Showing papers in "Archives of Otolaryngology-head & Neck Surgery in 1967"

Structural Pattern of the Organ of Corti.

Abstract: The authors have great experience in techniques of cochlear preparation for electron microscopy. They present a new domain of research technique in reconstructing normal as well as experimental cochleas. Three distinct contributions are made to improve conventional histopathological technique into an up-to-date technique utilizing the phase contrast and electron microscope. Surface Preparation Technique. —Contrasted to the conventional technique, this technique is used to demonstrate the membranous labyrinth, mainly the organ of Corti, devoid of bone. This technique is excellent for charting hair cells in early stages of pathology and forms the basis of a new cochleogram (vide infra). Cochleogram. —Reconstruction of the organ of Corti has been developed by various authors (Guild, Schuknecht, and others), although their technique has been based on conventional histologic sections. In conventional reconstruction, only one of every ten sections is represented. This new technique offers greater accuracy. Nerve Staining .—The authors improved the nerve staining technique of Maillet,

Vertigo in Cerebrovascular Disease

Abstract: FOR THIS SYMPOSIUM we have reviewed a personal series of cerebrovascular cases, chiefly thrombotic or embolic, and determined the frequency and type of dizziness associated with occlusion of each of the cerebral arteries—internal carotid, middle cerebral, basilar, etc. Before presenting the analysis, a few general remarks about the subject are in order, since the viewpoint of the observer colors his observations and conclusions. In this discussion the termdizzinesswill be used. Vertigo, in English, has the connotation of rotation and many patients with a vestibular disorder, peripheral or central, do not have or describe a spinning feeling. The term dizziness is used, therfore, to embrace all vestibular symptomatology, whether or not it is rotational. When "turning" is present, we may speak of rotational dizziness or vertigo. It is extremely common to hear, "It can't be vestibular, there was no turning," a viewpoint with which we disagree. Dizziness is a

Embryology and Anatomy of the Eustachian Tube

Abstract: THE AUDITORY TUBE was described in some detail by Eustachius in 1563. The structure was mentioned again by Valsalva in 1717. In 1818 Carus published his observations on amphibian embryos. He found structures suggestive of the gill structures in fish and concluded that the development of the eustachian tube was related to the respiratory tract. In 1825 Rathke published similar conclusions from his work with pig embryos. By the end of the 19th century the theory that the middle ear complex developed from the pharynx was universally accepted. The exact mechanism of development, however, is contested to this day. Hammar1of Upsala, using wax reconstruction, studied fetuses from three weeks to birth. He described three stages of development: (1) the anlage period; (2) the demarcation period; and (3) the transformation period. In the first period (three to seven weeks) a slit-like pouch develops from the first visceral groove of

Ciliary activity and middle ear clearance.

Abstract: IN A PREVIOUS COMMUNICATION 1,2 we described the microscopic structure of the middle ear lining. It was pointed out that the anterior half or two thirds of the middle ear lining is a true mucosa-bearing cilia and secreting mucus, which in all probability forms a functional mucus blanket (Fig 1). The secreted mucus and secreting glands were demonstrated histochemically; the cilia were best seen with phase microscopy. It is our purpose now to report qualitative studies on the function of the ciliary pathways in the human middle ear in vivo. This was done by observing and photographing the movement of foreign materials over the mucus blanket in the middle ear. These studies were part of the workup of patients suffering from large perforations in their ear drums. The ears were prepared for myringoplasty or tympanoplasty, and the studies helped in determining middle ear clearance. Method and Material The procedure consisted

Fiberoptic endotoscopes for examining the middle ear.

Abstract: TWO FIBEROPTIC instruments to be used for direct visualization of the structures of the middle ear are described. Direct visualization is of considerable value in the diagnosis and presurgical evaluation of middle ear disease. Until now, visual evaluation of the middle ear has been possible only by surgical entrance or by peephole views through perforations in the tympanic membrane. Also, some indirect knowledge of the middle ear has been obtainable from the appearance of the tympanic membrane. The two instruments developed for visualization of the middle ear fulfill the following specifications: (a) the diameter of the probe is small enough to permit insertion through a perforation or myringotomy; (b) the source of light for illumination of the specimen area is located externally so as not to damage the inner ear; and (c) an image of the specimen formed at the distal end of the probe is transmitted from the middle

