bluuebunny/crossref_metadata_2025 huggingface dataset:
Growth, Body Weight, Survival, and Tumor Trends in F344/N Rats during an Eleven-Year Period
Authors: Rao Ghanta N. , Haseman Joseph K. , Grumbein Sondra , Crawford Denise D. , Eustis Scot L.
Published: November 2015

Time trends for growth, body weight, survival and tumor prevalences in 144 diet control groups with a total of 5,184 male F344/N rats and 146 diet control groups with a total of 5,289 female rats of NCI-NTP 2-yr chemical carcinogenicity studies started during an 11-yr period (1971 to 1981) in 11 toxicology testing laboratories were evaluated. Male and female rats in more recent studies grew faster and attained a higher body weight than rats from earlier studies. Survival of males showed a significantly decreasing trend over time, which may have been related to diseases associated with increasing body weight, prevalence of leukemia and changes in criteria for euthanasia of moribund animals. The time trend for survival of females was not significant. There were highly significant ( p < 0.001) positive time trends for prevalences of leukemia, anterior pituitary tumors and thyroid C-cell tumors in both sexes, adrenal pheochromocytomas in males and mammary tumors and endometrial stromal polyps in females. The prevalence of mammary tumors in females and pituitary tumors in males had a highly significant ( p < 0.01) positive association with body weight. Histological reevaluation of tumor prevalences in approximately 250 rats of each sex at each of 4 different time periods indicated that changes in diagnostic criteria may have contributed to but could not totally explain the increased prevalence of leukemia. Changes in diagnostic criteria and the amount of tissue examined may have contributed to the increased prevalence of anterior pituitary tumors in both sexes and adrenal pheochromocytomas in males. Interlaboratory variability and changes in diet may also have contributed to the time-related trends.
Primary Carcinoma of Stensen's Duct
Authors: Owens Othella T. , Fligiel Alan G. , Ward Paul H.
Published: November 2015

Malignancy arising in Stensen's duct is uncommon. Fourteen cases have been published in the English literature, and a new case is presented. A rational and apparently successful approach in the diagnosis and management of these cases is presented, illustrated, and discussed.
Occult Thyroid Carcinoma Appearing as a Single Mandibular Metastasis
Authors: Osguthorpe J. David , Bratton J. Rufus
Published: November 2015

Extraglandular well‐differentiated follicular thyroid tissue in the head and neck can originate from aberrant embryologic rests, by separation from the main gland through strap muscle action, by “benign metastatic” seeding of the cervical lymphatics, and from mixed papillary‐follicular or pure follicular carcinoma. The management of this ectopic tissue is controversial. A case of occult follicular carcinoma with a sole metastasis to the mandible is presented.
Surgical Therapy of Chronic Mastoiditis with Cholesteatoma
Authors: Parisier Simon C. , Green Robert P. , Chute Patricia M. , Calhoun W. Ford , Som Peter M.
Published: November 2015

One hundred fifty‐seven ears treated surgically for chronic mastoiditis with cholesteatoma are reviewed. The selection of an operative procedure (“canal wall up” or “canal wall down”) was dictated by the extent of pathologic indications in relation to the size of the patient's mastoid. The incidence of recurrent or residual cholesteatoma, the hearing results, and the frequency of visits required for mastoid cavity care are reported.
Analysis of Test‐Retest Variability in Facial Electroneurography
Authors: Hughes Gordon B. , Nodar Richard H. , Williams George W.
Published: November 2015

Facial electroneurography is an objective electrophysiologic measurement of a muscle compound action potential used to assess prognosis for recovery from facial paralysis. In the present study, test precision is accompanied by a test‐retest variability of 6.2%. The primary source of this variability is trigeminal nerve artifact, but submaximal nerve stimulation, changing skin resistance, and inherent nerve properties may also influence results. An ideal stimulus intensity that avoids patient discomfort and trigeminal nerve artifact but attains maximal nerve response is not possible in every patient.
Corticosteroids in Airway Management
Authors: Hawkins Donald B , Crockett Dennis M , Shum Tony K
Published: November 2015

Adrenal corticosteroids exert a strong suppressive influence on the basic inflammatory response that leads to tissue swelling. The corticosteroid effect is nonspecific. In upper airway obstruction caused by edema from infection, allergy, or trauma, corticosteroids will exert some degree of suppressive effect. The steroid effect is local and directly proportional to the concentration of steroids in the inflamed tissue. In upper airway obstruction steroids should be delivered to the inflamed tissue in high concentration with the least delay. Dexamethasone and methylprednisolone produce high blood levels within 15 to 30 minutes of intramuscular injection. Recommended initial doses for acute airway obstruction are dexamethasone, 1.0 to 1.5 mg/kg, or methylprednisolone, 5 to 7 mg/kg. The risk of harm from steroid therapy of 24 hours or less is negligible.
Use of a Composite Autograft to Prevent Recurrent Cholesteatoma Caused by Canal Wall Defects
Authors: Adkins Warren Y. , Osguthorpe J. David
Published: November 2015

