摘要:

AbstractA review of the recent literature concerning Eustachian tube dysfunction and chronic secretory otitis media suggests that the function of and pathology in the fossa of Rosenmüller is being overlooked. Pathology in the fossa is a common cause of tubal dysfunction, and its correction is necessary to achieve satisfactory results in the treatment of secretory otitis media

ISSN:0023-852X    

DOI:10.1288/00005537-197310000-00001

出版商:John Wiley&Sons, Inc.    

年代:1973

数据来源: WILEY

摘要:

AbstractWe made direct measurements of the difference in pressure between the middle ear and the ambient atmosphere in 300 ears affected with chronic adhesive otitis media (CAOM), serous otitis media (SOM), and similar disorders of the ear caused by eustachian tube malfunction.We utilized a narrow bore, open U‐tube manometer made of No. 205 polyethylene tubing which was connected to a 20 or 22 gauge spinal needle. The needle was passed through the intact tympanic membrane and the displacement of the column of 95 percent alcohol in the manometer was noted and recorded.Our results showed that in 101 ears with CAOM, the average negative pressure difference between the middle ear and the ambient atmosphere was 9 mm 95 percent alcohol, equivalent to 7 mm of H2O.In 136 ears with SOM, the average negative middle ear pressure was 8 mm 95 percent alcohol, equivalent to 6.5 mm H2O.In 80 of the 300 diseased ears we tested, the middle and ambient atmospheric pressures were equal.Direct readings of the middle ear pressure tell us the status of the middle ear ventilation at the moment of the measuremen

ISSN:0023-852X    

DOI:10.1288/00005537-197310000-00002

出版商:John Wiley&Sons, Inc.    

年代:1973

数据来源: WILEY

摘要:

AbstractThe goals of tympanoplasty are two: elimination of disease and permanent restoration of hearing. A planned two‐stage tympanoplasty is recommended to accomplish these goals in cases with extensive middle ear mucous membrane disease, in cases with absence of all ossicular tissue and in cases in which there is uncertainty regarding the eradication of cholesteatoma.The most satisfactory technique for restoring hearing in cases without ossicular tissue is a cartilage strut to the stapes footplate. To avoid post‐operative sensori‐neural impairment the surgeon should not open the labyrinth while removing middle ear and mastoid disease. Serious consideration should be given to mastoid re‐exploration for residual disease in all cases in which a closed technique is used for mastoid cholesteatoma.The. otologist must have a thorough knowledge of principles of tympanoplasty and must execute the surgical techniques precisely. By so doing, he should be able to restore useful hearing to the majority of his p

ISSN:0023-852X    

DOI:10.1288/00005537-197310000-00003

出版商:John Wiley&Sons, Inc.    

年代:1973

数据来源: WILEY

摘要:

AbstractA retrospective evaluation of 129 Type II tympanoplasties is presented. The aim has been to assess the long term hearing results with reference to the type of reconstruction employed. The maximum follow‐up period is 11 years. Ninety‐four cases were reconstructed by interposing the incus. In 68 of these cases the stapes suprastructure was present, in 26 it was either absent or was bypassed. Thirty‐five cases were reconstructed by the “malleus‐stapes assembly.” Hearing levels for the 68 cases of incus interposition with the stapes intact were from 0‐30 db in 78 percent of patients at one year; 63 percent at two years and 40 percent at four or more years of follow‐up. Similar levels for 26 cases with suprastructure absent were one year, 50 percent; two years, 26 percent; and four years or more, 14 percent. With the “malleus‐stapes assembly” at one‐year, 83 percent had hearing levels between 0‐30 db; two years, 47 percent; ov

ISSN:0023-852X    

DOI:10.1288/00005537-197310000-00004

出版商:John Wiley&Sons, Inc.    

年代:1973

数据来源: WILEY

摘要:

AbstractSince World War II, major advances in surgical management and life support have made possible operative procedures that could not have been undertaken previously. As a result of these encouraging developments, it has become apparent that the possibilities for palliative surgery now demand our attention and should be considered along with radiotherapy, chemotherapy, cryosurgery, and immunotherapy as suitable management of the patient with advanced malignancy.It should be possible, on the basis of all available information, to excise the primary lesion and all metastases without leaving known tumor. This concept differs from that of “curability” in that it includes lesions which can be removed, but which are statistically not likely to be cured. The surgeon must be reasonably certain that the patient can be reconstructed sufficiently well and that his quality of survival will be superior to the disabilities that would be expected if the local tumor were left uncontrolled. The patient being considered for massive palliative surgery must, of course, be a sufficiently good surgical risk to tolerate the planned procedures.This criterion is not intended to be taken in the medicolegal sense, but rather implies that the patient and his family must fully understand the massive nature of the surgery planned. More important, all concerned must have a realistic expectation as to what can be accomplished.In applying these criteria to carefully selected cases, we have been encouraged to find that most patients are willing to undertake procedures that offer virtually no chance for cure in an effort to obtain the best possible quality of survival for as long as useful life can be prolonged. Morbidity as a result of these palliative attempts has been acceptably low and patient acceptance of these concepts very h

ISSN:0023-852X    

DOI:10.1288/00005537-197310000-00005

出版商:John Wiley&Sons, Inc.    

