bluuebunny/crossref_metadata_2025_split huggingface dataset:
Gunshot Injuries of the Temporal Bone
Authors: Duncan Newton O. , Coker Newton J. , Jenkins Herman A. , Canalis Rinaldo F. 
Published: November 2015

Concurrent with the increase in handgun crime in the United States is a rising incidence of gunshot wounds to the temporal bone. These injuries present challenging diagnostic and management problems to the otolaryngologist. A timely multicenter review of this entity revealed 22 cases evaluated and treated by the authors between 1975 and 1984. A wide variety of injuries were encountered, involving anatomic structures within or contiguous with the temporal bone. These included: eight intracranial injuries; 11 traumatized facial nerves; seven vascular wounds; 19 mastoid, middle, or inner ear injuries; and 11 cases of damage to the external auditory canals. A rational scheme for immediate and long‐term management of each type of injury is outlined. Illustrative cases representing vascular, neural, temporal bone, and central nervous system injury are presented.
The “plateau effect” of cis‐platinum‐induced hearing loss
Authors: Myers Steven F. , Blakley Brian W. , Schwan Sabina , Rintelmann William F. , Mathog Robert H. 
Published: November 2015

Cis‐platinum‐induced hearing loss has been reported to exhibit a “plateau effect” over the 2 to 8 kHz range. We examined serial audiometry data from 27 patients treated with cis‐platinum. Although a plateau at 60 to 70 dB HL often occurred, this hearing loss was clearly exceeded in a number of patients. We identified 14 patients with sufficient cis‐platinum‐induced sensorineural hearing loss to evaluate a plateau limit to hearing loss over the 4 to 8 kHz range. Half of these 14 patients had hearing losses that exceeded the plateau level. More severe 4 to 8 kHz hearing losses did not correlate with number of treatments, cumulative dosages of cis‐platinum, pre‐existing hearing loss, radiation therapy, other chemotherapeutic agents, or even hearing losses below 4 kHz. Although cis‐platinum therapy can induce a plateau of moderate hearing impairment for some patients over the 4 to 8 kHz range, a significant proportion of patients will experience more severe hearing impairment in this range, even after only one or two courses Of cis‐platinum.
A modified neoglottis procedure: Update and analysis
Authors: Brandenburg James H. , Cragle Stephen P. , Rammage Linda A. 
Published: November 2015

In recent years, various techniques have been introduced for construction of an epithelium‐lined shunt between the trachea and the esophagus or hypopharynx. We described a rigid neoglottis in a prelimlinary report of 12 cases in which the upper tracheal rings were used to construct the epithelium‐lined tract. This study reports the cases of 22 additional patients and offers an in‐depth analysis of additional demographics, complications, and long‐term speech results that quantify the vocal characteristics of neoglottic speakers. Results indicate rapid postoperative speech rehabilitation in nearly all patients, good long‐term speech results (mean followup, 52 months), and low morbidity. There was a low incidence of local recurrence and stenosis, and 26 of 34 patients had either no aspiration or occasional asymptomatic aspiration of small amounts of liquid. This modified neoglottis procedure should be considered for patients who need voice restoration after laryngectomy.
Protective effect of electrical stimulation in the deafened guinea pig cochlea
Authors: Hartshorn Duane O. , Miller Josef M. , Altschuler Richard A. 
Published: November 2015

The effect of chronic intrascalar electrical stimulation on the spiral ganglion cell survival of the ototoxically deafened guinea pig was investigated. Immediately after ototoxic drug administration, unilateral sinusoidal (1 kHz) charge‐balanced electrical stimulation on a 50% duty cycle was administered for 2 hours per day, 5 days per week, at intensities from 0 (control) to 400 μAmp via an implanted scala tympani electrode. The relationship of electrically evoked middle latency response (EMLR) to stimulation protocol and cell survival was studied. At 9 weeks post‐drug treatment, the animals were killed and temporal bones were prepared for morphometric analysis of spiral ganglion cell density. The subjects showed essentially complete elimination of outer hair sensory cells, with minimal remaining inner hair cells confined to apical turns. Variable loss of spiral ganglion cell populations was observed, which related to electrical stimulation. In animals that received daily unilaterally electrical stimulation, statistically significant increases in survival of spiral ganglion cells were observed in the stimulated ear, compared to the nonstimulated ear—particularly in basal cochlear regions near the electrode. Spiral ganglion cell density was a function of stimulation current intensity level. Moreover, the slope of the amplitude input/output (I/O) function of the EMLR was found to be dependent on stimulating current level. The effect of stimulation on induced survival may be dependent on a number of mechanisms, including metabolic effects of direct activation of “deafferented” spiral ganglion cells. These data support the suggestion that implantation may provide optimal benefits when performed shortly after deafness.
Is Melanoma Changing?
Authors: Conley John 
Published: November 2015

