bluuebunny/crossref_metadata_2025 huggingface dataset:
Groningen Dilatation Tracheoscope in Treatment of Moderate Subglottic and Tracheal Stenosis
Authors: Halmos György B. , van der Laan Bernard F. A. M. , Dikkers Frederik G.
Published: October 2014

Objectives:

We describe our experience with the Groningen Dilatation Tracheoscope (Karl Storz GmbH & Co, Tuttlingen, Germany) in treating benign subglottic and tracheal stenosis.

Methods:

We performed a retrospective survey from a medical record analysis of 26 patients with different origins of benign, grade II (Myer-Cotton) subglottic or tracheal stenosis. All patients underwent dilatation tracheoscopy for a total of 64 times (average, 2.46 operations per patient). Five patients had to undergo subsequent operations. Patient data (sex, age at intervention, underlying and other systemic diseases) and operation data (course, intraoperative and postoperative adverse events) were recorded. Analysis of the measured preoperative and postoperative peak flow values was performed.

Results:

The average predilatation and postdilatation peak flow values were 225 L/min and 331 L/min, respectively Eighty percent of the patients (21 of 26) were successfully treated with 1 or more dilatation tracheoscopy interventions without supplementary treatment for the stenosis. There is only 1 tracheal cannula–dependent patient in the examined population, making the overall success rate of our treatment 96%. No major intraoperative or postoperative complications were recorded.

Conclusions:

Dilatation tracheoscopy is a simple, relatively safe, and effective method in the treatment of benign subglottic or tracheal stenosis of various origins. The intervention is minimally invasive and is easily repeatable in case of restenosis.
Laryngopharyngeal Reflux with Sore Throat: An Ultrastructural Study of Oropharyngeal Epithelium
Authors: Amin Sameh M. , Maged Khaled H. Abdel , Naser Ashraf Y. , Aly Balegh H.
Published: October 2014

Objectives:

We performed an electron microscopic ultrastructural study of oropharyngeal epithelium in patients with laryngopharyngeal reflux (LPR) and sore throat to evaluate whether dilatation of intercellular spaces could be traced at this level.

Methods:

The study included 20 patients with LPR and sore throat and 5 control subjects. The patients were subjected to upper gastrointestinal tract endoscopy and flexible pharyngolaryngoscopy. Oropharyngeal biopsy specimens were taken from the patients and controls for ultrastructural study by transmission electron microscopy.

Results:

The entire group of patients with LPR showed dilatation of intercellular spaces essentially at the squamous basal and suprabasal levels in their oropharyngeal biopsy specimens, whereas none of the control subjects showed such a morphological marker.

Conclusions:

Dilatation of intercellular spaces as a morphological marker can be traced in patients with LPR and sore throat at the level of the oropharynx. This contributes to a better understanding of the pathophysiology of LPR. If this finding is confirmed in a large series, it will represent a cost-effective, relatively noninvasive method for diagnosis of LPR.
Bacteremia during Adenoidectomy: A Comparison of Suction Diathermy Adenoid Ablation and Adenoid Curettage
Authors: Casserly Paula , Kieran Stephen , Phelan Eimear , Smyth Edmond , Lacy Peter
Published: October 2014

Objectives:

Transient bacteremia is induced by adenoidectomy when the integrity of the nasopharyngeal membrane is broken. The aim of this study was to determine the incidence of bacteremia in patients undergoing adenoidectomy, to identify the causative organisms, and to compare the incidences of bacteremia between the two techniques suction diathermy and curettage.

Methods:

A prospective single-blind randomized trial was performed. Sixty-four patients between the ages of 2 and 13 years who were undergoing adenoidectomy were included in the study. Exclusion criteria included antimicrobial therapy in the immediate preoperative period and concurrent respiratory tract infection or pyrexia. Patients were randomized in the anesthetic room to either suction diathermy or curettage. Venous blood samples for culture were obtained 30 seconds after the procedure began (intraoperative sample) and 2 minutes after removal of the adenoid tissue (postoperative sample). Postoperative complications were recorded, and all patients were followed in the outpatient department.

Results:

Twenty-six patients underwent adenoidectomy by suction diathermy, and 38 underwent adenoidectomy by curettage. In the suction diathermy group, 38.5% of intraoperative and 19.2% of postoperative blood cultures had a positive result for bacteremia. In the curettage group, 31.6% of intraoperative and 23.6% of postoperative blood cultures had a positive result for bacteremia. There was no significant difference between the two groups. The techniques were equivalent in terms of postoperative complications. Gram-positive cocci were the most commonly isolated organisms.

Conclusions:

A transient bacteremia exists after pediatric adenoidectomy, but does not correlate with symptoms or signs. Neither suction diathermy adenoidectomy nor curettage adenoidectomy offers a particular advantage in terms of decreasing the incidence of bacteremia.
Cochlear Implantation in Children with Congenital X-Linked Deafness Due to Novel Mutations in POU3F4 Gene
Authors: Stankovic Konstantina M. , Hennessey Ann Marie , Herrmann Barbara , Mankarious Leila A.
Published: October 2014

Objectives:

We report novel mutations in the POU3F4 gene resulting in congenital X-linked deafness DFN3, and describe the results of cochlear implantation in 4 boys (3 siblings) followed for an average of 3.5 years.