Tympanic Membrane Grafting With Temporalis Fascia

Abstract: THE RESULTS of tympanic membrane grafting have improved dramatically in the past few years (Fig 1). In our hands, this improvement can be attributed for the most part to the technique of using temporalis fascia. The purpose of this report is threefold: (1) To review the steps in the transition from postauricular full-thickness skin to fascia as a tympanic membrane graft. (2) To present the technique used in tympanic membrane grafting by members of the Otologic Medical Group. (3) To present the results of tympanic membrane grafting during the last four years in 1,958 cases. Development of Grafting Technique Postauricular full-thickness skin was used for reconstruction of the ear drum membrane when tympanoplasty was first introduced in a systematic form by Wullstein and Zollner. There have been many changes in graft material during the 12 years or more since that time, involving skin from other areas (split-thickness arm skin and

A guide to newborn and infant hearing screening programs

Abstract: THE SCREENING of newborn infants for hearing problems has been widely urged by otolaryngologists, educators, and audiologists.1-3From the medical point of view, the detection of hearing loss at birth offers both an opportunity for early medical treatment and a source of valuable information on the etiology of hearing problems. From the educational and audiological points of view, early detection provides the opportunity to apply auditory habilitation at an age that is most likely to ensure the optimum development of the hearing function. It is generally agreed2that detection should be made before the infant is 6 months old so that medical or educational treatment can be initiated. Inasmuch as the newborn nursery is the only place where the entire infant population is conveniently available for screening, it is most feasible to conduct screening tests there. Such screening has found increasing acceptance among pediatricians, who are currently focusing

Neisseria catarrhalis in Exudate Otitis Media

Abstract: SPECIES of Neisseria other than N meningitidis and N gonorrhoeae are generally felt to be nonpathogenic. In the report on bacteriological findings in middle ear fluid obtained by needle aspiration by Feingold et al 1 N catarrhalis is listed as nonpathogenic. However, it is tabulated among the causative organisms in similar studies by Gronroos et al 2 and by Coffey. 3 Cases of meningitis due to N catarrhalis have been reported by Garland 4 and by Moersch and Thompson. 5 Lewin and Hughes 6 reported N subflava as a cause of meningitis and septicemia in five children. The purpose of this paper is to report a two-year study of the bacteriology and clinical observations of cases of exudative otitis media, this being a continuation of the previously reported study. 3 Materials and Methods Tympanic paracenteses were done on all patients with exudative otitis media seen in private clinic practice from

Tragal Perichondrium and Cartilage in Tympanoplasty

Abstract: SINCE THE introduction of tympanoplastic surgery, a number of varieties of tissue pedicles, autografts, and homografts have been advocated. The original use of postauricular skin has been replaced, in many centers, by other tissues, largely mesodermal in character. It seems timely to call attention to the natural forces for tympanic membrane growth as well as repair. Spontaneous healing of perforations and, indeed, spontaneous tympanoplasty are phenomena well described in old and in recent papers. It appears that there are at least two mechanisms which play major roles in growth and repair of tympanic membrane: the induction effect of the fibrous annulus and the special nature of basement membrane laminae in the middle layer of the tympanic membrane and in the "fibrous" annulus. These two factors may be responsible for growth and dedifferentiation characteristics of grafts applied to this area. Indeed, it is possible to expedite "spontaneous" healing by placing a

Prolonged Nasotracheal Intubation in Infants and Children

Abstract: THE ESTABLISHMENT and maintenance of a satisfactory artificial airway presents a major problem in the care of infants and children. Although tracheostomy is commonly used, it can produce serious complications at operation, during the period of intubation, and following decannulation. 1,2 For 2½ years we have utilized nasotracheal tubes instead of tracheostomy in the management of a variety of airway and pulmonary problems. Materials and Methods A total of 116 children were intubated for a variety of problems which included: acute laryngotracheobronchitis, pneumonitis, status asthmaticus with respiratory failure, postoperative thoracotomy, and respiratory failure complicating nonrespiratory diseases such as encephalitis, renal failure, and exogenous obesity (Table 1). The mean age was 19 months with a range from 1 day to 14 years. Each child was seen by a pediatrician, an anesthesiologist, and an otolaryngologist. A consensus was reached that the airway problem could be handled best by nasotracheal intubation. Technique When

