Showing papers in "Archives of Otolaryngology-head & Neck Surgery in 1965"

T-tube tracheal stent.

Abstract: IN A PREVIOUS publication1which offered a technique for reconstruction of the cervical trachea, a T-shaped acrylic tube was used both as a tracheal stent and as a tracheotomy tube.* Because of its rigidity it was necessary to construct the acrylic tube in two sections to facilitate its insertion into the trachea. The manufacture of this tube was technically difficult and costly. This stimulated a revision. The new T-tube is a flexible onepiece unit made from silicone rubber † (Fig 1). Indications for Usage Following Reconstruction of the Cervical Trachea.—The adult size tube (12 mm and 15 mm outside diameter) has been used as a stent after reconstruction of the cervical trachea. The tube is inserted immediately after completion of reconstruction whether it be a one- or two-stage procedure. For a few days following its insertion the tracheotomy portion of the T-tube remains open for the purpose of

The Oculomotor System.

Abstract: The oculomotor system has the dual tasks of maintaining stability of eye position and directing eye movements toward novel features of our environment. This system operates under very fine tolerances. The fovea, the region of highest visual acuity on the retina, “sees” only an area about the size of a quarter held at arm length. Thus, the eyes must be precisely directed toward an object of interest and held in that position for precise and clear vision. Drift of the eyes produces blurred vision, and misalignment of both eyes (strabismus) causes double vision, or diplopia.

Salicylate Ototoxicity: A Clinical and Experimental Study

Abstract: Introduction SIXTEEN billion aspirin tablets are consumed in the United States annually. 1 Fortunately, most people require the analgesic effect of aspirin only occasionally and then in small doses. However, the ingestion of large quantities of aspirin is necessary to achieve therapeutic success in the treatment of arthritis, rheumatic fever, and other connective tissue disorders. This same quantity of aspirin which relieves the pain of the underlying disease may also produce the annoying symptoms of hearing loss, tinnitus, and vertigo. These symptoms are used by some rheumatologists to establish the proper dosage of this medication. The reversibility of these symptoms makes such a program possible. However, the concept that these symptoms are related to the dosage of salicylates and are reversible has not been well documented, and many physicians assume that these are idiosyncratic or allergic reactions. A cinical study was undertaken to provide information that would be useful to

Hearing loss and coronary heart disease.

Abstract: OUR FIRST study in 1960-19611among members of the Mabaan tribe in southeast Sudan revealed their superior hearing. At 500 to 6,000 cps hearing is significantly more acute in all Mabaans aged 10 through 70 years than in people of the same age who live in industrial areas of the United States2(Fig 1). Except for the bleat of a goat and other sounds of nature, the Mabaans live in a dramatically quiet, almost silent atmosphere. The bombardment of excessive noise in our culture and the virtual absence of such in theirs could be one of the factors responsible for their superior hearing. Generally, hearing loss and increase in blood pressure occur with aging in healthy persons of the United States,3while the Mabaans' systolic and diastolic blood pressures remain the same at 75 as at 15 years of age, and coronary heart disease is unknown in

Eustachian Tubal Function in Normal and Diseased Ears

Abstract: Introduction Additional information concerning the function of the eustachian tube of normal and pathological ears is needed in modern otology. Poor eustachian tubal function has been implicated in the etiology of chronic diseases of the middle ear, and reconstructive surgical procedures of the middle ear require an adequately functioning eustachian tube. Previous studies of eustachian tubal function have mainly employed the technique of politzeration, which is somewhat insensitive and difficult to quantitate. The present project was undertaken to devise a method of accurately measuring the functional capacity of the eustachian tube under closely simulated physiological conditions. Such a method would be a useful addition to the present methods of evaluating eustachian tubal function. The present report describes the technique developed and analyzes normal tubal function and tubal function in ears with chronic suppurative otitis media. Methods and Materials Technique of Eustachian Tubal Testing. —The normal eustachian tube is closed at