Recurrent cholesteatoma following atticotomy or combined‐approach tympanoplasty remains a significant problem. The importance of closing defects created by surgery or disease in the posterosuperlor bony canal is recognized, and numerous materials and techniques have been advocated. Our experience with a composite autograft of tragal cartilage and perichondrium in 40 ears is presented after 1 to 6 years follow‐up. The composite autograft performed satisfactorily in 38 cases. In no case did recurrent cholesteatoma develop at the site of a defect that had been obliterated by the autograft.
Histology of Extruded Plasti‐Pore Ossicular Prostheses
Authors: Gamoletti Roberto , Bellomi Alberto , Sanna Mario , Zini Carlo , Scandellari Roberta
Published: November 2015

Twenty‐three Plasti‐Pore ossicular prostheses removed from the human middle ear following partial or total extrusion were investigated by light microscopy. No specific tissue reaction other than the ingrowth of histiocytic cells elicited from the porous Plasti‐Pore was found. The only histologic feature typical of extruded prostheses was the presence of granulocytes in all parts extruded. In our opinion this finding was the inflammatory reaction following the ischemic necrosis of tissue grown inside the pores and the superimposed bacterial colonization. We concluded that no histologic feature supports a biologic cause of extrusion, and that extrusion instead is related to biofunctional characteristics.
T‐Cell Subpopulations in Head and Neck Carcinoma
Authors: Johnson Jonas T. , Rabin Bruce S. , Hirsch Barry , Thearle Patricia B.
Published: November 2015

Peripheral blood T‐cell subpopulations were quantitated with monoclonal antibodies in a group of 27 patients with biopsy‐proved squamous cell carcinoma of the head and neck. Abnormal quantitative relationships between helper/inducer T cells (Th) and suppressor/cytotoxic T cells (Ts) were encountered in many patients. Short‐term follow‐up of these patients did not demonstrate a correlation between these immune parameters and clinical course. Longer follow‐up and expansion of the data base will be necessary before a determination can be made of the value of quantitative T‐cell subpopulation analysis relative to its use as a prognostic indicator in patients with head and neck cancer.
Estrogen and Progesterone Receptors in Hereditary Hemorrhagic Telangiectasia
Authors: Richtsmeier William , Weaver Gary , Streck William , Jacobson Herbert , Dewell Robert , Olson John
Published: November 2015

Hereditary hemorrhagic telangiectasia (HHT) often requires transfusion and has major ill‐effects. The recent literature reports successful high‐dose estrogen treatment of epistaxis caused by HHT. To investigate this, biopsy specimens taken from areas clinically involved with telangiectasia in four patients were evaluated for estrogen‐ and progesterone‐binding receptors. Specimens from two women (ages 34 and 38) were positive for both estrogen and progesterone receptors in ranges observed in breast carcinoma specimens. Specimens from two men (ages 34 and 78) were positive only for progesterone receptors at lower but clearly detectable levels of activity. Nasal mucosa specimens from control patients −2 male and 4 female – yielded no detectable levels of estrogen or progesterone receptors. Because of the side effects of high‐dose estrogen (especially in males), we have initiated systemic progesterone therapy with both megestrol acetate and medroxyprogesterone acetate. Marked diminution in epistaxis incidence and severity was observed in three patients after initial systemic progesterone treatment. All treated patients have been maintained with good epistaxis control for over 1 year.
The Patient Requiring Mechanical Ventilatory Support: Use of the Cuffed Tracheostomy “Talk” Tube to Establish Phonation
Authors: Kluin Karen J. , Maynard Frederick , Bogdasarian Ronald S.
Published: November 2015

Many patients requiring mechanical ventilatory support via a cuffed tracheostomy tube possess a normal larynx and intact linguistic and cognitive abilities yet are unable to communicate normally because of the interruption of airflow through the intact larynx. The usual alternative means of communication such as writing, gesturing, or the use of an electrolarynx have obvious limitations and are often impossible when there is neurologic motor impairment. Frustration, depression, and compromised medical care are frequent side effects of the patient's inability to communicate. An adapted speaking‐aid tracheostomy tube has been available since 1975 for the patient requiring mechanical ventilatory support. However, acceptance and satisfaction with this aid to phonation have not been uniform and there have been few claims of consistent acquisition of phonation. Reasons for success or failure have been unclear. We wish to report experience with the single‐cuffed tracheostomy “talk” tube in 19 patients, 14 of whom acquired satisfactory functional laryngeal phonation. Indications for its use, technical aspects of the tube, solutions of common problems, and potential reasons for failure are discussed.
The Perceived Severity of Tinnitus: Some Observations Concerning a Large Population of Tinnitus Clinic Patients
Authors: Meikle Mary B. , Vernon Jack , Johnson Robert M.
Published: November 2015

Detailed information about tinnitus was obtained from over 1800 patients attending a tinnitus clinic. Patients rated their tinnitus severity on a scale from 1 to 10 and also provided information concerning the quality, duration, localization, and other attributes of their tinnitus. In addition to standard audiometric tests, patients received tests for tinnitus pitch, loudness, maskability, and residual inhibition, and provided a brief medical history. The severity ratings of over 90% were at or above the scale value of 5. There was no correlation between rated severity and the loudness of tinnitus (obtained by a loudness balance procedure using external sounds matching the tinnitus pitch), thus confirming earlier observations. The severity also was not related to the type, quality, or pitch of tinnitus sound heard. However, severity ratings were highly correlated with incidence of sleep disturbance. Additional observations concerning relationships between perceived severity and other patient characteristics are discussed.
Laryngeal Pacemaker. Part I. Electronic Pacing of Reinnervated Strap Muscles lIn the Dog
Authors: Broniatowski Michael , Tucker Harvey M. , Kaneko Satoru , Jacobs Gordon , Nose Yukihiko
Published: November 2015

