Annals of Otology,Rhinology & Laryngology

Preliminary findings are presented from an ongoing clinical trial of 19 patients with moderate-to-severe respiratory papillomatosis. The patients were treated with partially purified human leukocyte (alpha) interferon; after treatment periods ranging from 6 weeks to 12 months, six had no residual disease, seven had minimal residual disease, four had moderate disease not requiring rescue laryngoscopies, and two had not responded to treatment. No patient had to be removed from the study because of drug toxicity. Although these appear to be among the best results in the literature to date, we do not know how long treatment will be required.

Although hearing is known to play a major role in the psychological development of human beings and their interactions in the society and culture, very little research on the effects of hearing loss on the psyche and its development has been undertaken. This paper discusses the problems of deafness as they impinge upon personality, its development and social adjustment, acquisition of language, and parenting. The physician's role as it relates to the deaf patient and to the parents is described.

A review of 467 cases of supraglottic laryngectomy operated during the last 30 years is presented. Cases have been subdivided into groups according to stage and TNM classification. By far the most numerous in this series were T₂ cases. N₀ cases prevailed over N₊ by 4:1. Stage II cases represented about 60% of the total. Results are analyzed according to TNM and staging. The average overall 5-year cure rate is 75%. The influence of factors other than TNM and staging upon results is also considered. Supraglottic laryngectomy may be extended to include one arytenoid, the base of the tongue, or both, with approximately equal results. Practically all cases had en bloc bilateral functional or classic neck dissection for threatening or actual lymph node metastases. This may have contributed to a higher number of successes. Combined surgery and radiotherapy is occasionally indicated, but rarely improves the prognosis of severe cases. Site and type of recurrences are considered and their treatment and prognosis are discussed. On the basis of the present study the clinical value of supraglottic laryngectomy is further assessed.

Determining nerve survival is important in selecting patients for cochlear implants, and in predicting outcomes from such implants. In search of a possible method we deliberately destroyed nerve fibers (ganglion cells) in 17 cat cochleas to produce a range of degenerations Months later, we electrically stimulated these ears (and seven controls) and recorded electrical ABR input-output functions. Cats with no surviving ganglion cells showed no ABR activity. Cats with 5%–10% surviving cells had ABRs which typically had normal thresholds but decreased input-output functions. The suprathreshold slopes of these input-output functions reliably predicted ganglion cell survival for all degrees of degeneration. Thus perceptual (or electrical) threshold is a poor indicator of nerve survival. Loudness growth (or growth in the electrically-induced auditory brainstem response) is a good index of surviving ganglion cells.

A recent study with dogs has defined an age-related period of transient hyperexcitability in the laryngeal adductor neurons. This observation suggests that age-related neurologic instability of laryngeal mechanisms and abnormal laryngeal closure may be a cause of transient upper airway obstruction, inducing potentially fatal central apnea that could result in the sudden infant death syndrome. Since hyperthermia has been implicated as a cofactor in sudden and unexpected infant death, its effect on laryngeal excitability requires clarification. This investigation has found that both the latency and threshold of the laryngeal adductor reflex decreases during hyperthermia. Thus, hyperthermia effectively enhances this reflex during its age-related period of hyperexcitability, and is capable of triggering upper airway-induced central apnea of sufficient severity to result in death. The effect of temperature on latency is attributed to changes in axonal conduction and synaptic transmission velocities. Temperature-dependent changes in synaptic transmission are hypothesized as the cause of the observed threshold changes.

We evaluated and compared the separate effects of ethyl, isobutyl, and fluoroalkyl cyanoacrylate on the promontory mucosa and surgically disarticulated incudostapedial joint in the adult cat middle ear. The animals were sacrificed at 10-, 30-, and 60-day intervals after glue application. All three cyanoacrylates elicited a chronic inflammatory response when placed directly on the promontory mucosa. The use of ethyl and isobutyl cyanoacrylate resulted in persisting discontinuity of the incudostapedial joint with erosion of the incus. Fluoroalkyl cyanoacrylate maintained incudostapedial continuity without ossicular erosion. Ethyl and isobutyl cyanoacrylate are probably not appropriate for middle ear surgery. The less toxic fluoroalkyl cyanoacrylate may be useful as an ossicular adhesive in selected cases. Our findings are further contrasted with those obtained in similar studies with methyl and butyl cyanoacrylate. The effects of each of the five cyanoacrylates are reviewed in the continuing search for a safe and effective ossicular adhesive.