Middle Ear Pressure Variations During Anesthesia

Abstract: WHEN performing myringoplasties under inhalation anesthesia administered by orotracheal intubation the surgeon often observes a bulging of the skin or vein graft. The bulging increases until it is so pronounced that air escapes from under the edge of the graft. The graft is seen to collapse, but soon the bulging will reappear. Quite obviously a positive pressure is generated in the middle ear, and it is likely to assume that this is caused by diffusion into the middle ear of the anesthetic gas in use. Some preliminary experiments corroborated this assumption and indicated that the positive middle ear pressure had to be attributed to the use of nitrous oxide, as the bulging ceased shortly after discontinuing the supply of this gas and started again when the supply was resumed. This observation is in accordance with the knowledge of the middle ear pressure and its relation to the tensions of the

Study of postlaryngectomy stomal recurrence

Abstract: THE SPECTER of peristomal recurrence hangs over the laryngectomized patient as one of the most insidious and lethal complications which can occur. Detection is often difficult even for the skilled and careful observer, and survival with the most aggressive treatment is rare. Our purpose in this paper is to analyze our experience with recurrence in the peristomal region, to define certain factors of significance in its etiology, and to suggest possible preventive measures. We may define postlaryngectomy peristomal recurrence as a diffuse infiltrate of neoplastic tissue at the junction of the amputated trachea and the skin. It may be localized to one side of the stoma, slowly producing a bulge of the immediately adjacent tracheal wall, or it may encircle the stoma, causing a gradual constriction of the aperture that is almost imperceptible, appearing at any time from six weeks to two or more years following laryngectomy. Occasionally the recurrence

Pathological studies in presbycusis: cochlear and central findings in 12 aged patients.

Abstract: Introduction PERCEPTIVE hearing loss associated with old age is well known, but the pathological basis for the hearing reduction is disputed, especially the localization and the cause of the alterations in the nervous system. Numerous works correlate audiometric data with histopathological studies, most often only in relation to a single structure or a single neuron. Causes of perceptive hearing loss in aged human beings and animals fall into five main categories: 1. Loss Due to Alterations in the Epithelial Elements of the Cochlea, Especially the Organ of Corti and the Basilar Membrane .—In the various structures of scala media the following alterations have been described in elderly patients: flattening and degeneration of the organ of Corti, reduction or total absence of hair cells, and flattening of the supporting cells. The tectorial membrane may be thin and is very often involved in the formation of synechiae, just as Reissner's membrane may

Problems in the measurement of speech discrimination.

Abstract: I. Introduction TRADITIONALLY, a speech discrimination score is the percentage of test items a person can identify correctly by ear. Two decades ago lists of monosyllabic words, the PB-50 tests, were adapted to the measurement of the speech discrimination of the hearing impaired. These materials have since become thoroughly entrenched in otological and audiological practice. unfortunately, a number of confusions regarding their use has persisted to the present. Our purpose is to review some of the factors that contribute to these confusions. The goal is to examine problems which, when kept in mind, can help otologists stabilize measurement of speech discrimination and unify their interpretation of its results. II. Test Materials The first problem is, "Which test materials shall one use?" A test of discrimination for speech, as opposed to a threshold test, must consist of relatively nonredundant items. Otherwise, the multiplicity of clues available to the patient will obscure

Electrodiagnosis in facial palsy.

Abstract: SPONTANEOUS paralysis of the muscles of expression of one side of the face (Bell's palsy) is a common neurological condition. Its cause is unknown and more than half the patients suffer a simple block of conduction from which they recover completely. The remainder develop some degree of denervation of the facial musculature and never recover completely. Once denervation has occurred "associated movement," especially on blinking, always develops (Taverner, 1955). Nevertheless only a small proportion of sufferers from Bell's palsy are eventually dissatisfied with the degree of recovery they attain. Troublesome sequelae, such as severe associated movements, marked contracture, and crocodile tears, only appear in those patients in whom total denervation of the facial muscles occurs. The early detection of denervation is therefore an essential prelude to the successful management of patients with peripheral facial paralysis, and various methods have been tried. The detection of fibrillation activity by needle electromyography has

Intracordal injection of silicone in selected dysphonias.