The best approach to management of bilateral vocal cord paralysis, with its resultant airway compromise, has not yet been universally agreed upon. Recently proposed methods have included direct stimulation of the laryngeal dilators by the modulation of rhythmic information from the chest wall, diaphragm, phrenic nerve, or accessory muscles of respiration. In such an approach, the information obtained is not necessarily related to inspiration only, and direct implantation of a stimulating electrode into the laryngeal musculature may not be fully efficient and tolerated over time. To obviate such difficulties, the authors propose to broaden the concept of electrical pacing by (1) developing a better source for the triggering of electrical activity during inspiration and (2) devising a reliable means of long‐term physiologic stimulation of denervated striated muscle not subject to deterioration over time. Such an experimental unit was constructed in the canine. It is based on afferent information that originates from the mechanical lengthening of the trachea during inspiration and is defected through a linear strain gauge sutured to the tracheal rings. The signal obtained is modulated through an impedance detector and is amplified. An efferent limb consisting of a monopolar cuffed electrode placed around a crossover nerve‐muscle pedicle from one sternohyoid muscle to the other was used successfully. Such a preliminary experiment with a strap muscle avoids the extraneous factors related to function of the paralyzed larynx. Successful nerve‐muscle pedicle pacing, synchronous with respiration, was verified through electromyographic recordings and direct observation in all animals studied.
The Less‐Than‐Satisfactory Rhinoplasty: Comparison of Patient and Surgeon Satisfaction
Authors: Tobin Howard A. , Webster Richard C.
Published: November 2015

An analysis of patient response to less‐than‐ideal results in rhinoplasty reveals a marked discrepancy between the way patients react and the way in which surgeons think they would react. We feel that, by showing less‐than‐ideal results to prospective patients, we may be able to develop a method to predict the degree of dissatisfaction that a patient might show to a result that was less than ideal.
Rhinorrhea and Pneumocephalus after Cerebrospinal Fluid Shunting: The Role of Lateral Extensions of the Sphenoid Sinus
Authors: Komisar Arnold , Weitz Stephen , Ruben Robert J.
Published: November 2015

Pneumocephalus is usually seen after trauma or neurologic surgery. A rare presentation is after cerebrospinal fluid (CSF) shunting for rhinorrhea. This may be a manifestation of shunt malfunction or of the failure to close a preexisting fistulous tract. A common site of failure is the sphenoid sinus, where CSF may leak from a dehiscence in the middle cranial fossa floor. These dehiscences often communicate with lateral extensions of the sphenoid. This complication is best managed by craniotomy with direct inspection of the floor of the middle cranial fossa and correction of deranged CSF dynamics.
Nonsurgical Management of Small and Intracanalicular Acoustic Tumors
Authors: Gardner Gale , Moretz William H. , Robertson Jon H. , Clark Craig , Shea John J.
Published: November 2015

It is generally accepted that the proper treatment for acoustic tumors is surgical removal. In fact, there is little, If any, reference to nonsurgical treatment of these tumors in the recent medical literature. We would like to report on the nonsurgical management of six patients with cerebellopontine angle tumors based upon CT examination. The diagnostic findings, follow‐up data, and the rationale upon which the decision was made to treat the patients nonsurgically will be presented, as will a review of the pertinent literature.
Infectious Croup: A Critical Review
Authors: Baugh Reginald , Gilmore Bennie B.
Published: November 2015

Infectious croup is a viral or bacterial syndrome characterized by a barking cough, hoarseness, and stridor. Three separate conditions will be discussed: laryngotracheobronchitis, spasmotic croup, and bacterial tracheitis. Each clinical entity will be defined and its treatment reviewed. Current treatment regimens for infectious croup involve various combinations of mist therapy, racemic epinephrine, corticosteroids, and syrup of ipecac. Tradition, rather than science, appears to be the basis of many of these treatments. Despite the frequent occurrence of infectious croup, no treatment has proved consistently successful. Prevention and better treatment methods are the keys for reducing the high cost of infectious croup to the medical care system.
Transcutaneous electrical stimulation of the recurrent laryngeal nerve: A method of controlling vocal cord position
Authors: Sanders Ira , Aviv Jonathan , Biller Hugh F.
Published: November 2015

This study was designed to examine the feasibility of transcutaneous stimulation of the recurrent laryngeal nerve. Electrical activation of the recurrent laryngeal nerve was achieved by applying a blunt electrode to the intact neck skin at specific points along the tracheoesophageal groove in anesthetized adult dogs. The stimulus consisted of 10 mA cathodal pulses, each of 1 msec duration, delivered at a frequency of 10 Hz and increased by 10 Hz increments up to 100 Hz. Vocal cord excursion was directly related to the frequency of applied current. In all six dogs studies, stimulation at 30 Hz resulted in maximal ipsilateral vocal cord adduction, while stimulation at frequencies greater than 40 Hz resulted in ipsilateral vocal cord adduction up to or across the midline. Vocal cord movement was immediate and persisted for the duration of the stimulus train. Surrounding neck muscles were not visibly activated. We propose that the observed frequency‐dependent movement of the vocal cords occurred because of the difference between the contraction times of the intrinsic abductor and adductor muscles of the larynx. Transcutaneous recurrent laryngeal nerve stimulation appears promising, both as a diagnostic aid in laryngoscopy and as a therapeutic tool in controlling the glottiC aperture.
Duration of Intubation in Children with Acute Epiglottitis
Authors: Gonzalez Carlos , Reilly James S. , Kenna Margaret A. , Thompson Ann E.
Published: November 2015

