Showing papers in "Annals of Otology, Rhinology, and Laryngology in 1974"
TL;DR: Physical finding among symptomatic patients reveal a wide spectrum ranging from mild hyperemia of the pharynx or tonsils, to exudative tonsillitis with tender cervical lymph nodes and moderate elevation of temperature.
Abstract: Four cases of gonococcal pharyngotonsillitis have been presented, along with a review of the world literature. This entity is most commonly seen in those individuals practicing fellatio, i.e., females and homosexual males. The infection may be passed to the newborn by the infected genitals of the mother during birth, to the infant from adult molestation, or among sexually promiscuous children. Most gonococcal pharyngeal infections result in a carrier state, and as such, are possible reservoirs of propagated infections. When symptomatic, the most frequent complaint is a sore throat. Physical finding among symptomatic patients reveal a wide spectrum ranging from mild hyperemia of the pharynx or tonsils, to exudative tonsillitis with tender cervical lymph nodes and moderate elevation of temperature. Most authorities agree that the preferred treatment is 4.8 million units of procaine penicillin G I.M., with one gm of probenecid by mouth thirty minutes before the injection. If allergic to penicillin, tetracycl...
290 citations
TL;DR: For surgical correction of subglottic stenosis the authors recommend division of the cricoid and upper trachea anteriorly with interposition of autogenous cartilage, without removal of scar tissue, and without internal laryngeal stenting.
Abstract: A survey of 25 consecutive cases of severe subglottic stenosis in children and infants, managed conservatively, revealed an unexpectedly high 24% mortality rate. A three year ongoing experimental s...
134 citations
TL;DR: Five patients with incapacitating benign paroxysmal positional vertigo for one year or longer were managed surgically by transection of the posterior ampullary nerve to relieve severe BPPV and add to the completeness of transcanal labyrinthectomy by denervating the inaccessible posterior canal crista.
Abstract: Five patients with incapacitating benign paroxysmal positional vertigo (BPPV) for one year or longer were managed surgically by transection of the posterior ampullary nerve. An approach to this nerve was devised based upon a careful study of the posterior ampullary nerve in temporal bone dissections and specimens of the inner ear. Using the round window membrane as the principal landmark, the singular canal was exposed in the round window niche via a tympanotomy approach under local anesthesia. Transection of the posterior ampullary nerve promptly and completely relieved the signs and symptoms of BPPV in all five patients. A severe sensorineural hearing loss was produced in one case as a result of traumatic labyrinthitis. Transection of the posterior ampullary nerve in the round window niche is recommended to: 1) relieve severe BPPV of one or more years duration, and 2) add to the completeness of transcanal labyrinthectomy by denervating the inaccessible posterior canal crista.
117 citations
TL;DR: Dendritic cells containing melanin pigment have been demonstrated with silver impregnation and bleaching techniques in the nasal cavities of both Caucasians and Negroes, explaining the histogenesis of melanomas of the nasal cavity as primary neoplasms.
Abstract: Dendritic cells containing melanin pigment have been demonstrated with silver impregnation and bleaching techniques in the nasal cavities of both Caucasians and Negroes. They were found in the respiratory epithelium, nasal glands and commonly in the superficial and deep stroma of the septum and middle and inferior turbinates, particularly in adult Negroes. The presence of melanocytes explains the histogenesis of melanomas of the nasal cavity as primary neoplasms at this site.
116 citations
TL;DR: Demonstration of lamellar substances similar to phospholipids in the secreta of the tube and middle ear mucosa of the guinea pig suggests the presence of auditory surface-active agent(s) (surfactant).
Abstract: A large part of normal middle ear cavity and Eustachian tube is provided with a mucociliary transportation system which is considered the first line of defense of the middle ear Secretory cells of
111 citations
TL;DR: The fact that sensory and neural degeneration rarely occur in reasonably “pure” forms may explain why it is often difficult to distinguish between them by means of audiological tests alone.
