bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cost‐Effectiveness of Prophylactic Antibiotics in Head and Neck Surgery
Authors: Mandell‐Brown Mark , Johnson Jonas T. , Wagner Robin L. 
Published: November 2015

Studies undertaken at the Eye and Ear Hospital of Pittsburgh indicate that antibiotic prophylaxis can reduce the incidence of patient morbidity. In this article we will demonstrate the effect of antibiotic prophylaxis on the economics of major head and neck surgery. One hundred and one patients were assigned to one of four treatment protocols, three of which entailed 1 day of a perioperative prophylactic antibiotic and the fourth a placebo. The study was conducted in a double‐blind, randomized fashion. Patients receiving a placebo experienced an infection rate of 78%. Patients receiving cefazolin experienced an infection rate of 33%. Ten percent of patients treated with cefoperazone or cefotaxime developed postoperative wound infection. Postoperative hospitalization averaged 17.9 days for patients who did not develop postoperative wound infection, in contrast to an average of 32.6 days for patients with postoperative wound infection. The added cost of postoperative infection justifies the added use of the newer, more expensive antibiotics in view of the reduced postoperative morbidity and postoperative hospitalization.
Erythromycin Ototoxicity: Analysis and Conclusions Based on 22 Case Reports
Authors: Haydon Richard C. , Thelin James W. , Davis William E. 
Published: November 2015

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

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

Between 1982 and 1984, a modified Infratemporal fossa approach was used to resect cancers with extensive primary or secondary Involvement of the Infratemporal fossa and parapharynx in 10 patients. Nine patients exhibited persistent or recurrent disease of the upper aerodigestive tract and posterior cranial fossa following planned, curative‐Intent therapy; the remaining patient had a carcinoma ex‐pleomorphic adenoma of the deep lobe of the parotid gland with a significant Infratemporal fossa extension. Considered to have “unresectable” tumors, by traditional methods, 7 of the 10 patients underwent an en‐bloc resection of their lesions with tumor‐free margins. Tumor was present at the margins of the specimens in the other 3 patients. Two of the 10 patients died early in the postoperative period of medical complications. Another died 5 months postoperatively of a tumor‐Induced Internal carotid artery rupture at the level of the foramen lacerum. A fourth patient died of his disease 6 months following his resection. One patient is alive, but has metastatic meningioma 2 years after surgery. The 5 remaining patients are without evidence of disease, with a mean follow up of 2 years. Indications for and refinements of the operative technique, particularly those related to the repair of such extensive ablative defects, are outlined on the basis of this early experience.
Clinical Evaluation of a New Nonelectronic All‐in‐the‐Ear Hearing Device for Mild Hearing Loss
Authors: Goode Richard L. , O'Keefe Richard , Homan Debra , Hosford‐Dunn Holly , Wood Melissa 
Published: November 2015

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

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

The attenuation of bone‐conducted stimuli across the human skull was determined in audiometric, ultrasonic, and supersonic frequency ranges (250 to 64,000 Hz). An increase in attenuation with an increase in frequency, as well as significant resonance effects, was observed. For the audiometric frequency range, bone conduction stimulation of one side of the head results in almost equal stimulation of the other side. In the ultrasonic and supersonic ranges, the contralateral side is progressively isolated.
ECoG and Perilymphatic Fistulae: An Experimental Study in the Guinea Pig
Authors: Gulya Aina J. , Boling Lloyd S. , Mastroianni Mary Ann P. 
Published: November 2015

Perilymph fistulae present a diagnostic dilemma to the clinician. As yet, there is no readily available, widely accepted diagnostic test. Electrocochleography (ECoG), with the advent of extratympanic recording techniques, has become a clinically applicable probe of cochlear function. Clinical ECoG was used to study guinea pigs (n = 35) both before and after surgical fistulization (n = 18) or fistulization and repair (n = 17) of the round window membrane. The animals were killed, and histopathologic examination of the temporal bones was carried out 0, 1, 3, 4, 7, 10, 14, 21, and 28 days after surgery. Of the 33 animals that survived surgery, 30 demonstrated ECoG waveforms. No significant difference between the preoperative and postoperative waveforms could be detected. Histopathologic study showed rapid healing of the fistulae, with no evidence of hydrops. Although there appeared to be a relatively selective loss of the outer hair cells of the cochlear basal turn, autolysis precluded detailed analysis. ECoG, as performed clinically, does not appear to detect the presence, spontaneous healing, or repair of a round window membrane fistula in the guinea pig.
Histopathologic Evaluation of Adipose Autografts in a Rabbit Ear Model
Authors: Bartynski Jeffrey , Marion Mitchell S. , Wang Tom D. 
Published: November 2015