Nasotracheal intubation has been demonstrated to be effective in supporting the airways of children with acute epiglottitis. Length of intubation and criteria used for extubation are still controversial. A 6‐year retrospective review at Children's Hospital of Pittsburgh identified 100 cases of acute epiglottitis, which were initially managed with nasotracheal intubation. Extubation was based on direct laryngeal inspection performed in the operating room (1979–1981) and, more recently, in the intensive care unit (1982–1984). Length of intubation decreased from 63.8 hours in 1979 to 42.1 hours in 1984. The percent of children intubated longer than 48 hours decreased from 69% to 22% in the same time period. These data indicate that a shorter period of intubation is aided by daily laryngeal inspection in the ICU. We propose a staging system for acute epiglottitis to aid in the decision to safely extubate these children.
The Endoscopic Management of Early Squamous Carcinoma of the Vocal Cord with the Carbon Dioxide Surgical Laser: Clinical Experience and a Proposed Subclassification
Authors: Koufman James A.
Published: November 2015

Sixteen patients with T1 vocal cord squamous cell carcinoma were treated with endoscopic laser excision during a 4‐year period. Laser excision was the initial treatment in 11 patients, and it was used to treat 5 patients who had recurrence after radiotherapy. Postoperatively, 13 (81%) of the 16 patients had normal voices. Two patients with persistent postoperative hoarseness had had anterior commissure lesions and previous radiotherapy; the other patient had a subtotal cordectomy. One patient developed a subsequent new lesion 27 months after the initial laser treatment; he was successfully managed with a second endoscopic laser excision. Involvement of the anterior commissure or involvement of the vocal process with minimally invasive disease proved not to be a contraindication to laser excision. The overall results in this small series suggest that laser excision of T1 vocal cord carcinoma is an excellent method of treatment.
Migration of Teflon after Vocal Cord Injection
Authors: Ellis John C. , McCaffrey Thomas V. , Desanto Lawrence W. , Reiman Herbert V.
Published: November 2015

Each of eight mongrel dogs received a 0.5 ml injection of polytef paste into the right vocal fold. These dogs were killed at 1 week, 1 month, 3 months, and 6 months after injection, and a number of organs were examined. Polarizing microscopy was used to examine the upper cervical lymph nodes, lower cervical lymph nodes, mediastinal lymph nodes, abdominal lymph nodes, cerebral cortex, brainstem, lung, liver, spleen, and kidney to determine if migration of polytef had occurred. Examination of these organs revealed that there was consistent migration of polytef particles into the cervical lymph nodes, with the highest incidence occurring in upper cervical lymph nodes on the side of injection. There was no evidence of migration of polytef particles to distant sites. The study shows that polytef particles may migrate to cervical lymph nodes after injection into the larynx; however, there is no evidence of distant migration.
Eustachian Tube Function and Healing after Myringoplasty
Authors: Holmquist Jörgen , Lindeman Pontus
Published: November 2015

The function of the eustachian tube (ET) was measured preoperatively among patients with dry, chronic, tympanic membrane perforations. Tympanograms were obtained 1 to 2 years postoperatively. A significantly better healing rate was found in the group classified as “good” ET‐function. Also, a significantly greater number of tympanograms with no deflections were found in the “bad” ET‐function group. Thus, the ET‐testing allows an identification of patients who must be followed up with extra care during the post‐operative period, in order that complications such as reperforation of the tympanic membrane may be avoided.
Hydrostatic Pressure Measurements of Endolymph and Perilymph in a Guinea Pig Model of Endolymphatic Hydrops
Authors: Long Charles H. , Morizono Tetsuo
Published: November 2015

The primary histologic correlate of Meniere's disease is endolymphatic hydrops. From this, many investigators have postulated the existence of endolymphatic hypertension, although there have been no measurements published to substantiate this concept. Seventy guinea pigs, surgically treated with right endolymphatic duct obstruction, were later assessed by use of a micro‐electrode technique that measured their en‐dolabyrinthine hydrostatic pressures. For 21 of these animals, the pressures of both scala tympani (Pst) and scala media (Psm) of both ears of each animal were successfully measured. Similar measurements were made in a control group of 25 guinea pigs that had not undergone any previous surgery. For normal ears‐as well as those with hy‐drops‐pressure differences between perilymph and endolymph (Pst ‐ Psm) varied around 0 >2.0 mm Hg. When only the right (obstructed) ears were considered, there appeared to be a slight, relative pressure elevation (p <0.05) in scala media during the first 7 days after endolymphatic duct obstruction‐and in those ears with EP, less than 70 mV. The magnitude of this pressure difference that can be attributed to the state of endolymphatic hydrops‐and not to natural variability‐is calculated (within 95% confidence limits) to be less than 0.5 mm Hg.
Squamous Cell Carcinoma of the External Ear: A Review of 75 Cases
Authors: Shockley William W. , Stucker Fred J.
Published: November 2015