年代:1973

数据来源: WILEY

摘要:

AbstractThis report is based on 178 pediatric patients diagnosed with head and neck tumors in a 10‐year period at the Children's Hospital Medical Center in Boston, Mass. A statistical comparison was made with two other publications limited to pediatric head and neck tumors, and the similarity in rank‐order was clearly noted except in a few isolated instances.Malignant tumors of theneckoccurred in 104 children. From newborn to six years, the most common neck tumors were neuroblastoma, lymphosarcoma, and rhabdomyosarcoma. From ages seven to 13 the most common neck tumors were Hodgkin's disease, lymphosarcoma, and thyroid tumors. From ages 14‐21 the most common neck tumors were Hodgkin's disease, lymphosarcoma, and squamous cell carcinoma.Malignant tumors of theheadoccurred in 74 children. Each anatomic site of the head was analyzed to determine what tumor cell was present when a mass lesion occurred. These data may help the physician to make more accurate clinical diagnoses.A general discussion of the methods of treatment are also presented, including surgery, radiation therapy, chemotherapy and a new modality, cryosu

ISSN:0023-852X    

DOI:10.1288/00005537-197310000-00006

出版商:John Wiley&Sons, Inc.    

年代:1973

数据来源: WILEY

摘要:

AbstractForty‐six cases of glomus tumor involving the middle ear are presented. The average follow‐up period is 7.1 years. Surgical success rate is 73 percent and radiation is 20 percent. As a secondary modality of therapy for persistent or recurrent tumors, the surgical success rate was 71 percent and radiation was 40 percent. The therapeutic failures are described by anatomic location. There were two tumor related deaths. The treatment of choice for glomus tumors and for tumor recurrences or persistences, providing that they do not invade the intracranial cavity, is surgical. A wide excision (including a jugular bulb and vein resection when indicated) is advoca

ISSN:0023-852X    

DOI:10.1288/00005537-197310000-00007

出版商:John Wiley&Sons, Inc.    

年代:1973

数据来源: WILEY

摘要:

AbstractEighteen years of personal experience of Vidian neurectomy by the author's trans‐antral route in 242 patients is fully reviewed with longterm follow‐up.In otherwise intractable and severe cholinergic (non‐atopic) chronic vasomotor rhinitis, Vidian neurectomy has given complete relief in 94 percent of the patients sustained throughout five to 15‐year follow‐up. The operation has proved valuable in most cases with additional evidence of atopy, but the incidence of complete relief falls to 57 percent.Occasional indications in other conditions are discussed with the results obtained.The need for both meticulous case selection and impeccable technique is stressed. Given these, there now seems no significant risk of material complication. Incautious use of an unsuitable probe for diathermy in the pterygoid canal can give 2 percent risk of serious ophthalmoplegia. Such risk is eliminated by proper use of the author's shoulder

ISSN:0023-852X    

DOI:10.1288/00005537-197310000-00008

出版商:John Wiley&Sons, Inc.    

年代:1973

数据来源: WILEY

摘要:

AbstractOtolaryngology and psychiatry both deal with disorders of communication. Situations which illustrate the overlap between these two disciplines are seen throughout the patient's life cycle. Some of the general areas which are discussed briefly include congenital problems, tonsillectomy and other childhood surgery, adolescent illnesses, cosmetic surgery, head and neck cancer and care of the dying patient. Handling these problems requires attention to both verbal and non‐verbal patterns of communicatio

ISSN:0023-852X    

DOI:10.1288/00005537-197310000-00009

出版商:John Wiley&Sons, Inc.    

年代:1973

数据来源: WILEY

摘要:

AbstractFeatures of energy production and utilization in the cochlea are discussed, with special attention given to the effects of various interferences upon these mechanisms, both with respect to electrophysiologic parameters and with respect to changes in steady state levels of selected metabolites. As a specific example the influence of ethacrynic acid upon the energy metabolism of the stria vascularis is considered. ATP and phosphocreatine concentrations were determined at control conditions and following intoxication with ethacrynic acid using the endolymphatic potential as monitor of functional damage. At the maximum depression of the endolymphatic potential phosphocreatine levels in the stria vascularis were normal and ATP levels slightly reduced; furthermore, if ethacrynic acid intoxicated ears were subjected to the additional stress of ischemia, the decline of both electrophysiologic indicators and high energy phosphates proceeded at a much slower rate. The findings were interpreted as showing that ethacrynic acid reduces the rate of energy consumption, with no significant effects on energy production.

ISSN:0023-852X    

DOI:10.1288/00005537-197310000-00010

出版商:John Wiley&Sons, Inc.    

年代:1973

数据来源: WILEY