignancy: Use of the CO2 Laser Bronchoscope
Authors: Shapshay Stanley M. , Davis R. Kim , Vaughan Charles W. , Norton Martin , Strong M. Stuart , Simpson George T.
Published: November 2015

A CO2 laser rigid bronchoscope system has been used to palliate symptoms of a malignancy obstructing the tracheobronchial airway. Fifty‐nine endoscopic laser operations (34 patients) were done between 1975 and 1981. Severe dyspnea and obstructive atelectasis were the most common indications for treatment. Contraindications for treatment included extrinsic tracheobronchial compression, widespread distant metastases, rapidly progressing tumors, and highly vascular neoplasms. There were nine primary tracheal malignancies, five metastases from distant sites, and 20 primary lung cancers with tracheobronchial obstructions. Most patients were previously treated with one or more standard modalities (radiation therapy, surgery, and chemotherapy). Removal of airway obstruction was occasionally indicated prior to radiation therapy to facilitate treatment. There were seven instances of complications in this group of patients and one mortality. Most patients (23 of 34) have died from their malignancy. The best palliation was achieved in proximal (tracheal and main stem bronchial), slower growing tumors.
Practical Techniques of Office Voice Recording
Authors: Izdebski Krzysztof
Published: November 2015

Advances in restoration and preservation of voice necessitate adequate documentation of changes in patients’ voices. Magnetic sound recording currently offers the best means for such documentation, and it can be performed in an office setting. An outline of equipment needs and recording protocols is given.
Histamine‐Evoked Nasal Secretion in the Dog
Authors: Wilder William H. , McCaffrey Thomas V. , Malm Lars , Kern Eugene B.
Published: November 2015

Nasal secretory activity was measured in seven dogs in response to topical stimulation by histamine and methacholine. The methacholine response was blocked by atropine but not by chlorpheniramine. The histamine response was blocked by chlorpheniramine but not by atropine. These results suggest that there are two independent mechanisms of nasal secretion in the dog.
Effect of Chemoreceptor and Pulmonary Receptor Stimulation on Dilator Nares EMG Activity in the Dog
Authors: Blum Daniel J. , McCaffrey Thomas V.
Published: November 2015

To define the relationship between central control of upper airway muscles and respiratory muscle function, the electromyographic responses of the dilator nares muscles to stimulation of chemoreceptors and pulmonary receptors were studied in six anesthetized dogs. Only at maximal levels of hypoxia was the inspiratory activity of the dilator nares significantly increased. Hypercapnic stimulation increased the inspiratory activity with each incremental increase in CO2. Pulmonary stretch receptor stimulation produced by lung inflation inhibited dilator nares activity. Pulmonary irritant receptor stimulation by intravenously administered histamine increased dilator nares activity, as did pulmonary J receptor stimulation by the intravenous administration of capsaicin.
Hearing Preservation in Patients with Acoustic Neuromas via the Middle Fossa Approach
Authors: Wade Patrick J. , House William
Published: November 2015

Twenty patients with acoustic neuromas were operated on in an attempt to preserve hearing. These patients were selected from a series of approximately 300 patients seen from May 1975 to March 1979. All patients were operated on via the middle fossa approach. Hearing was preserved in approximately 35% of the patients. Preoperative and postoperative audiograms were performed on all patients. Tumor size ranged from 5 to 15 mm. These current cases are compared and added to our previous series of 17 cases (10 with hearing preserved) from a series of 500 acoustic neuromas reported elsewhere. Selection of patients, audiogram results, details of the middle fossa procedure, and work by other investigators are discussed.
Middle Fossa Vestibular Neurectomy: An Update
Authors: Glasscock Michael E. , Kveton John F. , Christiansen Sidney G.
Published: November 2015

Middle fossa section of the vestibular nerve is a neurotologic skull‐base procedure that has found a successful, albeit limited, role in the surgical management of Meniere's disease. Incapacitating vertigo can be controlled in 94% of the cases, while serviceable hearing is maintained in 70%. Tinnitus and aural pressure are reduced in 60% and 80% of cases, respectively. The morbidity of this approach is similar to that of other destructive procedures of the labyrinth when careful patient selection and precise surgical technique are employed. In the incapacitated vertiginous patient with serviceable hearing, middle fossa vestibular nerve section should be considered as an alternative to other destructive procedures involving the otic capsule.
Use of Streptomycin Sulfate in the Treatment of Meniere's Disease
Authors: Silverstein Herbert , Hyman Susan M. , Feldbaum James , Silverstein David
Published: November 2015

