bluuebunny/crossref_metadata_2025 huggingface dataset:
Functional evaluation of the patient with cholesteatoma
Authors: Pratt Lindsay L. , Murray John
Published: September 2006

Aural cholesteatoma presents a challenging management problem. The literature abounds in excellent reports concerning surgical management, but emphasis should also be placed on the pre‐operative evaluation of the patient in a systematic and complete manner.

Relative to the patient's evaluation, the surgeon must decide whether or not surgery is necessary, the anticipated prognosis, and the effects of the management upon the patient in his socioeconomic environment.

A series of seven questions are presented. Their answers should assist the otologist in systematically approaching the management of the patient with aural cholesteatoma.
Eosinophilic granuloma of the temporal bone
Authors: Toohill Robert J. , Kidder Thomas M. , Eby Lee G.
Published: September 2006

Three patients, all children, are presented with a diagnosis of eosinophilic granuloma isolated to the temporal bone. In two cases the disease was unilateral, and in the third, bilateral disease was encountered. General evaluations, audiometric studies, and laboratory findings will be discussed. X‐rays will be shown as well as photomicrographs of the gross and microscopic lesions to supplement this discussion. Our approach was surgical in all four ears involved. Radiation therapy was not utilized. A thorough review of the literature on this subject will accompany the presentations of these cases. Long term results have been satisfactory and will be correlated with those in the literature treated by other methods.
Embryonal rhabdomyosarcoma of the head and neck in children
Authors: Sessions Donald G. , Ragab Abdelsalam H. , Vietti Teresa J. , Biller Hugh F. , Ogura Joseph H.
Published: September 2006

The usual clinical course of children with embryonal rhabdomyosarcoma of the head and neck has been the rapid development of distant metastases and death within one year of clinical presentation. Since 1967, seven children with the diagnosis of embryonal rhabdomyosarcoma have been treated with a specific regimen of surgery, radiation therapy and chemotherapy. All five patients who presented with tumor localized to one region of the head and neck showed objective tumor response. In four patients, the tumor disappeared completely, and there has been no sign of recurrence for five and one half, three and one half, one and one half, and one half years, respectively.
Hypernephroma metastatic to the head and neck
Authors: Miyamoto Richard , Helmus Christian
Published: September 2006

Six cases of hypernephroma metastatic to the head and neck are presented (larynx, tongue, temporal bone, supraclavicular region, nasopharynx, and occipital region) and the literature is reviewed. Hypernephromas that metastasize to the head and neck often simulate primary tumors, and the otolaryngologist must be aware of this diagnostic possibility, especially when dealing with paratracheal masses. Surgical removal of accessible solitary metastasis is recommended and offers the best palliation.
A model for experimental vasomotor rhinitis
Authors: Whicker James H. , Neel H. Bryan , Kern Eugene B. , Reynolds Herbert Y.
Published: September 2006

Clinical and experimental observations suggest that vasomotor rhinitis results primarily from a relative overactivity of the parasympathetic nervous system; however, some questions remain unanswered. Does the autonomic imbalance produce vasomotor rhinitis through local neural effects on the mucosal and submucosal structures or is there activated a more systemic response involving, for instance, the immunologic system? Our study was designed to determine whether we could consistently produce unilateral vasomotor rhinitis in dogs by thorough ipsilateral sympathectomy and to evaluate the role that the immunologic system may have in the etiology of this disorder.

Histologic observations were made on the nasal mucosa of control and sympathectomized dogs. In addition, serum and nasal wash specimens were collected for albumin and immunoglobulin analysis.

When compared to that of control dogs, the nasal mucosa of sympathectomized dogs initially demonstrated epithelial discontinuity, submucosal fluid, and cellular infiltrates. There was no significant difference in mean albumin or immunoglobulin values of the nasal washings from control and sympathectomized dogs. Although not statistically significant, a trend was suggested in that serum IgA and IgGa,b levels were lower in the sympathectomized dogs. Although histologic changes suggestive of vasomotor rhinitis occurred in the sympathectomized dogs, biopsy specimens of nasal mucosa taken three months after operation did not reveal the prominent mucosal changes present one month after operation.

The decrease in serum IgA and IgGa,b levels in the sympathectomized dogs suggests decreased production secondary to autonomic disturbance.

The entity of vasomotor rhinitis may be contrived from several factors. The local effects of autonomic imbalance combined with alterations in immunologic competence may be of particular importance.
Rhinoplasty tip ptosis: Etiology and prevention
Authors: Tardy M. Eugene
Published: September 2006

Commonly, 12‐18 months must elapse before the final postoperative result following rhinoplasty may be judged. Unless actively compensated for during surgery, an inconstant degree of nasal tip ptosis (“settling”) may lead to displeasing nasal profile characteristics. Supra‐tip rounding accentuates tip ptosis, creating the undesirable “pollybeak” deformity. Generally, these two complications of rhinoplasty are predictable and preventable, providing that their various etiologies are clearly understood.