Methods:

The diagnosis of DFN3 was made in infant boys on the basis of the radiologic criteria of an underdeveloped modiolus, a wide cochlear fossette, and the presence of all cochlear turns. The POU3F4 gene was sequenced. A standard, transmastoid, facial recess approach was used for cochlear implantation. A lumbar drain was placed before the operation.

Results:

The identified mutations in the POU3F4 gene were novel (p.R167X in the 3 siblings) or recently reported (p.S310del). A high-flow cerebrospinal fluid leak through the cochleostomy was encountered in each patient and was ultimately controlled. Although the implants functioned properly, the auditory perceptual abilities did not progress past sound detection in the 3 siblings, or past closed-set word identification in the non-sibling, who achieved better speech perception with contralateral amplification. Three boys (2 siblings) show signs of other learning disorders; 1 boy was too young for a complete assessment.

Conclusions:

Preoperative gene mutation analysis in DFN3 patients who are considering cochlear implantation may help in long-term counseling and in avoidance of postoperative complications. Limited auditory perception and language acquisition may result. Amplification may sometimes be a better alternative than cochlear implantation, despite the severity of the hearing loss.
Initial Experience Using Propranolol as an Adjunctive Treatment in Children with Aggressive Recurrent Respiratory Papillomatosis
Authors: Maturo Stephen , Tse Sze Man , Kinane T. Bernard , Hartnick Christopher J.
Published: October 2014

We performed a retrospective chart review with a 6-month follow-up to examine the initial use of propranolol as an adjunctive treatment in children with severe recurrent respiratory papillomatosis. This is the first such report. Two of 3 children with severe recurrent respiratory papillomatosis demonstrated a response to oral propranolol therapy, as evidenced by an improved voice and by an increased time between surgical interventions. One child demonstrated no response to propranolol, and medication was halted. Both children who demonstrated a response had undergone more than 10 surgical interventions in the previous year, along with prior treatment including surgical excision and adjuvant therapy. Both children more than doubled the interval between treatments after propranolol administration, and the parents of both children noted marked improvement of the child's voice as measured by their Pediatric Voice-Related Quality of Life score (from 40 to 67.5 in one child and from 27 to 60 in the other child). No child experienced hypoglycemia or blood pressure abnormalities. We conclude that initial use of propranolol as an adjunctive measure in severe recurrent respiratory papillomatosis shows it to have some efficacy in delaying surgical intervention and improving voice. Previous reports have demonstrated relatively safe use of propranolol in children with hemangiomas. Further studies are needed to determine the long-term effectiveness, dosing strategies, and side-effect profile of propranolol for treatment of recurrent respiratory papillomatosis.
Effect of Successful Surgical Treatment on Changes of Position during Sleep in Adults with Obstructive Sleep Apnea Syndrome
Authors: Choi Ji Ho , Kim Eun Joong , Choi June , Kwon Soon Young , Lee Heung Man , Kim Tae Hoon , Lee Sang Hag , Shin Chol , Lee Seung Hoon
Published: October 2014

Objectives:

The purpose of this study was to evaluate the changes of position during sleep as determined by polysomnography before and after upper airway surgery for obstructive sleep apnea syndrome in patients with no response to surgery (“nonresponse group”) and in those who did have a response to surgery (“response group”).

Methods:

We analyzed a total of 106 polysomnograms from 53 subjects and compared the preoperative-postoperative differences in the frequency of positional changes during sleep and the distribution of sleep positions between the nonresponse group (n = 25) and the response group (n = 28). Surgical response was defined as a greater than 50% decrease in the postoperative apnea-hypopnea index.

Results:

The positional change index in the response group was significantly reduced (from 4.2 ± 3.8 to 2.6 ± 1.6; p = 0.038), whereas the positional change index in the nonresponse group did not significantly change (from 3.4 ± 2.0 to 3.4 ± 2.1; p = 0.861). The proportion of sleep time spent in the supine position did not significantly change in the nonresponse group (from 62.4% ± 18.1% to 60.5% ± 21.3%; p = 0.904) or the response group (from 55.5% ± 23.9% to 60.1% ± 23.1%; p = 0.412).

Conclusions:

The frequency of positional changes during sleep was significantly decreased with the improvement of respiratory disturbances and arousals in the response group after upper airway surgery.
Analysis of Functional and Anatomic Success following Endonasal Dacryocystorhinostomy
Authors: Zuercher Barbara , Tritten Jean-Jacques , Friedrich Jean Paul , Monnier Philippe
Published: October 2014

Objectives:

The aim of this study was to assess the concomitant perioperative procedures, the causes of nasolacrimal duct obstruction, the success rate, and the complications associated with endonasal dacryocystorhinostomy (ENDCR).

Methods:

In this single-center retrospective study, 98 patients underwent 104 ENDCRs between January 1994 and February 2006. There were 78 patients with 84 nasolacrimal duct obstructions who were included in this study.

Results:

The overall functional success rate with improvement in symptoms was 94.9% for primary surgery (59 of 84 obstructions) and 63.6% for salvage surgery after failure of primary surgery performed in another hospital (25 of 84 obstructions). The mean follow-up time was 36.8 ± 17.11 months. Primary surgery showed better results, with a complete success rate of 93.2%, than did salvage surgery, with a success rate of only 68%. Persistent symptoms, despite an open rhinostomy, were found in 1.7% of patients with primary surgery and in 12% of those with salvage surgery. Failure of ENDCR was observed in 3.4% of patients after primary surgery and in 20% after salvage surgery. We encountered only minimal perioperative complications, and these were essentially related to lacrimal intubation.