Nine hundred ninety‐five cases of melanoma of the head and neck were divided into two groups so that certain comparisons could be made concerning the behavior of melanoma over a 55‐year period. One hundred twelve melanomas of the occular system were excluded from this review. The first group consisted of 660 melanomas seen during a period from 1932 to 1972. The second group consisted of 223 melanomas seen during a period from 1973 to 1987. Thirteen parameters, including sex, age, distribution, pre‐existing mole, amelanotic melanoma, delay in diagnosis, classification, levels, local recurrence, regional metastasis, systemic metastasis, morbidity, and survival, were studied to assess the behavior and the variations. There is no question that the most important aspect of the favorable changes that have occurred are because of earlier diagnosis and better management by a larger group of well‐trained specialists. There are some subtler changes that could possibly indicate biologic alterations, but this requires more time and study to substantiate.
The use of fine‐needle aspiration in the diagnosis of metastatic pulmonary adenoid cystic carcinoma
Authors: Pitman Martha Bishop , Sherman Mark E. , Black‐Schaffer W. Stephen 
Published: November 2015

Nine patients with a history of adenoid cystic carcinoma (ACC) arising in the head and neck and in whom transthoracic fine‐needle aspiration (FNA) was performed to investigate pulmonary lesions are described. FNA yielded a definitive diagnosis of metastatic ACC in all cases. In six of the nine patients, the pulmonary metastases were asymptomatic. Lung lesions were discovered up to 19 years after primary tumor presentation, and in two, pulmonary spread was the only evidence of recurrent disease. On the basis of the FNA diagnosis, these two patients were treated surgically for their isolated pulmonary metastases, and are disease free at 107 and 139 months. Six of the nine patients received radiation or chemotherapy; one initially refused treatment. Thoracotomy was avoided in these patients on the basis of the FNA diagnosis. All are alive with disease at 25 to 246 months. The metastatic tumors were indistinguishable cytologically from two primary pulmonary ACCs that were available for comparison. Our experience suggests FNA is a useful tool in the diagnosis of ACC in pulmonary material—one which obviates the need for thoracotomy with its associated morbidity.
Endoscopic surgery for lacrimal obstruction
Authors: Metson Ralph 
Published: November 2015

Intranasal access to the lacrimal drainage system has been greatly enhanced with the advent of endoscopic nasal surgery. This technique has been used for the treatment of recurrent lacrimal obstruction after failed external dacryocystorhinostomy (DCR) in 12 patients. Improved intranasal visualization with the endoscope allowed easy identification and opening of the lacrimal sac, with no need for a skin incision. Obstructing intranasal pathology, including adhesions from previous DCR, an enlarged middle turbinate, and ethmoid sinus disease, was readily identified and corrected. There were no intraoperative complications. Lacrimal obstruction was completely relieved in nine of 12 patients (75%), with a followup of 7 to 25 months. Endoscopic revision DCR should be considered in patients with recurrent epiphora after external DCR.
Effect of glycerol and mannitol on perilymphatic PO2 in guinea pig cochlea
Authors: Yoshida Masafumi , Uemura Takuya 
Published: November 2015