Squamous cell carcinoma of the external ear can be a potentially lethal lesion. Although it is the most common cancer involving the pinna, the variables that have the greatest impact on prognosis are still in question. We reviewed 75 cases of squamous cell carcinoma of the external ear to determine patterns of occurrence and treatment failure. Forty patients had adequate follow‐up for determination of cancer control rates. Local control was successful with initial treatment in 85% of the cases. The incidence of lymph node metastases was 10%, whereas distant metastasis occurred in only one patient (2.5%). This series differs from others in that most patients were unselected and most of the lesions treated were early (less than 1 cm). The significance of positive margins after surgical excision is also analyzed.
Acute Bacterial Sinusitis and Diabetes Mellitus
Authors: Jackson Robert M. , Rice Dale H.
Published: November 2015

Diabetes mellitus has deleterious effects on the immune system which may lead to infection that is more serious and difficult to treat. Fifteen diabetic patients with acute bacterial sinusitis are reviewed. Diabetic pathophysiology and its relationship to infection are discussed. A protocol for treatment is outlined, with emphasis on the importance of intravenous antibiotics.
Long‐Term Results of Tympanic Membrane Repair
Authors: Halik Jerry J. , Smyth G.D.L.
Published: November 2015

Long‐term results of tympanic membrane repair were analyzed in 605 patients operated upon from 1970 to 1975. By survival life table analysis, 81% closure of perforations was found at 11 years, and only 74% of patients had normally healed tympanic membranes. Children less than 10 years of age and with anterior perforations healed more poorly. A second group of patients—all with anterior perforations operated upon from 1982 to 1984—showed autologous temporalis fascia to be superior to homograft dura as the graft material. Analysis of results also showed a 60% chance of perforation closure at revision operation. These results are believed to represent an accurate and realistic assessment of tympanic membrane repair by use of survival life table analysis.
Effect of Urea, Glycerol, and Mannitol on Basilar and Labyrinthine Arteries
Authors: Takeda Kazuo , Lowry Louis D. , Liu James J. C.
Published: November 2015

We studied the effect of urea, glycerol, and mannitol on basilar and labyrinthine arteries of dogs In vitro by use of tension recording methods. When the tissue was exposed to urea or glycerol, temporary relaxation of smooth muscles was initially observed, but was followed by gradually increasing contraction. With mannitol, relaxation of the smooth muscles remained stable as long as mannitol existed in the bathing solution. When the specimens were washed with normal Krebs solution after exposure to any of these three substances, large phasic contractions of the smooth muscles were observed. While only theoretical, we propose a possible explanation for the different effects of these three drugs in the improvement of hearing loss that results from Meniere's disease.
Chemotherapy of Bilateral Acoustic Neuromas
Authors: Jahrsdoerfer Robert A. , Benjamin Robert S.
Published: November 2015

In patients with bilateral acoustic neuromas, it is not unusual for the tumors to be of unequal size. At the time of the first examination, the smaller tumor may have already destroyed the hearing, while the ear with residual hearing may harbor a large acoustic neuroma. The remaining hearing is then at great risk if surgical removal of the tumor is attempted. Chemotherapy of bilateral acoustic neuromas is here presented as a possible alternative to surgery in those patients whose prognosis for conservation of hearing is poor.
Provocation‐Neutralization: A Two‐Part Study Part II. Subcutaneous Neutralization Therapy: A Multi‐Center Study
Authors: King William P. , Fadal Richard G. , Ward Walter A. , Trevino Richard J. , Pierce William B. , Stewart J. Alan , Boyles John H.
Published: November 2015

Presented is a triple‐blind crossover study that investigates the efficacy of subcutaneous neutralization food hypersensitivity therapy. Seven physicians and thirty‐three patients from various parts of the country participated. Each patient underwent three 2‐week treatment sessions, with 1 week off treatment between each session. During each treatment session, one injection a day was given. The injection consisted of a placebo for one 2‐week session, and the active allergen during the other two sessions. The active dose was determined by earlier intracutaneous provocative food testing. The diet during the study period was not varied. Medication‐symptom diaries were maintained and treatment result evaluations for both individual complaints and overall results were detailed on a standard form at the end of each treatment session. While the number of foods treated per patient varied from 1 to 13, the majority were treated with 3 to 5 foods. Treatment with the active medication was more efficacious than with placebo. A few patients' symptoms were aggravated with the active medication. This indicates a correct diagnosis, but incorrect treatment dose. In the clinical setting such adverse response should be reversed. Overall, neutralization subcutaneous treatment should be beneficial approximately 75% of the time, and further enhanced by supplemental diet manipulation.
ECoG Results in Perilymphatic Fistula: Clinical and Experimental Studies
Authors: Arenberg I. Kaufman , Ackley Robert S. , Ferraro John , Muchnik Chava
Published: November 2015