Conclusions:

Because of the possibility of treating concomitant sinonasal disorders, the cosmetic advantages, and the excellent results, ENDCR represents the procedure of choice for treating nasolacrimal duct obstructions. The main challenge lies in the exact preoperative assessment, as well as postoperative evaluation in case of failure.
Low-Acid Diet for Recalcitrant Laryngopharyngeal Reflux: Therapeutic Benefits and Their Implications
Authors: Koufman Jamie A.
Published: October 2014

Objectives:

Laryngopharyngeal reflux (LPR) is an expensive, high-prevalence disease with a high rate of medical treatment failure. In the past, it was mistakenly believed that pepsin was inactive above pH 4; however, human pepsin has been reported to be active up to pH 6.5. In addition, it has been shown by Western blot analysis that laryngeal biopsy samples from patients with symptomatic LPR have tissue-bound pepsin. The clinical impact of a low-acid diet on the therapeutic outcome in LPR has not been previously reported. To provide data on the therapeutic benefit of a strict, virtually acid-free diet on patients with recalcitrant, proton pump inhibitor (PPI)–resistant LPR, I performed a prospective study of 20 patients who had persistent LPR symptoms despite use of twice-daily PPIs and an H2-receptor antagonist at bedtime.

Methods:

The reflux symptom index (RSI) score and the reflux finding score (RFS) were determined before and after implementation of the low-acid diet, in which all foods and beverages at less than pH 5 were eliminated for a minimum 2-week period. The subjects were individually counseled, and a printed list of acceptable foods and beverages was provided.

Results:

There were 12 male and 8 female study subjects with a mean age of 54.3 years (range, 24 to 72 years). The symptoms in 19 of the 20 subjects (95%) improved, and 3 subjects became completely asymptomatic. The mean pre-diet RSI score was 14.9, and the mean post-diet RSI score was 8.6 (p = 0.020). The mean pre-diet RFS was 12.0, and the mean post-diet RFS was 8.3 (p < 0.001).

Conclusions:

A strict low-acid diet appears to have beneficial effects on the symptoms and findings of recalcitrant (PPI-resistant) LPR. Further study is needed to assess the optimal duration of dietary acid restriction and to assess the potential role of a low-acid diet as a primary treatment for LPR. This study has implications for understanding the pathogenesis, cell biology, and epidemiology of reflux disease.
Quantity and Three-Dimensional Position of the Recurrent and Superior Laryngeal Nerve Lower Motor Neurons in a Rat Model
Authors: Weissbrod Philip , Pitman Michael J. , Sharma Sansar , Bender Aaron , Schaefer Steven D.
Published: October 2014

Objectives:

We sought to elucidate the 3-dimensional position and quantify the lower motor neurons (LMNs) of the recurrent laryngeal nerve (RLN) and the superior laryngeal nerve (SLN) in a rat model. Quantification and mapping of these neurons will enhance the usefulness of the rat model in the study of reinnervation following trauma to these nerves.

Methods:

Female Sprague-Dawley rats underwent microsurgical transection of the RLN, the SLN, or both the RLN and SLN or sham surgery. After transection, either Fluoro-Ruby (FR) or Fluoro-Gold (FG) was applied to the proximal nerve stumps. The brain stems were harvested, sectioned, and examined for fluorolabeling. The LMNs were quantified, and their 3-dimensional position within the nucleus ambiguus was mapped.

Results:

Labeling of the RLN was consistent regardless of the labeling agent used. A mean of 243 LMNs was documented for the RLN. The SLN labeling with FR was consistent and showed a mean of 117 LMNs; however, FG proved to be highly variable in labeling the SLN. The SLN LMNs lie rostral and ventral to those of the RLN. In the sham surgical condition, FG was noted to contaminate adjacent tissues — In particular, in the region of the SLN.

Conclusions:

Fluorolabeling is an effective tool to locate and quantify the LMNs of the RLN and SLN. The LMN positions and counts were consistent when FR was used in labeling of either the RLN or the SLN. Fluoro-Gold, however, because of its tendency to contaminate surrounding structures, can only be used to label the RLN. Also, as previously reported, the SLN LMNs lie rostral and ventral to those of the RLN. This information results in further clarification of a rat model of RLN injury that may be used to investigate the effects of neurotrophic factors on RLN reinnervation.
Surgery or Botulinum Toxin for Adductor Spasmodic Dysphonia: A Comparative Study
Authors: Mendelsohn Abie H. , Berke Gerald S.
Published: October 2014

Objectives:

Currently, botulinum toxin (Botox) injection is the standard of treatment for adductor spasmodic dysphonia (ADSD). We sought to compare the outcome of selective laryngeal adductor denervation-reinnervation (SLAD-R) surgery for ADSD to that of Botox injections.

Methods:

Patient-oriented measures (VHI-10) and objective single-blinded gradings of digital voice recordings were utilized as outcome measures. The surgical cohort, recruited by retrospective patient selection, consisted of 77 patients with a mean follow-up time of 7.54 ± 2.55 years (range, 2.2 to 14.2 years). The injection cohort, recruited prospectively, included 28 patients with a mean follow-up time of 46.37 ± 5.51 days (range, 36 to 54 days).