The effects of glycerol and mannitol on partial oxygen pressure (PO2) in perilymph were studied with a polarographic technique in the guinea pig cochlea. Following a transient reduction immediately after the intravenous injection of each drug, the oxygen tension increased to reach a peak 5 to 10 minutes later, and then decreased gradually. The magnitude and duration of the PO2 increases were larger after the administration of glycerol than after that of mannitol. These results corresponded well with the clinical experience that glycerol was more effective than mannitol in improving hearing in Meniere's disease. The increase of PO2 in the cochlea, therefore, is considered to be one of the possible contributory factors for the improvement of hearing in patients with Meniere's disease after glycerol administration.
Facial nerve monitoring in acoustic tumor surgery
Authors: Kwartler Jed A. , Luxford William M. , Atkins James , Shelton Clough 
Published: November 2015

Anatomic and functional preservation of the facial nerve during acoustic tumor surgery remains a primary goal. Intraoperative electromyographic facial nerve monitoring with auditory feedback has enabled the surgeon to more readily achieve this goal. We compared a group of monitored translabyrinthine acoustic tumor removals (N = 89) to a similar unmonltored group (N = 155) in regard to facial nerve function. Function was assessed immediately postoperatively, at time of discharge, and at 1 year postoperatively using the House six‐point scale. Results were grouped as satisfactory, intermediate, or poor and were analyzed by tumor size. Facial nerve results were better at all time intervals in the monitored groups, although the difference was not statistically significant at the 1‐year interval. There was no difference between monitored and unmonitored patients in the subgroups with tumors smaller than 2.5 cm in diameter. This study supports the usefulness of intraoperative facial nerve monitoring in improving facial nerve results, particularly in larger tumors.
Radiotherapy of advanced laryngeal cancer using three small fractions daily
Authors: Bradley Patrick J. , Morgan David A.L. 
Published: November 2015

Since 1983, we have treated advanced (UICC stages 111 and IV) squamous carcinomas of the larynx by primary radiotherapy, using three small fractions a day, 3‐4h interfraction interval, 5 days per week. The early patients received doses per fraction of 1.5 Gy, and a total dose of approximately 70 Gy, given as a split‐course over 6 to 7 weeks. While overall tumor control and laryngeal preservation was good, a number of severe late radiation reactions were seen. The schedule was then modified, with a reduction in the fraction size to 1.1 Gy, the total dose to 60 Gy, and the overall time to 4 weeks, with omission of the mid‐treatment “split.” Since 1986, we have treated 26 patients in this way. Acute reactions are brisk, but rapidly healing. loco‐regional control was achieved in 22 patients, only one of whom has relapsed to date, in a solitary node, salvaged by radical neck dissection. Four have died of uncontrolled loco‐regional malignancy, and three of intercurrent disease while in clinical remission. No serious late morbidity has been observed in surviving patients, and vocal quality is good in the majority. These results suggest that this hyperfractionated and accelerated radiotherapy schedule may offer an acceptable nonsurgical, voice‐preserving treatment for advanced laryngeal carcinoma; it can be used in a normally working radiotherapy department.
Successful treatment of selected cases of abductor spasmodic dysphonia using botulinum toxin injection
Authors: Ludlow Christy L. , Naunton Ralph F. , Terada Sumiko , Anderson Barbara Jean 
Published: November 2015

Ten patients with abductor spasmodic dysphonia, who exhibited spasmodic bursts and heightened activity of the cricothyroid muscle during speech, were selected for participation. Between 5 and 20 U of botulinum toxin type A were injected into both right and left cricothyroid muscles. Six patients benefited substantially, whereas four did not. Acoustic analyses of voice patterns showed similar changes to the clinical impressions. Significant group improvements were found in sentence duration while selected patients improved in the proportion of their speech that was voiced and the duration of their voiceless consonants. Those patients with abductor spasmodic dysphonia and other muscle abnormalities in addition to the cricothyroid and with constant breathiness did not benefit.
Acute laryngeal trauma: A review of 77 patients
Authors: Bent John P. , Silver John R. , Porubsky Edward S. 
Published: November 2015