Nasal tip ptosis in the postoperative healing period occurs if false projection of the tip confuses the surgeon. Operative tip swelling (infiltration anesthesia and edema) along with malpositioned columellar “bunching” sutures and “orthopedic” septocolumellar sutures create spurious tip projection. Loss of normal tip support occurs when incisions interrupt the attachment of the lower lateral cartilages to the upper lateral cartilages as well as the “wrap‐around” relationship of the feet of the medial crura to the caudal cartilaginous septum. Complete transfixion incisions should be avoided when possible. Cartilaginous or bony shoring struts increase tip support. Modeling of the lower lateral cartilage should not include over‐generous removal of the lateral crura, thus further weakening tip support.

Unfavorable healing factors contributing to tip ptosis include linear contraction of the transfixion incision scar, the natural downward torque influence of the lower lateral cartilages, and detrimental synergistic activity of specific muscles of facial expression.

Tip ptosis may accentuate the undesirable formation of supra‐tip prominence, thus unmasking the eventual stigma of “pollybeak” deformity. Supra‐tip prominence may develop as the result of:

1. Inadequate lowering of cartilaginous dorsal hump.

2. Inadequate lowering of upper lateral cartilages.

3. Insufficient nasal skin undermining.

4. Failure to excise adequately redundant mucous membrane projecting above the newly‐established profile line.

5. Inadequate tip splinting.

Preventive operative maneuvers can reduce the incidence of displeasing profile relationships, leading to a natural and harmonious postoperative rhinoplasty appearance.
Sphenoid sinus mucoceles
Authors: Maisel Robert H. , El Deeb M. , Bone Robert C.
Published: September 2006

Mucoceles of the sphenoid or posterior ethmoid sinuses usually behave in a similar manner. Because of the thinness of surrounding bone and the proximity of vital structures, these lesions can expand aggressively at a clinically alarming rate. Presenting symptoms vary but characteristically include headache and ocular disturbance. Careful radiologic evaluation helps in the correct assessment of these lesions. The authors feel that the rhinologic approach to the sphenoid cavity, via an external ethmoidotomy, affords the best visualization possible of the diseased area without entailing possibly serious central nervous system complications. Six cases are discussed from the standpoint of presenting signs and symptoms, radiologic assessment, therapy and outcome.
Otitic barotrauma
Authors: Brookler Kenneth H.
Published: September 2006

Otitic barotrauma occurs upon descent in individuals with a nasopharyngitis, a large nasopharyngeal lymphoid mass, and for no apparent reason. A Surface Active Membrane (S.A.M.) was found lining the eustachian tube with surface tension lowering properties similar to pulmonary surfactant (S.A.M.). Eustachian S.A.M. allows the lumenal surface of the tube to separate in response to the pull of the musculature. S.A.M. is destroyed by proteolytic enzyme producing bacteria and pulmonary S.A.M. is reduced in cigarette smokers. Reduced or absent eustachian S.A.M. will not allow the lumenal surfaces to separate and pressure equalization to take place. Otitic barotrauma occurs when there is insufficient eustachian S.A.M. resulting in an inability to allow transmission of air from the nasopharynx to the middle ear during descent. A lecithin aerosol used as an effective treatment of hyaline membrane disease (absent S.A.M.) of the newborn may treat or prevent otitic barotrauma.4
Mandibular fractures from civilian gunshot wounds: A study of 20 cases
Authors: May Mark , Cutchavaree Amnuay , Chadaratana Phadung , West Joseph
Published: September 2006

Management of penetrating wounds of the mandible caused by civilian firearms differs from military injuries primarily because of the difference in missile velocity. Most reports are based upon war‐time experience. Since civilian gunshot wounds of the mandible have been recorded in isolated case reports, a review of our experience managing 20 patients is reported.

All fractures were initially managed by closed reduction reserving open reduction for those cases that failed to respond to closed reduction.

Eighteen had displaced fractures and two were undisplaced. Only two patients required open reduction, both had the displaced type.

Airway obstruction occurred in six out of 20 and were associated with injuries to the floor of the mouth or tongue. Five of these patients received tracheotomy while one, in whom a tracheostomy was not performed, died.

Only one patient developed infection. Osteomyelitis in this case responded to antibiotics.
Blast injuries of the ear
Authors: Ruggles R. L. , Votypka Ray
Published: September 2006

A series of 11 tympanic membrane perforations from a searing blast injury which underwent immediate repair has been reported. Immediate repair is advocated in that often drum remnants can be re‐approximated, four of 11 with no failures. In cases of total or near total perforations, fascia grafts were needed in five of 11.
Averaged evoked auditory responses in the chronically implanted cat
Authors: Mathog Robert H. , Matz Gregory J.
Published: September 2006

Averaged evoked auditory responses from chronically implanted dural electrodes over the midectosylvian gyrus were evaluated in eight cats. The effects of the distribution of electrodes and levels of alertness were observed for each animal and the entire group. Changes in duration, rise and decay times, and repetition rates were also analyzed. Data from these experiments suggested a large variability in the amplitude and latency of the response. On the other hand, they also suggested a stable reproducible threshold of detectability — a point where the response disappeared upon further reduction in sound pressure levels. This characteristic of the evoked system served as a reliable measurement of an evoked auditory threshold and appeared as a potential means for evaluating relative changes of auditory function within the same animal.
Protection of facial nerve anastomosis with a vein graft
Authors: Miglets A. W. , Thomas J. R.
Published: September 2006

When a cut nerve, which has been repaired, does not function properly it is usually due to the regenerating axons failing to cross the site of the anastomosis. The axonal regrowth may be blocked either by the presence of granulation tissue between the cut ends of the nerve, or to poor stabilization of the nerve stumps with resultant movement and torsion.