Abstract: THE EFFECTIVENESS of intracordally injected Teflon in restoring or improving the voice in a variety of dysphonias, particularly unilateral recurrent nerve paralysis, has been established by Arnold1-5and corroborated by others.6,7Specific indications for the use of Teflon are restricted to situations in which dysfunction is permanent. Where there is doubt as to whether cordal function will return, injection of Teflon must be withheld until at least six months have elapsed. Should this rule not be observed and a paralyzed vocal cord spontaneously recover after the injection of Teflon, the voice would be rendered permanently disturbed instead of returning to its normal preparalytic state by virtue of the foreign material within the substance of the cord acting as a benign space-occupying lesion. There is a period of time, therefore, during which the patient with dysphonia from unilateral palsy of uncertain prognosis must endure his disability with no immediate

Ossicular problems in tympanoplasty.

Abstract: THE SURGICAL treatment of patients with chronic otitis media presents a challenge to the otologist. One of the major stumbling blocks has been reconstruction of the ossicular chain. During the last few years the techniques for solving ossicular problems have stabilized to a large extent. The purpose of this paper is to present in detail procedures used by members of the Otologic Medical Group in reconstruction of the ossicular chain in tympanoplasty. Aims of Tympanoplasty Elimination of infection is the prime objective in tympanoplasty. Once the infection has been eliminated, there remain three aims: Avoid a cavity Reconstruct the ear drum in its normal location Reconstruct the ossicular chain Why Reconstruction? When tympanoplasty surgery was introduced in a systematic form by Wullstein 1 and Zollner, 2 little attempt was made to reconstruct the ossicular chain. Rather, it was a matter of adaping the operation to the ossicular

Congenital deafness associated with piebaldness.

Abstract: DURING a study of the frequency of generalized albinism in the various Indian populations occurring in the southwestern part of the United States, two Hopi male siblings with piebaldness (partial albinism) and congenital deafness were encountered. 15 Since this syndrome has never been presented before, and these siblings, born in 1952 and 1956, show a remarkably similar pattern of pigment variegation, it was considered worthwhile to describe them in detail. Scientific impetus for this paper is the interest shown in recent years on the association between deafness and pigment defects. 4,10,11,13 Albinism Among the Hopi Indians The Hopi Indian Reservation is located in northeastern Arizona, where it is completely surrounded by the Navajo Indian Reservation. Hopis lived in the same region when the Spaniards first encountered them in the sixteenth century. Their origin is unknown. Today there are 12 Hopi villages, most of which are situated on top of three

An Analysis of Cough at The Level of the Larynx

Abstract: EVERY LAYMAN knows about cough, because he has experienced its distress. Every physician knows about cough, because he realizes its value for the protection and preservation of the lower respiratory passages. Only the scientist confesses ignorance, for he finds few precise experimental data about cough, particularly regarding its effect upon the laryngeal structures. The sound of a cough is characteristic and cannot be confused with speaking, singing, laughing, or other vocal manifestations. It seems reasonable to assume, therefore, that cough is associated with a specific pattern of vocal cord vibration and laryngeal behavior. However, these events transpire at such speeds that they cannot be visualized or measured with the usual diagnostic equipment of the clinician. As a result of his careful observations on human subjects and animals Negus 7 reached the conclusion that "cough in the human race ... depends on closure of the ventricular bands, with raising of intrapulmonary pressure

Caloric tests in deaf children.

Abstract: T THERE ARE only a few reports in the literature concerning the vestibular reactivity in children that suffer from severe sensorineural impairment of hearing. Shambaugh et al 13 collected, in 1930, information about 5,348 children from schools for the deaf in the US. They found normal vestibular reactions in about 70% of the children, and this proportion was very nearly the same in both the congenital and the acquired types of deafness. Furthermore, it made little difference whether the acoustic function was totally or only partially abolished. Lindenov 11 (1945) examined 58 deaf-mutes by means of irrigation with water at a temperature of 18 C. In his series normal reactions appeared to be characteristic for inherited types of deafness, but also in acquired deafness such findings were not unusual, and he concluded that this examination was without diagnostic value for the type of hearing loss. It is interesting, however, that

Fibrous dysplasia of the jaws.

