摘要:

AbstractThe effects of chronic prosthetic implantation and interval electrical stimulation were studied in the normal and neomycin‐perfused cochlea of the guinea pig. One group of guinea pigs was implanted with a multiple‐electrode prosthesis in the scala tympani. During a 4‐week period, the device was stimulated for 3 hours weekly with a continuous, 1 kHz sinusoidal current of constant intensity. A second group of guinea pigs underwent identical implantation and stimulation except that cochlear perfusion with .1 M neomycin was performed at the time of implantation. Current intensities ranged from .1 to .6 mA RMS. Two complementary control groups were implanted but not stimulated. The animals were sacrificed, the cochleae were perfused with a fixative, and the temporal bones were prepared for examination under a light, transmission, or scanning electron microscope.In the electrically stimulated cochleae, degenerative changes occurred in both the inner and outer hair cells and supporting elements. A decrease was apparent in spiral ganglion cell and nerve fiber populations in areas of inner hair cell depletion and did not seem to correspond to the survival of supporting cells. The electrically active electrodes were uniformly surrounded by a connective tissue matrix and areas of immature bone. These changes occurred at all the intensities tested, and did not monotonically relate in severity to current intensity. None of the changes was apparent in the normal control ears. Morphological changes induced by the ototoxic drug neomycin were so severe is both stimulated and unstimulated cochleae that comparison was not possible; this form of pretreatment is apparently unsuitable for use in studies of electrically induced damage. It appears that in the normal animal, chronic implantation with interval electrical stimulation results in a cumulative form of sensory and neural damage histologically similar to that proceeding from chronic noise exposure as well as other ototoxic agents. Such effects should be minimized if surviving sensorineural and supporting elements in the functionally compromised cochlea are to be pres

ISSN:0023-852X    

DOI:10.1288/00005537-198307000-00001

出版商:John Wiley&Sons, Inc.    

年代:1983

数据来源: WILEY

摘要:

AbstractInjuries to the inferior and lateral orbital walls are traditionally classified as either “blow‐out” or trimalar fractures. This simplified system has helped considerably in the understanding of the causes of the two types of injury and methods of repair. Unfortunately, simultaneous occurrence can cause immediate and delayed problems that potentiate each other. Enophthalmos and globe ptosis, in combination with a depressed malar eminence, present a major challenge to the reconstructive surgeon's efforts to achieve satisfactory function and appearance.This paper reports the results of combined orbital floor and lateral wall injuries as an important clinical trauma syndrome. The interaction of the two fractures with regard to pathophysiology, sequelae, and methods of correction will be discussed. A review of cases will be used to describe the authors' techniques of repair, and to illustrate the preferred methods of bone grafting for correction of retrusion and depression of the globe, muscle entrapment and depression of the malar emi

ISSN:0023-852X    

DOI:10.1288/00005537-198307000-00002

出版商:John Wiley&Sons, Inc.    

年代:1983

数据来源: WILEY

摘要:

AbstractRhinoscleroma is a rare chronic granulomatous infection predominantly affecting the upper respiratory tract. The patient presented here exemplifies several features of the disease, including the fact that diagnosis may elude the clinician for years, and this delay may increase morbidity substantially. The most common initial complaint is nasal obstruction, and physical examination frequently reveals erythematous granular or nodular swellings covered with crusts. Its tumor‐like appearance and local spread arouses suspicion of malignancy, but differential diagnosis also includes fungal infections and numerous granulomatous diseases. The classic histopathology consists of large vacuolated Mikuliz's cells and transformed plasma cells with Russell bodies. Numerous antibiotics have been used for treatment of this infection with varying degrees of success. Long‐term follow‐up is important because these patients can have numerous relapses. Geographic distribution is also disc

ISSN:0023-852X    

DOI:10.1288/00005537-198307000-00003

出版商:John Wiley&Sons, Inc.    

年代:1983

数据来源: WILEY

摘要:

AbstractSurgical correction of mechanical nasal airway obstruction is commonly attempted by means of septoplasty or submucous resection. In spite of these procedures, patients continue to present postoperatively with inadequate nasal airflow due to hypertrophied turbinates. Partial resection of turbinate mucosa, submucous turbinate resection, electrocautery and outfracture of turbinates provide additional improvement but are incomplete procedures.Total inferior turbinectomies have been performed on 40 patients over the past 5 years; 29 of these patients have been followed from 2 to 60 months postoperatively by clinical examination and by formal questionnaire. Twenty‐five patients described a marked improvement of their nasal breathing, 3 had mild improvement, and 1 had no improvement at all. Only 1 patient, 1 year postoperatively, described excessive dryness, 2 described mild dryness, 3 described excessive secretions and none complained of foul smell or pain postoperatively. All patients had patent airways by clinical examination by at least 2 otolaryngologists.The inferior turbinates play a role in humidification and temperature regulation of inspired air. The removal of them, however, does not seem to be fraught with the morbidity which has heretofore been attributed to this procedur

ISSN:0023-852X    

DOI:10.1288/00005537-198307000-00004

出版商:John Wiley&Sons, Inc.    