Patients with perilymphatic fistula have been described as having symptoms similar to Meniere's disease and endolymphatic hydrops. Direct clinical or experimental evidence linking the two inner ear disorders has been lacking. An enhancement of the summating potential observed with electrocochleography suggests a diagnosis of ELH in both of these inner ear disorders. In this study, ECoG results of 27 patients with surgically confirmed PLF are reported. Fourteen patients with surgically confirmed spontaneous PLF had abnormal ECoG. Six of these 14 patients had normal hearing. The ECoG changes in patients with Meniere's disease and those with surgically confirmed PLF are identical, indicating the underlying pathologic change in both is hydrops. But there is no specific diagnostic abnormality on ECoG that differentiates these two inner ear disorders. Also, an experimental model of PLF was developed and studied in guinea pigs. “Inactive” PLF is defined as “an opening was made into the cochlea, but if no perilymph moved out through the fistula, it was defined as inactive” An “active” PLF occurs when perilymph actually moves from the inner ear out to the middle ear. ECoGs were recorded before and after creation of an “active” PLF. ECoG abnormalities were seen in “active” PLF and correlated with histologic data demonstrating ELH. An abnormally enhanced summating potential was demonstrated after active removal of perilymph through the experimentally created fistula. Cochlear duct histology showed hydropic distention of Reissner's membrane in the experimental ears and no changes in the membranous labyrinths of the unoperated, control ears. Experimental PLF, with histologically confirmed secondary ELH, produced changes similar to those observed in guinea pigs with ELH experimentally produced on a primary basis. Preliminary experimental data suggest ECoG may be helpful in differentiating (acute) PLF and (secondary) ELH. ECoG obtained in intensity series showed greatest intensity effect at 40 dB and no effect at 60 dB. Further studies using similar intensity series information will be elucidated to better determine the significance of these observations. The underlying common denominator for the two disorders of inner ear fluid dynamics is ELH. ELH, either primary or secondary, is indicated by the same ECoG changes of enhancement of the summating potential. Since the abnormal ECoG can occur in patients with vertigo but no clinical hearing loss, it is presumed ELH can occur in the vestibular labyrinth as well as in the cochlear duct.
Problems with Reoperation of the Parotid Gland and Facial Nerve
Authors: Conley John J.
Published: November 2015

The decision as to how to handle recurrent benign disease in the parotid gland can be a perplexing problem. It may cover the gamut of clinical observation, through conservative surgery to radical ablation. The situation is a balance between the nature of the biological process, the possibility of cure or control, and the status of the facial nerve. These problems can be exceptionally difficult in analysis and philosophical management, and are frequently pinioned between technical craftsmanship, curability, and deformity. An understanding, however, of the variety of possibilities—and particularly their relationship to the facial nerve—will help to position these cases within the realm of surgical reality. A new technique of interfascicular dissection is proposed in certain instances.
Safety of Outpatient Tonsillectomy and Adenoidectomy
Authors: Reiner Seth A. , Sawyer William P. , Clark Keith F. , Wood Mark W.
Published: November 2015

Recent changes in reimbursement for tonsillectomy and adenoidectomy have resulted in a large number of these procedures being done on an outpatient basis. There is still considerable controversy, however, as to the safety of this concept. We reviewed the charts of 1000 consecutive patients who underwent these procedures. Three hundred ninety‐six procedures were performed as inpatient surgery and 604 were performed as outpatient surgery. Patients were considered as candidates for outpatient surgery if they met specific criteria, such as good overall medical health, no central apnea, normal bleeding history and profile, and had adequate social considerations. The inpatient group included those patients who did not meet the criteria to be outpatients. We compared the complication rates of these two groups with regard to age, type of procedure performed (tonsillectomy, adenoidectomy, adenotonsillectomy), and indication for surgery in order to determine if there was any increased risk of outpatient surgery, despite strict selection criteria. The two groups were similar in their distribution with regards to age, sex, type of procedure, and indication for surgery. The overall complication rate for the entire group was 7.9%, with an 11.8% complication rate for inpatients and 4.1% complications for outpatients. The higher complication rate among the inpatient group is probably a direct result of the selection process because this group included the higher‐risk patients. On the basis of these findings, we believe that surgery of the tonsils and adenoids can be performed safely as an outpatient procedure, regardless of age, indication, or procedure, if the candidates for ambulatory surgery are carefully selected by the surgeon.
Bilateral vestibular paresis: Diagnosis and treatment
Authors: Telian Steven A. , Shepard Neil T. , Smith‐Wheelock Michael , Hoberg Matthew
Published: November 2015

Patients with bilateral peripheral vestibular dysfunction present a substantial diagnostic and therapeutic challenge to the otologist. Caloric irrigations that suggest bilateral weakness may mislead the clinician when considerable peripheral function remains. Rotary chair testing at several frequencies is helpful in confirming the degree of residual function and may identify patients who have a better prognosis in rehabilitation. Forty‐nine patients with bilateral vestibular paresis were evaluated. The diagnosis was based on caloric responses of less than 5 degrees/sec in both ears and reduced gain on rotary chair trials. Oscillopsia occurred in the minority of patients (35%) and was rare unless severe paresis was present. Episodic vertigo occurred in 43%. All patients had abnormal posturography results, with vestibular dysfunction and severe dysfunction patterns predominating. The treatment outcomes of 22 patients who underwent vestibular rehabilitation are discussed. Prevention of bilateral vestibular paresis remains a high priority.
Cerebrospinal fluid leaks and meningitis in acoustic neuroma surgery
Authors: Bryce Graham E. , Nedzelski Julian M. , Rowed David W. , Rappaport Jamie M.
Published: November 2015