In the past, many substances have been utilized to protect these anastomosis, most with unfavorable results. The most popular material used today for nerve protection is silastic sheeting which appears to offer some protection without having any major undesirable side effects.

Gibb in a previous article, suggested that autogenous vein may be an excellent material for the protection of facial nerve anastomosis. It is readily available, easily tailored and completely physiologic. We felt his proposal had merit, but that it first should be evaluated in an animal model before embarking on a clinical trial.

Eighteen dog facial nerves were severed. In six animals (control group) the nerve was repaired with three 7/0 silk sutures in neurolemmal sheath. In the second six, after the nerve sheath was repaired, a section of post auricular vein was wrapped around the anastomosis, being held in place with 7/0 silk sutures. In the remaining six animals, prior to repairing the severed nerve, a tube‐like section of post‐auricular vein was slipped around the proximal segment of the nerve, then after the nerve anastomosis was completed, the vein tube was pulled down over the anastomosis and held in place with 7/0 silk suture.

Animals in each group were sacrificed at one, two and three months, in addition, three animals in each group were kept until maximum return of facial function occurred.

Clinical evaluation revealed that the animals which had their nerve anastomosis protected with the vein tube or vein sheeting, had more complete return of facial function than the control group.

Histological sections showed the vein still to be identifiable during the first two postoperative months, after this is became lost in the general fibrous reaction that occurred around the anastomosis. There was no difference between the groups in the amount of granulation tissue or fibroblasts in the area of the anastomosis. It appears that a careful anastomosis of the neurolemmal sheath will prevent granulations from entering the nerve as effectively as the vein tube; however, we felt that the additional stabilizing effect of the vein tube contributed to the improved results in the sheated animals.

It appears that autogenous vein is a safe substance for the protection of facial nerve anastomosis, and is suitable for clinical use.
Pitfalls in the diagnosis of acoustic and other cerebellopontine angle tumors
Authors: Glasscock Michael E. , Hays James W.
Published: September 2006

The early detection of acoustic and other cerebellopontine angle tumors depends upon a high index of suspicion on the part of the otolaryngologist. He must be willing to perform a routine neuro‐otologic evaluation on every patient with unilateral tinnitus, unilateral sensori‐neural hearing loss or any symptoms of an inner ear disorder. The audiometric and vestibular examinations should be reliable and X‐rays of the temporal bone must be of excellent quality.

There is a natural tendency to forego X‐rays when a patient seems to have an obivous diagnosis such as Ménière's disease; in fact, there are many such pitfalls in which the physician can allow himself to be misled. The purpose of this paper is to review the neuro‐otologic diagnosis. Six case histories are presented that represent some of the more common pitfalls that can confused the diagnosis of a cerebellopontine angle tumor. The symptoms and objective findings in tumor patients are discussed in detail. Emphasis is placed on the team approach to diagnosis, encouraging cooperation among the otolaryngologist, audiologist, neurosurgeon and radiologist. In this manner, these tumors can be detected when they are small, and their removal can be accomplished with a low morbidity and mortality.
The otolaryngologist's role in catastrophe surgery
Authors: Mcfarland Guy E.
Published: September 2006

In presenting “The Otolaryngologist's Role in Catastrophe Surgery” acute management will be discussed, including laceration repair, facial nerve injuries, airway problems, facial fractures, both maxillary and mandibular, and vessel injuries of the neck.

Reconstructive management of the ear, nose and throat injuries will be discussed including utilization of the regional and local flaps, grafts and inplants.

Pictorial representation of problems encountered in civilian and war situations, with stepwise solutions to these problems will be incorporated. Some attention will be given to basic principles involved.

The major purpose of this paper is to call attention to practicing otolaryngologists and other physicians the capabilities of present day otolaryngologists.
Carotid artery rupture
Authors: Shumrick Donald A.
Published: September 2006

A carotid artery rupture should never occur. The figures presented strongly indicate that elective ligation of an impending rupture is the procedure of choice; however, this should seldom be necessary if nutritional deficiencies have been corrected; if pre‐operative radiation has been properly planned and timed, and if safe incisions are utilized with dermal graft protection, the carotid artery rupture should not occur, and an impending carotid rupture should become a rare event. The surgeon responsible for the patient must have the courage to resect electively an area of impending rupture and cover the region with a split thickness skin graft or with an adjacent skin flap.
A preliminary report on segmental tracheal prosthetic replacement in dogs
Authors: Wykoff Thomas W.
Published: September 2006

Forty‐six dogs had a five ring segment of their trachea resected and replaced with different prostheses. The different prosthetic combinations are described, and a technique of sutureless anastomosis which eliminated intra‐luminar sutures is reported.

