摘要:

AbstractSubglott́ic stenosis was corrected surgically in three young children. The key surgical maneuver is the anterior and posterior division of the cricoid cartilage. Endoscopic, xerographic and speech assessments have been done at intervals since decannulation. The anterior commissure is widened and the endolarynx derformed in two children examined. Radio‐graphic studies indicated that increased airway diameters have been maintained to date. Speech has been adversely affected to some degree in all three patien

ISSN:0023-852X    

DOI:10.1288/00005537-197610000-00001

出版商:John Wiley&Sons, Inc.    

年代:1976

数据来源: WILEY

摘要:

AbstractTwo cases of bifid epiglottis are presented: one with an associated laryn‐geal cyst and another with an associated cricoid stenosis. The occurrence of multiple laryngeal anomalies in association with bifid epiglottis has not previously been described. The occurrence of an extra digit is noted to be statistically significant both in the current series and in a review of the literature. A brief review of the embryologic classification and staging by the Carnegie System, and the correlation of the time sequence of development of the epiglottis is presented. No correlation is made as to the mechanism of the origin of this laryngeal anomaly, as adequate embryologic knowledge of the development of the pharynx is not available at this tim

ISSN:0023-852X    

DOI:10.1288/00005537-197610000-00002

出版商:John Wiley&Sons, Inc.    

年代:1976

数据来源: WILEY

摘要:

AbstractSixteen children with anomalies of the auricle and/or middle ear who presented malformations of the face, mouth, upper airway, spine, limbs, heart, gastrointestinal (GI), and/or genitourinary (GU) systems, were described. While clusters of anomalies suggested syndromes such as the oculo‐auriculo‐vertebral syndrome of Goldenhar, hemifacial microsomia, mandibulo‐facial dysostosis (Treacher Collins syndrome), Pierre Robin, Klippel‐Feil, Moebius, Duane, and/or VATER syndromes, many children did not fit what are usually considered even minimal criteria for these syndromes. Several children had malformations which fit the description of more than one syndrome.The importance of investigating the children for unsuspected anomalies, especially of the GU system, was emphasized. Life threatening problems in this group consisted of airway problems, congenital heart disease, and major anomalies of the GI and GU systems. Better management of sucking, swallowing and airway problems might have decreased the early morbidity and mortality (3/16) in this group.Children with multiple defacing anomalies may not be mentally retarded so that aggressive management of their visceral anomalies and hearing problems, and early educational intervention are mandatory. Delay in development may be due to hearing loss, vestibular impairment, ataxia, the consequences of early malnutrition, and multiple hospitalizations rather than to mental retardation. A pessimistic attitude in infancy is unwarranted since it is impossible to predict which children will end up competitive indi

ISSN:0023-852X    

DOI:10.1288/00005537-197610000-00003

出版商:John Wiley&Sons, Inc.    

年代:1976

数据来源: WILEY

摘要:

AbstractBacterial meningitis remains a life‐threatening infection even in the present antibiotic era; thus, any abnormality which predisposes a patient to a recurrence of this serious disease, must be identified and corrected. This report describes the history of a 12‐year‐old boy with a profound neurosensory hearing loss, a related absence of vestibular function and a Monclini‐type of temporal bone dysplasia who developed recurrent episodes of meningitis which were due to an idiopathic cerebrospinal fluid otorrhea. Even though the meningitis was labyrinthogenic in origin, the patient did not experience the associated symptoms of hearing loss and/or vertigo since the affected inner ear was clinically unreactive. By surgically exploring the middle ear, the presence of a cerebrospinal fluid otorrhea was confirmed. The leak was observed to be coming from a defect in the stapes footplate, and it was controlled by firmly packing the inner ear vestibule with muscle.A remarkable similarity exists between the patient described above and the 15 previously reported cases of meningitis due to a spontaneous cerebrospinal fluid otorrhea. Generally, the problem occurred in young children, the average age being 6.4 years; male and female were equally afflicted. All 15 previously reported cases had a severe neurosensory hearing loss which was unilateral in 10 individuals and bilateral in the other five. In 11 of the case reports, the vestibular function was evaluated, and the labyrinth was noted to be unreactive in the affected ear. An associated congenital abnormality of the inner ear was described in 11 of the patients reviewed.Anatomically, in 13 cases, the leak was observed to be coming from the oval window area. Other affected sites included one report of a fissure of the promontory and one report of a defect in the roof of the eustachian tube.Multiple surgical procedures were required in 11 of the 15 patients in order to identify the exact source of the otorrhea and to seal it permanently. In three cases, the successful procedure was a middle ear exploration with stapedectomy and packing of the inner ear vestibule. Overall, a total of 36 operations was performed in the 15 patients reviewed.In conclusion, when the physician is confronted by a case of meningitis in a patient with a unilateral or bilateral total loss of hearing and vestibular function, the possible presence of an idiopathic cerebrospinal fluid leak should be considered, especially if radiographic studies demonstrate a temporal bone dysplasia. In these selected cases, if the etiology of the meningitis is obscure, a middle ear exploration should be performed both for diagnostic purposes as a means to ascertain definitely the presence of a leak and for therapeutic purposes to seal it effe