Streptomycin sulfate has been known to be ototoxic since its use in the treatment of tuberculosis. This report describes 10 years of experience in the treatment of Meniere's disease with streptomycin. Streptomycin has been used in (1) classical Schuknecht ablation of the vestibular system in bilateral Meniere's disease; (2) classical Schuknecht ablation of the vestibular system in unilateral Meniere's disease in the only hearing ear; (3) intratympanic streptomycin in the treatment of unilateral Meniere's disease; and (4) low‐dose intramuscular streptomycin as outpatient treatment in unilateral Meniere's disease. The results of bilateral vestibular ablation were similar to Schuknecht's and others. Patients developed profound ataxia with a wide‐based gait and oscillopsia, which improved rapidly over a period of months. Approximately 30% experienced significant improvement in hearing, which usually deteriorated again after several months. All patients were relieved of vertigo. Patients with unilateral Meniere's disease in the only hearing ear responded as did the bilateral cases. Hearing in the only hearing ear was preserved in all cases. Low‐dose subototoxic streptomycin as outpatient treatment offers promise in some cases for relieving attacks of Meniere's disease while improving hearing without producing the temporary disabling effects of ataxia and oscillopsia. Streptomycin and similar drugs that may reduce the production of endolymph may eventually be the treatment of choice in Meniere's disease.
The Role of Electromyography in Clinical Laryngology
Authors: Miller Robert H. , Rosenfield David B.
Published: November 2015

Laryngeal electromyography (EMG) has been used primarily as a research tool with only limited application to clinical practice. We have performed laryngeal EMG in a clinical research setting for over 2 years and have found it a valuable adjunct in selected situations. The electrophysiology and technique of laryngeal EMG are reviewed. Laryngeal EMG is the most accurate method of determining compromise of the superior laryngeal nerve. It is valuable in evaluating patients with mechanical fixation of the vocal cords. The eventual outcome of recurrent laryngeal nerve paralysis may also be predicted in certain patients. Laryngeal EMG is safe, easy to perform, and should be considered when evaluating the patient with laryngeal dysfunction.
Interferon Therapy in Juvenile Laryngeal Papillomatosis
Authors: Lundquist Per‐G. , Haglund S. , Carlsöö B. , Strander H. , Lundgren E.
Published: November 2015

Seventeen patients with severe juvenile laryngeal papillomatosis (12 in Stockholm and five in Umeå) were treated with exogenous leukocyte interferon (IFN‐α) prepared in Helsinki and Umeå, respectively. Tumor progression occurred in all cases before treatment. During treatment tumor growth diminished in all cases, up to complete tumor disappearance. Of 17 patients, nine were cured and no longer are being treated, four exhibit no tumor growth but are still being treated, one has visible tumor but only slight growth, two still have active but diminished growth, and one, who has refused further treatment, is experiencing active tumor growth as before the start of interferon therapy. It is concluded that IFN‐α therapy in a dosage of 3 × 106 units three times a week intramuscularly can arrest papilloma growth. Further trials are needed to optimize treatment.
An Otolaryngology Surgical Coding and Reporting System
Authors: Lee Jimmy W.C. , Schaefer Steven D. , Anderson Robert G.
Published: November 2015

A computerized information‐gathering system has been developed at The University of Texas Health Science Center at Dallas for otolaryngologic head and neck surgery. Surgeons enter data on operations by answering multiple‐choice questions at computer terminals situated near the operating rooms of each hospital. The system's main functions are to ensure completeness in the collection of operation data, allow easy review of such data for weekly conferences, and increase availability of such information for future comprehensive analysis. The scheme for data input, the logics of classifications, and the benefits of such a system are described.
Production of Mucous Glycoproteins by Nasal Turbinates in Vitro
Authors: Patow Carl A. , Shelhamer James , Marom Zvi , Logun Carolea , Feldman Bruce , Hausfeld Jeffery , Kaliner Michael
Published: November 2015

An in vitro system of human nasal turbinate tissue culture has been developed. Nasal turbinate tissue resected during surgery for nasal obstruction is dissected free of bone, placed on absorbable gelatin sponges, and cultured with CMRL‐1066 medium containing antibiotics. Viability of explants may be demonstrated both physiologically and histologically through a period of 4 weeks. 3H‐glucosamine added to the medium is biosynthetically incorporated into mucous glycoprotein (MGP). Gel filtration column chromatography on Sephacryl S‐1000 in 6M urea in 0.005M phosphate buffer demonstrates human turbinate MGP to fractionate with 85% of the radiolabel filtered and 15% excluded by the column. The excluded MGP fractionates with globular proteins of >20 × 106 daltons, while the fractions that enter the column filter with molecular sizes of 0.4 × 106 to 20 × 106 daltons. MGP synthesized by human lung airways has comparable sizing characteristics, suggesting a similarity in upper and lower airway mucus chemistry.
Cost‐Effectiveness of Prophylactic Antibiotics in Head and Neck Surgery
Authors: Mandell‐Brown Mark , Johnson Jonas T. , Wagner Robin L.
Published: November 2015