The initial prosthetic combinations were developed to provide support for regeneration of the animal's own mucosa. In no cases was there any evidence of migration of mucosa into the prosthetic segment. The animals were sacrificed if they developed any signs of airway impairment or respiratory distress. All post mortem tracheas were examined and photographed.

The best results were obtained when the prostheses had a smooth, nonporous artificial lining which was either thin walled stainless steel or shrinkable teflon tubing.

Even though this experiment failed to produce a successful long‐term prosthetic tracheal replacement, encouraging results indicate that further experimentation would be worthwhile.
Septal dermoplasty for von willebrand's disease in children
Authors: Letson James A. , Birck Herbert G.
Published: September 2006

The purpose of this paper is to describe the application of a well known surgical procedure, septal dermoplasty, in children afflicted with the severe form of von Willebrand's disease. This operation allows a lasting control over the child's epistaxis problem and frees it for a meaningful active childhood.
Early vascular insufficiency and the vestibular system
Authors: Berkowitz Wallace P. , Stroud Malcolm H.
Published: September 2006

The early diagnosis of dizziness of vascular origin in the face of few positive historical, physical and clinical findings can be made when mild internuclear ophthalmoplegia in lateral gaze is noted in association with central or peripheral VIIIth nerve involvement. Early symptoms and physical findings are described and certain relevant diagnostic studies recommended. Functional correlation with the central anatomical areas supplied by the vertebral‐basilar artery system are reviewed.
Reconstruction of the canine trachea with urinary bladder wall
Authors: Marshak Gabriel , Porter James H. , McAdams A. James
Published: September 2006

In dogs, a cervical tracheal sleeve measuring 8‐10 cm. was replaced with autogenous urinary bladder wall.

The critical point of stenting was solved by using a silastic tube around which the bladder wall was wrapped with the mucosal surface facing the neck tissues. Four months later, an osseous neotrachea is formed. This tube is rigid enough to sustain the intratracheal pressure changes and is lined with metaplastic epithelium.
Trigeminal neuralgia: A new surgical approach. (Percutaneous electrocoagulation of the trigeminal nerve.)
Authors: Tew John M. , Mayfield Frank H.
Published: September 2006

Percutaneous electrocoagulation of the trigeminal nerve, a new approach to the surgical treatment of trigeminal neuralgia promises a satisfactory method for achieving longstanding relief avoiding many of the objectionable side effects associated with other forms of surgical therapy. Careful control of electrical currents permits destruction of the sensory portion of the trigeminal nerve sufficient to relieve pain yet spare touch and motor function in the face. The rational, technique and results associated with the procedure in a substantial series of cases are presented in this report.
Lactose content of tube feeding diets as a cause of diarrhea
Authors: Walike Barbara Caleen , Walike Joseph W.
Published: September 2006

Tube feedings are frequently used by otolaryngologists in treating head and neck malignancies and other diseases. Common side effects of these diets include: borborygmi, meteorism, cramping, distention and diarrhea. These may vary from mild gastrointestinal distress to incapacitating diarrhea. This study investigated the role of lactose as a possible cause of diarrhea associated with tube feeding diets. Lactose, the primary carbohydrate of milk, is the basic ingredient of most tube feeding diets.

Two identical diets, differing only in the presence or absence of 7 percent lactose, were administered to 11 patients in a double blind fashion. Each diet was given to each patient for approximately 10 consecutive days. The patients were studied in clinical research units where meticulous intake and output and total nitrogen balance studies were possible.

Nine of the 11 patients had a significant increase in the frequency of stools and a shift toward a more liquid stool consistency while on the lactose containing diet. Only two of these nine patients revealed a classical intolerance to lactose as indicated by a flat lactose tolerance test. The remaining seven patients had a relative lactose intolerance. This was clinically apparent only when they ingested a large quantity of lactose such as is contained in the usual tube feeding diet.

Because lactose is not necessary for adequate nutrition, these data suggest that its elimination in tube feeding diets would result in more comfortable and efficient tube feeding.
A cochlear prosthesis: Further clinical observations; preliminary results of physiological studies
Authors: Michelson Robin P. , Merzenich Michael M. , Pettit C. Robert , Schindler Robert A.
Published: September 2006

A series of simple psychoacoustic studies were conducted on three deaf patients with indwelling scala tympani electrodes to determine better what they hear as a consequence of electrical stimulation. Physiological experiments on cats implanted with a similar electrode were conducted to determine how the sensation heard by these patients is generated and encoded in the auditory nervous system. Some preliminary results of these animal experiments are described. Additional improvements in the surgical implantation procedure are detailed.