Abstract: PROGESSIVE knowledge of histiogenesis and staining methods has solved the diagnostic problems of many jaw lesions but has done little to solve the problems of certain connective tissue lesions of the jawbones. For many years there has been a progressive tendency to diagnose lesions of the jaws demonstrating fibrous tissue proliferation as fibrous dysplasia. Thus, fibrous dysplasia has become a wastebasket term for many fibrous tissue lesions that present diagnostic problems. I will not attempt to discuss all lesions of the jawbones that present fibrous tissue proliferations but will confine my discussion to the diagnostic problems encountered with some of these lesions. Since much of the controversy that exists relates to fibrous dysplasia, I shall attempt to discuss this term and its meaning to different investigators. Dysplasia implies an abnormal tissue development or hamartoma. Most of the fibrous tissue lesions under discussion do not comply with this definition. It is

Standard classification for surgery of chronic ear infection

Abstract: To the Editor: The recommendations of 15 otologists from various universities and institutions regarding a standard classification for surgery of chronic ear infection, published in theArchives of Otolaryngology(81:204-205 (Feb) 1965), may constitute a retrograde step. A standard classification is suggested, and the second paragraph ends as follows: "This multiplicity of terms has resulted in considerable semantic confusion with consequent difficulty in classification of the work done by different surgeons." Yet the whole proposal begins with a semantic difficulty, because there is no definition of what is meant by chronic ear infection. The chronic ear problem still requires intensive clinical study. At this stage it cannot be solved by adopting a number of surgical pigeonholes, still less by the continued use of a phrase like chronic suppurative otitis media with or without cholesteatoma. Since the acute-chronic sequence is no longer acceptable in Western communities there is a need to

Draining ears and deafness among alaskan eskimos.

Abstract: Middle ear pathology in Alaska is a problem of considerable magnitude. Various studies 1-3 reported hearing loss in 14% of Caucasians and 34% of Eskimos and evidence of chronic otitis media in about one third of Alaskan natives. An infant morbidity and mortality study conducted by the Arctic Health Research Center in Eskimo villages revealed that of 323 infants, 38% had at least one episode of draining ears during their first year of life. 4 To combat acute and chronic otitis media, routine medical and surgical treatment is dispensed within the limits of available personnel, and an aggressive tonsillectomy and adenoidectomy campaign is in progress. 5 The present study was undertaken to investigate the natural history and epidemiology of ear disease and also the relationship between hearing loss and otitis media. Material and Methods The major portion of the study was conducted in the Bethel area in southwestern Alaska among

Quantitative Measurements of The Nasolacrimal Reflex: In the Normal and in Peripheral Facial Paralysis

Abstract: THE NASOLACRIMAL reflex (NLR) consists of lacrimation following chemical or mechanical stimulation of the nasal mucosa. The trigeminal nerve (ophthalmic and maxillary branches) forms the afferent paths. Its efferent paths proceed from the superior salivary nucleus along the intermedius nerve, through the geniculate ganglion, the greater superficial petrosal nerve, and the nerve of the pterygoid canal to the sphenopalatine ganglion from which they continue through the sphenopalatine nerves to the maxillary nerve and via the zygomatic nerve to the lacrimal nerve and the lacrimal gland (Fig 1). In the main, the pathway of the reflex was mapped by Wernoe 16 in 1927. As early as 1900, however, Koster 11 found that the secretomotor fibers to the lacrimal gland proceed along the above-mentioned course. That the reflex path takes this course is apparent from the following findings (Zilstorff-Pedersen 18 1959): In 15 cases of postoperative total peripheral facial palsy following removal

Surgical Complications in Irradiated Patients

Abstract: Introduction In the past there have been numerous articles pertaining to surgical resections in tissue which had previously been irradiated Prior to 1950, most articles written by surgeons stated that the complications attendant to operating in irradiated tissue were almost too high to justify the attempt In later years, a more optimistic mood is noted in the literature, and surgeons have operated more frequently in irradiated tissues The newer concept of combined therapy (irradiation followed by excision) for certain malignancies of the head and neck, as suggested by MacComb 1 and others, 2,3 has led to renewed interest in studies of complications attendant to surgery in irradiated tissues Two years ago, the Section of Radiation Therapy, the University of Michigan, reported complication rates in 50 patients with head and neck carcinoma who were irradiated and then underwent surgery Complication rates in these 50 patients were compared to and noted to