Pathogenesis and Pathology of the Idiopathic Blue Ear Drum

Abstract: HAVING eliminated other known causes of middle ear bleeding such as trauma, tumors, and bleeding diathesis, investigators have called the presence of blood or altered blood in the middle ear "idiopathic hemotympanum," "idiopathic" referring to bleeding from an unknown source. The patient usually presents with the findings of a painless unilateral blue ear drum with conductive hearing loss of insidious onset. A chocolate brown sterile fluid is recovered after myringotomy. Characteristically this condition is a long standing one and difficult to treat conservatively. Similar findings may be seen in patients with middle ear effusions of sterile serous fluid. This is widely recognized today because of an increased awareness and improvement of diagnostic methods as well as, probably, an increased incidence resulting from the after effects of antibiotic therapy for middle ear infections. Occasionally the ear drum in chronic serous otitis media will appear bluish, but not as intensely blue-black in

A direct approach to cochlear anatomy and pathology in man.

Abstract: OUR PRESENT understanding of the complex and beautiful structure of the human inner ear is based upon the labors of more than one generation of outstanding 19th-century microscopists, many of them having names that are now firmly attached to one or another type of cochlear cell. Although the great Stockholm histologist Gustaf Retzius 1,2 is no longer closely identified with any specific cochlear structure, it is he who has given us the most detailed graphic representation of the cytoarchitecture of Corti's organ in man. Of the 39 remarkable plates that illustrate the second volume of his incomparable work, Das Gehororgan der Wirbelthiere (1884), the last seven are devoted to his drawings of the human ear, representing a rich variety of dissections of the entire membranous labyrinth and its various parts, cross sections of the cochlear duct, and longitudinal or surface preparations of the organ of Corti of fetus, infant, child,

Bifurcation of the facial nerve.

Abstract: GROSS ABNORMALITIES of the facial nerve in the temporal bone are rare, but they occur with sufficient frequency that the otologic surgeon must be mindful of their possibility. In the past, mastoid operations for suppurative disease drew attention to intraosseous aberrations in the vertical segment of the nerve's course. These have been well documented. 1-9 An increasing number of reconstructive middle ear operations with the operating microscope require that middle ear facial nerve anomalies be equally well recognized. Normal Anatomy of the Intratemporal Part of the Facial Nerve According to Anson, 8 the nervus intermedius (of Wrisberg) and the motor root of the facial nerve enter the opening of the facial canal (aqueductus falopii) in the fundus of the internal auditory meatus. The composite nerve passes laterally between the cochlea and the semicircular canals, toward the medial wall of the middle ear. It bends suddenly backward and runs in that

Sudden deafness. An otologic emergency.

Abstract: SUDDEN DEAFNESS is an otologic emergency because successful recovery depends on prompt treatment. The hearing loss is predominantly unilateral, but may be bilateral. Not only must the deafness be treated immediately, but in some cases the underlying medical or surgical disease must also be treated. Sudden deafness is defined as a hearing loss that the patient notices in an instant or one that rapidly progresses over 24 to 48 hours. The hearing loss may be total or partial and is often described by the patient as a "fullness" or "stuffiness" in the ear. The hearing loss is sensorineural. The records of 143 patients with sudden sensorineural hearing loss were reviewed at the University of Michigan Medical Center. Of these patients, 139 had unilateral sudden deafness, and 4 had bilateral sudden deafness. The Table summarizes the etiology of the sudden deafness. Etiology Viral infections were diagnosed clinically in 40 patients. The

Kanamycin dosage and levels in ear and other organs.

Abstract: THE BASIC STREPTOMYCES antibiotics, streptomycin and kanamycin, are valuable and effective means in the hands of a physician. In many cases their use is indispensible, despite the danger of a toxic damage to the inner ear. The physician is therefore always faced with the weighty question of how these antibiotics are to be dosed in order to avoid possible damage. It is difficult not only to estimate the amount of the individual dosage that may be prescribed but also the sequence of the injections. Even today, as with other antibiotics as well, treatment with daily injections prevails. Treatment only at intervals recommended by several authors, is only seldom tried. Berger and Wehrle, 1 viewing the short duration of the blood level of antibiotics consider more frequent injections of every six hours necessary to the maintenance of therapeutically effective blood concentrations. This suggestion should be considered critically. In using toxic antibiotics

Laryngeal nerve paralysis and benign thyroid disease.