Studies undertaken at the Eye and Ear Hospital of Pittsburgh indicate that antibiotic prophylaxis can reduce the incidence of patient morbidity. In this article we will demonstrate the effect of antibiotic prophylaxis on the economics of major head and neck surgery. One hundred and one patients were assigned to one of four treatment protocols, three of which entailed 1 day of a perioperative prophylactic antibiotic and the fourth a placebo. The study was conducted in a double‐blind, randomized fashion. Patients receiving a placebo experienced an infection rate of 78%. Patients receiving cefazolin experienced an infection rate of 33%. Ten percent of patients treated with cefoperazone or cefotaxime developed postoperative wound infection. Postoperative hospitalization averaged 17.9 days for patients who did not develop postoperative wound infection, in contrast to an average of 32.6 days for patients with postoperative wound infection. The added cost of postoperative infection justifies the added use of the newer, more expensive antibiotics in view of the reduced postoperative morbidity and postoperative hospitalization.
In Vitro Sensitivity and Resistance of Cultured Human Squamous Carcinoma Cells to Cis‐Platinum and Methotrexate
Authors: Spiegel Joseph , Carey Thomas E. , Shimoura Steven , Krause Charles J.
Published: November 2015

To determine whether resistance to chemotherapy in advanced head and neck squamous cell carcinoma stems from biochemical mechanisms and to assess the potential usefulness of new anticarcinogens, an in vitro test would be highly desirable. In the past 4 years our laboratory has developed methodology to establish squamous carcinoma cell lines in tissue culture from patients with squamous cancer of the head and neck. We used some of these lines to compare the in vitro effects of methotrexate on squamous carcinoma, fibrosarcoma, and melanoma cells. Three of the squamous carcinoma lines were tested for sensitivity to both methotrexate and cis‐platinum; all but one squamous carcinoma cell line exposed to methotrexate showed growth inhibition at the physiologically attainable concentration of 10−7 M. In contrast, a tenfold higher concentration was required to produce similar effects in the melanoma, while no concentration inhibited fibrosarcoma growth. Cis‐platinum showed consistent squamous carcinoma cytotoxicity in 10–5 M and 10–6 M concentrations. This approach should be useful for determining the relative sensitivity and resistance of head and neck cancers to chemotherapeutic agents in vitro.
Animal Model for Peripheral Nerve Grafting
Authors: Ellis John C. , McCaffrey Thomas V.
Published: November 2015

We propose an animal model from which it is possible to follow nerve‐muscle unit recovery after a nerve graft easily, consistently, and relatively inexpensively. The model is also compatible with subsequent histologic or histochemical analysis. We document the recovery of a group of animals after nerve grafting to demonstrate the flexibility of the model.
Psychological and Aesthetic Considerations in Outpatient Facial Plastic Surgery
Authors: Pastorek Norman J.
Published: November 2015

The surgeon, medical and nonmedical staff, and the reception, consultation, treatment, surgical, and recovery areas constitute the basic elements of the office operating room complex. In reality these elements are an inseparable dynamic unit; however, for the purpose of discussion they have been examined separately to study their particular aesthetic and nonaesthetic psychological contributions to outpatient surgery. Knowing why a patient forms certain attitudes about the doctor, the office staff, and the office or suite and having some insight into how a patient perceives these same elements are very important to the young practitioner of facial piastic surgery. It is possible that in the contemporary medical world where there are many surgeons of equal ability, success may depend on understanding these psychological aspects.
Erythromycin Ototoxicity: Analysis and Conclusions Based on 22 Case Reports
Authors: Haydon Richard C. , Thelin James W. , Davis William E.
Published: November 2015

Although the majority of patients receiving erythromycin experience no hearing loss, certain patients are susceptible. Erythromycin ototoxicity data were analyzed on 20 patients from 13 reports in the English language literature as well as on two patients from the University of Missouri–Columbia. Patients were classified with respect to age, sex, premorbid diagnosis, renal/hepatic function, type of erythromycin used, dosage, duration of therapy, and route of administration. The following auditory effects were considered: onset of symptoms, degree and configuration of hearing loss, and recovery of hearing. The factors which, when combined with the use of high‐dose erythromycin (≥2 gm/day), might place patients at risk for erythromycin ototoxicity are preexisting renal or hepatic disease, age (elderly), and perhaps being female. With knowledge of the predisposing factors and auditory effects, the clinician can more easily recognize hearing loss caused by erythromycin and properly counsel referring physicians and affected patients.
Acoustic Neuromas with Normal Pure Tone Hearing Levels
Authors: Beck Howard J. , Beatty Charles W. , Harner Stephen G. , Ilstrup Duane M.
Published: November 2015

