摘要:

AbstractTinnitus is a frequent presenting symptom. Tinnitus that is rhythmic and synchronous with the patient's heartbeat is rare. Pulsatile tinnitus may be the only symptom of life‐threatening and treatable diseases. The presence of hearing loss or vertigo focuses the diagnostic evaluation. The cause of pulsatile tinnitus may be found on otoscopic examination. Audiologic assessment and enhanced computed tomography often contribute to the diagnosis. Increased intracranial pressure should be excluded with a fundoscopic examination. Arteriography is required to diagnose life‐threatening and treatable lesions in the presence of normal otoscopy, audiologic assessment, and enhanced computed tomogra

ISSN:0023-852X    

DOI:10.1288/00005537-198704000-00001

出版商:John Wiley&Sons, Inc.    

年代:1987

数据来源: WILEY

摘要:

AbstractIt is often suggested that tumors will respond to induction chemotherapy and result in improved survival for patients with squamous cell carcinoma of the head and neck. Two regimens of induction chemotherapy were studied in separate randomized, prospective trials over the last 6 years. Eighty‐three patients with advanced disease were entered into the first study (43/chemotherapy; 40/control), and 60 into the second (27/chemotherapy; 33/control). Patient randomization was stratified by stage (III/IV) and site (oral cavity, oropharynx, nasopharynx, hypopharynx, larynx, paranasal sinuses). The first study utilized bleomycin, Cytoxan,® methotrexate and 5‐fluorouracil in two cycles (one cycle if no tumor response), followed by standard treatment which consisted of combined irradiation and surgery or, in some instances, primary irradiation alone. The second study utilized cisplatin and 5‐fluorouracil in three cycles prior to standard treatment. An objective tumor response to chemotherapy was observed in 68% in the first study and 85% in the second. The patient survival in both studies @ 24 months in the first; @ 19 in the second) was better in the control than that in the experimental groups (43% to 31%; 69% to 46%). In the second study, the average length of delay of standard treatment was longer than in the first study (95 daysvs.66 days;P<.02). Results combining theP‐values of both studies indicate that the relative risk of having persistent disease was 2.9 times greater for patients who received chemotherapy. While toxicity to chemotherapy was not a factor in survival, the number of patients who withdrew from the studies and those who did not comply with treatment were greater in the chemotherapy groups. Except for new drug regimens of exceptional promise, it is recommended that future studies be designed so that chemotherapy is given concurrent with, or following the completion of standard t

ISSN:0023-852X    

DOI:10.1288/00005537-198704000-00002

出版商:John Wiley&Sons, Inc.    

年代:1987

数据来源: WILEY

摘要:

AbstractBy using monoclonal and polyclonal antibodies against cell‐membrane receptors and cytoskeletal proteins, the cellular and tissue composition of any organ can be far better determined. This is illustrated in the tympanic membrane, middle ear mucosa, and cholesteatoma. Immunotechnology applied to the temporal bone is shown with an animal‐ototoxicity model. Antibodies to keratin and vimentin (i.e., to proteins of the fibrillar components that make up the cytoskeleton) stain specific tissue compartments. Langerhans' cell and T‐lymphocyte subsets predominate in a cholesteatoma. The normal human tympanic membrane is devoid of these cells. Gentamicin can be traced with a polyvalent anti‐gentamicin antiserum in serial sections of the cochlea and kidney. The drug accumulates in the outer hair cells and proximal tubular cells, respectively.A new technique of CT‐scanning, microslicing, plastic embedding, and semithin sectioning of undecalcified human temporal bone is described. Perspectives in applying immunotechnology to this method of human temporal bone processing are

ISSN:0023-852X    

DOI:10.1288/00005537-198704000-00003

出版商:John Wiley&Sons, Inc.    

年代:1987

数据来源: WILEY

摘要:

AbstractTonsilloadenoidectomy is performed over 340,000 times per year in the United States, usually as a same day admission procedure with a postoperative overnight stay. Because of the current emphasis on reducing health care costs, many insurers are requiring the procedure of tonsilloadenoidectomy be performed on an outpatient basis, even though there is a lack of data supporting the safety of such a requirement.The charts of 2,944 pediatric patients who underwent tonsillectomy and/or adenoidectomy from January 1, 1983 to December 31, 1984 were reviewed. Analyses revealed predictive variables that could be used to identify patients with a low risk of complications. Nineteen percent of the patients could be released 4 hours postoperatively with an 8.1% chance of subsequent complications. No patients who underwent the combined procedure of tonsillectomy and adenoidectomy were in this group. Of the remaining patients, 0.4% could be released 6 hours after surgery, or 85.9% could be released 8 hours after surgery, or 98.2% could be released 10 hours after surgery, all with a less than 10% chance of subsequent complications. This study supports keeping tonsilloadenoidectomy patients at least 8 hours and possibly 10 hours after surgery to minimize the risk of complications after discharge.

ISSN:0023-852X    

DOI:10.1288/00005537-198704000-00004

出版商:John Wiley&Sons, Inc.    