Abstract: In our temporal bone material, sensory and neural degeneration do not occur independently. Usually there is a good correlation between the extent and severity of hair cell loss and the nerve degeneration in the osseous spiral lamina. Sensorineural degeneration in ototoxicity and after sound exposure is mostly sensory in nature in the initial phase of the process. Presence of supporting elements effectively delays secondary nerve degeneration. Degeneration of Corti's organ can often be complete, but the corresponding nerve degeneration is usually only severe to subtotal, never complete. Sensorineural degeneration which is predominantly neural (without parallel hair cell loss) is rare and occurred in less than 5% of our material. Severe subtotal nerve degeneration with hair cells still remaining was found only in one single temporal bone. Furthermore, Spoendlin's experiments in the cat suggest that in man also a portion of the first-order cochlear neuron could have an unusual degeneration behavior and may n...
107 citations
TL;DR: The silicone T-tube tracheal stent, which has been in usage for the past nine years, is described and illustrated and should be familiar with these techniques prior to his discharge from the hospital.
Abstract: The silicone T-tube tracheal stent, which has been in usage for the past nine years, is described and illustrated. This stent has served to support the repaired and reconstructed cervical trachea and also an end-to-end anastomosis of the trachea. While the T-tube is in place with its external limb plugged, the patient usually enjoys a normal airway and phonatory function. Of utmost importance is the care of the tracheal T-tube following its insertion into the cervical trachea. Detailed instructions are included for suctioning, cleaning, and changing of the T-tube. The patient should be familiar with these techniques prior to his discharge from the hospital. With proper care the T-tube has remained in place and uncomplicated for periods ranging from one month to one and one-half years.
103 citations
TL;DR: Following myringotomy, most of the Eustachian tubes of children with prior otitis appeared to be more “floppy,” when compared with tubes of patients with traumatic perforations and an otherwise negative otologic history.
Abstract: Middle ear pressures were assessed by tympanometry in a group of 56 children with concurrent or recent middle ear effusions, prior to myringotomy and tympanostomy tube insertion Following myringot
98 citations
TL;DR: Endotracheal and endobronchial carbon dioxide laser surgery has been particularly helpful in the bloodless removal of recurrent papillomas from the trachea and main stem bronchi of ten children with tracheostomies.
Abstract: Endotracheal and endobronchial carbon dioxide laser surgery can be carried out using standard ventilating bronchoscopes, a recently developed laser endoscope attachment and a 50W CO2 surgical laser unit. General anesthesia, using nonflammable anesthetics, is delivered through the side arm of the ventilating bronchoscope; the tidal flow of gases keeps the trachea and bronchi free of steam and smoke. The technique has been particularly helpful in the bloodless removal of recurrent papillomas from the trachea and main stem bronchi of ten children with tracheostomies. While three of the patients have gone into remission following laser excision, the method cannot be curative of itself. There were no complications attributable to the carbon dioxide laser surgery, per se, but constant vigilance must be exercised as with all laser surgery. As instrumentation becomes refined the technique will have wider application in the management of tracheobronchial disease.
95 citations
TL;DR: Both the anatomical relation of certain melanocytes to capillaries, and the biochemical relation of melanin to the catecholamines support the hypothesis that they may have a vasomotor function, and other evidence suggests that the melanocytes may play a role of some biological consequence in the inner ear.
Abstract: The melanocytes of the vestibular labyrinth as seen in colored guinea pigs show a characteristic pattern of distribution in the wall of the utricle and in the ampullae, but they are not present in the wall of the saccule. They are found mainly in well-vascularized regions of apparent secretory or metabolic importance, including the “dark cell” areas. Their dendrite-like processes are often in intimate contact with the capillaries, although no pinocytotic vesicles or other indications of transfer of substances between the melanocytes and the capillary endothelium are seen under the electron microscope. In the human ear, the apparent density of the melanocytes varies with skin color. They are numerous in the cochlea, especially in the bony wall of the modiolus and on the osseous spiral lamina, and they occur also in Reissner's membrane and in the stria vascularis. In the vestibular system they are found in the wall of the saccule as well as in the utricle, the crus commune, and the ampullae, but not in the ...