From 1966 through 1983, 408 patients underwent primary removal of an acoustic neuroma at the Mayo Clinic. Of these, 21 had preoperative pure tone hearing levels of 25 dB hearing loss or better at 500, 1000, and 2000 Hz, which for this study was defined as normal pure tone hearing. Fourteen patients (67%) had dysequilibrium and 13 (62%) had subjective hearing impairment. Nystagmus was the most common physical finding. Five patients (23%) had completely symmetric pure tone hearing levels through all frequencies tested. The mean speech discrimination score was 90%. Mean tumor size was 2.4 cm. Brain stem evoked response audiometry was the most helpful of the special tests in the evaluation of these patients with normal pure tone hearing levels. Our results suggest that 5% of patients with acoustic neuromas have normal pure tone hearing levels. A careful history, a thorough physical examination, and an appropriate selection of tests will identify these patients.
Disposable Plastic Diapers: A Foreign Body Hazard
Authors: Johnson Charles M.
Published: November 2015

Foreign body ingestion and aspiration in children has been a serious problem, occasionally resulting in airway obstruction and death. Airway obstruction by balloons and subsequent asphyxiation is well documented. Respiratory blockage by plastic dry‐cleaning sacks has resulted in warning labels on most such materials. Two recent cases of nasal aspiration of plastic coating from a commonly used disposable diaper are compared to reports of similar occurrences documented by the U.S. Consumer Product Safety Commission. On the basis of these reports we recommend that disposable diapers be continuously covered by other clothing to prevent the child's access to the plastic. Otolaryngologists and pediatricians should be aware of the potential hazard when examining diapered children with chronic rhinorrhea or sudden respiratory distress.
Experience with the Resection of Parapharyngeal Cancers via the Infratemporal Fossa Approach
Authors: Smith Peter G. , Sharkey Daniel E.
Published: November 2015

Between 1982 and 1984, a modified Infratemporal fossa approach was used to resect cancers with extensive primary or secondary Involvement of the Infratemporal fossa and parapharynx in 10 patients. Nine patients exhibited persistent or recurrent disease of the upper aerodigestive tract and posterior cranial fossa following planned, curative‐Intent therapy; the remaining patient had a carcinoma ex‐pleomorphic adenoma of the deep lobe of the parotid gland with a significant Infratemporal fossa extension. Considered to have “unresectable” tumors, by traditional methods, 7 of the 10 patients underwent an en‐bloc resection of their lesions with tumor‐free margins. Tumor was present at the margins of the specimens in the other 3 patients. Two of the 10 patients died early in the postoperative period of medical complications. Another died 5 months postoperatively of a tumor‐Induced Internal carotid artery rupture at the level of the foramen lacerum. A fourth patient died of his disease 6 months following his resection. One patient is alive, but has metastatic meningioma 2 years after surgery. The 5 remaining patients are without evidence of disease, with a mean follow up of 2 years. Indications for and refinements of the operative technique, particularly those related to the repair of such extensive ablative defects, are outlined on the basis of this early experience.
Skull‐Base Surgery: Operative Refinements
Authors: Gulya Aina J. , Glasscock Michael E. , Jackson C. Gary , Pensak Myles L. , Harris Perry F. , Bond Arthur
Published: November 2015

Advances in microsurgical techniques, with the use of the laser and the ultrasonic suction aspirator, have paved the way for even more aggressive surgical approaches to large skull‐base lesions, such as glomus tumors, adenocarcinomas of the temporal bone, and cranial nerve neuromas. Postoperative morbidity of multiple cranial nerve dysfunction has been aggravated in the past by cerebrospinal fluid leakage and/or gastro‐intestinal dysfunction. At the Otology Group, P.C., In the course of dealing with more than 86 skull‐base tumors, we have developed a standardized, multispecialty approach to such extensive skull‐base lesions, including tracheotomy, gastrostomy, “ventriculoatrial” shunt placement, and rotated temporalis muscle flap closure. This article presents cases that Illustrate the evolution of the current, “standard skull‐base” operative procedure and the rationale for incorporation of the shunt and the muscle flap closure as operative refinements. Their beneficial effects upon postoperative morbidity are detailed.
Clinical Evaluation of a New Nonelectronic All‐in‐the‐Ear Hearing Device for Mild Hearing Loss
Authors: Goode Richard L. , O'Keefe Richard , Homan Debra , Hosford‐Dunn Holly , Wood Melissa
Published: November 2015