Results:

As measured by the VHI-10, the surgical patients had significantly improved voice handicap outcome scores (mean, 14.4 ± 13.6) as compared to the patients who had Botox injection (mean, 26.5 ± 12.1; p = 0.001). Aside from VHI-10 item 2, the surgical group demonstrated significantly improved voice-related function on each VHI-10 component (p = 0.01). Within the injection subgroup, 88% agreed that Botox successfully treats their ADSD, yet only 63% agreed that Botox improves their speech consistently. Within the surgical subgroup, 82% would recommend this surgery to others, and 78% agreed that their voice was actually better after surgery than after Botox. Objective voice ratings demonstrated similar levels of breathiness and overall voice quality in the treatment subgroups.

Conclusions:

When indicated, the SLAD-R surgery for ADSD demonstrates outcomes equal to or superior to those of the current standard of Botox injections.
Application of Natural Orifice Transluminal Endoscopic Surgery (NOTES) Instrumentation to the Endolarynx
Authors: Tan Melin , Prufer Neil , Chinosornvatana Nina , Park Chan , Woo Peak
Published: October 2014

Objectives:

RealHand instruments are high-dexterity instruments that have been designed for natural orifice transluminal endoscopic surgery applications. They provide dexterity by offering a full range of motion to endoscopic instruments. We hypothesize that RealHand instruments will resolve some of the limitations encountered in traditional endolaryngeal surgery. They have the potential to do so in the following ways: 1) they negate the limitation of mobility of traditional laryngoscopy instrumentation, which is rigid and fixed; 2) they maintain the ability of direct visualization through a telescope while precluding the need for an operating microscope; 3) they provide the dexterity to perform tasks that are otherwise not possible with traditional instrumentation; and 4) they provide flexibility that can be advantageous in difficult foreign body retrieval from distal airways.

Methods:

To test this hypothesis, we developed and optimized a cadaveric lamb larynx model for endolaryngeal microsurgery. To evaluate the feasibility of the RealHand instruments in their application to laryngeal surgery, we had 2 otolaryngology senior residents and 2 laryngology fellows-in-training perform 5 different endoscopic tasks: 1) foreign body removal; 2) arytenoidectomy; 3) microflap elevation; 4) cricopharyngeal myotomy; and 5) endoknot suture tying.

Results:

Experience with RealHand instruments demonstrated that although they are limited in application to phonosurgery, they have the potential for more facile tissue manipulation in the supraglottic and hypopharyngeal structures. Endoscopic suturing ability is enhanced.

Conclusions:

RealHand high-dexterity instrumentation allows for full range-of-motion instrumentation and, with modification, has potential for wider application in endoscopic laryngeal surgery.
In-Office Stand-Alone Balloon Dilation of Maxillary Sinus Ostia and Ethmoid Infundibula in Adults with Chronic or Recurrent Acute Rhinosinusitis: A Prospective, Multi-Institutional Study with 1-Year Follow-up
Authors: Levine Steven B. , Truitt Theodore , Schwartz Michael , Atkins James
Published: October 2014

Objectives:

This study evaluated in-office balloon dilation of maxillary sinus ostia and ethmoid infundibula to treat chronic rhinosinusitis (CRS) and recurrent acute rhinosinusitis (RARS).

Methods:

Seventy-four patients with disease in the maxillary and anterior ethmoid sinuses on computed tomography were prospectively enrolled across 12 study centers. All procedures were performed in the office. The primary outcomes were clinical effectiveness and health-care utilization at 1 year, measured by the validated surveys Sino-Nasal Outcome Test (SNOT-20) and Rhinosinusitis Symptom Inventory (RSI).

Results:

Dilation was successful in 69 patients (93.2%), and the average periprocedural pain level was 3.2 (scale of 0 to 10). The mean improvement on the SNOT-20 at 1 year was clinically and statistically significant (p < 0.0001), with no significant difference between the CRS and RARS patient outcomes. The treatment effect was the same in the CRS and RARS subgroups and was either “moderate” or “large” for 10 of 12 symptoms. The mean numbers of antibiotic courses (p ≤ 0.001), sinus-related physician visits (p < 0.0001), and number of acute sinus infections (p < 0.001) decreased significantly in both subgroups. There were no serious device-related adverse events, and the rate of revision surgery was 5.8%.

Conclusions:

Stand-alone balloon dilation of the maxillary sinus ostia and ethmoid infundibula performed in the office is well tolerated and effectively treats both CRS and RARS.
Nasal Obstruction and Unilateral Chronic Otitis Media: Evaluation by Acoustic Rhinometry
Authors: Toros Sema Zer , Karaca Cigdem Tepe , Onder Serap , Caypinar Basak , Sahin-Yilmaz Asli , Oysu Cagatay
Published: October 2014

Objectives:

In a prospective study at Umraniye Research and Education Hospital, we aimed to evaluate the differences in acoustic rhinometric findings between the affected and nonaffected sides in patients with unilateral chronic otitis media (COM) and to investigate whether unilateral COM correlates with the side of nasal obstruction.

Methods:

Fifty-five consecutive patients with unilateral COM were involved in this study. All patients were evaluated with acoustic rhinometry, the Nasal Obstruction Symptom Evaluation (NOSE) scale, and measurement of their nasal mucociliary transport time.

Results:

The mean cross-sectional area 1, mean cross-sectional area 2, volume 1, and volume 2 values were not different between the affected and nonaffected sides (p > 0.05). The NOSE score had a reverse correlation with the mean cross-sectional area 2 (p < 0.05) and volume 2 (p < 0.01) of the affected side. Saccharin time was not correlated with the acoustic rhinometric values of the affected side (p > 0.05).