Results of these studies suggest the following: 1. long‐term intracochlear implantation is technically feasible without unusual complications; 2. mechanical stability of the implant prosthesis has been improved by fixing the implant to the temporal bone with methyl methacrylate cement; 3. with simple periodic electrical stimuli the implanted patients described tonal sensation for frequencies ranging from about 100 Hz to more than 10 kHz; 4. apparent pitch changes rapidly as a function of stimulus frequency at frequencies below about 500 Hz; 5. subjects are able to identify many common environmental sounds and a few words, but conventional speech discrimination is poor; 6. the sound sensation generated by electrical stimulation arises as a consequence of simultaneous excitation of a broad segment of the acoustic nerve; therefore, no “place” coding of the electrical stimuli occurs in the cochlea; 7. if no cochlear place coding occurs then tonal quality ascribed to sounds heard with electrical stimulation at low stimulus frequencies must be encoded by the temporal ordering of discharges in stimulated neurons.
Columellar advancement for nasal tip elevation
Authors: Goode Richard L. , Ross Joel
Published: September 2006

V‐Y columellar advancement procedures can be successfully used to re‐elevate depressed nasal tips following trauma or septoplasty, even though a normal length columella exists. The columellar flap, with its lateral darts, produces the necessary long term nasal elevation. Two cases are described that illustrate the technique.
Frozen section diagnosis: Accuracy and errors; uses and abuses
Authors: Saltzstein Sidney L , Nahum Alan M.
Published: September 2006

In a series of 2,665 frozen sections, false‐positive diagnoses of cancer occurred only four times (0.15 percent) and false‐negative diagnoses of cancer 43 times (1.61 percent). In 46 instances, the diagnosis had to wait for paraffin sections.

Errors of three types: sampling, interpretive, and communicative — can occur, and sampling errors account for more than half of the errors. The types of lesions which lead to interpretive errors are the very well differentiated malignant tumors which are confused with benign proliferative conditions and the very poorly differentiated malignant tumors which are confused with inflammation. No significant errors of communication occurred in this series.

The only indication for a frozen section is the need for an immediate decision requiring immediate action. These decisions may revolve about the nature of the disease, the extent of the disease, biopsy technique, identification of tissue, viability of tissue, or even administrative matters. If a decision will be made or a course of action selected, regardless of the frozen section results, one should not get a frozen section.
Plastic sheeting in tympanoplasty
Authors: Sheehy James L.
Published: September 2006

The goal of tympanoplasty is hearing restoration. One prerequisite for obtaining this objective is a mucosal‐lined air‐filled middle ear space. Silastic and Supramid sheeting are used in selected cases to accomplish this result. In the absence of middle ear mucosa the operation must be performed in two stages.

The otologist must have a thorough knowledge of the principles of middle ear surgery and the causes of failure. Careful execution of precise surgical techniques should result in satisfactory hearing in the majority of cases.
The relationship of the fossa of rosenmüller to secretory otitis media
Authors: Compere W. E.
Published: September 2006

A review of the recent literature concerning Eustachian tube dysfunction and chronic secretory otitis media suggests that the function of and pathology in the fossa of Rosenmüller is being overlooked. Pathology in the fossa is a common cause of tubal dysfunction, and its correction is necessary to achieve satisfactory results in the treatment of secretory otitis media.
Middle ear pressures in eustachian tube malfunction: Manometric studies
Authors: Buckingham Richard A. , Ferrer Jose L.
Published: September 2006

We made direct measurements of the difference in pressure between the middle ear and the ambient atmosphere in 300 ears affected with chronic adhesive otitis media (CAOM), serous otitis media (SOM), and similar disorders of the ear caused by eustachian tube malfunction.

We utilized a narrow bore, open U‐tube manometer made of No. 205 polyethylene tubing which was connected to a 20 or 22 gauge spinal needle. The needle was passed through the intact tympanic membrane and the displacement of the column of 95 percent alcohol in the manometer was noted and recorded.

Our results showed that in 101 ears with CAOM, the average negative pressure difference between the middle ear and the ambient atmosphere was 9 mm 95 percent alcohol, equivalent to 7 mm of H2O.

In 136 ears with SOM, the average negative middle ear pressure was 8 mm 95 percent alcohol, equivalent to 6.5 mm H2O.

In 80 of the 300 diseased ears we tested, the middle and ambient atmospheric pressures were equal.

Direct readings of the middle ear pressure tell us the status of the middle ear ventilation at the moment of the measurement.
Tympanoplasty: Staging the operation
Authors: Sheehy James L. , Crabtree James A.
Published: September 2006

The goals of tympanoplasty are two: elimination of disease and permanent restoration of hearing. A planned two‐stage tympanoplasty is recommended to accomplish these goals in cases with extensive middle ear mucous membrane disease, in cases with absence of all ossicular tissue and in cases in which there is uncertainty regarding the eradication of cholesteatoma.

The most satisfactory technique for restoring hearing in cases without ossicular tissue is a cartilage strut to the stapes footplate. To avoid post‐operative sensori‐neural impairment the surgeon should not open the labyrinth while removing middle ear and mastoid disease. Serious consideration should be given to mastoid re‐exploration for residual disease in all cases in which a closed technique is used for mastoid cholesteatoma.