A new, nonelectronic hearing aid was studied in 112 patients with mild sloping sensorineural hearing loss. The device, worn all in the ear and made of clear plastic, produced a mean functional gain of 9.6 dB at 1500 Hz, 12.4 dB at 1750 Hz, and 9.1 dB at 2000 Hz, with lesser gains at adjacent frequencies between 1000 and 2500 Hz. Speech discrimination in quiet and in noise was improved. Patient acceptance of the device (in a group of 884 patients) was 76%. The device appears to be useful in the treatment of mild hearing loss.
Medical Treatment of Chronic Otitis Media with Effusion (Secretory Otitis Media)
Authors: Gates George A. , Wachtendorf Christine , Holt G. Richard , Hearne Erwin M.
Published: November 2015

To determine whether antimicrobial therapy is of value in the treatment of chronic otitis media with effusion (secretory otitis media), we treated 1,429 4‐ to 8‐year‐old children—2224 affected ears—with a fixed regimen of an antibiotic mixture (Pediazole) for 10 days and a decongestant (Novated) for 30 days. We observed the children monthly to determine the rate of clearance. Validity of diagnosis was greater than 90% with an algorithm of pneumatic otoscopy and tympanometry. Medication compliance was not measured. At 1 month, 45% of the children (48% of the ears) had cleared and at 2 months, 60% of the children (63% of the ears) had cleared. Factors such as sex and prior treatment in the preceding 3 months were no different in the cured vs. the uncured groups. Age significantly Influenced the cure rate (P < 0.0001); the older the child, the higher the clearance rate. Tympanograms type 5, 8, and 12–14 were significantly more prevalent in the uncleared group (P = 0.0001). The clear rate for unilateral cases was 76% and for bilateral cases, 47% (P < 0.0001). Children with chronic otitis media with effusion are most likely to be cured by medical therapy/time if they are older, have unilateral disease, or a peaked tympanogram. Surgery should be withheld in these children for 2 or more months to permit the highest rate of spontaneous resolution.
Bronchoscopic Laser Surgery: Which Laser when and why
Authors: Ossoff Robert H.
Published: November 2015

The use of the carbon dioxide (CO2) and neodymium:yttrium aluminum garnet (Nd:YAG) lasers for the endoscopic management of patients with diseases of the tracheobronchial tree is discussed. Advantages and disadvantages of each wavelength are presented. It would appear that there should be unique indications for both of these laser systems; however, each can be used relatively safely and interchangeably if certain precautions are followed.
Sleep Parameters after Surgery for Obstructive Sleep Apnea
Authors: Blakley Brian W. , Maisel Robert H. , Mahowald Mark , Ettinger Milton
Published: November 2015

Obstructive sleep apnea (OSA) is a disorder that is frequently treated surgically. Few reports in the literature give objective reports of the effect of such treatment on polysomnographic parameters before and after treatment, although symptomatic improvement is common. This article reviews total sleep time (TST) spent in apnea, number of apneic episodes per hour or sleep apnea index (SAI), and oxygen desaturations in such patients treated with tracheostomy, uvulopalatopharyngoplasty (UPP), and combinations of these. Although improvement is noted in these parameters after UPP, this is not as impressive as some reports in the literature indicate. Our suggested indications for this type of surgery are discussed.
The Effect of Sterile Inflammation on Skin Flap Survival
Authors: Gaughan Rebecca N. , Otto Randal A. , Renner Gregory J. , Templer Jerry W. , Davis William E.
Published: November 2015

Several investigations have suggested that a sterile inflammatory reaction in a skin flap enhances flap survival. A chemical peel produces a mild chemical burn, which is one form of nonbacterial inflammatory response. Some authors advocate the concomitant use of face lift and chemical peel, while others caution that the peel might jeopardize the facial flaps. To determine whether the reaction caused by a chemical peel enhances or impairs skin flap survival, a study using miniature pigs was undertaken. Survival length of flaps treated with a chemical peel was compared to that of untreated flaps. A total of 36 dorsally based random flaps were used on three miniature pigs. Six identical 14 × 4 cm flaps were designed on each side of the pigs. A chemical peel was applied to the area of 18 of the proposed flaps 2 days prior to elevation. Alternate flaps on each side of the pigs were treated. As the flaps were elevated, the tips were examined to document the inflammatory response histologically. After 14 days, the surviving length of the flaps was measured. As determined by the Wilcoxon matched‐pairs signed‐ranks test, there was no significant difference between the treated and untreated groups. Our study shows that a nonbacterial inflammatory response produced by a chemical peel does not improve skin flap survival, at least not in pigs.
OculopharyngeaL muscular dystrophy: Clinical and histopathologic correlations
Authors: Dobrowski John M. , Zajtchuk Joan T. , Lapiana Francis G. , Hensley Samuel D.
Published: November 2015