Cerebrospinal fluid leaks and associated meningitis are the most common life‐threatening complications of surgery for acoustic neuromas. This retrospective study reviews 319 patients who had surgery for 321 acoustic tumors at the Sunnybrook Health Sciences Center, University of Toronto, from April 1975 to March 1990. Cerebrospinal fluid leaks occurred after 13.4% of primary tumor operations. Surgical repair was required in 6.2% of all patients; 4.4% needed more than one operation. Meningitis occurred in 5.3% of all patients. These complications were more common in larger tumors and after the combined translabyrinthine middle fossa approach. Transnasopharyngeal eustachian tube obliteration was used to stop recurrent cerebrospinal fluid leaks in two patients.
Changing patterns of epiglottitis in children
Authors: Emmerson Susan G. Phillips , Richman Barbara , Spahn Thomas
Published: November 2015

With an increased awareness of appropriate management of childhood epiglottitis, overall morbidity and mortality has decreased. However, some trends have developed over the past several years that are variations on the classic picture. In a series of 42 patients seen from 1977 to 1986, epiglottitis has occurred in a progressively younger population. Thirty‐six percent of our patients were found to be less than 2 years old, and 51% were less than 3 years old. Also, the causative organism, Haemophilus influenzae, has been found to be increasingly ampicillin‐resistant. The incidence, presentation, management, and outcome of the patients are reviewed, and compared to similar data from other series in the literature.
Evaluation, treatment, and follow‐up results of post polio patients with dysphagia
Authors: Silbergleit Alice K. , Waring William P. , Sullivan Michael J. , Maynard Frederick M.
Published: November 2015

Twenty consecutive patients were evaluated for reports of dysphagia from post‐polio clinics. Only half the patients reported a history of swallowing problems at the time of their acute poliomyelitis. Each patient received a videofluorographic evaluation of the oral and pharyngeal phases of swallowing, and then was provided with recommendations to improve swallowing skills. A follow‐up questionnaire was sent to all patients. The respondents had an average interval of 12 months since the initial evaluation. Of the 18 patients responding to the questionnaire, 14 (77%) reported regular use of the swallowing suggestions. Comparison of pre‐evaluation results to followup of the18 respondents yielded a statistically significant decline in the frequency of choking (p = 0.0156) and food sticking in the throat (p = 0.0195). We conclude that a dysphagia program can result in significant improvement of the swallowing symptoms reported with the post‐polio population.
Hypoglossal‐facial nerve interpositional‐jump graft for facial reanimation without tongue atrophy
Authors: May Mark , Sobol Steven M. , Mester Sara J.
Published: November 2015

The hemitongue paralysis that occurs as a result of a classic hypoglossal‐facial nerve crossover procedure can result in profound functional deficits in speech, mastication, and swallowing. The procedure is not an option in patients with bilateral facial paralysis or those at risk for combined cranial nerve deficits. To address some of the drawbacks and limitations of this classic procedure, we developed the hypoglossal‐facial nerve interpositional jump graft (12‐7 jump graft) procedure. This procedure involves interposing a nerve graft between a partially severed but functionally intact twelfth cranial nerve and the degenerated seventh cranial nerve, and is often combined with other reanimation procedures. To date, we have performed 33 12‐7 jump graft procedures in 30 patients (three were treated for bilateral facial paralysis); this report describes the procedure and its indications, and details the results of 23 procedures performed in 20 patients for whom 24‐month follow‐up data are available. Twelfth nerve deficits occurred in only three patients in this report. Recovery of facial function began between 3 and 24 months postoperatively. Facial tone and symmetry were achieved in every patient, no patient had significant mass movement, and 13 patients (two of whom were treated for bilateral facial paralysis) had excellent and three had superb restoration of facial movement. These results show the 12‐7 jump graft to be a valuable adjunct for facial reanimation in selected patients.
The Impact of Screening Sinus CT on the Planning of Functional Endoscopic Sinus Surgery
Authors: Sonkens Jerry W. , Harnsberger H. Ric , Blanch G. Marsden , Babbel Robert W. , Hunt Steven
Published: November 2015

The clinical and radiologic records of 500 sequential patients who underwent screening sinus CT as a prelude to possible functional endoscopic sinus surgery (FESS) were reviewed in order to answer three clinical‐radiologic questions: (1) Can distinct radiologic patterns of inflammatory disease be identified on screening sinus CT (SSCT)? (2) If so, what are these radiologic patterns? (3) How do the findings seen on SSCT influence the endoscopic surgical plan? Five basic radiologic patterns of sinonasal inflammatory disease were identified among the 500‐member patient population. These were based on known patterns of mucociliary drainage correlated with obstructive patterns observed on the CT scans. These radiologic batterns included: (1) Infundibular (129 of 500 or 26%), (2) ostiomeatal unit (126 of 500 or 25%), (3) sphenoethmoidal recess (32 of 500 or 6%), (4) sinonasal polyposis (49 of 500 or 10%), and (5) sporadia (unclassifiable) (121 of 500 or 24%) patterns. Normal SSCT was seen in 133 of the 500 patients (27%). Although the ostiomeatal unit is the central feature in sinonasal inflammatory disease, obstruction of the infundibulum alone or of the sphenoethmoidal recess can cause unique inflammatory patterns of disease that require tailored FESS. The identification of sinonasal polyposis raises a different set of FESS considerations. The sporadic pattern of inflammatory disease, when identified, creates unique FESS challenges, depending on the specific sinus or sinuses involved. Assignment of these patterns to the individual case also assists in patient management by grouping patients into nonsurgical (normal CT), routine (infundibular, ostiomeatal unit, and most sporadic patterns) and complex (sinonasal polyposis and sphenoethmoidal recess) surgical groups.
Effects of Hydroxyethyl Starch, Nimodipine, and Propylene Glycol on Cochlear Blood Flow
Authors: Coleman J. K. M. , Dengerink H. A. , Wright John W.
Published: November 2015

