Annals of Otology,Rhinology & Laryngology

Specimens of pus were obtained from 24 patients who developed postoperative wound infection after head and neck cancer surgery. Aerobic bacteria only were isolated in two instances (8%), anaerobic bacteria only in one (4%), and mixed aerobic and anaerobic bacteria in 21 (88%). A total of 146 isolates were recovered (66 aerobic and 80 anaerobic), an average of six isolates per specimen (2.7 aerobic and 3.3 anaerobic). The most frequently recovered isolates were Peptostreptococcus sp, Staphylococcus aureus, Bacteroides sp, Fusobacterium, and enteric gram-negative rods. Twenty-two isolates recovered from 17 wounds (71%) produced β-lactamase. These included all five isolates of S aureus and nine of 17 (53%) of the Bacteroides melaninogenicus group. The polymicrobial aerobic/anaerobic nature of postoperative wound infections after head and neck cancer surgery and the presence of β-lactamase-producing bacteria may have important implications for the management of these infections.

Click-evoked otoacoustic emissions were recorded in a group of normally hearing subjects (n = 52 ears) and a group of patients demonstrating several common types of sensorineural hearing loss (n = 85 ears) in order to study the clinical applicability of acoustic emissions. In the normally hearing population, all ears demonstrated acoustic emissions that could be elicited at intensities below the normal subjective threshold for the sequence of clicks (mean, −5.2 dB hearing level [HL]). Sixty-seven percent of the normal ears showed long (>20 ms) click-evoked emissions, and spectral analysis showed a broadband spectral component with several narrowband frequency peaks. In patients with sensorineural hearing loss, the incidence of acoustic emissions decreased and the detection threshold increased linearly with increasing threshold. No emissions were elicited from ears exhibiting subjective click thresholds >35 dB HL. Hearing-impaired ears showed a significantly higher proportion of short duration emissions and a significant reduction in the mean number of narrowband frequency peaks in comparison to the controls. Therefore, acoustic emissions can be used as a reliable technique for objective study of normal micromechanical activity within the cochlea and for detection of subtle changes in cochlear disease. However, they have not been demonstrated to be useful in differentiating cochlear disease.

Histologic and bacteriologic evaluations of tonsils removed at surgery from ten patients with a diagnosis of recurrent tonsillitis were performed. The bacteriology was complex, with an average of 6.3 aerobic bacteria and 3.3 anaerobic bacteria isolated from each patient. Histologic sections revealed chronic cryptitis, with intact tonsillar architecture. These findings provide a possible explanation for the failure of commonly used antibiotic regimens to eradicate recurrent infection from this site.

The variability of the dimensions of the facial recess and extended facial recess with age, sex, and degree of pneumatization was measured in 87 temporal bones serially sectioned in the horizontal plane. Although some statistically significant differences in dimensions were identified, the absolute differences were small compared to the range of measurements. The mean dimensions were very similar in all groups studied. The clinical relevance of the data to mastoid surgery and cochlear implantation is discussed.

A new technique is described that enables discrete activation of individual laryngeal muscles by electrical stimulation across overlying mucosa. In 15 dogs, we defined six distinct motor points by transmucosal stimulation at 3 mA while observing the resulting characteristic position of the arytenoid and true vocal cord. Five dogs were then paralyzed with succinylcholine in order to simulate bilateral vocal cord paralysis. Application of a 3-mA stimulus at each motor point yielded no motion of the cords, but when the current was increased to 20 mA, characteristic responses were elicited. In five other dogs, botulinum toxin was injected directly into laryngeal muscles. Stimulation was used in an attempt to quantify the degree of neuromuscular blockade. In the last group of five dogs, we simulated cricoarytenoid arthritis by scarifying the joint. The extent and nature of the joint's impairment could be demonstrated by stimulation. Transmucosal stimulation appears promising as a clinical technique for correlating particular vocal cord movements and thresholds of activation with specific laryngeal disorders. Additionally, such a technique may be useful in clarifying how each laryngeal muscle acts upon the cricoarytenoid joint.

High resolution computed tomography of the temporal bone is performed routinely in the preoperative evaluation for cochlear implantation. A retrospective review was performed to determine the effect of these studies. The clinical significance was determined through consultation with the referring otolaryngologist and review of the operative reports. Twelve examinations were reviewed. Abnormalities were identified in 12 of the 24 ears examined (eight of 12 patients studied). In two patients the CT examination strongly influenced the selection of the ear to be implanted. In four additional cases information felt to be useful in preoperative planning was provided. Useful information related to potential complications with the mechanical insertion of the electrode apparatus. We conclude that temporal bone abnormalities are common in the population undergoing cochlear implantation and that high resolution temporal bone CT is essential in preoperative evaluation. The CT scan should be interpreted with adequate knowledge of the operative procedure to evaluate any possible barriers to the mechanical insertion of the internal components of the system.