年代:1987

数据来源: WILEY

摘要:

AbstractThe risk of contracting acquired immune deficiency syndrome (AIDS) is a concern to otolaryngologists and other health care workers. Failure to appreciate this valid concern is dangerous, but overestimating it may be equally injurious to the delivery of good patient care.We review the data on antibody titers and recovery of cultured virus in blood, saliva, middle ear fluid, cerumen, tears, and nasal mucous. We also report the initial findings of a prospective study of otolaryngologists at the San Francisco General Hospital.It appears that the risk of transmission of AIDS is low and can be minimized by sound infection control measures similar to those for hepatitis B.

ISSN:0023-852X    

DOI:10.1288/00005537-198704000-00005

出版商:John Wiley&Sons, Inc.    

年代:1987

数据来源: WILEY

摘要:

AbstractThe hypothesis that there is an alternative motor input to the trapezius muscle through cervical spinal nerves is evaluated through a review of the literature and through experimental studies performed by the author.Electrophysiologic testing of the spinal accessory nerve and of the ventral rami of the cervical spinal nerves was performed in cats and humans. These studies indicated that motor potentials recorded in the trapezius muscle after stimulation of the ventral rami of cervical spinal nerves in general represented the spread of current to the contiguous portions of the spinal accessory nerve or directly to the trapezius muscle. Rarely did there seem to be evidence of motor innervation to the upper and lower trapezius by fibers conveyed by the ventral rami of cervical spinal nerves. The predominant motor input to the trapezius muscle is through the spinal accessory nerve.Subjective evaluation, objective strength testing, and electromyographic evaluation were performed on patients who had undergone neck dissections. Three types of neck dissection were employed. These were modified neck dissection with preservation of the spinal accessory nerve, radical neck dissection with sacrifice of the spinal accessory nerve, and reconstruction using a cable graft and classical radical neck dissection. Regarding all of the methods of evaluation and comparison, the patients who retained function of the spinal accessory nerve in the postoperative period fared better than those who had a classical radical neck dissection with sacrifice of the spinal accessory nerve. This again supports the concept that the most important and predominant motor supply to the trapezius muscle is through the spinal accessory nerve.All of this information was used to construct a model of the spinal portion of the accessory nerve and of the innervation of the trapezius muscle. The clinical implications of this model are stated.

ISSN:0023-852X    

DOI:10.1288/00005537-198704000-00006

出版商:John Wiley&Sons, Inc.    

年代:1987

数据来源: WILEY

摘要:

AbstractThis paper describes the speaking fundamental frequency (SFF) and phonational range characteristics of 35 patients with bilateral diffuse polypoid degeneration. These speakers had average SFFs that were not only substantially lower than normal but also below those associated with many other types of laryngeal pathology. These patients also had phonational ranges that were substantially different from normal. Although both extremes of the pitch range were altered, the upper limit of the voice range was affected profoundly by the morphologic changes in the vocal folds that occur as a result of polypoid degeneration.

ISSN:0023-852X    

DOI:10.1288/00005537-198704000-00007

出版商:John Wiley&Sons, Inc.    

年代:1987

数据来源: WILEY

摘要:

AbstractPharyngoesophageal myotomy, performed in 16 laryngectomees to improve vocal rehabilitation, proved to have some negative side effects. Although no failures of speech rehabilitation using a button were consequently found, a considerable number of button assisted esophageal speakers had a breathy voice. Also, the number of poor injection‐esophageal speakers was much higher than in the group of nonmyotomized laryngectomees.A “normal” pseudoglottis could only rarely be identified by fluoroscopy in the myotomized group. A significantly lower intratracheal pressure appeared to be required for tracheo‐esophageal phonation after myotomy. To improve the slightly disappointing voice rehabilitation results of the myotomized laryngectomees, a modified myotomy is p

ISSN:0023-852X    

DOI:10.1288/00005537-198704000-00008

出版商:John Wiley&Sons, Inc.    

年代:1987

数据来源: WILEY

摘要:

AbstractA transcutaneous electrical stimulation method was used to treat hemifacial spasms. This treatment was applied concomitantly with drug therapy to 21 patients, and was found effective in 17 patients (81%). Electrotherapy is considered to be useful in patients with mild spasms and in those with severe spasms for whom surgical treatment is not possible.

ISSN:0023-852X    

DOI:10.1288/00005537-198704000-00009

出版商:John Wiley&Sons, Inc.    

年代:1987

数据来源: WILEY

摘要:

AbstractAir insufflation testing of tracheoesophageal (TE) puncture candidates as currently practiced lacks objectivity and relies on subjective evaluation of the sound produced. Intraesophageal pressure measurements were obtained from 21 consecutive laryngectomized patients during air insufflation by either experienced examiners or a compressed air source at 1 liter or 3 liters per minute. Postoperatively, three levels of TE speech fluency were identified. Preoperative intraesophageal pressure measurements were associated with a specific post‐TE puncture speech fluency result. Intraesophageal pressure measurements may offer a reliable objective preoperative assessment of post‐TE puncture speech fluency and identify patients who would benefit from pharyngeal myotomy at the time of TE punct

ISSN:0023-852X    

DOI:10.1288/00005537-198704000-00010

出版商:John Wiley&Sons, Inc.    

年代:1987

数据来源: WILEY