Acute laryngeal trauma is a rare injury. In the past 18 years, 77 patients with acute laryngeal trauma have been evaluated at our institution. Each patient's care was overseen by the senior author (E.S.P.). The 61 patients who were seen within 48 hours of their accident are compared with those treated after 48 hours. All patients are classified by both injury (groups 1 through 5) and treatment (types I through III). Results are reported for voice, airway, and swallowing. Our methods of evaluation and treatment are outlined, and controversial aspects of patient management are addressed. We conclude that conservative treatment of group 1 and 2 injuries is 100% effective, expeditious repair of laryngeal injuries greatly reduces poor outcome, and the type of injury can be used to roughly predict patient outcome. Further, with use of current methods of diagnosis and management, almost all patients will be decannulated (98%) with functional speech (100%) and normal deglutition (100%). (OTOLARYNGOL HEAD NECK SURG 1993;109:441‐9.)
Acute epiglottitis: Changing epidemiologic patterns
Authors: Frantz Timothy D. , Rasgon Barry M. 
Published: November 2015

We determined incidence of acute epiglottitis in the Northern California Region of the Kaiser Permanente Medical Care Program during an 11‐year period, from 1980 through 1990. The health plan membership is representative of the ethnicity, age, sex, and occupation of the Northern California population. The study included 135 children and 258 adults. Annual incidence in adults was relatively stable, ranging from 1.16 to 2.12 cases per 100,000. Annual incidence in children, however, decreased from 3.47 cases per 100,000 in 1980 to 0.63 cases per 100,000 in 1990. The ratio of annual incidence in children to that in adults decreased from 2.6 in 1980 to 0.4 in 1990. This changing epidemiologic pattern may be the effect of the Hemophilus influenzae type b vaccine (Hib), which was first given to children in 1985. Acute epiglottitis, classically considered a disease of children, is now becoming a disease of adults. (OTOLARYNGOL HEAD NECK SURG (1993;109:457‐60.)
Assessment of survival and microscopic changes in porcine skin flaps undergoing immediate intraoperative tissue expansion
Authors: Guida Roberta , Cohen James I. , Cook Ted A. , Swanson Neil A. , Burgeson Robert , Johnson Timothy M. 
Published: November 2015

The technique of rapid Intraoperative tissue expansion has been used with increasing frequency in the clinical setting over the last several years. This technique takes advantage of the skin's ability to immediately stretch and increase in surface area when expanded under a constant load. Sixteen random‐pattern, rapidly expanded skin flaps on 10 domestic male pigs were studied to assess the predictive value of the fluorescein test for flap viability after rapid intraoperative tissue expansion. Partial fluorescence was found to be a more accurate predictor of flap survival in the experimental rapidly expanded flaps when compared to full fluorescence. Partial fluorescence was found to under‐predict flap survival by 0.3 to 0.5 cm, whereas full fluorescence was found to under‐predict flap survival by 2.5 cm. Additionally, histologic and ultrastructural changes were examined in rapidly expanded skin from the hip region in three pigs. The only microscopic change noted between control and experimental flaps was dilated capillaries in the dermis of expanded skin, which was noted by electron microscopy. Collagen and elastic tissue changes were not demonstrated in rapidly expanded pig skin by electron microscopy, direct immunoflurescence, collagen, and elastic tissue stains.
Effects of probe insertion depth on real ear measurements
Authors: Dirks Donald D. , Ahlstrom Jayne B. , Eisenberg Laurie S. 
Published: November 2015

The purpose of this article is to provide an overall summary of the role probe insertion depth has on real ear measurements, and to compare the real ear sound pressure level measured by a probe microphone system, using three methods for positioning the probe in an ear canal. The probe insertion techniques that were compared included: (1) an acoustic method that incorporates use of the quarter‐wave antiresonance property of the ear to determine acoustically the location of the probe tube relative to the eardrum in an individual ear; (2) a constant insertion depth method (25 mm from the intratragal notch); and (3) the earmold + 5 mm method, which places the probe 5 mm beyond the tip of the individual's earmold in the canal, thereby avoiding problems associated with the transition region, where sound exits from the bore of the earmold into the larger ear canal. Measurements were obtained for each method at 32 frequencies in the unoccluded ears of 17 subjects. Results indicated that the sound pressure levels measured by the acoustic method were significantly larger than those measured by the other two methods. This result was most evident in subjects with long ear canals (> 25 mm) and at high test frequencies (4.0 to 6.3 kHz). For subjects with short or average length ear canals, the three methods provided essentially equivalent results.
Autorotation test abnormalities of the horizontal and vertical vestibulo‐ocular reflexes in panic disorder
Authors: Hoffman Donna L. , O'Leary Dennis P. , Munjack Dennis J. 
Published: November 2015