Conclusions:

These findings do not support the hypothesis that unilateral COM is correlated with the side of nasal obstruction.
Testing for “Recruitment” by Electrocochleography
Authors: Portmann Michel , Aran Jean-Marie , Lagourgue Patrice
Published: October 2014

Normal electrocochleographic (E.Co.G.) tracings were compared with those showing characteristics which resemble audiometric recruitment. The normal E.Co.G. shows two major features as click levels are raised: 1) Over the intensity range from 0–80 dB H.L., for the click, the VIII nerve action potential (AP) latency decreases from approximately 4 to 1.5 msec; and 2) at low click levels, the AP wave-form is diphasic, and shows a slow growth with increasing intensity, while at higher levels, the AP wave-form is monophasic and increases more rapidly with increases in sound level. Yoshie has referred to the low and high intensity portions of the AP amplitude curve as the L and H curves, respectively. In patients showing the “recruiting responses”, the threshold for the click is elevated and the latency is reduced at threshold. The wave-form of AP is diphasic over the entire intensity range, and AP amplitude grows much more rapidly than in the normal case. It appears that these “recruiting” responses represent the H curve of Yoshie with the L curve removed. The differences between normal and “recruiting” E.Co.G. responses can be given a tentative interpretation based on current findings on the structure and function of the peripheral auditory receptor.
Serous Otitis Media
Authors: Veltri Robert W. , Sprinkle Philip M.
Published: October 2014

The middle ear fluids of seven patients with bilateral, and five patients with unilateral serous otitis media (SOM), were demonstrated to be microbiologically sterile when assessed for the presence of bacteria, mycoplasma, viruses, and fungi. The concentrations of immunoglobulins G, M, A, D, and lysozyme (muramidase) were determined in the serum and middle ear fluids. Lysozyme levels of middle ear aspirates were found to be elevated in SOM patients. The elevated levels of lysozyme in combination with the antibody-containing classes of immunoglobulins may explain the microbiologically sterile condition of the middle ear fluids of SOM patients. Also, the elevated lysozyme concentrations in middle ear fluids may indicate the previous presence of neutrophils and hence a previous inflammatory insult. The increased levels of IgA demonstrated in middle ear fluids may indicate local synthesis of secretory IgA by secretory cells of Eustachian tube and middle ear. The closed Eustachian tube, partial vacuum conditions and absence of a portal of exit for accumulated serous fluids are offered as a possible explanation for SOM.
Treatment of Acquired Subglottic Stenosis
Authors: Waggoner Lyle G. , Belenky Walter M. , Clark Charles E.
Published: October 2014

Four children, who had undergone major cardiac surgery, were treated for severe subglottic stenosis following prolonged endotracheal intubation and assisted respiration. Following removal of the endotracheal tube, all required tracheotomy after varying lengths of time. An adequate airway and good voice was obtained in each with injections of triamcinolone acetonide suspension combined with hyaluronidase, and gentle dilatations. This treatment greatly reduced the needed time of tracheotomy maintenance from that required with the previously recommended conservative management consisting of dilatations only. It also avoided the use of alloplastic stents which frequently resulted in a deformed larynx and poor voice.
Glomus Jugulare Tumors
Authors: Spector Gershon J. , Maisel Robert H. , Ogura Joseph H.
Published: October 2014

Radiotherapy is an often used treatment in glomus tumors of the middle ear. Histologic evidence revealing nonuniform radiotherapeutic effect on tumor vessels is shown. The reticular tumor stroma is replaced by collagen. The chief cells demonstrate little change. The results in 19 radiated patients demonstrate that radiation eliminated the tumor in 20% of the cases. Radiation followed by surgery was more successful in tumor eradication than surgery followed by radiation.
Silicone Tracheal T-Tube
Authors: Montgomery William W.
Published: October 2014

The silicone T-tube tracheal stent, which has been in usage for the past nine years, is described and illustrated. This stent has served to support the repaired and reconstructed cervical trachea and also an end-to-end anastomosis of the trachea. While the T-tube is in place with its external limb plugged, the patient usually enjoys a normal airway and phonatory function. Of utmost importance is the care of the tracheal T-tube following its insertion into the cervical trachea. Detailed instructions are included for suctioning, cleaning, and changing of the T-tube. The patient should be familiar with these techniques prior to his discharge from the hospital. With proper care the T-tube has remained in place and uncomplicated for periods ranging from one month to one and one-half years.
Association of Nerve Fibers and Plasma Cells in Abnormal Human Nasal Respiratory Mucosa
Authors: Cauna Nikolajs , Cauna Dzidra
Published: October 2014

Degeneration of sensory and autonomic nerve endings and intimate association of preterminal nerve fibers with plasma cells are described in eight patients suffering from nasal congestion. Two of the patients also suffered from nasal polyps. The association between nerve fibers and plasma cells is characterized by membrane to membrane apposition, absence of the nerve basement membrane in the contact area, and by extension of the nerve basement membrane from the free surface of the nerve fiber over the free surface of the plasma cell. It is suggested that the degeneration of nerves may be caused by autoimmune reaction as a result of tissue exposure to infection or drugs, and that the development of polyps may be the consequence of chronic tissue denervation.
Effects of Age, Sex, and Smoking on Electrical Taste Threshold
Authors: Coats Alfred C.
Published: October 2014