年代:1983

数据来源: WILEY

摘要:

AbstractWe have used cryotherapy as an office treatment for severe posterior nasal epistaxis for 15 years. In 1971 we reported a retrospective study on 42 consecutive patients with severe posterior nasal bleeding; 26 had cryotherapy and 16 had anterior and posterior nasal packing. Our data showed that cryotherapy controlled epistaxis with less morbidity. We have now used cryotherapy for posterior epistaxis in over 450 patients.In this presentation we review the history of cryotherapy, rationale for treatment with cryotherapy, experimental tissue changes in cryotherapy, and the method for freezing in cryotherapy. We then discuss 50 recent patients with severe posterior nasal bleeding whom we have treated with cryotherapy. We have found that cryotherapy is a successful way to manage patients with severe posterior nasal bleeding.

ISSN:0023-852X    

DOI:10.1288/00005537-198307000-00005

出版商:John Wiley&Sons, Inc.    

年代:1983

数据来源: WILEY

摘要:

AbstractPatients presenting with xerostomia and other signs of Sjogren's syndrome pose diagnostic problems. Many other underlying diseases cause these symptoms and a systematic evaluation is necessary to make an accurate diagnostic assessment.There are immunological tests and histological studies which help make them distinctive and are herein outlined. Patients with this information presenting with sicca syndrome, therefore, can be more accurately assessed and have better treatment regimens instituted.The “sicca syndrome,” which is a disorder discussed primarily in the rheumatology literature, is rarely a topic in the otolaryngology literature, although there are often presenting symptoms of this problem in the head and neck. This paper reviews this problem, discusses the confusion regarding terminology, and outlines a practical method of diagnosis for the clinic

ISSN:0023-852X    

DOI:10.1288/00005537-198307000-00006

出版商:John Wiley&Sons, Inc.    

年代:1983

数据来源: WILEY

摘要:

AbstractHurthle cell lesions of the thyroid gland, which are derived from follicular cells, occur in a variety of thyroid diseases. Hurthle cell neoplasms are generally easy to differentiate from non‐neoplastic lesions, but the separation of benign from malignant Hurthle cell tumors is difficult on a purely histologic basis unless capsular or vascular invasion or metastases are present. Since this distinction is so difficult to make, the authors recommend treating all Hurthle cell neoplasms as potentially malignant. Treatment includes total thyroidectomy, peritracheal node dissection and if palpable jugular nodes are present, a regional node dissection. A series of 11 patients with this disease and the literature are reviewed to document these recommendation

ISSN:0023-852X    

DOI:10.1288/00005537-198307000-00007

出版商:John Wiley&Sons, Inc.    

年代:1983

数据来源: WILEY

摘要:

AbstractThere is probably no other head and neck group of tumors as those found in the parotid gland that constitute such a diversity of growths, both benign and malignant. Warthin's or papillary cystadenoma lymphomatosum is the second most common benign tumor of the parotid gland. One universally held clinical characteristic of this tumor is its high male ratio. Because of a high frequency of female Warthin's tumor seen at Geisinger Medical Center, a review of all primary parotid gland tumors from 1971 to 1981 was carried out. Sixty‐two cases out of 204 primary neoplasms were classified as Warthin's. There was no significant difference in the number of male and female cases with 32 males and 30 females. The clinical characteristics of Warthin's tumor and this unusually high female occurrence are discusse

ISSN:0023-852X    

DOI:10.1288/00005537-198307000-00008

出版商:John Wiley&Sons, Inc.    

年代:1983

数据来源: WILEY

摘要:

AbstractSounds arising from abnormalities of or abnormal communications between blood vessels in the neck or cranial cavity may result in objective tinnitus. It is audible to patient and examiner alike. Contrary to the usual subjective tinnitus of non‐vascular origin, it is low pitched and pulsatile in character. That tinnitus which arises from and within the internal jugular vein is particularly important, as it may be loud enough to interfere with sleep, and result in some loss of hearing. Diagnosis is important as it can be cured by simple ligation of the internal jugular vein. Such a case is reporte

ISSN:0023-852X    

DOI:10.1288/00005537-198307000-00009

出版商:John Wiley&Sons, Inc.    

年代:1983

数据来源: WILEY

摘要:

AbstractConceptual, technological, electronic and computer revolutions have transformed the methodology for evaluating the patient with dysequilibrium. What has been said and written for the past 25 years is not currently applicable.Present day, cost effective, clinical evaluation format is presented, including changes and deletions in the conventional ENG test battery. It also includes the addition of computer technology in the rotation and ocular tracking tests. These deletions and additions in technique provide the clinician with more useful practical data for diagnosis. There is also capability for patient follow‐up and monitoring. These concepts are presented from the clinical vantage point and are supported with patient evaluation example

ISSN:0023-852X    

DOI:10.1288/00005537-198307000-00010

出版商:John Wiley&Sons, Inc.    

年代:1983

数据来源: WILEY