94 citations
TL;DR: A consistent pattern of ultrastructural pathology within the lateral cochlear wall was found and Horseradish peroxidase (HRP) was employed as an indicator of transport from vessels.
Abstract: One hundred and ten chinchillas were exposed to a 700–2800 Hz noise at 123 dB for 15 minutes. A consistent pattern of ultrastructural pathology within the lateral cochlear wall was found. Significant damage to the stria vascularis was first observed one hour postexposure, reached a peak at 24 hours, and had recovered almost completely by 28 days. Spiral prominence damage was permanent. The pathology included stria widening, temporary disappearance of intermediate cells, alterations of the internal membrane system and abnormal vessel transport. Horseradish peroxidase (HRP) was employed as an indicator of transport from vessels. Transport from the stria vessels was absent when stria ultrastructural abnormality was at a maximum; at other postexposure times, however, abnormally rapid exodus of HRP from the vessels of the stria was observed in animals who had received intravenous injections of HRP 30 seconds prior to sacrifice. On the other hand, no leakage was observed in the animals injected one minute befor...
TL;DR: A large series of cases of cervical osteophytic lesions producing compression of the posterior pharyngeal wall and esophagus are reviewed to determine their symptoms and modality of therapy, and to present a new transoral surgical approach for their removal.
Abstract: Cervical osteophytic lesions producing compression of the posterior pharyngeal wall and esophagus are a known, though uncommon cause of dysphagia. These abnormal deposits of calcium along the ventral aspects of the cervical vertabrae have been recognized since the utilization of radiography as a diagnostic tool; however, only in recent years have bona fide cases been reported in which dysphagia has been proven to be secondary to these misplaced deposits of calcium.l\" The purpose of this paper is to review a large series of these cases to determine their symptoms and modality of therapy, and to present a new transoral surgical approach for their removal.
TL;DR: Histological study of the IM and IS joints in 125 ears from 86 individuals varying in age from infancy to 96 years showed arthritic changes which increased in severity with advancing age.
Abstract: Histological study of the IM and IS joints in 125 ears from 86 individuals varying in age from infancy to 96 years showed arthritic changes which increased in severity with advancing age. The earliest changes in the articular cartilage consisted of fraying and fibrillation, followed by thinning and calcification. The joint capsule showed atrophy and hyalinization and the articular disc showed hyaline deposits in early cases and calcium deposits in severe cases. Audiograms which were available on 55 ears showed that arthritic changes in these joints did not impair sound transmission through the middle ear.
TL;DR: An organ culture system is presented for the mammalian inner ear that allows for morphological development of differentiation of the neurosensory structures of the inner ear.
Abstract: An organ culture system is presented for the mammalian inner ear. The development of the inner ear is recorded with time lapse cinematography and conventional histological techniques. The system allows for morphological development of differentiation of the neurosensory structures of the inner ear. The use of the organ culture system as a research tool for the understanding of normal and abnormal development of the inner ear is discussed.
TL;DR: The author's series of 168 consecutive cases of chronic otitis media from the years 1965 to 1972 were reviewed with regard to the occurrence and management of pathological fistulae in the bony labyrinth and results indicated that the matrix can be removed with reasonable safety from most small semicircular canal fists.
Abstract: The author's series of 168 consecutive cases of chronic otitis media from the years 1965 to 1972 were reviewed with regard to the occurrence and management of pathological fistulae in the bony labyrinth. Fourteen cases (incidence 8.3%), of which nine involved only the semicircular canals and five involved primarily the cochlear wall occasionally associated with a semicircular canal fistula, were examined particularly in terms of postoperative sensorineural hearing loss following removal of cholesteatoma matrix from the fistula. The results indicated that the matrix can be removed with reasonable safety from most small semicircular canal fistulae. Only when the cholesteatoma matrix is firmly adherent to a large area of membranous semicircular canal is removal not recommended. When the cholesteatoma was removed from three cochlear fistulae, sensorineural hearing loss resulted. In two cases with cochlear fistula, hearing was preserved when the cholesteatoma matrix was not removed from the fistulized area. Th...