Abstract: PREOPERATIVE paralysis of a recurrent laryngeal nerve is far more commonly associated with malignant than benign disease of the thyroid gland. Ceroni et al,1in a series of 100 cases, showed that 24% of recurrent laryngeal nerve paralyses were associated with benign conditions. Cunning,2in a much larger series, showed the incidence to be only 2.3%. The present article records an additional eight cases occurring in a series of 1,200 consecutive patients with thyroid disease undergoing thyroidectomy. Materials and Methods A series of 1,200 consecutive patients admitted for thyroidectomy were examined routinely preoperatively for evidence of laryngeal nerve paralyses. This was a highly select group, clinical examination excluding all but those with thyroid disease. Vocal cord paralysis was used to determine recurrent laryngeal nerve paralysis, both preoperatively and postoperatively. The vocal cords were examined within seven days postoperatively to determine the result of surgical removal of the thyroid

Fibrous Dysplasia and Malignant Degeneration

Abstract: IN THE current literature there is disagreement regarding the malignant degeneration of fibrous dysplasia. Certainly such an occurrence is rare, but a careful review of the literature yields 28 cases. In this paper we shall briefly review the important clinical aspects of fibrous dysplasia and its malignant potential, and we shall report an additional well-documented case of malignant degeneration. The treatment of fibrous dysplasia and bone sarcoma is reviewed as well. Report of a Case A 50-year-old white woman was admitted to the Massachusetts Eye and Ear Infirmary on Sept 23, 1964, with a questionable diagnosis of malignant degeneration of fibrous dysplasia of the right maxilla. At the age of 10 the patient had fallen and struck the right side of her face. Three years later she first noted swelling of the right side of her face which increased until the age of 19 (in 1933) when she underwent a

Laryngeal Tissue Responses to Teflon

Abstract: DURING THE Congress held by the German Association of Laryngologists in 1911, W. Brunings presented a series of patients suffering from unilateral recurrent laryngeal paralysis. He had injected hard paraffin (melting point 46 C) in the paralyzed vocal chords by means of a special syringe. The technical intervention presented no problems, the postoperative period was uneventful, and the functional results were very good. Despite these good clinical results, there were some disadvantages to this method which developed consequently. In fact, the injected paraffin caused a chronic foreign body reaction which ultimately resulted in a paraffinoma. Moreover, the product did not remain static and what was even more serious, resulted in embolism. Similarly, paraffin injections into the posterior pharyngeal wall for the improvement of velopharyngeal closure in instances of cleft palate proved to be of no use; the paraffin generally descended, sometimes even as far as the mediastinum. Although it

Inner Ear Pathology of Congenital Deafness

Abstract: CASES of congenital deafness which appear to be based on developmental defects of the internal ear have been grouped into four main types. These have been named after the investigators who described the essential pathologic changes and have been extensively discussed by Ormerod 1 ; therefore they need be only briefly listed here: (1) Michel type, complete lack of development of the inner ear; (2) Mondini-Alexander type, development of only a single curved tube or a flattened and shortened cochlea with bony abnormalities which is coupled with an enlarged saccule and endolymphatic sac; (3) Bing-Seibenman type, normal bony labyrinth with a lack of development of both the pars inferior and superior membranous structures; (4) Scheibe type, normal bony labyrinth with malformation limited to the pars inferior (the cochleosaccular type). Even with the above classification there are several major problems in the assessment of pathology of congenital deafness. The foremost of these

Inner Ear Pathology in Acoustic Neurinoma

Abstract: ACOUSTIC neurinoma has been exhaustively studied clinically, anatomically, surgically, and pathologically. The most outstanding contributions appear to be those of Henschen (1915),1Cushing(1917),2Pool and Pava (1957),3and recently House (1964).4However, cases of acoustic neurinoma with clinical and histological reports are rare. In this communication the histological examinations of the temporal bones of ten patients with acoustic neurinomas are discussed correlating the pathological changes in the inner ear and the clinical symptomatology. These tumors are benign, encapsulated, and arise as the result of neoplastic proliferation of Schwann's sheath cells of the eighth cranial nerve, usually from the vestibular division within the internal auditory meatus. This origin from Schwann's sheath cells was first suggested in 1908 by Verocay5who expressed the opinion that the tumor arose from "nerve fiber cells" which he felt were capable of producing nerve fibers. The term "neurinoma," meaning nerve

