摘要:

AbstractDuplication embryological anomalies of the first branchial cleft are reported. Six cases are presented which were treated since 1963.A classification of these cases is suggested wherein there are Type I and Type II lesions.Type I is of ectodermal origin and is considered a duplication of the membranous external auditory canal. Initial infection and subsequent infection often necessitate repeated incision and drainage. Only one of the five cases of Type I did not show infection. Characteristically, these lesions occur medial to the concha and frequently extend to the postauricular crease. They pass anterior and deep to the ear lobe, superior to the facial nerve, parallel to normal external auditory canal and finally end in acul‐de‐sacon a bony plate at the level of the mesotympanum. Microscopically, these lesions are cystic, have a squamous epithelium lining, form keratin and may or may not show accessory skin structures. Surgical excision is the treatment of choice. The surgery must be performed during remission from infection and consists mainly of parotid gland and facial nerve dissections. After the lesion is excised, the normal membranous external auditory canal is incised lengthwise, and an iodoform pack is placed in the area of the excised anomaly and brought out externally through the recently incised membranous external auditory canal and the meatus. During the first few days postoperatively, the pack is gradually removed and the bed of the wound repacked if necessary. Such a technique enhances wound healing.Type II are duplication anomalies of the membranous external auditory canal and pinna; they contain skin (ectoderm )and cartilage (mesoderm). These anomalies likewise are usually diagnosed after infection has taken place and after incision and drainage of an abscess at a point below the angle of the mandible. The upward extension of this lesion passes over the angle or horizontal ramus of the mandible. It continues upward passing either lateral or medial to the facial nerve and in rare instances may split its main trunk. It may end inferior to the membranous external auditory canal or form a sinus in that location. The middle ear is normal. Only one case with such anomaly is reported here, but in 1963, Work and Proctor reported five of six cases as Type II anomalies. Wide surgical excision is curative. The facial nerve must be preserved intact.Types I and II anomalies are not associated with pretragal cysts or sinu

ISSN:0023-852X    

DOI:10.1288/00005537-197209000-00001

出版商:John Wiley&Sons, Inc.    

年代:1972

数据来源: WILEY

摘要:

AbstractBell's palsy is considered by many authorities to be an ischemic paralysis. The mechanism is thought to be a primary vasoconstriction of the vasa nervorum supplying the facial nerve within the fallopian canal and a secondary ischemia induced by the bony canal. The factor precipitating the vasospasm is the proclivity of certain individuals toward segmental arteriolar spasm.In our work.on experimental ischemic facial paralysis, another explanation for the etiology of Bell's palsy presented itself. We observed that dogs sensitized to horse serum showed a greater paralytic response and more marked histopathologic changes after the intrafallopian injection of saline than non‐sensitized dogs. Subsequent investigations using a more potent antigen seemed to strengthen the idea that the experimental paralysis we have accomplished in these dogs is the result of an immunologic or hypersensitivity reaction.In these experiments using adequate control dogs, the animals were sensitized with intravenous horse serum and with a Freund's. adjuvant — horse serum mixture. The presence of horse serum antibodies was demonstrated in the serum of three dogs. The fallopian canal was injected with a combination of solutions: saline solution, Ringer's solution, distilled water, horse serum and the dog's serum. At the end of two weeks, the degree of paralysis was recorded, the nerve was removed and was sent for histopathologic examination.The significant degree of paralysis and the major histopathologic changes were seen in the sensitized dogs injected with saline or Ringer's solution or horse serum.The mechanism of the paralysis is postulated to be an initial antigenantibody reaction with a complement fixation, a degranulation of mast cells producing vasoactive components, an increased capillary permeability, edema, vasospastic phenomenia, and subsequent trophic changes in the nerve. In addition, the edematous neuropathy is severely affected by the compression of the nerve by the bony canal wall.We suggest that these events observed experimentally may be related to the changes seen in Bell's palsy, and Bell's palsy is caused by a localized immunologic or hypersensitivity react

ISSN:0023-852X    

DOI:10.1288/00005537-197209000-00002

出版商:John Wiley&Sons, Inc.    

年代:1972

数据来源: WILEY

摘要:

AbstractA method for restoration of hearing in the fenestration ear is presented which consists of implanting a tailored malleus homograft between the manubrium in the drum and a vein grafted oval window following total stapedectomy.Twelve out of 14 cases followed from six months to four years closed the bone‐air gap within 20 db. Two cases were failures, with one of these a dead ear. None of the cases extruded the homograft malleus. Hearing has been maintained at the serviceable level in 70 percent of the cases for a period up to four years.Results have been promising enough to continue the use of this techniqu

ISSN:0023-852X    

DOI:10.1288/00005537-197209000-00003

出版商:John Wiley&Sons, Inc.    