The present study was designed to elucidate the effect of immunotherapy on the beating frequency of nasal cilia in patients with nasal allergy. Of 40 patients with nasal allergy due to Dermatophagoides farinae, 20 were treated with immunotherapy by the use of D farinae extracts, and 20 control patients were treated with antihistamine tablets. Mucosal pieces were taken from the right inferior turbinate before and 1 year after the initiation of treatment, and the ciliary beating frequency (CBF) was examined by a photoelectric method. The use of antihistamine tablets did not increase CBF even when it relieved the nasal symptoms. Immunotherapy, on the other hand, increased CBF in 66.7% of patients when it alleviated their nasal symptoms. The CBF before immunotherapy of patients who showed an increased CBF after treatment was statistically higher than that of patients who did not.

Thirteen atelectatic ears were politzerized with CO₂, O₂, air, and N₂. In consequence, the atelectasis in these ears disappeared, only to reappear again slowly. The reappearance of retraction corresponded in speed to the diffusion coefficient of the gases, indicating a regular diffusion process. At the same time, four of these politzerized patients were able to collapse the tympanic membrane of their air-filled middle ears abruptly through sniffing or swallowing. At least three patients could introduce air actively and voluntarily into their ears. These observations indicate that in atelectatic ears, as in normal ears, air can enter and leave the middle ear through one of two routes. One is the eustachian tube, through which air can pass both ways as a bolus. The second route is through the bloodstream, which gases enter and leave according to the rules of biologic diffusion. While the origin of negative pressure in atelectatic ears is unknown, this study shows that it may be a complex process stemming from a quantitative imbalance of loss versus gain of gas entry through either of the two routes.

Fabry's disease is a rare progressive X-linked recessive disorder of glycosphingolipid metabolism. The accumulation of glycosphingolipids occurs in virtually all areas of the body, including the endothelial, perithelial, and smooth-muscle cells of blood vessels, the ganglion cells of the autonomic nervous system, and the glomeruli and tubules of the kidney. Although otologic symptoms have been described in these patients, to our knowledge there have been no temporal bone histopathologic reports. We describe the clinical histories, audiometric results, and temporal bone findings of two patients with this rare disorder. Both patients demonstrated a bilateral sloping sensorineural hearing loss audiometrically. Middle ear findings of seropurulent effusions and hyperplastic mucosa were seen in all four temporal bones. Strial and spiral ligament atrophy in all turns, and hair cell loss mainly in the basal turns, were also common findings. The number of spiral ganglion cells was reduced in all temporal bones; however, evidence of glycosphingolipid accumulation was not observed in the spiral ganglia.

Twenty-three adult patients with type 2 Usher's syndrome were evaluated for changes in pure tone average (PTA), discrete frequency thresholds, and speech discrimination scores. These patients were evaluated over a period of 5 years on the average (range, 2 to 9 years). Analyses of ear data showed a <10-dB change on PTA and discrete frequency thresholds for most ears. Of the ears that showed a threshold change ≥ 10 dB, statistical significance was reached only at 4,000 Hz (p < .01), where 11 ears representing ten patients dropped 10 to 15 dB. Speech discrimination data showed a ≥ 16% change in score for 18 ears (12 patients). Sixteen of those ears (ten patients) had a 16% to 52% decrease in score (p < .01), and the remaining two ears (two patients) showed a 20% and 30% improvement in score. These findings document little or no change in pure tone sensitivity for type 2 Usher's syndrome patients, but demonstrate the importance of monitoring their speech discrimination performance.

The purpose of the present investigation was to determine whether temperature has an effect on the magnitude of fixation suppression (FS) in normal subjects. The subject population consisted of 23 patients ranging in age from 35 to 74 years (mean age of 58.13 years). Each subject received a conventional vestibulometric test battery that included bithermal caloric testing and the FS test. The warm caloric media elicited larger nystagmus slow-phase eye velocities than the cool caloric media. Following warm caloric irrigations, FS was significantly smaller than that following cool caloric irrigations. It also worsened as a function of subject age. The results suggest that separate normal upper limits for FS need to be determined for cool and warm caloric testing. They also suggest that FS ability may decrease with age.