A primary goal of pharmacologic treatment for otopathologies of vascular origin is to elevate cochlear blood flow (CoBF), thus facilitating the transport of oxygen and nutrients without compromising perfusion pressure in other tissues. In the present investigation, significant increases in CoBF were measured during intra‐arterial infusion of the plasma expanding agent, hydroxyethyline starch (HES), and the vasodilator nimodipine, in anesthetized adult male guinea pigs. There were no changes in systemic blood pressure during the infusion of HES or nimodipine. Intra‐arterial infusion of propylene glycol (PG), which is used as a nonaqueous solvent, produced inconsistent CoBF effects accompanied by initial decreases in systemic blood pressure with subsequent increases. It is concluded that nimodipine and HES are very promising agents for inducing increases in CoBF, whereas PG produced inconsistent effects on CoBF while elevating blood pressure, thus compromising its potential usefulness in the treatment of otopathologies.
Effect of Substance P on Ciliary Beat Frequency in Human Adenoid Explants
Authors: Staskowski Paul A. , McCaffrey Thomas V.
Published: November 2015

This study investigated the direct effects of substance P (SP) on ciliary beat frequency of human upper airway mucosa. Human adenoid explant tissue was maintained in serum free culture media, MCDB153. Ciliated epithelial cells were observed with phase‐contrast microscopy and ciliary activity was measured using a photometric technique. Oscillations in transmitted light caused by ciliary beating were recorded and modal ciliary beat frequency was determined by fast Fourier transformation. Specimens were treated with SP at concentrations of 10−4, 10−5, 10−6, and 10−7 mol/L and with equal molar solutions of SP and (D‐Pro2, D‐Trp7,9)‐SP, a SP antagonist. Substance P was found to increase ciliary beat frequency in a dose‐dependent manner with a maximum increase of 12.1%. This effect was not seen with solutions containing (D‐Pro2, D‐Trp7,9)‐SP. This suggests that SP exerts a direct stimulatory effect on ciliated cells of the upper airway. Because SP is known to be released in the upper airway in response to chemical irritation, it is presumed that the stimulatory effect of SP on mucosal cells provides a protective mechanism against inhaled irritants.
Autologous, Orthotopic Thyroid Follicular Cell Transplantation: A Surgical Component of Ex Vivo Somatic Gene Therapy
Authors: O'Malley Bert W. , Finegold Milton J. , Ledley Fred D.
Published: November 2015

Ex vivo strategies for somatic gene therapy involve the harvest of primary cells from patients, the transfer of novel genetic material into these cells in cell culture, and reimplantation of the genetically engineered cells back into patients. In consideration of methods for targeting somatic gene therapy to the thyroid, we have studied the autologous, orthotopic transplantation of thyroid follicular cells in a canine model. Using the fluorescent dye Dil, we were able to stain follicular cells in vitro before transplantation and then follow the pattern of engraftment through histologic sectioning and microscopy up to 14 days after transplantation. The transplantations involved the direct injection of intact and disrupted follicles into a remaining thyroid lobe after cell harvest from the contralateral lobe. We also demonstrated engraftment of individual follicular cells recovered from primary monolayer cultures. Histologic studies revealed the presence of transplanted cells and follicles as well as focal regions of granulomatous reaction in close relation to the engrafted material. These studies demonstrate the feasibility of autologous, orthotopic transplantation of thyroid follicular cells. This method is an essential component of ex vivo strategies for targeting somatic gene therapy to the thyroid gland.
Orbital complications in functional endoscopic sinus surgery
Authors: Corey Jacquelynne P. , Bumsted Robert , Panje William , Namon Ari
Published: November 2015

Endoscopic sinus surgery can result in both minor and major complications. Among these, orbital complications—including retroorbital hematoma—are among the most feared. Injuries can be direct or indirect from pulling on diseased structures. A retrospective chart review of 616 endoscopic sinus procedures revealed eight orbital complications in seven patients. These included two medial rectus injuries, five orbital hemorrhages, and one nasolacrimal duct injury. Predisposing factors may include hypertension, lamina papyracia dehiscences, extensive polypoid disease, previous surgery, inability to visualize the maxillary ostia, violent coughing or sneezing, and chronic steroid use. Suggested management in the literature includes lateral canthotomy, steroids, and mannitol with ophthalmologic consultation. Opening of the wound by means of an external ethmoidectomy incision has also been suggested. We suggest that adding orbital decompression by means of multiple incisions into the periorbita should be added for fully effective relief. A “management” tree of decision parameters relevant to orbital complications is presented.