The. otologist must have a thorough knowledge of principles of tympanoplasty and must execute the surgical techniques precisely. By so doing, he should be able to restore useful hearing to the majority of his patients.
Incus interposition and the “malleus‐stapes assembly” (a study of type II tympanoplasties at the henry ford hospital)
Authors: Muzaffar Kamil , Nichols Richard D.
Published: September 2006

A retrospective evaluation of 129 Type II tympanoplasties is presented. The aim has been to assess the long term hearing results with reference to the type of reconstruction employed. The maximum follow‐up period is 11 years. Ninety‐four cases were reconstructed by interposing the incus. In 68 of these cases the stapes suprastructure was present, in 26 it was either absent or was bypassed. Thirty‐five cases were reconstructed by the “malleus‐stapes assembly.” Hearing levels for the 68 cases of incus interposition with the stapes intact were from 0‐30 db in 78 percent of patients at one year; 63 percent at two years and 40 percent at four or more years of follow‐up. Similar levels for 26 cases with suprastructure absent were one year, 50 percent; two years, 26 percent; and four years or more, 14 percent. With the “malleus‐stapes assembly” at one‐year, 83 percent had hearing levels between 0‐30 db; two years, 47 percent; over four years, 39 percent.
Glomus tumors in the middle ear. I. An analysis of 46 patients
Authors: Spector Gershon J. , Maisel Robert H. , Ogura Joseph H.
Published: September 2006

Forty‐six cases of glomus tumor involving the middle ear are presented. The average follow‐up period is 7.1 years. Surgical success rate is 73 percent and radiation is 20 percent. As a secondary modality of therapy for persistent or recurrent tumors, the surgical success rate was 71 percent and radiation was 40 percent. The therapeutic failures are described by anatomic location. There were two tumor related deaths. The treatment of choice for glomus tumors and for tumor recurrences or persistences, providing that they do not invade the intracranial cavity, is surgical. A wide excision (including a jugular bulb and vein resection when indicated) is advocated.
Vidian neurectomy: Its results and complications
Authors: Golding‐Wood Philip H.
Published: September 2006

Eighteen years of personal experience of Vidian neurectomy by the author's trans‐antral route in 242 patients is fully reviewed with longterm follow‐up.

In otherwise intractable and severe cholinergic (non‐atopic) chronic vasomotor rhinitis, Vidian neurectomy has given complete relief in 94 percent of the patients sustained throughout five to 15‐year follow‐up. The operation has proved valuable in most cases with additional evidence of atopy, but the incidence of complete relief falls to 57 percent.

Occasional indications in other conditions are discussed with the results obtained.

The need for both meticulous case selection and impeccable technique is stressed. Given these, there now seems no significant risk of material complication. Incautious use of an unsuitable probe for diathermy in the pterygoid canal can give 2 percent risk of serious ophthalmoplegia. Such risk is eliminated by proper use of the author's shouldered probes.
Psychological problems in otolaryngology
Authors: Lucente Frank E.
Published: September 2006

Otolaryngology and psychiatry both deal with disorders of communication. Situations which illustrate the overlap between these two disciplines are seen throughout the patient's life cycle. Some of the general areas which are discussed briefly include congenital problems, tonsillectomy and other childhood surgery, adolescent illnesses, cosmetic surgery, head and neck cancer and care of the dying patient. Handling these problems requires attention to both verbal and non‐verbal patterns of communication.
Dysfunctions of energy releasing and consuming processes of the cochlea
Authors: Thalmann R. , Kusakari J. , Miyoshi T.
Published: September 2006

Features of energy production and utilization in the cochlea are discussed, with special attention given to the effects of various interferences upon these mechanisms, both with respect to electrophysiologic parameters and with respect to changes in steady state levels of selected metabolites. As a specific example the influence of ethacrynic acid upon the energy metabolism of the stria vascularis is considered. ATP and phosphocreatine concentrations were determined at control conditions and following intoxication with ethacrynic acid using the endolymphatic potential as monitor of functional damage. At the maximum depression of the endolymphatic potential phosphocreatine levels in the stria vascularis were normal and ATP levels slightly reduced; furthermore, if ethacrynic acid intoxicated ears were subjected to the additional stress of ischemia, the decline of both electrophysiologic indicators and high energy phosphates proceeded at a much slower rate. The findings were interpreted as showing that ethacrynic acid reduces the rate of energy consumption, with no significant effects on energy production.
Irrigation handle with temperature sensor and flow control
Authors: Proctor L. R. , Byrnes R. G.
Published: September 2006