Electrical taste thresholds from 249 otologically and neurologically “normal” subjects demonstrated the following: 1) The frequency distribution was highly skewed to the right, with a mode of 34.1 μA, a median of 42.3 μA, and a mean of 100.5 μA; 2) Normal electrical taste tliresholds ranged from 6 μA to 600 μA, which is too wide a range to be usable clinically; hence, a comparison between sides is required; 3) Females tended to have better electrical taste acuity than males; 4) In males, smoking caused a progressive deterioration of taste threshold with advancing age; 5) In nonsmokers and female smokers, aging produced a slight but not statistically significant decline in electrical taste acuity. These results show distinct parallels with results obtained with dilute solutions and suggest that sex, smoking habits, and possibly age may influence the normal limit of the clinical Electrogustometry (EGM) examination.
Preventing Decalcification of Human Ossicles Stored in a Buffered Formaldehyde Solution
Authors: Baron Barry C. , Perkins Rodney
Published: October 2014

Harvested human homograft ossicles stored in buffered formaldehyde solution pH 5.6 begin to exhibit decalcification after two weeks. This study determined the rate and extent of decalcification of temporal bone core tissue stored in a 4% buffered formaldehyde pH 5.6. The addition of 350 ppm CaCl2.2H2O was found to be effective in preventing decalcification of harvested human homograft ossicles kept in 4% buffered formaldehyde pH 5.6. The practical aspects of these findings for tissue banking and distribution are discussed.
Otology and Industrial Hearing Conservation
Authors: Sataloff Joseph
Published: October 2014

The Occupational Safety and Health Act is establishing limits for industrial noise exposure The Act may also require physicians to evaluate audiograms and examine almost two million employees annually. Otolaryngologists must take special training and become certified to provide American industry with expertise in industrial hearing conservation.
Clinical Manifestations of Leprous Rhinitis
Authors: Barton R. P. E.
Published: October 2014

Over 25 million people in the World have leprosy. In the lepromatous form of the illness the nose is involved at a very early stage and in this paper the clinical manifestations are described. The nasal discharge in early untreated lepromatous leprosy contains vast numbers of the causative bacillus (M. leprae) and the important implications of these observations are discussed.
Correlation of Tubal Function and Volume of Mastoid and Middle Ear Space as Related to Otitis Media
Authors: Andréasson Lars
Published: October 2014

In 69 ears with chronic otitis media and nine ears with traumatic perforations tubal function, the size of the mastoid air cell system measured planimetrically on roentgenograms and the functional volume of the air filled ear spaces were studied for any correlations. The roentgenographic area and the functional volume were also studied for any variation in the duration of the disease. A correlation was found between abnormally small volumes and impaired tubal function, probably due to mucosal damage of the whole system, i.e. Eustachian tube, middle ear and mastoid air cells. No such association was found between area and tubal function. The volume, but not the area, decrease with the duration of the disease.
Inner Ear Degeneration in Acoustic Neurinoma
Authors: Suga Fumiro , Lindsay John R.
Published: October 2014

The temporal bones of three cases of acoustic neurinoma are described to illustrate histopathological features of inner ear lesions due to chronic partial obstruction of blood circulation by the tumor in the internal auditory meatus. Degenerative changes in the inner ear due to acoustic neurinoma were evaluated and compared with changes in the opposite ear. The main pathological findings in the inner ear which were attributed to the tumor were degeneration of nerve fibers and of ganglion cells, degeneration of the stria vascularis, degeneration of the tectorial membrane, fibrosis and ossification of a semicircular canal. Fairly good preservation of sensory cells was observed in the presence of total degeneration of nerve fibers and ganglion cells and subtotal degeneration of the stria vascularis.
Course of the Peripheral Gustatory Nerves
Authors: Rollin Heinz
Published: October 2014

The multiple variations of the course of the gustatory nerves still considered possible are discussed. Recent investigations lead to the conclusion that there is only one path for the gustatory fibers for each gustatory area: 1) from the anterior part of the tongue via the tympanic cord and facial nerve to the medulla oblongata; 2) for the posterior part of the tongue in the IX cranial nerve; and 3) from the soft palate via the greater superficial petrosal nerve to the facial nerve. The trigeminal nerve carries no gustatory fibers to the brain.
Adenoidcystic Carcinoma (Cylindroma) of the Parotid Gland
Authors: Cummings Charles W.
Published: October 2014

Adenoidcystic carcinoma or cylindroma of the parotid gland is a slow-growing, relentless, and often lethal disease which kills usually by local occurrence and direct extension of the disease. The reported incidence of adenoidcystic carcinoma with reference to other parotid malignancies varies from 5% to 37%. The incidence in this series is 36%. The presence of facial nerve involvement adversely affects the long-term survival. Some authors regard facial nerve involvement as an indication of noncurability. The incidence of local pain is reported to be as high as 50% and is thought to be caused by perineural invasion by the tumor. This is well-documented histopathologically. There is no uniform or standard treatment for this disorder. Extensive resection of the parotid gland (including the facial nerve if there is any indication of involvement), followed by external irradiation to the parotid area and upper neck is the most rational approach to the problem. This is supported both in the review of the literature and from the present series. A radical neck dissection is not included as part of initial therapy unless there are clinically suspicious cervical nodes. Postoperative radiotherapy appears indicated in all cases of adenoidcystic carcinoma of the parotid gland. Four case histories are presented which demonstrate the hallmark characteristics of the disease, i.e., multiple cranial nerve deficits, facial pain and subsequent death by direct intracranial extension of disease. The protracted, relentless course of the disease is well-documented in one case in which 25 local recurrences developed over an 18-year period.
Effects of Putative Transmitters on Afferent Cochlear Transmission
Authors: Robbin Richard P. , Thompson Mary Helen
Published: October 2014