Injection of autologous adipose tissue removed via liposuction has been used clinically for facial contouring, the aging face, furrows, facial atrophy, acne scars, nasolabial folds, chin, and various other surgical defects. Survival rates for autografts of fat have been quoted anywhere from 30% to 80%. Our study uses a reproducible rabbit animal model for autotransplantation of adipose tissue and examines the histopathologic changes that occur to the graft over time. Autogenous subcutaneous fat was removed from a dorsal scapular donor site, treated to stimulate cannula damage as in liposuction, then reinjected at the base of the ear. Histologic examination of the grafts were made at 5, 10, 15, 20, 40, and 100 days after transplantation. Hematoxylin‐eosin sections were graded on degree of fibrosis present (0 to 4+), viable fat (1 to 10), degree of inflammation (0 to 4+), and neovascularization (+ or ‐). Viability of fat decreased from 8.5 to 10 at 5 days to 2 viability at 40 days. Acute inflammation peaked at 10 days, followed by the chronic inflammatory response with macrophages and multinucleated giant cells scavenging the dying fat graft. Neovascularization began at 5 days, peaked at 10 days, and remained constant thereafter only at the edge of the graft. Microcysts appeared at 15 days and increased in number in proportion to the decrease in viable fat. In summary, the temporal histologic events are progressive fibrosis; decreased amount of viable fat; inflammation beginning with a neutrophilic response, later a macrophage and giant cell response; and neovascularization at the periphery of the graft insufficient to maintain graft viability. In our animal model, autografts of fat appear to have limited long‐term viability and are replaced by fibrous tissue. This may have clinical implications in autografting of fat in facial plastic and reconstructive surgery.
Cochlear nucleus cell size is regulated by auditory nerve electrical activity
Authors: Pasic Thomas R. , Rubel Edwin W 
Published: November 2015

Accumulating evidence suggests that sensorineural hearing loss in animals is rapidly followed by degenerative changes in central auditory neurons. For example, cochlear removal in birds and mammals results in a reduction in central auditory neuron cell size within 48 hours. A similar decrease in cell size after pharmacologic blockade of auditory nerve electrical activity with tetrodotoxin has been reported. In the present study, we evaluate the reversibility of central auditory changes after a profound sensorineural hearing loss caused by blockade of auditory nerve action potentials. Tetrodotoxin, which blocks voltage‐sensitive sodium channels, was embedded in a slowrelease vehicle and placed next to the round window membrane of gerbils. Tetrodotoxin diffused into perilymph and unilaterally blocked electrical activity in auditory nerve axons. Electrical activity blockade was confirmed with recordings of auditory brainstem response. Animals were killed immediately after 24 hours of electrical blockade or 7 days after a transient 24‐ or 48‐hour blockade. large spherical cells of the anteroventral cochlear nucleus ipsilateral to manipulation were measured and compared to large spherical cells on the opposite, unmanipulated side of the brain. Animals killed immediately after a 24‐hour blockade of electrical activity showed a mean decrease of 16% in cell size ipsilateral to the blockade (p< 0.05). In animals allowed to recover for 7 days after blockade for 24 or 48 hours, cell size returned to previous levels. There was no longer a consistent difference in cell size between the two sides of the brain in these animals (p> 0.05). Thus changes in size of anteroventral cochlear nucleus large spherical cells were reversible after recovery of electrical stimulation. These data provide evidence that electrical activity is involved in the regulation of cell size in mammalian central auditory neurons. Additionally, cochlear nucleus neurons can return to their former size after brief periods without stimulation.
Technique for transmission and immunoelectron microscopy of the human endolymphatic sac and vestibular epithelia
Authors: Wackym Phillip A. , Ward Paul H. , House William F. , Linthicum Fred H. , Micevych Paul E 
Published: November 2015