A new caloric test irrigation handle incorporating a temperature sensor and flow control valve was found to provide temperature measurements which accurately represented temperature of the irrigation fluid. Fluid temperature within the handle was never more than .06° different from that in the nozzle tip, whereas bath temperatures ranged unpredictably between 0.12° to 0.46° higher. There was a delay of about 10 seconds between a step‐wise change in water bath temperature and the appearance of this change in the irrigation nozzle; there was no measurable delay between registration of temperature change in the handle and in the nozzle. A change of 1.5° in irrigation fluid temperature was found to be erroneously registered in the water bath as 1.8° but correctly registered in the handle.
Nasopharyngeal electrodes in auditory evoked response research
Authors: Peters Jon F. , Reilly Edward L.
Published: September 2006

Auditory evoked responses recorded from central scalp electrodes referred to both ear and nasopharyngeal electrodes, were compared to those recorded from the commonly employed vertex to ear derivation. Consistent responses were recorded from both the central to ear and central to nasopharyngeal combinations which were morphologically quite similar to those from the vertex to ear combination. Minimal responses of prolonged latency were seen in ear to nasopharyngeal derivations.
Air and bone conducted speech reception thresholds
Authors: Merrell Hal B. , Wolfe Donald L. , McLemore Donald C.
Published: September 2006

The negative psycho‐educational effects and the need for early diagnosis and treatment of mild hearing loss in children is documented. Literature is cited which suggests that air and bone conducted speech stimuli may be superior to pure tone stimuli when used to measure the hearing acuity of children. The sparse literature dealing with the use of bone conducted speech stimuli is reviewed.

Experimental data obtained from children is presented, which demonstrates that air and bone conducted speech stimuli yield thresholds equivalent to those obtained with pure tones and that thresholds can be obtained faster by using speech stimuli. Pediatric cases are presented which demonstrate that the use of air and bone conducted speech reception thresholds can differentiate conductive and sensori‐neural hearing loss and that reliable speech reception thresholds can frequently be obtained from pediatric patients when pure tone thresholds cannot.

The use of air and bone conducted speech reception thresholds is advocated as both an alternative and a complement to traditional pure tone audiometry, particularly with pediatric cases.
Oncocytic and oncocytoid tumors of the salivary glands
Authors: Johns Michael E. , Batsakis John G. , Short Charles D.
Published: September 2006

Histochemistry and electron microscopy have now enabled investigators to define precisely the oncocyte of salivary tissue. By these techniques, all oncocytes are characterized by a rich complement of mitochondria and most often by high oxidative enzyme activity.

The routine light microscopic appearance of oncocyte, i.e., swollen and eosinophilic, is in large part due to its increased mitochondrial content but is non‐specific and may be simulated by other cytoplasmic components such as endoplasmic reticulum, lysosomal bodies, secretory granules and other cell organelles.

The term, oncocytoid, should be used for cells not fulfilling minimal his‐tochemical requirements for the oncocyte.
Hemangiopericytoma of the parotid gland: A case report with autopsy
Authors: Neal Thomas F. , Starke William R.
Published: September 2006

Hemangiopericytoma is a vascular tumor first described by Murray and Stout in 1942 and featuring Zimmerman's pericytes. The tumor is relatively rare and occurs primarily in the skin and musculo‐skeletal system. It is now apparent that this tumor is potentially very malignant and at least half of them metastasize. A case report involving the parotid gland is presented, and pathological and clinical features are described.
The co‐existence of acoustic neuroma and otosclerosis
Authors: Clemis Jack D.
Published: September 2006

Dual or multiple pathologic entities simultaneously affecting the same anatomical region presents a blinding challenge to the clinician for an early and precise diagnosis. The co‐existence of acoustic neuroma and otosclerosis in seven patients is analyzed with detailed histories and clinical commentary. The diagnosis of otosclerosis preceeded that of neuroma in all cases. Any unilateral shift in hearing, whether sudden or progressive, is unusual and should provoke suspicion of active retrofenestral (labyrinthine) otosclerosis, perilymph fistula in post stapedectomy cases, labyrinthine ischemia, or neuroma. The literature on these subjects has, therefore, been reviewed and critically discussed in relation to each of the case reports.

The association of nasopharyngeal irradiation with acoustic neuroma in Case 4 prompted a search of the literature and summaries of the three previously reported cases of cervical neurofibroma associated with regional irradiation are included.

The eighth case is a fascinating corollary to the theme — a woman with von Recklinghausen's disease who has stapedial otosclerosis. Her life has been threatened with malignant degeneration in a peripheral neuroma. Malignant degeneration of neuromas in von Recklinghausen's disease has been reviewed but no report of malignant degeneration in an acoustic neuroma could be found.
Prophylactic antibiotics in oral, pharyngeal and laryngeal surgery for cancer: (A double‐blind study)
Authors: Dor Pierre , Klastersky Jean
Published: September 2006

Ampicillin plus Cloxacillin (2 gm of each daily) or a placebo were given at random and on a double blind basis to 52 and 50 patients undergoing oral, laryngeal or pharyngeal surgery for neoplastic lesions.