Oculopharyngeal muscular dystrophy is an autosomal dominant myopathy that exhibits the symptoms of progressive dysphagia, with ptosis usually occurring after the age of 40. Literature review of this rare disease reveals a high incidence in the French‐Canadian population, as well as in five other ethnic groups. Our article details the clinical history and genealogy of the disease through four generations in a family of English descent. Radiographic studies show a cricopharyngeal bar and aspiration. Results of electron microscopic examination of muscle biopsy specimens from the vastus lateralis and cricopharyngeus muscles confirm a chronic, active, severe, myopathic process that is more pronounced in the cricopharyngeus muscle. The recommended treatment for blepharoptosis and the cricopharyngeus muscle pathosis is discussed.
Drug‐Induced Alterations in Cochlear Blood Flow as Recorded by the Laser Doppler Flowmeter
Authors: Ernster Joel A. , Meyers Arlen D.
Published: November 2015

A number of clinical entities may result from a decrease in inner ear blood flow. Investigators have attempted to determine a relationship between decreased blood flow and such entities. In this article, we shall relate the effects of administration of drugs in animal models on cochlear blood flow, using the laser Doppler flowmeter.
Safely precautions for bronchoscopic co2 laser surgery
Authors: Duncavage James A. , Ossoff Robert H.
Published: November 2015

Certain safety precautions are necessary in the performance of CO2 laser bronchoscopy. These include special instrumentation and careful selection of patients. Assessment of tumor vascularity is mandatory because of the limited hemostasis provided by the CO2 laser. The x‐ray film evaluation of the integrity of the tracheobronchial tree—for treatment that involves the palliation of obstructing malignant lesions—is outlined.
Routine use of Office Endoscopy in Otolaryngology
Authors: Selkin Stuart G.
Published: November 2015

A skilled endoscopist using a flexible fiberoptic nasopharyngolaryngoscope can complete a thorough examination of the upper aerodigestive tract in less time than it takes to heat up a laryngeal mirror. The examination is accomplished with only minimal discomfort for the majority of patients. Consistently clear photographs may be made of the physical findings. The yield, in terms of disease demonstrated and documented, well justifies the routine use of the flexible fiberoptic nasopharyngolaryngoscope on virtually every patient seen for otolaryngologic evaluation. I shall present sixteen examples of pathosis of the upper aerodigestive tract that were overlooked by the traditional means of otolaryngologic examination. All were discovered by the “routine” use of flexible fiberoptic endoscopy. Seven malignant conditions are included.
Staple Closure of the Gullet after Laryngectomy: An Experimental Study
Authors: Sessions Roy B. , Shemen Larry J. , Reuter Victor E.
Published: November 2015

Traditionally, gullet closure that is done after a laryngectomy has been accomplished with tedious and time‐consuming suturing procedures. As an alternative to this, staple closure of the gullet has been growing in acceptance and implementation as a mucosal eversion technique. In this article, we shall present several aspects and considerations of this method of surgical closure.
Antibiotic Prophylaxis in High‐Risk Head and Neck Surgery: One‐Day vs. Five‐Day Therapy
Authors: Johnson Jonas T. , Schuller David E. , Silver Fred , Gluckman Jack L. , Newman Richard K. , Shagets Frank W. , Snyderman Nancy L. , Leipzig Bruce , Wagner Robin L.
Published: November 2015

Patients who undergo major contaminated surgery of the head and neck benefit from perioperative antibiotic prophylaxis. This study was developed to determine if 5 days of antibiotic administration would be more effective than 1 day. A multi‐institutional prospective randomized double‐blind study was designed. Patients who were identified as requiring pedicled flap reconstruction were potential candidates for the study. Later, patients were randomly assigned to receive cefoperazone sodium for either 24 hours or 120 hours. In each case, the drug was administered intravenously, beginning 1 to 2 hours preoperatively and continued for the prescribed period. One hundred nine patients were evaluable. Fifty‐three patients were assigned to 1 day of perioperative prophylaxis. Wound Infection developed in ten patients (18.9%). Fifty‐six patients were assigned to 5 days of perioperative antibiotic prophylaxis. Wound infection developed in 14 (25%) of these patients (P >.05). These data suggest that no beneficial effect from administration of antibiotics for longer than 24 hours postoperatively can be achieved in patients who undergo myocutaneous flap reconstruction.
A Free Radical Scavenger Reduces Hematoma‐Induced Flap Necrosis in Fischer Rats
Authors: Angel Michael F. , Haddad Joseph , Abramson Maxwell
Published: November 2015