TL;DR: The temporal bones of ten cats implanted with intracochlear electrodes for three to 117 weeks were stained with hematoxylin and eosin and examined with light microscopy and showed evidence of degeneration of spiral ganglion cells in the basal cochlea in several animals, but most primary auditory neurons, including most of those in the region directly over the electrode, survived implantation in every cat.
Abstract: The temporal bones of ten cats implanted with intracochlear electrodes for three to 117 weeks were stained with hematoxylin and eosin and examined with light microscopy. The electrodes were embedded in Silastic® which was molded to fill the most basal 9 mm of the scala tympani. They were inserted directly into the scala through the round window. Among our observations were the following: 1) All or nearly all hair cells were lost in the basal coil during the first several weeks after implantation. Some, but not all, supporting cells were also lost. There was extensive hair cell loss in the middle and apical turns, although some hair cells were seen there in all examined cats. 2) There was evidence of degeneration of spiral ganglion cells in the basal cochlea in several animals, but most primary auditory neurons including (with two exceptions) most of those in the region directly over the electrode, survived implantation in every cat. The radial nerve fibers of the spiral ganglion cells also survived long-t...
TL;DR: The repeatability of the early components of the AER makes them more reliable response indices than the late components for audiometry with neonates, and this support the belief in the primary auditory system as the mediator of these responses.
Abstract: The early (approximately 8–50 msec latency) averaged electroencephalic responses (AER) to 55 dB HL clicks were elicited from ten normal newborns 36 to 72 hours after birth. Early components were observed in all ten babies with 512 clicks presented at 4.5/sec and 9.0/sec. Mean peak latencies in msec were: Po — 11, Na — 17, Pa — 28, Nb — 35, and Pb — 51. The neonates' early component waveforms closely resemble those of adults. The latency and waveform stability of the early components in neonates and adults support the belief in the primary auditory (lemniscal) system as the mediator of these responses. Furthermore, the repeatability of the early components of the AER makes them more reliable response indices than the late components (approximately 50–400 msec) for audiometry with neonates.
TL;DR: In in vitro experiments with subcellular fractions of guinea pig cerebral cortex, neomycin altered the labeling of the polyphosphoinositides from γ−32P-ATP and inhibited their hydrolysis, and it is suggested thatNeomycin toxicity is mediated by an inhibition of polyph phosphoinositide turnover.
Abstract: Phospholipids of guinea pig inner ear tissues were labeled in vivo by perfusing the perilymphatic spaces with 32P-labeled inorganic phosphate. The most highly labeled lipids obtained after a 45 min incubation time were phosphatidylinositol phosphate and phosphatidylinositol diphosphate. 32P-incorporation into the latter in the Organ of Corti was significantly decreased in guinea pigs previously treated with neomycin (100 mg/kg body weight) for 21 days. In in vitro experiments with subcellular fractions of guinea pig cerebral cortex, neomycin (10−4 M) altered the labeling of the polyphosphoinositides from γ−32P-ATP and inhibited their hydrolysis. It is suggested that neomycin toxicity is mediated by an inhibition of polyphosphoinositide turnover.
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TL;DR: The effectiveness of cough depends upon the linear velocity of the gas in the airways, and a high flow and a small cross-section are the ideal conditions for an effective cough.
Abstract: The effectiveness of cough depends upon the linear velocity of the gas in the airways. Because velocity = flow/cross-sectional area, a high flow and a small cross-section are the ideal conditions for an effective cough. Pleural pressures become positive during cough and compress the large airways producing a marked reduction in cross-sectional area. At high lung volumes, expiratory flow rates are high so that the linear velocities in the trachea are approximately one-third of the speed of sound. The velocity falls in higher bronchial generations, both because the total cross-sectional area of each generation becomes progressively larger beyond the lobar bronchi, and because at high volumes the compressed segment of the airway only extends from the lobar bronchi to the thoracic outlet of the trachea. In normal lungs cough is effective in clearing secretions from these airways only. In chronic bronchitis and emphysema, expiratory flow rates are markedly reduced. Furthermore, in some cases the large airways ...