Putative transmitters and related substances were perfused through the guinea pig scala tympani while monitoring the compound action potential of the cochlear nerve (AP) and the cochlear microphonic potential. Various substances were then ranked according to their ability to reduce the AP. The more active compounds ranked: methysergide (1 mM) > ATP (10 mM) = tyramine (10 mM) > salicylate (10 mM) > bicuculline (10 mM) > aspartate (10 mM) > glutamate (10 mM) > citrate (10 mM) > dextrose (100 mM) > glycine (100 mM) > GABA (100 mM) > prostaglandin E2 (1 mM) > serotonin (10 mM). The activity of substances at 100 mM indicates a physical, osmotic change in the cochlear structure. Activity at 10 mM and 1 mM indicates afferent transmitter-like activity for the putative transmitters and interference with the endogenous transmitter for related substances. It is concluded that several substances can be eliminated as afferent transmitter candidates, while others warrant further examination.
Choriocarcinoma of the Nose
Authors: Mukherjee D. K.
Published: October 2014

A case of choriocarcinoma in a 17-year-old unmarried female is presented. She attended the E.N.T. Clinic with a rapidly growing mass at the tip of the nose. Histologic report of the excised mass was reported as a secondary deposit from a choriocarcinoma. Further questioning at this stage revealed the history of an abortion two years before. Gynecological examination revealed secondary deposits in the vagina. X-rays of the chest showed evidence of metastases in the lungs. She died of profuse bleeding from the vagina.
Pathology of Chronic Otitis Media
Authors: Meyerhoff William L. , Kim Chong Sun , Paparella Michael M.
Published: October 2014

A review of 800 pathological temporal bones collected from autopsy cases revealed 333 (41.6%) to have some type of otitis media; purulent otitis media (52.5%), serous otitis media (6%), mucoid otitis media (4.5%), and chronic otitis media (36.9%). The 123 temporal bones with chronic otitis media were further studied and found to have granulation tissue, cholesteatoma, cholesterin granuloma, bone changes, and fibrosis. Other findings included tympanic membrane perforation, tympanosclerosis, metaplasia of the epithelium with subepithelial glandular formation, suppuration, labyrinthitis, and evidence of complications of chronic otitis media (meningitis, subdural abscess, brain abscess, petrositis, and endolymphatic hydrops). From this study it was concluded: 1) chronic otitis media occurred quite frequently, from a histological standpoint, in the absence of tympanic membrane perforation; 2) granulation tissue in temporal bones was found much more frequently in chronic otitis media than was cholesteatoma; and 3) complications and sequelae of otitis media tended to occur more commonly secondary to granulation tissue than to cholesteatoma.
Effects of Irradiation on Cervical Lymph Nodes
Authors: Welsh Louis W. , Campellone Frank
Published: October 2014

The effects of irradiation upon the functional integrity of lymph nodes were studied in the isolated cervical region of the dog. After 6000 rads were applied in one dose plan, the measure of lymph flow was determined by the migration of radiogold from the larynx to the associated primary lymphatic terminals at intervals of 2, 4, and 12 weeks, and six months post-irradiation. Interference with lymph flow was identified by radionuclide stasis in the injection depot; alteration in the direction of flow was identified by relative concentration of the tracer item in the associated nodal terminals. The lymph flow was minimally distorted by irradiation in the test period unless secondary damage to the associated lymphatic channels intervened. The relative migration was consistent with the normal data in 52%, depressed in 13% and increased in 35% of the cases studied. Major obstruction and rerouting of lymph flow contralaterally was evident in 19% of the subjects due to fibrosis secondary to local infection.
Laryngeal Nerve Crush for Spastic Dysphonia
Authors: Biller Hugh F. , Som Max L. , Lawson William
Published: October 2014

Four patients with spastic dysphonia refractory to speech and phychiatric therapy were treated by crushing the recurrent laryngeal nerve. Vocal cord paralysis was produced in all patients. Vocal spasticity subsided in all patients. Vocal cord motion returned in four to six months. Three of four patients remained free of spasticity for a minimum of 24 months.
Autoimmune Sensorineural Hearing Loss
Authors: McCabe Brian F.
Published: October 2014

The author proposes the existence of a new entity, autoimmune sensorineural hearing loss, on the basis of diagnostic study and treatment experience with a series of 18 patients. In each case the clinical pattern did not fit with known entities and thus seemed to merit distinctive categorization. In the one patient in whom tissue was available, a vasculitis was evident, a feature of autoimmune disease. All patients responded to treatment for an autoimmune disease, namely, chronic cortisone and cyclophosphamide therapy. The author suggests that all otolaryngologists should be aware of the possibility of this condition, because it is one of the few forms of sensorineural deafness for which we have a treatment.
Otoscopy and Photography
Authors: Chen Benjamin , Fry Terry L. , Fischer Newton D.
Published: October 2014