Free radicals have been shown to play an important role in hematoma‐induced flap necrosis. The present study investigated the effect of deferoxamine, a free radical scavenger and iron chelator, on flap necrosis. A 4×2 cm dorsal flap was raised in Fischer inbred rats, and 3 cc of blood from inbred donors was instilled beneath the flap. Saline‐treated control animals (Group 1) were compared with two experimental groups. In Group 2, deferoxamine 150 mg/kg was administered 15 minutes before surgery and every 8 hours for 5 days. In Group 3, deferoxamine was given every 8 hours for 3 days before surgery and every 8 hours for 5 days postoperatively. Flap necrosis was assessed on postoperative day 5. Group 2 had significantly less necrosis, 18.6%, than the control group, 64.0% (p <0.001). Group 3, with 36.0% necrosis, also showed improvement (p <0.05). Group 2 and Group 3 were not significantly different. Deferoxamine, a safe and well‐tolerated free radical scavenger, greatly enhanced flap survival, presumably by the neutralization of damaging free radical species and by Chelation of iron.
Otolaryngologic Features of Craniometaphyseal Dysplasia
Authors: Kletzker G. Robert , Smith Peter G. , Killeen Thomas E.
Published: November 2015

Craniometaphyseal dysplasia, one of several rare familial systemic bone disorders of the osteopetrosis bone‐disease group, is characterized by abnormal bony thickening of the skull and multiple cranial neuropathies. Hearing loss, commonly of a mixed type, is the usual symptom presented to the otolaryngologist—head and neck surgeon; however, recurring facial paralysis, blindness, and atypical fades may also be noted. A case of bilateral facial nerve dysfunction in a neonate, the offspring of a thoroughly studied kindred with known craniometaphyseal dysplasia, Is presented. The clinical and radiographic features of the disorder are discussed, including an outline of the operative management of facial paralysis.
Carotid Artery Vasospasm Complicating Extensive Skull Base Surgery: Cause, Prevention, and Management
Authors: Smith Peter G. , Killeen Thomas E.
Published: November 2015

Arterial spasm is rarely encountered in the uncomplicated cervical lymphadenectomy. Intense, often dramatic, vasospasm of the internal carotid artery, however, is not infrequently observed in the removal of skull‐base lesions. This myogenic reaction is independent of autonomic innervation, occurs more frequently in younger patients, and appears to be due mainly to longitudinal arterial traction and prolonged arterial contact with fresh blood. A case of severe internal carotid artery spasm, which led to a fatal stroke in a young woman who underwent removal of a large glomus jugulare tumor, is presented to emphasize not only the lethal potential of carotid spasm, but intraoperative changes in the character of the artery which suggest the need for immediate spasmolysis. Perioperative guidelines for the prevention and treatment of arterial spasm—including topical and systemic pharmacotherapy and refined surgical techniques—are outlined on the basis of our subsequent experience.
Nasal Spine Suspension for Reduction and Immobilization of Mandibular Fractures
Authors: Renner Gregory , Davis William E. , Templer Jerry
Published: November 2015

Successful treatment of mandibular fractures involves proper fracture reduction and immobilization for an adequate length of time. A simple wire fixation technique that can be used in many situations involves suspension wiring from the base of the anterior nasal spine to a pair of circummandibular wires. The technique may be used alone or adjunctively with other methods of fixation. It offers several advantages over other methods, particularly in the treatment of pediatric mandibular fractures.
Surgical Treatment of the “Marginal Mandibular Lip” Deformity
Authors: Glenn Michael G. , Goode Richard L.
Published: November 2015

Unilateral permanent paralysis of the lower lip after section or compression of the marginal mandibular branch of the facial nerve is not rare. It may occur after trauma or as a result of parotid, ear, or upper neck surgery. Surgical treatment of the deformity—which we term the marginal mandibular lip—is indicated to improve cosmesis and restore oral competence during eating and speech. We describe our experience with partial resection of the paralyzed lower lip as an effective yet simple method of surgical correction. We also review the alternate methods of treatment for comparison.
Emergency Endotracheal Intubation under Fiberoptic Endoscopic Guidance for Malignant Laryngeal Obstruction
Authors: Wei W.I. , Siu K.F. , Lau W.F. , Lam K.H.
Published: November 2015