A surgical technique is presented to obtain the entire vestibular aqueduct, containing the endolymphatic duct and sac as well as the vestibular epithelia, from the maculae and cristae during labyrinthectomy. The inner ear tissue was fixed in 3% glutaraldehyde, decalcified in 0.1 mol/L Na‐EDTA, and routinely processed for transmission electron microscopy, including post‐fixation with osmium tetroxide. Postembedding protein A‐colloidal gold immunoelectron microscopy was performed after exposure of cellular antigenic sites by sodium metaperiodate. To validate this technique, thin sections from the crista ampullaris and the endolymphatic sac were incubated with antibodies raised against S‐100, a protein present in specific types of neural tissue. Specific immunoreactivity was observed in the crista ampullaris, but not in the endolymphatic sac. The surgical biopsy technique described provides a means for the neuro‐otologist to collect inner ear tissue from surgical patients that can be used for pathological studies using immunohistochemistry and electron microscopy.
Vestibular autorotation test asymmetry analysis of acoustic neuromas
Authors: O'Leary Dennis P. , Davis Linda L. , Maceri Dennis R. 
Published: November 2015

The vestibular autorotation test (VAT) measures the vestibulo‐ocular reflex (VOR) response from 2 to 6 Hz, during 18 seconds of active head movements, while the patient attempts to fixate on a wall‐mounted target. A new method of measuring eye velocity asymmetry from VAT data is presented, based on computer estimation of the 0th harmonics of discrete Fourier spectra over short segments of digital eye and head velocity records. Eye asymmetries greater than a 3% normal range are shown to be directionally correlated with the side of the lesions in patients with unilateral labyrinthectomies. Among patients with a diagnosis of acoustic neuroma, who were tested preoperatively with the VAT, nine of nine patients showed eye asymmetries greater than 3% toward the side of the neuroma. Those patients with acoustic neuromas who have sufficiently vigorous high‐frequency head responses showed mean percentages of eye asymmetry that were linearly correlated with the size of the acoustic neuroma. These results suggest that VAT high‐frequency asymmetry provides a useful method of diagnostic evaluation of the side and extent of unilateral peripheral lesions.
Is the vestibular system affected by middle ear effusion?
Authors: Ben‐David J. , Podoshin L. , Fradis M. , Faraggi D. 
Published: November 2015

The association between middle ear effusion (MEE) and vestibular pathology is controversial. To investigate this point, 50 children with MEE scheduled for myringotomy and grommet, and 20 normal hearing children without MEE scheduled for adenotonsillectomy, underwent vestibular investigations by craniocorpography and rotatory chair, preoperatively and postoperatively. Most of the correlations, preoperative vs. postoperative, and study vs. control groups, were nonsignificant. Assuming that serous labyrinthitis is responsible for vestibular involvement in MEE, the lack of significant vestibular pathology in our study could probably be explained by the fact that no children with acute otitis media episodes or otalgia were included. (OTOLARYNGOL HEAD NECK SURG 1993;109:421‐6.)
Middle ear air injection after chronic ear surgery
Authors: Silverstein Herbert , Gordon Michael , Rosenberg Seth I. , Seidman Michael , Willcox Thomas O. , Silverstein Julie 
Published: November 2015

In the early period after chronic ear surgery, the reasons for conductive hearing loss may be difficult to determine. Patients who cannot autoinflate the middle ear after 3 weeks, or who have a negative Rinne test result with the 512 Hz tuning fork, are treated with a transtympanic injection of 0.5 cc of air with a 27‐gauge needle and tuberculin syringe. This represents 20% of patients who had chronic ear surgery. Results show that hearing may be immediately improved, the sensation of pressure in the ear may be reduced, and fluid may be cleared from the middle ear. Other benefits may include the release of adhesions. The surgeon is better able to assess the thickness of the graft, and the status of the ossicular chain reconstruction can be determined. There have been no complications of middle ear infection or failure of the micropuncture site to heal. In our practice, middle ear air injection is a routine procedure in patients with inadequate eustachian tube function after chronic ear surgery. This report describes the results of 100 patients over 14 years who received middle ear air injections after chronic ear surgery compared with a control group of 100 patients who did not meet the criteria for requiring air injection. Hearing was immediately improved in 74% of patients as determined by Rinne testing. Audiograms were performed in 25 of these patients, documenting a mean improvement in pure‐tone average of 16 dB. The long‐term hearing results in patients undergoing air injection, who by definition had evidence of poor eustachian tube function, are similar to the results in the control group. This may indicate a lasting benefit of air injection. (OTOLARYNGOL HEAD NECK SURG 1993;109:488‐92.)
The biochemistry of neutralization
Authors: Trevino Richard J. 
Published: November 2015