ISSN:0023-852X    

DOI:10.1288/00005537-197610000-00004

出版商:John Wiley&Sons, Inc.    

年代:1976

数据来源: WILEY

摘要:

AbstractThe validation of otological care in the previous quarter century has been based, by and large, on short‐term follow‐up information. The rapid variation in procedures introduced during this period indicates that there may be need for further consideration. Analyses based on relatively short duration have led to the “acceptance” of a variety of diagnostic and treatment methods which have proven disappointing in some cases. To help avoid this invalid “acceptance,” a review of patients with significant follow‐up may result in a more critical evaluation of future procedural changes.This presentation will be in four parts:1History of the office structure.2Discussion of five long‐term patients that illustrates and supports certain otological concepts.1A review of surgical care for chronic suppurative otitis media in 1968.1A review of patients treated for serous otitis media with myringotomy and tubal in

ISSN:0023-852X    

DOI:10.1288/00005537-197610000-00005

出版商:John Wiley&Sons, Inc.    

年代:1976

数据来源: WILEY

摘要:

Abstract“Theragenic” diseases produce common ENT complaints. They are frequently and predictably induced by self or physician treatment. Fifteen percent of first office visits in various practice situations stem from ther‐apeutically‐induced disease. Self treatment by cotton tip applicator ear cleaning, nasal decongestants, mouth washes, and lozenges produce symptoms which mimic other etiologies. Prescription medications produce diseases with ENT symptoms which are based on pharmacologic toxicity, multiple drug therapy, drug intolerance, and occasional idiopathic hyper‐sensitivity. The treatment of these diseases is simple and effective once their etiology is d

ISSN:0023-852X    

DOI:10.1288/00005537-197610000-00006

出版商:John Wiley&Sons, Inc.    

年代:1976

数据来源: WILEY

摘要:

AbstractPharyngoesophageal dysphagia occurred in 51.3 percent of 1,000 consecutive patients with gastroesophageal reflux. Aspiration, secondary to food obstruction, occurred in 30 percent of these patients, and some developed significant secondary respiratory symptoms.The site of obstruction was localized to the cricopharyngeus by timing the interval from swallow to obstruction. Cricopharyngeal incoordination was demonstrated in 20 of 52 patients studied by high speed esophageal manometry.Surgical correction of gastroesophageal reflux in patients with intractable reflux symptoms was shown to be effective in relieving pharyngoesophageal dysphagia in all but a small number of patients with very severe symptoms. In those with persistent dysphagia cricopharyngeal myotomy at a later stage was effective in giving relief.

ISSN:0023-852X    

DOI:10.1288/00005537-197610000-00007

出版商:John Wiley&Sons, Inc.    

年代:1976

数据来源: WILEY

摘要:

AbstractNinety‐nine patients, twenty‐three men and seventy‐six women, who complained of a lump in the throat were evaluated with the Minnesota Multiphasic Personality Inventory, which revealed that these patients had a higher than average score on the depression and the hypochondriasis scales. The intensity of this finding was greater in males. One must never overlook the possibility of a neurotic patient also having serious organic di

ISSN:0023-852X    

DOI:10.1288/00005537-197610000-00008

出版商:John Wiley&Sons, Inc.    