Endotracheal intubation under fiberoptic flexible scope guidance is an easy technique to master and can be performed under local anesthesia. It provides immediate and safe intubation of malignant obstructive lesions of the larynx and allows surgical resection and reconstruction to be carried out as an emergency procedure. Ten patients with malignant obstructive lesion of the larynx were intubated and managed successfully in this manner. Refinements of intubation techniques under fiberoptic endoscopic guidance were described.
The Tullio Phenomenon and Perilymph Fistula
Authors: Fox Eileen J. , Balkany Thomas J. , Arenberg Kaufman
Published: November 2015

Establishing the diagnosis of perilymph fistula remains a dilemma. At this time, identification of an active perilymph fistula can be confirmed only by surgery. On the basis of clinical history and audiovestibular testing, 54 patients underwent middle ear exploration for possible perilymph fistula at the Colorado Ear Clinic between July 1980 and June 1986. This group represents approximately 1% of all surgical procedures performed during that period. Seven patients (12%) were found to have the Tullio phenomenon preoperatively. Six of these were found to have active, free‐flowing fistulas at the time of exploration. The presence of a Tullio phenomenon may be helpful in preoperative assessment of a patient with suspected perilymph fistula.
Delayed Onset Post‐Tympanotomy Otorrhea
Authors: Gates George A. , Avery Christine , Prihoda Thomas J. , Holt G. Richard
Published: November 2015

Otorrhea is the most frequent complication of the use of tympanostomy tubes. When it occurs after the immediate postoperative period, otorrhea is probably the result of external contamination of the middle ear or acute otitis media. We analyzed data from 627 operations upon 1248 ears of 491 children with chronic secretory otitis media and found that delayed onset (longer than 7 weeks) postoperative otorrhea occurred after 26.4 percent of the 382 operations in which tympanostomy tubes were used. The average number of episodes of otorrhea per case was 1.46 and ranged from 1 to 9. The rate of otorrhea occurrence in patients with tubes in place was significantly higher in the summer months. Otorrhea also occurred after 9.0 percent of 245 myringotomy procedures. The average number of episodes was 1.32 and ranged from 1 to 3. Treatment of postoperative otorrhea increases the health care costs of surgical treatment of chronic otitis media with effusion; this problem should be included in the calculation of cost‐effectiveness.
Facial Nerve Evoked Potentials in the Cat
Authors: Metson Ralph
Published: November 2015

Electrophysiologic facial nerve testing usually involves stimulation of the peripheral nerve in order to make some indirect inference about nerve integrity at a more proximal site of lesion. In an attempt to develop a test of facial nerve function by use of across‐the‐lesion testing, the cat facial nerve was stimulated percutaneously at the stylomastold foramen while retrograde activity through the temporal bone and cranium was monitored with scalp electrodes. A biphasic evoked potential could be identified within 3 milliseconds of stimulation with the use of a signal‐averaging computer. This potential remained when the animal was paralyzed and disappeared when the facial nerve was cut proximal to the stimulation site. A potential of similar latency and duration but larger amplitude was recorded from the subarachnold space. Mapping studies indicated its origin to be a dipole located between ipsilateral mastoid and parietal recording sites that corresponded to the region of the intracranial facial nerve. Optimal stimulation and recording techniques for subsequent studies of human beings are discussed.
Vertigo in the Hyperviscosity Syndrome
Authors: Andrews James C. , Hoover Larry A. , Lee Regina S. , Honrubia Vicente
Published: November 2015

Diseases that cause hyperviscosity of the blood can result in otologic symptoms—especially vertigo. These symptoms are predominantly produced by peripheral vestibular involvement. The pathophysiology probably involves vascular obstruction in the venules. Specific changes in the microvasculature are presumed to be comparable to those that occur with hyperviscosity disorders in the retina. Maintenance of a normal blood viscosity will prevent damage to the ear, as well as other organs. Additionally, reduction of the blood viscosity can greatly improve otologic symptoms. Case studies and a review of the pertinent literature are included.
The Role of Radiation Therapy in the Management of Catecholamine‐Secreting Glomus Tumors
Authors: Schwaber Mitchell K. , Gussack Gerald S. , Kirkpatrick Wanda
Published: November 2015

The major source of controversy that surrounds the use of radiation for glomus tumors is the finding of persistent chief cells years after completion of the treatment. Questions have been raised as to the viability of the irradiated chief cell and its capacity to proliferate. The radiotherapists consider a stable glomus tumor a radiation “cure,” whereas skull base surgeons are fearful that these lesions will continue to slowly grow and cause problems 20 to 30 years later. We have recently managed a patient who was not a candidate for surgery, with a catecholamine‐secreting glomus jugulare tumor. after 4750 rad of radiation therapy, no changes in tumor size or in catecholamine secretion have been observed (at 20 months of followup). The implications of the case are discussed.