The frequency of postoperative wound and respiratory infections was significantly higher (p <0.05) among the placebo‐treated patients. Most infections in both groups were caused by gram‐negative rods. No untoward effects were related to the use of ampicillin plus cloxacillin and this form of therapy did not increase the rate of pharyngeal or wound asymptomatic colonization by bacteria.
Surgical treatment of xerophthalmia
Authors: Shanon Eliahu , Lazar Moshe , Redianu Chaim
Published: September 2006

During the past year, two patients suffering from xerophthalmia were treated by transposition of Stensen's duct into the inferior conjunctival fornix. The case history of one patient is reviewed and the operative technique as well as a modification which allows for a simultaneous reconstruction of an obliterated fornix are described. Profuse lacrimal epiphora appeared and a suggestion is made to evaluate the functional capacity of the parotid gland pre‐operatively with the help of scintigrams. If necessary, partial or subtotal excision of the parotid gland may be done in conjunction with the transposition procedure. Attention is drawn to possible analogy between aural and ocular lubricant systems.
The correlation between bacteriological findings in the nose and maxillary sinus in acute maxillary sinusitis
Authors: Axelsson A. , Brorson J. E.
Published: September 2006

Nasal and sinus bacteriology have been investigated in healthy controls and in patients with acute maxillary sinusitis. Comparatively few healthy noses were sterile, and in controls the nasal bacterial flora commonly consisted mainly of staphylococci and diphtheroid rods. Nasal specimens from patients with sinusitis showed most common findings to be “no growth,” pneumococci, Haemophilus influenzae and staphylococci in that order. In aspirated sinus secretions there was a predominance of pneumococci, “no growth” and Haemophilus influenzae. Other bacteria were uncommon. Staphylococci were shown conclusively to be nasal contaminants. The same organisms were found in the nasal and sinus secretions of patients with sinusitis in only 64 percent, thus indicating that nasal samples are of low predictive value in reflecting sinus flora. It can be argued that in the individual patient with sinusitis it is more reliable to base therapy on the results of previous bacteriological investigations than on the individual bacteral findings in the nose.
Abnormal dinitrochlorobenzene skin sensitization: A prognostic sign of survival in head and neck squamous cell carcinoma
Authors: Maisel Robert H. , Ogura Joseph H.
Published: September 2006

Dinitrochlorobenzene (2‐4 DNCB) forms a hapten with skin protein when topically applied. The delayed hypersensitivity reaction which secondary application produces is useful to measure cell‐mediated immunity as a gross measure of cancer immunity. Lymphocytopenia and anergy to attempted delayed hypersensitivity elicitation may both reflect poor host response to neoplasia.

A prospective study on 55 patients with localized or regional squamous cell carcinoma of the larynx, pharynx and mouth was done. These patients were sensitized and stimulated with DNCB and lymphocyte counts measured. Eighty‐eight percent of positive DNCB reactors were alive and tumor free at one year while 53 percent of non‐responders survived free of disease. All 19 DNCB responders with normal or increased lymphocyte counts survived without recurrence. The potential usefulness of prognostic evaluation of host response is described.
Facial palsy: Bell's versus parotid vascular malformation: Case report
Authors: May Mark , Lucente Frank E. , Farrell Frank W.
Published: September 2006

The occurrence of facial paralysis in a patient with a parotid vascular malformation is reported. Topographic diagnostic tests suggested a lesion in the tympanomastoid portion of the nerve. Subsequent surgical exploration confirmed the benign nature of the parotid mass. Although extremely rare, in view of the possible relationship of the parotid lesion with the facial paralysis, the authors suggest that this case be classified as peripheral facial paralysis associated with a benign parotid vascular anomaly.
Papillary cystadenoma of the larynx
Authors: Donald Paul J. , Krause Charles J.
Published: September 2006

A patient with a tumor of the larynx resembling a Warthin's tumor of the parotid salivary gland is described. A comparison is drawn between this lesion and oncocytoma. A discussion of the morphology and pathogenesis of oncocytic adenomas is presented.
Indirect microlaryngostroboscopy
Authors: Padovan I. F. , Christman N. T. , Hamilton L. H. , Darling R. J.
Published: September 2006

Use of the operating microscope for indirect microlaryngoscopy in routine office practice has been broadened by the development of a supplementary system which offers indirect microlaryngostroboscopy as a practical tool for routine laryngological practice. The supplementary system has been adapted to the Zeiss operating microscope equipped with a 300 mm objective. The original light source on the microscope is replaced by a stroboscopic bulb which flashes in synchrony with the output of an audible tone generator. The tone generator is used to guide the patient's vocalization during the examination, and, thereby, produces a stop‐action image of the vocal cords. Its use in conjunction with clinical judgment by the examiner can aid in the diagnosis and treatment of various dysfunctions of the vocal cords.
Air in the neck
Authors: Thawley Stanley E.
Published: September 2006

Air in the neck is normally found in the pharynx, larynx and trachea. Free air may enter the neck by direct opening of potential fascia spaces, dissection within the fascia spaces from the head or mediastinum and by injury to the upper respiratory or alimentary tracts. The sources for free air in the neck are numerous and varied and range from the rectum to the sinuses. The otolaryngologist should have a thorough knowledge of the differential diagnosis for air in the neck since the definitive therapy depends on the etiology.