Nerve Excitability Tests In Facial Paralysis

Abstract: Introduction IT is generally believed that the decision as to the therapeutic approach to be adopted in patients with peripheral facial paralysis will be greatly facilitated if the severity of the conductive disorder can be established in an early stage after the onset of paralysis. In any individual case of paralysis, especially complete paralysis, therefore, two concrete questions are to be answered as early as possible: (1) Is this paralysis still in a reversible stage (reversible conduction block), or is the nerve already degenerated? (2) In case the paralysis is still in a reversible stage, which signs (if any) are to be feared as heralding an imminent or incipient unfavorable development? From publications by Cawthorne, 3 Jongkees, 11,12 Kettel, 13 Taverner, 19 and many others, as well as from our own study (Laumans 16,17 ), we know that on the basis of clinical examination alone the above-mentioned questions cannot be answered.

Standard Classification For Surgery of Chronic Ear Infection: I. Of the Technical Procedures in Surgery for Chronic Ear Infection: II. Of the Gross Pathology Found at Such Operations: III. For the Reporting of Postoperative Results of the Surgical Procedures Mentioned: THE COMMITTEE ON CONSERVATION OF HEARING OF THE AMERICAN ACADEMY OF OPHTHALMOLOGY AND OTOLARYNGOLOGY

Abstract: OTOLARYNGOLOGISTS have been increasingly concerned with the difficulty in evaluating reports of tympanoplasty procedures. In some instances the case analysis or follow-up is too superficial to provide meaningful information. Essential facts related to the status of the middle ear and mastoid at surgery are at times omitted. Owing to the large number of otologic surgeons involved in the development of these new techniques, a multiplicity of terms to describe similar surgical procedures has developed. This multiplicity of terms has resulted in considerable semantic confusion with consequent difficulty in classification of the work done by different surgeons. A subcommittee of the Committee on Conservation of Hearing of the American Academy of Ophthalmology and Otolaryngology was appointed whose duty it was to prepare a classification for operations on the middle ear and mastoid that would be both comprehensive and reasonably simple. This group consisted of 15 men representing opinions by otologists affiliated

Juvenile nasopharyngeal angiofibroma in a female. Report of a case.

Abstract: THIS UNCOMMON lesion of the upper air passages has been a well-established entity for at least 100 years but its precise nature and origin are still subject to debate. Its tumor-like behavior causing obstruction of the airway and its fibrovascular structure giving rise to severe hemorrhage have long been associated with a predilection for pubescent males. The sex incidence is underlined by the fact that many of the larger published series such as the 29 cases of Martin and associates, 1 the 26 cases of Hubbard, 2 the 52 cases of Harma, 3 and the 9 cases of Patterson 4 are exclusively male. On the other hand, a number of authors have reported the condition as occurring occasionally in females. The earliest record was that of Pluyette 5 who reported 12 alleged cases in females but, since many were outside the usually accepted age incidence, it is doubtful whether they

Cerebrospinal otorrhea with meningitis in congenital deafness.

Abstract: Cerebrospinal otorrhea is a rare but dangerous condition as it is often combined with meningitis. Most cases of cerebrospinal otorrhea can be related to traumatic fractures through the labyrinthine bony capsule or infectious destruction of the thin bony wall between the cerebrospinal cavity and the middle ear (Claus, Dysart, Caneghem). A few cases have been described in literature, however, where the cerebrospinal otorrhea has been of different origin. Dehiscence in the temporal bone with more or less developed prolapse of the dura and the brain into the middle ear has been described (Ferrer, Kline, Koch). Most of these defects have been related to congenital malformation of the temporal bone. Nenzelius found a fistula ending on the promontory in a malformed ear in a 15-month-old baby. Bauer described spontaneous otoliquorrhea with meningitis in a 4-year-old boy who died of meningitis and where sections from the temporal bone showed a congenital cyst

Nasal tumors of olfactory origin.