Patients with panic disorder often describe dizziness as a disturbing symptom, with more severe episodes reported than in other psychiatric populations. Nineteen patients diagnosed as having a panic disorder were tested for vestibulo‐ocular (VOR) abnormalities with the Vestibular Autorotation Test (VAT), a computerized test of the high‐frequency (2 to 6 Hz) VOR. The patients were unselected for the presence or absence of balance disorders. Results showed VOR abnormalities, relative to a normal population, in the horizontal and/or vertical VORs of all 19 patients. Vestibulo‐ocular reflex asymmetries were commonly present. Because the VAT tested the VOR over a frequency range encountered during common daily activities, the observed abnormalities could result in a perceptually moving visual field (oscillopsia). We hypothesize that the resulting experience of a visual‐vestibular disturbance—perhaps in a biologically or psychologically predisposed individual—is catastrophically misinterpreted, leading to more bodily symptoms and anxiety. These could then contribute to more misinterpretation in a positive feedback sense, ultimately leading to a panic attack.
Advanced giant cell granuloma: A twenty‐year study
Authors: Tallan Eric M. , Olsen Kerry D. , McCaffrey Thomas V. , Unni K. Krishnan , Lund Bruce A. 
Published: November 2015

Giant cell granuloma is a benign lesion that generally involves the mandible and maxilla. It may be locally aggressive and result in extensive tissue destruction in advanced cases. A retrospective analysis of giant cell granuloma during the Interval 1970 to 1990 revealed 18 cases of advanced disease, as defined by bone destruction and a greatest dimension of 2.0 cm or more. Epidemiologic factors, physical findings, Imaging studies, pathologic specimens, treatment modalities, and outcome were reviewed for each case. Eight lesions were treated by local excision and curettage, and 10 were treated by partial mandibulectomy. Five mandibular defects were reconstructed with lilac bone grafts and one with a free flap. Only one patient with maxillary giant cell granuloma who underwent curettage had regrowth of what is suspected to have been residual disease. Individualized treatment, tailoring the extent of resection to the extent of disease, provided excellent results.
Pharyngoesophageal Reconstruction Using the Radial Forearm Fasciocutaneous Free Flap: Preliminary Results
Authors: Kelly Kevin E. , Anthony James P. , Singer Mark 
Published: November 2015

Pharyngoesophageal reconstruction remains a challenge to the head and neck surgeon. The goals of pharyngoesophageal reconstruction include restoration, with minimal morbidity, of a person's ability to swallow and to speak. Myocutaneous flaps, gastric pull‐up, and the jejunal free flap are popular methods of pharyngoesophageal reconstruction; however, none of these modalities is clearly ideal. We have begun utilizing the radial forearm fasciocutaneous free flap for pharyngoesophageal reconstruction. Twelve patients have had reconstruction with this flap with follow‐up from 2 to 15 months. Seven defects were circumferential, and five were noncircumferential. Ten patients (83%) have had successful restoration of both swallowing ability and voice. Donor site morbidity was minimal. The leading complication was salivary leak, which was present in eight (67%) patients. Five of the leaks closed with nonsurgical intervention. No cases of flap necrosis occurred. The radial forearm free flap is a thin and pliable flap that closely approximates the tissue consistency of normal pharynx. Successful restoration of a patient's ability to swallow approximates that of enteral flaps and is superior to that of MC flaps. Successful speech restoration is superior to that of enteral and MC flaps. Donor site morbidity is less than that caused by enteral flaps because laparotomy is avoided. Salivary leak is higher than with enteral flaps. Part of this difference is accountable to the high number of secondary and technically challenging reconstructions in this series, and we have taken steps to lower this rate of leakage. These preliminary data show that the radial forearm fasciocutaneous free flap is well suited for pharyngoesophageal reconstruction. Additional experience with this flap for pharyngoesophageal reconstruction is necessary to fully evaluate its utility.