年代:1976

数据来源: WILEY

摘要:

AbstractComputerized tomography (CT) of the brain has been available since 1973 and has changed neurological, neurosurgical and radiological practice beyond recognition. A rapid growth of literature has documented its role in the diagnosis of intracranial hematoma, cerebral atrophy, brain tumor, orbital lesions and postoperative tumor evaluation.This computerized method of image reconstruction is now also being applied to the rest of the body and to other diagnostic modalities such as isotopes and ultrasound.The initial impact of CT scanning in otolaryngology is largely in four areas:1Facial deformities either acquired or congenital as hypertelorism, fibrous dysplasia, ossifying fibroma and Crouzon's disease.2Tumors involving sinuses primarily or by secondary invasion.3Cerebello‐pontine angle lesions as meningiomas, acoustic neuromas, and glomus jugulare tumors. The larger acoustic neuroma is well visualized by this technique rendering contrast myelography unnecessary.In CT scanning, subtle differences in position and an increase in density before contrast enhancement should allow a differentiation of angle meningiomas from acoustic neuromas; in addition, CT scanning has a very important role in the postoperative assessment of angle tumors.4Infections as cerebral abscess or cerebritis secondary to sinus or mastoid disease.The future holds changes that will allow much finer detail, re‐orientation of the horizontal information into any plane, and much more accurate differentiation of tissue density.The principle of CT image reconstruction is being; applied to both isotope and ultrasound scanning and should improve their accuracy and yield. If the rapid growth of the new technology over the past two years continues, even greater usefulness can be anticipa

ISSN:0023-852X    

DOI:10.1288/00005537-197610000-00009

出版商:John Wiley&Sons, Inc.    

年代:1976

数据来源: WILEY

摘要:

AbstractThis clinicopathologic study was undertaken to determine whether true vocal cord fixation produced by epidermoid carcinoma is an absolute con‐tra‐indication to treatment by hemilaryngectomy.In a consecutive series of 114 hemilaryngectomies performed at McMillan Hospital (1960‐1967) for previously untreated epidermoid carcinoma, 18 patients had fixation of the involved true vocal cord. Each hemilaryngectomy specimen (serial step sections in the longitudinal plane) was re‐examined to ascertain the cause of vocal cord fixation; the adequacy of margin; and the presence of blood vessel, nerve sheath and cartilage invasion. Clinical follow‐up on each patient was current through December, 1972 (5‐12 years postop). All of these cases were seen initially by one of the authors (J. H. O.).Serial sections revealed that true vocal cord fixation was caused by muscle invasion in 14 of the 18 patients. “Positive margins” were present in eight patients but no immediate treatment was given. Two of these patients developed biopsy proven local recurrences, and both were cured with Co“0irradiation.Among the 18 patients with T3epidermoid carcinoma treated by hemilaryngectomy:aThree local recurrences developed, all in the anterior commissure. Two were cured with irradiation. The third had a laryngectomy but died from persistent cancer.bTwo patients developed cervical metastases (without local recurrence), and one was salvaged with radical neck dissection.cFour patients died of other causes, cancer free, three to five years postoperatively.Of the 14 determinant patients, two patients died of cancer. Twelve (85 percent) were alive and free of cancer five years postoperatively. Two had received full course irradiation; one had a radical neck dissection, and all 12 had a functioning larynx.When Ogura's patients are added to the reports of other hemilaryngec‐tomies performed despite true vocal cord fixation (Leroux‐Robert [1950] 18/24, Kirchner, Som [1971]13/19), a determinant salvage rate of 78 percent can be expected.True vocal cord fixation is generally caused by invasion of the vocalis muscle and thus may be well encompassed by a hemilaryngectomy. The precise anatomical limits of the lesion should dictate the type of surg

ISSN:0023-852X    

DOI:10.1288/00005537-197610000-00010

出版商:John Wiley&Sons, Inc.    

年代:1976

数据来源: WILEY