Osteoma of the Tongue

Abstract: NONCALCIFIED benign neoplasms are commonly seen on the tongue and are usually located on the lateral borders in the anterior two thirds. The ventral surface and posterior third of the tongue are rare sites for benign neoplasms. Benign tumors of the tongue containing cartilage and so-called mixed tumors containing cartilage, fibrous connective tissue, and bone have also been reported. 1-7 True osteomas of the tongue, however, are exceedingly rare lesions and, in reviewing the literature, only eleven cases have been reported. 8-18 A 12th case is to be presented (the table). In all but one case, the patients were females. The oldest patient was 39 and the youngest 11. With the exception of the 11 year old, the remainder of the patients were in their 20's and 30's. The average age of the patients was 25 1/2 years. The most common presenting complaint was difficulty in swallowing although

The Snout After Resection of Nasal Septum in Adult Rabbits

Abstract: THE SEPTOVOMERAL REGION has been considered an important growth center of the nose and adjacent facial structures. Consequently in a previous experiment various amounts of the septovomeral region (including cartilage, vomer, and premaxilla) were resected in young growing rabbits. 1 In a subsequent less traumatic experiment a relatively large amount of only cartilaginous nasal septum was resected in young growing rabbits. 2 The postoperative period ranged from 15 to 20 weeks. In both groups the findings were striking and comparable. They consisted essentially of a markedly shorter, smaller, tapered snout with a deflection of the dorsum in an anterior direction. The nasal bones and cavity, as well as the piriform aperture, were considerably smaller than normal. The incisors were in malocclusion, malshaped, and overerupted. Since in both of the above experiments in young growing animals the anterior dorsal snout did not attain its normal size, it was concluded that resection

Carotidynia: A Distinct Syndrome

Abstract: HEAD AND NECK pain related to abnormalities in and around the extracranial carotid artery is unusual but not rare. Mechanisms include inflammatory infiltration of the arterial wall (cranial arteritis), dilatation (vascular headache), and extrinsic pressure with displacement (carotid body tumor, lymphadenitis). The purpose of this paper is to review clinical features of a common but infrequently recognized form of carotidynia which has a benign and self-limited course. Clinical Data Thirty-three patients constitute this series. One patient was seen in two separate attacks. All patients were personally examined by the author and all had an unequivocally positive "Fay test," ie, digital compression of the involved common or internal carotid artery invoked significant local pain and frequently reproduced the facial and head discomfort of the spontaneous attack. Pertinent data are summarized in Table 1. Sex distribution was approximately equal. The average age was 37, but span ranged from 15 to 78

The nasal cavity in complete unilateral cleft lip and palate.

Abstract: THE ROOF of the mouth is also the floor of the nose. It follows that a disarrangement in the architecture of the roof of the mouth must, of necessity, be reflected within the nasal cavity. Conversely, anatomic variants within the nasal chambers could influence the architecture of the palatal vault. Cleft lip and palate is a unique experiment of nature in which such interrelations may be explored (Fig 1). The mobility of the cleft palatal segments and their responsiveness to muscle or tissue tensions, as well as mechanical forces, permit a variety of observations under varying conditions not possible in the intact palate. The interrelation between the form of the maxillary arch and that of the nasal chambers raises questions of considerable clinical significance: Is there a direct correlation between collapse of the cleft maxillary arch and reduced width of the nasal chambers? If so, would this impede airflow, modify

Experimental use of laser in otosclerotic stapes.

Abstract: CERTAIN characteristics of the laser suggest its potential usefulness in otology. Foremost is the very small and discrete area that can be irradiated without affecting adjacent tissue. For example, the light produced by a laser can be so focused that it can damage a single large blood cell without evident injury to nearby cells. Since all of the light energy in the pulsed laser is emitted in a short time, the laser is a narrow beam of extremely high power. Another important feature is that the light generated by the laser is of a very narrow frequency band. This enables us to predict to some extent which tissues will absorb and which will transmit the laser light beam. A ruby laser, for instance, has a wave length of 0.649μ and falls into the visible spectrum whereas a neodymium laser has a wave length of 1.06μ and falls into the infrared