Abstract: NEUROGENIC TUMORS of the nasal fossa have been reported sporadically since Berger, Luc, and Richard 1 reported the first case in 1924. The number of these tumors seen at any one institution is few, and, therefore, conclusions reached by various authors are not always in agreement as to the method of management and as to the prognosis. In 1961 von Largiader 2 reviewed the world's literature on the subject and reported some 51 cases which have been documented to that date. The purpose of this paper is to present a clinical analysis of 18 patients in the records of Memorial Hospital which have been followed up from 5 to 27 years. 3 The period of follow-up of the cases reported in the world's literature has been relatively short and in many cases limited to a year or less. It is of considerable interest, therefore, to examine the clinical behavior

Bell's Palsy: A Surgical Emergency?

Abstract: THE NECESSITY for surgical treatment is almost generally accepted in a number of cases of facial paralysis. I do not think that a serious man who has eyes to read and ears to hear will doubt the necessity of an immediate operation in a case of palsy of the seventh nerve complicating chronic otitis media. And I can also hardly imagine that anyone who has obtained the available knowledge about facial paralysis, directly after surgical interferences upon the ear, will not agree that in such cases immediate operative treatment is necessary in order to get the best possible results for the patients. On the other hand, not even the most fervent supporter 1 of surgery in many other cases of these paralyses will decide to open the fallopian canal in cases of central palsy or to operate upon the mastoid if this approach cannot possibly ameliorate the pathological condition of

The Problem of Malignant Transformation in a Nasal Papilloma: Report of a Case

Abstract: EPITHELIAL papillomata of the nasal cavity are rare, 1,2 and even rarer still are nasal papillomata reported to have undergone a malignant change. A review of the literature revealed only 14 such cases. Since we had occasion to observe a case in which such malignant change occurred, it was considered worthwhile to review the previously reported cases and to report this additional case. Hellman 3 reported the first such case in 1897. His patient had been treated for recurrences of a nasal papilloma over a ten year period, and on microscopic examination of the last specimen a malignant change was noted for the first time. Kramer and Som, 4 in 1935, reported a case of papillary carcinoma of the left nostril and antrum. Three biopsies in the preceding three years had revealed no evidence of malignancy. Further review of the previous biopsy specimens gave no clues of malignancy. Hall

Metastases of Glomus Jugulare Tumors

Abstract: Introduction THE GLOMUS JUGULARE, a normal structure first described by Guild, 3 lies in the dome of the jugular bulb just below the floor of the middle ear. The "glomus" is quite small, 0.5 × 0.25 mm, and is composed of nonchromaffin staining paraganglia cells arranged in an organoid pattern. No physiological function has yet been proved, but neoplasms of this tissue are the most frequent type of middle ear tumor 12 and were first described by Rossenwasser. 9 Much confusion as to the nomenclature, clinical signs and symptoms, instance of metastases, and proper therapy of these tumors remains. The purpose of this report is to review the nine cases of glomus tumors with metastases and to record an additional instance of distant spread to the lungs. Material and Methods Medical literature was reviewed for reports on cases of metastatic glomus tumors. The more interesting features of the nine

Hereditary Hemorrhagic Telangiectasia: Review of 102 Cases and Presentation of an Innovation to Septodermoplasty

Abstract: SINCE 1865 when Babington 1 first called attention to this unusual form of epistaxis in a brief letter to the editor of Lancet , physicians have written on the history, etiology, pathology, clinical syndrome, and treatment of hereditary hemorrhagic telangiectasia. Rendu 2 was the first to associate telangiectasia with familial epistaxis and separate it from hereditary hemophilias. Osler 3 in 1901 gave the first complete clinical description of the disease, pointing out the familial occurrence and the total body distribution of hemorrhagic telangiectasia. Six years later Weber discussed the condition, and he later emphasized that this was a "congenital-developmental" disease which manifests itself in later life. 4 In 1909 Hanes, 5 the forgotten man in Rendu-Osler-Weber disease, was the first to give the histopathologic description of the lesion and produce color plates of persons with typical lesions. His classic description of the skin lesions of hereditary hemorrhagic telangiectasia spoke of "the