The cricothyroid muscle (CT) appears to be an accessory muscle of respiration. Phasic inspiratory contraction is stimulated by increasing respiratory demand. Reflex activation of the CT may be responsible for the paramedian position of the vocal folds, and hence airway obstruction, in patients with bilateral recurrent laryngeal nerve (RLN) paralysis. Previous research has demonstrated the influence of superior laryngeal nerve (SLN) afferents on CT activity. The present study addresses the effects of vagal and RLN afferents. Electromyographic activity of the CT and right posterior cricoarytenoid muscle was monitored in anesthetized cats during tracheotomy breathing and in response to tracheal or upper airway occlusion in the intact animal. This was repeated following left RLN transection, bilateral vagotomy, and bilateral SLN transection. Vagotomy abolished CT response to tracheal occlusion and markedly reduced the response to upper airway occlusion. Vocal fold position following RLN transection appeared to correlate with CT activity; however, observed changes were minor.

The effect of nitrogen mustard-N-oxide (NMO) on the endocochlear potential (EP) was investigated from the aspect of the ion concentrations and permeabilities in the cochlea. Compared with the untreated animals, in NMO-treated animals 20 to 30 hours after administration, the EP was decreased (30.8 ± 3.5 mV in NMO versus 82.4 ± 1.6 mV in control), the K⁺ concentration in perilymph of the scala tympani was increased (8.2 ± 1.0 mM versus 5.3 ± 0.7 mM), the K⁺ concentration in endolymph was decreased (128.5 ± 10.6 mM versus 157.9 ± 7.9 mM), and the Na⁺ concentration in endolymph was increased (9.6 ± 3.6 mM versus 2.5 ± 0.4 mM). The permeability coefficient for Na⁺ of the cochlear partition in the NMO-treated animals significantly decreased, while that for Cl⁻ significantly increased. The negative EP, which presumably exists in the normal state, diminished further (−2.7 mV versus −27.8 mV), and the calculated electrogenic potential of the EP was depressed remarkably (33.5 mV versus 110.2 mV). The results suggest that the effects of NMO involved changes in ion permeabilities of the partition and the inhibition of electrogenic transport processes in the cochlea.

The present study deals with the immunohistochemical detection of four brain-derived proteins and cytokeratin in the normal olfactory mucosa of humans and guinea pigs. Neurofilament protein immunoreactivity was found in the olfactory vesicles, dendrites, and perikaryon of receptor cells, and in thick nerve bundles located deep in the lamina propria. The antiserum to neuron-specific enolase (NSE) selectively stained olfactory receptor cells throughout the length of the bundles. The NSE immunoreactivity also was recognized in nerve bundles of various sizes throughout the lamina propria. Glia-specific S-100 protein immunoreactivity was present in Bowman's glands as well as in all nerve bundles in the lamina propria, but not in any cellular elements constituting the olfactory epithelium. Immunoreactivity for spot-35 protein, which was considered to be specific for cerebellar Purkinje cells, was found in flasklike cells (microvillar cells) occurring near the free surface of the epithelium. The basal cells in the olfactory and respiratory epithelium were stained positively with a cytokeratin antiserum.

Prostaglandins are thought to be of importance in the pathophysiology of otitis media with effusion (OME), and the possibility of reducing the frequency and persistence of this condition by using prostaglandin inhibitors has been suggested. In a double blind manner, naproxen was administered to children with acute otitis media, in addition to amoxicillin, and its influence on the subsequent occurrence and persistence of middle ear effusion was evaluated. Eighty-one children participated in the study. No significant difference was found in the number of patients with tympanograms consistent with OME in the two groups. After 10 days of treatment, 63% in the naproxen and 58% in the placebo group, and after 30 days, 41% and 59%, respectively, had type B tympanograms. Similarly, there were no differences between the two groups with respect to other parameters studied (duration of otalgia, fever, otoscopic findings). No side effects related to naproxen were observed.

An intravestibular lipoma was discovered during destructive surgery for disabling vertigo in a case diagnosed as delayed endolymphatic hydrops. The author recommends that in cases that resemble Meniere's disease but have unusual symptoms, the existence of other lesions within the inner ear should be suspected.

Ewing's sarcoma is a distinctive clinical and pathologic entity that may be intraosseous or of soft-tissue origin. In the facial bones, the incidence of the sarcoma is estimated at 2.5% of all Ewing's sarcoma of bone. The soft tissues of the head and neck account for 11% of extraskeletal sites of the neoplasm. Combined modality treatment has modified its high-grade malignancy.