A new hand-held otoscope photographic system, convenient and suitable for clinical application, is introduced. This instrument allows clear otoscopic examination in stenotic or tortuous ear canals, and photographs the subject in one procedure. The instrument consists of a rodlens optical system, a fiberoptic light source, a camera, and exchangeable speculum and a strobe light. Color photographs of tympanic membranes and middle ear pathology are presented.
Cricopharyngeus Myotomy as the Only Treatment for Zenker Diverticulum
Authors: Zuckerbraun Lionel , Bahna M. S.
Published: October 2014

Cricopharyngeal dysfunction, one of the most common causes of pharyngeal dysphagia, exhibits a variety of manifestations, one of which is Zenker diverticulum. This paper examines the physiology of swallowing, pathophysiology of its aberrations, and various methods of treating Zenker diverticulum. It is our purpose to emphasize cricopharyngeus (CP) myotomy as the only needed treatment for this diverticulum. Even in its advanced stages, excision of the diverticulum is a needless surgical exercise. Seven cases of Zenker diverticulum are reported in elderly patients; one of them had an excision of the diverticulum prior to presentation. Some were either completely obstructed or aspirating on esophagram. Cricopharyngeus myotomy, the only treatment provided, proved to be safe and effective without morbidity or fatalities. Patients' ability to eat orally was restored on the night of or the morning after surgery. No Levin tube is necessary and there is no risk of suture line leakage after the conventional diverticulectomy and CP myotomy. Hospital stay is greatly reduced and there is no risk of structure formation. In contrast to endoscopic division of CP muscle, there is no risk of mediastinitis because there is no break through the mucosa.
Effects of Attention-Requiring Tasks on Vestibular Nystagmus
Authors: Kileny P. , McCabe B. F. , Ryu J. H.
Published: October 2014

The purpose of this investigation was to determine the influence of two types of attention-requiring tasks on vestibular nystagmus elicited by caloric stimulation: mental arithmetic and a short conversation. The subjects were divided into four groups according to stimulus paradigm and task. It was found that conversation was consistently superior to mental arithmetic in engaging the cortex and preventing response decline and even reverse caloric-induced habituation.
Validation of an Automatic Otoadmittance Middle Ear Analyzer
Authors: Fria Thomas J. , Cantekin Erdem I. , Probst Gretchen
Published: October 2014

Tympanometry and acoustic reflex measurements were performed with an automatic otoadmittance middle ear analyzer (MEA) on 40 otologically normal children and 172 children with a history of recurrent acute otitis media or otoscopic evidence of persistent otitis media with effusion (OME), or both. For children with OME, the measurements were taken within a one-hour period prior to myringotomy. Myringotomy findings were used to validate predictive schema aimed at determining admittance values associated with OME. Predictive accuracy was quantified with percent sensitivity and specificity values. The results show that the MEA demonstrated suitable diagnostic predictability, but this was significantly influenced by the schema chosen to interpret obtained admittance measures. The simple presence or absence of a tympanometric peak (regardless of gradient) yielded the highest sensitivity and specificity values, whereas the manufacturer's suggested approach, with or without the acoustic reflex, was not as successful. The implications of these results are discussed.
Brainstem Auditory Evoked Potentials for Detection of Retrocochlear Pathology
Authors: Kinney Sam E. , Nodar Richard H.
Published: October 2014

Since May 1976 the techniques of brainstem auditory evoked potential (BAEP) testing have been used as a clinical tool in evaluating patients with neurotologic disease in the Department of Otolaryngology and Communicative Disorders at the Cleveland Clinic Foundation. A total of 676 patients was tested using this technique and included patients with primary otologic complaints as well as patients with neurologic disorders. Patients were evaluated with suspected multiple sclerosis, for threshold assessment, children at risk for possible sudden infant death syndrome, brainstem gliomas, systemic neurologic or metabolic disorders, and the final group of 408 patients or 60% were tested for suspected eighth nerve lesions. In the group of patients studied for detection of an eighth nerve lesion, the BAEP test was extremely useful if the result was found to be normal, for at the time of this report, no patient with an eighth nerve lesion, such as an acoustic neuroma, had a normal BAEP test result. However, abnormal results in the BAEP test were found in approximately 34% of patients who underwent Pantopaque® myelography for definitive detection of an eighth nerve lesion in which the myelogram was normal. This unusually high false-positive rate is thought to be the result of testing a different patient population than those that have previously been reported in the literature. There still may be some eighth nerve pathology present; however, the results of the BAEP test which have been suggestive of an eighth nerve lesion remain unexplained at this time. The BAEP test is a very important part of the evaluation of patients with neurotologic disease; however, it is not sufficiently understood to eliminate the need for a complete work-up in patients suspected to have a retrocochlear lesion.
Endoscopy and Biopsy in Gastroesophageal Reflux in Infants and Children
Authors: Benjamin Bruce , Pohl David , Bale Patricia M.
Published: October 2014

The clinical features of abnormal gastroesophageal reflux in infants and children extend beyond repeated vomiting and include dysphagia, pain, bleeding, failure to thrive, esophageal stricture, and recurrent respiratory symptoms including aspiration pneumonitis and cyanotic attacks. The unreliability of the traditional barium swallow examination as a diagnostic test is well known. This study reports the results of endoscopic assessment and esophageal biopsy in 100 infants and children and relates them to the clinical findings and the changes in the contrast esophagogram. The results show that further valuable diagnostic information can be gained from endoscopic examination of the esophageal mucosa, especially when there is esophagitis with ulceration, bleeding, or stricture. Endoscopic biopsies are useful to confirm the presence of esophagitis but biopsies alone do not give absolute diagnostic information.