It has been shown that injections of low closes of common environmental antigens or irritants cause a reduced sensitivity during a subsequent exposure to the same antigen and irritant. On the basis of these findings, the following study was performed: 20 allergic patients who manifested allergic symptoms were observed during skin end‐point titration testing, which is described in the manuscript. During the testing procedure, 60% of the patients reported a complete relief of symptoms. It is postulated that a cytoprotective dose was given during the testing procedure that caused the symptoms to be relieved. The second part of the study was a double‐blind placebo control study in which 40 patients received the end‐point dose and 10 patients received placebo. All patients entered the study with allergic symptoms. None of the placebo patients reported any relief of symptoms when given their injection. Of patients who received the active ingredient, 67.5% reported relief of symptoms within 5 to 10 minutes after the subcutaneous administration of the active ingredient. With these findings, it is postulated that this low dose of active ingredient caused the production of prostaglandin E intracellularly, which causes an increase in cyclic AMP and a decrease in cyclic GMP, which results in the resolution of symptoms.
Neurotologic manifestations of chiari 1 malformation
Authors: Weber Peter C. , Cass Stephen P. 
Published: November 2015

It is important for otolaryngologists to recognize Chiari malformations as part of the differential diagnosis of balance disorders because patients may initially be seen with symptoms referable to the vestibular system, including ataxia, nystagmus, or vertigo. The objective of this paper is to review the signs, symptoms, and vestibular test findings of a series of patients with Chiari 1 malformation. Six patients were identified by retrospective chart review with a diagnosis of Chiari malformation. Each patient had a complete otoneurologic examination and vestibular function testing. The results indicated that patients fell into two different vestibular test result profiles. First, patients with advanced symptoms demonstrated oculomotor dysfunction, central vestibular nystagmus, abnormal vestibular visual interaction, and abnormal tilt suppression of postrotatory nystagmus. On the other hand, a number of patients were identified with incidentally noted Chiari malformation on magentic resonance imaging scan who had a vestibular test profile consistent with peripheral vestibulopathy without signs and symptoms of central nervous system dysfunction. Guidelines are provided to help determine the extent of the group of symptoms attributable to an incidentally discovered Chiari malformation.
Sources of error in use of beta‐2 transferrin analysis for diagnosing perilymphatic and cerebral spinal fluid leaks
Authors: Skedros Demetrios G. , Cass Stephen P. , Hirsch Barry E. , Kelly Robert H. 
Published: November 2015

Beta‐2 Transferrin Is A Protein Found In Cerebral Spinal Fluid And Inner Ear Perilymph, But Not In Blood, Nasal, Or Ear Secretions. The Clinical Use Of This Test Has Been Previously Demonstrated, But Sources Of Test Error Have Not Been Addressed. The Purpose Of This Study Was To Evaluate Sources Of Error Related To This Test In Order To Improve Its Clinical Use. We Reviewed The Specimens Submitted For Beta‐2 Analysis Over The First 12 Months Of Test Availability At Our Institution To Identify Potential Factors Leading To Test Error. Sources Of Error Were Categorized Into The Following Groups: Sample Collection, Delivery, And Extraction Factors; Assay Factors; Physician‐Related Factors; And Patient‐Related Factors. The Test For Beta‐2 Transferrin Is A Valuable Diagnostic Tool For The Management Of Difficult Clinical Problems, Provided The Physician Is Aware Of Potential Factors That Can Lead To Test Error And Clinical Mismanagement.