TL;DR: Histologic evidence revealing nonuniform radiotherapeutic effect on tumor vessels is shown and radiation followed by surgery was more successful in tumor eradication than surgery followed by radiation.
Abstract: Radiotherapy is an often used treatment in glomus tumors of the middle ear. Histologic evidence revealing nonuniform radiotherapeutic effect on tumor vessels is shown. The reticular tumor stroma is replaced by collagen. The chief cells demonstrate little change. The results in 19 radiated patients demonstrate that radiation eliminated the tumor in 20% of the cases. Radiation followed by surgery was more successful in tumor eradication than surgery followed by radiation.
TL;DR: The results of laser surgery to be superior to conventional techniques in the treatment of papilloma, polyps, polypoid degeneration, hyperkeratosis and carcinoma in situ.
Abstract: Techniques for the application of the carbon dioxide laser to laryngeal surgery are outlined and include operative and anesthetic management. Laser surgery teaches improved surgical judgment in and application of conventional procedures. The lack of trauma, the degree of precision and the speed of healing as seen in one year of experience indicate the results of laser surgery to be superior to conventional techniques in the treatment of papilloma, polyps, polypoid degeneration, hyperkeratosis and carcinoma in situ. A family of laryngeal retractors is introduced whose utilization with intralaryngeal mirrors makes essentially all areas of the larynx accessible for lasing.
TL;DR: A tracheoesophageal shunt was used for vocal rehabilitation in 29 laryngectomized patients and T-E shunt speech equals or exceeds other forms of alaryngeal speech when measured against the parameters of rate, duration, and intelligence.
Abstract: A tracheoesophageal shunt was used for vocal rehabilitation in 29 laryngectomized patients. Twenty-three patients had the shunt constructed at the time of laryngectomy. Radiation therapy or radical neck dissection did not limit the usefulness of the shunt. Twenty of the 29 patients acquired useful speech (69%). T-E shunt speech equals or exceeds other forms of alaryngeal speech when measured against the parameters of rate, duration, and intelligence. Failure to acquire useful speech occurred in nine patients because of either stenosis of the shunt (10%), aspiration (7%), or wound probems (14%). Stenosis of the shunt was primarily a problem in patients who received postoperative radiation therapy without a stent in the shunt. Wound problems were related to either our previous use of a lateral based flap or diabetes mellitus. Since January 1973 there has only been one failure in fourteen shunts constructed. The technique as now used is simple, applicable in a wide variety of clinical situations and associat...
TL;DR: This animal model provides opportunities for basic research concerning the possible prevention of genetic disorders involving the inner ear and the genetic basis for involvement of Mn in otolith development was discussed.
Abstract: The genetically mutant pallid mouse (which possesses specific otolith defects) and the manganese-supplemented (Mn) pallid mouse (in which otolith defects were prevented) were studied using light and transmission and scanning electronmicroscopy. Untreated pallid mice which showed head-tilting, circling and ataxia also had swimming difficulty. In these animals, the otolith defects were the only consistent findings. With one exception, no pronounced anomalies were found in the sensory epithelium, nerve fibers and ganglion cells. Only a few vestibular melanocytes, in which the melanin granules failed to fully mature, were observed in the pallid mouse. Melanization in vestibular melanocytes appeared to be improved by Mn-supplementation. The genetic basis for involvement of Mn in otolith development was discussed. This animal model provides opportunities for basic research concerning the possible prevention of genetic disorders involving the inner ear.
TL;DR: A new cause for excessive sleepiness during the day is gradually emerging from 24-hour polygraph sleep studies: intermittent upper airway obstruction which is usually hypopharyngeal but can also be nasal in origin.
Abstract: A new cause for excessive sleepiness during the day is gradually emerging from 24-hour polygraph sleep studies: intermittent upper airway obstruction which is usually hypopharyngeal but can also be nasal in origin. Three such cases are described. One was cured by a permanent tracheotomy and another by a submucous resection.