年代:1972

数据来源: WILEY

摘要:

AbstractEquilibrium disturbances may occur after neck lesions such as whiplash injuries. Abnormal proprioceptive inputs and vascular changes which involve not only the peripheral labyrinth, but also the brain stem are major factors producing these disturbances.Neck proprioceptor ablation was performed in healthy young adult squirrel monkeys by unilateral section of C1, C2 dorsal roots, or by injection of 1 cc of 1 percent Xylocaine® without epinephrine into the unilateral deep neck region.The dorsal root section was histologically confirmed by investigating spinal ganglion and adjacent nerve tissues. The Nauta stained spinal cord cross sections showed neuronal degeneration coming from the dorsal root.No spontaneous nystagmus was observed in the present series after section of the C1, C2 dorsal roots or Xylocaine® injection.After the Xylocaine® deep neck injection, the slow phase eye speed of optokinetic nystagmus declined in either direction in all animals. Slight decline of the quick component was also noticed. The wave form was also changed. The decline of slow phase eye speed partly represents the ablative effect of neck proprioceptors (joints, ligaments, and muscles), although the effect produced through other channels or by systemic toxicity cannot be eliminated. After the left C1, C2 dorsal root section, the slow phase eye speed declined only when there was clockwise stimulation. Statistical studies suggested significant differences between pre‐ and postoperative status. This finding suggested that the cervical input is connected to the oculo‐oculomotor pathway.Immediately after left C1, C2 dorsal root section, a reduction of the slow phase eye speed of postrotatory nystagmus occurred after counter‐clockwise rotation. The randomization test was used, and it was found that the postoperative scores are significantly lower than the pre‐operative scores.After the ablation of C1, C2 dorsal root, subjects failed to demonstrate any significant change in the pattern or numbers of pendular rotation nystagmic responses. On the other hand, three monkeys after Xylocaine® deep neck injection showed some change.The present experimental results indicate that the slow phase eye speed is a proper nystagmic parameter to study the neck proprioceptor contribution to oculomotor function.All animals after unilateral C1, C2 dorsal root section in the present series demonstrated moderate dysequilibrium (measured by the squirrel monkey rail test) confirming that neck injury can produce ataxia. There was no clear postoperative directional dominance of falls. For the diagnosis or investigation of the prognosis of many cervical disorders, bodily equilibrium examination is also important in addition to studying oculomot

ISSN:0023-852X    

DOI:10.1288/00005537-197209000-00004

出版商:John Wiley&Sons, Inc.    

年代:1972

数据来源: WILEY

ISSN:0023-852X    

DOI:10.1288/00005537-197209000-00005

出版商:John Wiley&Sons, Inc.    

年代:1972

数据来源: WILEY

摘要:

AbstractAn attempt was made to elucidate the cytological nature of the defense mechanisms of the normal middle ear with special emphasis on the secretory system.Autoradiography was performed with the use of isotope‐labeled glucose in order to determine the rate of glucose uptake by middle ear cells, particularly by secretory cells. Mucus‐secreting glands in the guinea pig eustachian tube incorporated a large amount of glucose, while the demilune cells (serous) incorporated only a moderate amount. Some simple squamous epithelium of the bulla also took up a large amount of glucose. Since the mucous blanket of the bulla was labeled after only one hour, it is speculated that these flat cells are of the secretory type.A cytochemical demonstration of the enzyme acid phosphatase was done in order to determine the localization of this lysosomal enzyme in the middle ear cells. A strong reaction was consistently noted in the cytoplasm of both light (mucous) and dark (serous) secretory cells. This reaction appears to take place on the outer surface of the secretory granules, but, occasionally, it takes place inside the granules. The strongest reaction was noted in the lysosomal bodies. A weak reaction was frequently noted in the nuclear chromatin of the secretory cells.An immunofluorescent study demonstrated the presence of immunoglobulin‐producing cells in the eustachian tube and in the guinea pig middle ear mucosa. Fluorescein‐labeled cells (round cells) were numerous, particularly in the eustachian tube near the glands.It can be suggested from the foregoing that the middle ear is provided with mucociliary, enzymatic, and immunological (secretory and serum) defense systems.The pathological characteristics of human serous otitis were also reviewed. Evidence was shown of an increase in the number of secretory and ciliated cells, of free macrophages, and of the round cells of the submucosal connective tissue. Evidence of the free escape of transudate through intercellular spaces of the epithelial cells and capillary wall damage in the submucosal layer was also noted in pure serous effusion cases. These changes are identical to those that take place in inflammatory reactions. The middle ear effusion, therefore, can be looked upon as the result of enhanced middle ear defense mechanisms occurring in different

ISSN:0023-852X    

DOI:10.1288/00005537-197209000-00006

出版商:John Wiley&Sons, Inc.    