Human Larynx Injected With Teflon Paste: Histologic Study of Innervation and Tissue Reaction

Abstract: ONE OF US 1 recently reviewed the development of intrachordal injection procedures in the treatment of chronic vocal disability. After having experimented with various substances, 2,3 Arnold, 4 in 1962, proposed the injection of Teflon granules suspended in glycerin. The present designation of the implant material is PTFE Paste for Injection (modified polytetrafluoro-ethylene, 50% weight in weight w/w in glycerin). This technique made it possible to revive the original idea published by Brunings 5 in 1911 who injected paraffin for the correction of laryngeal paralysis. Numerous authors soon followed these suggestions and published their own experiences with the injection of granulated bone paste, " silastic, 7 Teflon, 8-11 glycerin, 12 and silicone. 13 All these publications stressed the good functional results when suitable instances of this disability were treated with proper indication and correct techniques. Possible disappointments and their reasons have been discussed by Rubin. 14 Further discussion of these

Pseudocysts of the Auricle in Caucasians

Abstract: NONTENDER cystic swellings of the auricle which are traumatic or spontaneous in origin are classically referred to as subperichondrial effusions or hematomas. A collection of fluid or blood is incarcerated between the perichondrium and the cartilage. This is treated by opening or needling the perichondrium and packing the auricle in contour. The author noted when attempting to incise a spontaneous cystic bulge of the auricle that even though the perichondrium had been opened the cyst had not yet been reached. The cartilage was then opened and the fluid exposed and drained. The serous fluid was enclosed by a cartilaginous wall in all parameters and was then an intracartilaginous collection of fluid. Weeks later a similar problem was seen and the identical situation was found. During the next four years, four more cases were seen. When this paper was being prepared the author had used the term "intracartilaginous cyst" but Engel's 1

Inner ear pathology of sudden deafness. Histopathology of acquired deafness in the adult coincident with viral infection.

Abstract: EACH YEAR an enormous amount of information has been contributed to the literature regarding viral disease. The cause of the "common cold" now could be one of several score of viruses, from several morphologically different groups. 1 Since many of these same viruses which usually have been associated with benign disease can at times be extremely virulent, through central nervous system infection 2,3 it is not surprising that when viremia does occur the inner ear can be involved in a pathologic process. In spite of this, our knowledge of the histopathology of viral labyrinthitis in the adult is extremely limited. The purpose of this paper is to present two cases of sensorineural deafness, one of which began in association with an upper respiratory infection probably of viral origin, the second showed similar course and histopathological findings but lacked a definite history of association with an upper respiratory infection. Report of

Ceruminous gland tumors

Abstract: THE LINING of the external acoustic meatus is lined with skin that is continuous with the auricle. The part of this skin covering the cartilaginous portion of the meatus (8 mm long) contains hair follicles, sebacous glands, and modified sweat glands or ceruminous glands. In the longer bony portion, the aforementioned skin structures are absent. Arising from the narrow confines of the cartilaginous portion and corresponding histologically to the ceruminous glands, a special form of tumor, the "ceruminoma," has been described. Relatively common in lower animals, especially the dog and the cat, tumors of ceruminal gland origin are rare in man. This report is a clinicopathological assessment of ceruminomata, based on a review of the literature 1-6 and experience with two previously unreported cases of ceruminoma treated at the University of Michigan Medical Center. Report of Cases Case1.—A 71-year-old white woman was first seen at the University of Michigan

Reissner's Membrane: An Ultrastructural Study

Abstract: REISSNER'S membrane 1 separates scala media from scala vestibuli It extends from the limbus to the stria vascularis at its superior extent Until Naftalin and Harrison 2 proposed that it served as a filter allowing the passage of sodium, but not potassium, ions from scala media to scala vestibuli, Reissner's membrane was assumed to function as a simple isolator The thickness and relatively large number of cells in the lower layer, together with the increased surface area (microvilli), led Lawrence et al 3 to speculate that Reissner's membrane might well be a selectively absorbing tissue Whether or not it serves this function is important to longitudinal and radial theories of endolymph flow 2-12 The authors therefore feel that an ultrastructural description is timely Methods and Materials Dark young guinea pigs weighing between 250 and 350 gm were decapitated, the bulli removed, the labyrinth opened and perfused with 2% veronal acetate buffered osmium tetroxide within