We have presented the histological findings in the inner ear of a patient who experienced occlusion of the vertebral and basilar arteries 17 days before death. A large infarction was observed in the medulla and pons on the right side. There was severe degenerative change in the right membranous labyrinth as well as in the right cochlear and vestibular nerves, which was presumably caused by ischemia from occlusion of the right labyrinthine artery. The organ of Corti and sensory epithelia of the vestibular labyrinth showed the most advanced state of degeneration. The histopathological appearance was similar to that observed in the subacute stage following obstruction of the labyrinthine arteries in animal experiments.

Fifty-five consecutive cases of neoplastic involvement of the internal auditory meatus resulting in ipsilateral retrocochlear auditory dysfunction were reviewed. The majority of these tumors (89%) were solitary schwannomas of the eighth nerve. Eleven percent were other tumors. Preoperative facial paralysis was unusual in eighth nerve schwannomas (6.1%) and much more common in other tumors (66.6%). These data tend to suggest that facial paralysis preoperatively increases the probability that the tumor is other than an eighth nerve schwannoma. Furthermore, facial paralysis resulting from an eighth nerve schwannoma indicates a poorer prognosis for ultimate facial nerve function. The small numbers in this series, though far from conclusive, suggest that normally functioning facial nerves may be infiltrated by eighth nerve schwannomas. Failure of eventual recovery of facial nerve function in the postoperative period may suggest tumor infiltration.

Data on 87 patients (113 ears) with chronic secretory otitis media (SOM) are reported. The bacteriological analysis of the middle ear fluid (MEF) revealed Streptococcus pneumoniae in 7% of ears, Hemophilus influenzae in 9%, opportunistic bacteria in 20%, while 64% of the samples showed no growth. Free capsular polysaccharide pneumococcal antigens were found in 5 % of the MEF samples using counterimmunoelectrophoresis (CIEP) with Omniserum containing 83 different pneumococcal polysaccharide types. Heating of the samples to disrupt the immune complexes increased the frequency of positive samples to 27%. These findings, together with the frequent occurrence of S pneumoniae and H influenzae in the nasopharynx, strongly support the opinion that chronic SOM in a considerable number of cases is an immune complex disease.

Complications from otitis media and mastoiditis continue to occur despite modern antibiotic therapy. We report a case of lateral sinus thrombosis and extension to the subclavian vein following a chronic otitis media. This is the first such report of this complication. The presentation and management of lateral sinus thrombosis are also discussed.

Adenolymphoma (Warthin's tumor) is a relatively frequent tumor of the parotid gland with characteristic cytological, histological and clinical features. Malignant transformation of the epithelial component of adenolymphomas is extremely rare and not well documented in the literature. In a series of eight adenolymphomas of the parotid gland transition to malignancy was demonstrated cytologically and histologically in one case.

To evaluate the effects of chronic intrascalar implants on spiral ganglion cells, we studied 15 monkey cochleas that had had implants for periods ranging from 1 to 28 months. All cases exhibited loss or ongoing degeneration of cells. Cell loss typically was greater in the basal turn, where the implants were located, than at more apical locations. Increasing apical damage was a function of postimplant survival time. Preimplant local treatment of the inner ear with neomycin did not influence the loss of spiral ganglion cells. Osteoneogenesis occurred in the majority of cases, appearing in the basal turn with occasional extension into middle and apical turns. Cell loss was inconsistently associated with new bone formation. Electrical stimulation had no obvious influence on cell survival.

Twelve spasmodic dysphonia patients were evaluated by three different auditory brainstem response parameters; 75 % were abnormal. Three of the 12 had prolonged wave I-V interpeak latency. Seven had pathologic wave V latency shifts at a high stimulus rate. Amplitude ratios were normal for all subjects. The authors hypothesize that spasmodic dysphonia is a disorder of variable cranial nerve symptom presentations, and offer several possible models to account for its sporadic representation in the nervous system.

A rare case of dysphagia, caused by ectopic gastric mucosa situated in the upper esophagus, is reported.

A special device for collecting exfoliative cells in nasopharyngeal carcinoma diagnosis by negative pressure suction method is recommended. This device consists of a metallic suction tube with a round tip and a modulator which is connected to a suction pump; it passes via the oral cavity into the nasopharynx to collect exfoliative cells. From March 1973 to July 1977, 824 out-patients were examined with cytology and biopsy in our hospital. Of these, 481 cases were confirmed as nasopharyngeal carcinoma. Among them, 431 were cytology-positive; 453 cases were biopsy-positive. The positive cytology rate was 89.6% and the positive biopsy rate was 94.2%.