年代:1972

数据来源: WILEY

摘要:

AbstractThe bursting pressure necessary to rupture the tympanic membrane of cats and guinea pigs was determined by increasing and decreasing the intrabullar pressures and by increasing and decreasing the pressures in the external auditory canal after the bulla was vented to the outside. The average pressures in all experiments varied from 100 to 180 mm. Hg. Such pressures are far greater than the fall in intrabullar pressure which occurs following ligation of the eustachian tube in cats. It is suggested that drumhead perforations in humans with serous otitis may be due to smaller diminished tympanic pressures over a long period of time, leading to retraction pocket, entrapment of debris, and development of an expanding epithelial‐lined cys

ISSN:0023-852X    

DOI:10.1288/00005537-197209000-00007

出版商:John Wiley&Sons, Inc.    

年代:1972

数据来源: WILEY

摘要:

AbstractAn effort to characterize middle ear effusions by biochemical, histologic and physical means was undertaken in order to propose a hypothesis of the pathophysiology of serous otitis media.A group of patients numbering 145 yielded 289 specimens for study. All patients had clinical chronic otitis media. The patient population ranged in age from two months to 14 years.The following measurements were made. Microviscosity, smear with Wright's stain, total protein, glucose, alkaline phosphatase, acid phosphatase, GOT, CPK, alkaline phosphatase isoenzymes.The data indicate that middle ear effusions are locally produced and represent a nonspecific inflammatory response of the middle ear mucosa.

ISSN:0023-852X    

DOI:10.1288/00005537-197209000-00008

出版商:John Wiley&Sons, Inc.    

年代:1972

数据来源: WILEY

摘要:

AbstractEustachian tube function studies were carried out in patients with concurrent or recent middle ear effusions. Radiographic techniques were employed in assessing tubal response to liquid flow. Studies of air flow and air pressure were carried out using a Madsen bridge, and depended on the presence of either a perforation or a tympanostomy tube.Most of the Eustachian tubes studied showed varying degrees of obstruction or abnormal distensibility or both, often depending on the direction of flow, or on whether pressures were increased or reduced.Quite apart from other factors which may contribute to intrinsic oxextrinsic obstruction of the Eustachian tube, its compliance appears to play an important role in determining its function. In particular, compli. ance appears to be an important factor in the response of the Eustachian tube to increased positive or to negative pressures.Elimination of the causes of both nasal obstruction and abnormal nasopharyngeal secretions may alleviate problems in the function of the Eustachian tube which seem attributable to increased tubal compliance.

ISSN:0023-852X    

DOI:10.1288/00005537-197209000-00009

出版商:John Wiley&Sons, Inc.    

年代:1972

数据来源: WILEY

摘要:

AbstractThe purpose of this paper is to develop a method to determine how the eyes actually move in normal subjects, separately and in concert, in response to a given vestibular stimulus, that is, to develop a method of establishing electro‐nystagmogram norms for normal subjects.A data acquisition system utilizing DC recordings was designed and built. The horizontal and vertical movement of each eye was measured independently utilizing a four‐channel DC system. Two two‐channel DC strip chart recorders were used for immediate visualization and also a seven‐channel data acquisition system which is capable of changing analog information into digital form. This information is recorded on magnetic tape which can be fed as data into a digital computer.A computer program was developed which identified all nystagmus cycles and statistically established different values for the characteristics deemed necessary to the establishment of normal electro‐nystagmograms. The program also determines the correlation coefficient of the eye movement of the two eyes during caloric stimulation of a single labyrinth.Since no prior knowledge was assumed as to how the eyes would respond to a given stimulus to the vestibular organ, the position of the electrical axis of the eye must be known at all times. This was documented by recording the circumferential movement of the eye on a duel channel, duel trace storage oscilloscope and photographing the resulting trace.Preliminary data from a limited number of normal patients are shown to indicate order of magnitudes of the characteristics previously mentioned. This data also indicated that the characteristics of a normal electro‐nystagmogram were not affected by the temperature of the water used in the caloric

ISSN:0023-852X    

DOI:10.1288/00005537-197209000-00010

出版商:John Wiley&Sons, Inc.    

年代:1972

数据来源: WILEY