TL;DR: A high jugular bulb, an ectopic carotid artery, and an intratympanic cholesterol granuloma may, at times, mimic a middle ear glomus tumor, otoscopically.
Abstract: A high jugular bulb, an ectopic carotid artery, and an intratympanic cholesterol granuloma may, at times, mimic a middle ear glomus tumor, otoscopically. The otoscopic and radiographic findings which differentiate these lesions include microscopic otoscopy, tomography, carotid arteriography, and retrograde jugular venography. Examples of otoscopic and radiographic findings and procedures which enable the clinician to differentiate these lesions are presented.
TL;DR: The development of fiberoptic endoscopes and the discovery of a new system of telescope optics have dramatically revolutionized endoscopy, and the superior photographic documentation that is now possible through these instruments is presented.
Abstract: The development of fiberoptic endoscopes and the discovery of a new system of telescope optics have dramatically revolutionized endoscopy These advances are discussed, and the superior photographic documentation that is now possible through these instruments is presented
TL;DR: Middle ear effusions can be approached by looking at them as questions of: 1) mucus clearance; 2) excessive mucus production; 3) middle ear ventilation and 4) etiology of middle ear inflammation.
Abstract: Recent investigations have identified the viscous middle ear effusions in secretory otitis media as being of the same nature as true mucus — the “backbone” of which is glycoproteins. The source of ...
TL;DR: It appears most probable that the cells of the organ of Corti (like all other epithelial organs) are metabolically supplied from their base, i.e., from the perilymph, which may as a first approximation be considered an ultrafiltrate of blood.
Abstract: Perilymph may as a first approximation be considered an ultrafiltrate of blood. Under quasi-stationary conditions there is a balance of concentrations of nonproteinbound low molecular weight substances in the blood and perilymph, the blood concentration being the governing factor. The rate of equilibration of such substances depends on the exchange rate of perilymph, which may be characterized by τ, the “cochlear half life.” In guinea pigs the mean cochlear half life is ten min, which means that half the perilymphatic volume (8 μl) is exchanged every ten min. It appears most probable that the cells of the organ of Corti (like all other epithelial organs) are metabolically supplied from their base, i.e., from the perilymph. The oxygen supply via the perilymph amounts to 0.1 nM/min, whereas the oxygen supply via the endolymph (equal τ assumed) would only be 1.6% of the perilymphatic supply. The glucose concentration of the perilymph does not constitute a limiting metabolic factor.
TL;DR: From 1949 to 1974, 27 patients with adenocarcinoma of the larynx were treated at the Mayo Clinic, and patients with cylindromas tended to differ from patients with other adenOCarcinomas in respect to sex, symptoms, origin of the cancer, and length of survival.
Abstract: From 1949 to 1974, 27 patients with adenocarcinoma of the larynx were treated at the Mayo Clinic. Histologically, the cancers were classified as indeterminate adenocarcinoma (12 tumors), cylindroma...
TL;DR: In 456 cases of cancer of the skin of the nose there was an even distribution in the sexes with the highest incidence occurring in the fifth and sixth decades, and one patient with basal cell, five with squamous cell and one with sweat gland tumor died as a result of carcinoma of the eye and nose.
Abstract: In 456 cases of cancer of the skin of the nose there was an even distribution in the sexes with the highest incidence occurring in the fifth and sixth decades. Basal cell cancer comprised 87%, occurring predominantly on the ala, tip and root; squamous cell cancer, more common on the lateral borders and columella, occurred in 10.7% of the cases. Previous exposure to irradiation was the most pernicious etiological factor. Fifty-one percent had been previously treated inadequately and presented with a recurrence. Metastases developed in 0.25% of the basal cell cancers and in 18.5% of the squamous cell cancers. Nine percent had recurrence after definitive treatment. Treatment was predominantly surgical excision, but irradiation, electrodesiccation and combinations of these with chemosurgery were also used. One patient with basal cell, five with squamous cell and one with sweat gland tumor died as a result of carcinoma of the skin of the nose. Another small group, previously exposed to full face irradiation, b...