The fine structure of human nasal blood vessels was studied in 15 nasal allergic patients. Biopsies were taken at different stages after provocation. In the early stage (two minutes after provocation), characteristic alterations of capillaries and venules were congestion, gap formation between two endothelial cells, and swollen vascular endothelial cells. Evidence of locally increased vascular permeability and congestion causing mucosal edema was found. In the late stage (20 minutes after provocation), evidence of congestion disappeared. Vascular dilatation and marked interendothelial cell gaps were observed. In both perivascular space and sometimes in intravascular space, de-granulated eosinophils were observed, suggesting that not only histamine but also lysosomal enzymes in eosinphil granules may be involved in causing increased vascular permeability.

Some of the most common symptoms and signs of acute maxillary sinusitis were graded and compared with the radiological findings during the course of the disease. Four different treatment modes were used in 176 patients. The radiological and the subjective findings did not differ among the groups, which consequently were evaluated as an entity. The radiographic results demonstrated that the healing course during the first 15 treatment days follows an even regression line. The subjective findings show a more marked improvement during the first five days than subsequently, and also a more rapid initial improvement than radiography shows. The cough symptom showed the slowest recovery subjectively and also compared most closely with radiological findings. Patients with sinusitis which did not show an initial healing radiographically also had more marked symptoms the fifth day, and vice versa: Patients who showed less than average healing subjectively also showed a slower healing radiographically.

The mucociliary flow in the frontal sinus of dogs is in a spiral pattern from medial to lateral. The final evacuation of mucus is through the ostium positioned anteriorly. Mucus flow rate is most rapid in the areas of the ostium and slowest in the area of the intersinus septum. Mucus flow patterns remain the same despite removing the intersinus septum and blocking one frontal sinus ostium. Mucociliary flow rate, however, appears to be diminished in the reoperated frontal sinus. Mucus does not appear to migrate readily across the intersinus septal areas when the septum has been removed and one nasofrontal duct is obstructed.

The clinical and pathologic findings of 10 laryngeal sarcomas (8 fibrosarcomas and 2 rhabdomyosarcomas) are reported. These cases constituted 0.02% of the 4,717 patients with carcinoma histologically verified at Faculty of Medicine in Istanbul from 1934 to 1980. Analysis of laryngeal fibrosarcomas reveals that they are more frequently seen in the fourth and fifth decades, while rhabdomyosarcomas of the larynx are rather tumors of childhood. They are generally less infiltrating than carcinomas and tend to grow as polypoid masses. Metastases are rare but recurrences are frequently seen.

Twelve patients with Shy-Drager syndrome (SDS) presenting symptoms of multiple nervous system atrophy and orthostatic hypotension were examined for laryngeal movement disorders and vocal impairment in speech. Vocal fold abductor paresis was found in 11 patients and was bilateral in 10. Speech task performance was recorded in SDS patients, Parkinson patients and age- and sex-matched controls. Trained listeners with inter-rated reliability ≥ .85 judged each recording on 20 attributes while blind to speaker identity. SDS patients had a breathy and strained voice quality, reduced loudness, monopitch and monoloudness, imprecise consonants, variations in rate and rate-slowing, suggesting a flaccid type of dysarthria. In comparison with Parkinson patients, SDS patients had excess vocal hoarseness, intermittent glottal fry and a slow and deliberate speaking rate. Orthostatic hypotension, laryngeal stridor, hoarseness, intermittent glottal fry and slow speech rate were found to be discriminating symptoms of SDS.

Organic acids in the contents of the cholesteatoma sac from 28 cases were studied by gas chromatographic technique. Five volatile fatty acids (acetate, propionate, isobutyrate, butyrate and isovalerate) and lactate were detected in large amounts, which may lower the pH of the cholesteatoma content. These acids were considered to be derived from products of anaerobic microorganisms. Therefore, the contents from 12 cases were cultured anaerobically in a glove box. Obligate microorganisms were identified in 92% of the cases and Peptococcus, Bacteroides, and Clostridium species were frequently isolated. In vitro, such obligate anaerobes produced various organic acids from the cholesteatoma content. Facultatives such as Staphylococcus aureus and Proteus mirabilis produced acetate in the content under aerobic and anaerobic conditions, whereas no organic acid was produced by Pseudomonas aeruginosa. Organic acids in the cholesteatoma content could be fermentative products made by the microorganisms, anaerobes and facultatives, which use the content as a substrate for acid production.

Primary squamous cell carcinomas of the major (parotid and submandibular) salivary glands are uncommon neoplasms. Statistics contrary to that statement are tainted by the inclusion of mucoepidermoid carcinomas and, in the instance of the parotid gland, by metastatic carcinomas. The true frequency is less than 1% of all tumors in the parotid gland and approximately 4% for the submandibular gland.