A.M.A. Archives of Otolaryngology

Shambaugh, George E.

1960 A.M.A. Archives of Otolaryngology

doi: 10.1001/archotol.1960.03770020003001

This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables. Abstract The week of March 16-21, 1959, a Workshop on Reconstructive Middle Ear Surgery was held in Chicago to bring together a number of the active contributors to this rapidly developing aspect of otology with Professor Wullstein, one of the foremost pioneers in this field. The speakers who comprised the faculty were selected because of their original contributions to this field, and the members of the Worshop consisted of board-certified otolaryngologists, accepted on the basis of priority of registration. The facilities limited the number of participants to approximately 280 registrants. The formal lectures each day were limited to 30 minutes each, allowing a leisurely question-and-answer period after each luncheon. Each day ended with an unrehearsed round-table discussion by the speakers of that day, with audience participation. In addition, on the first three days there were motion pictures by members of the faculty. These motion pictures supplemented the scientific sessions. The great

1960 A.M.A. Archives of Otolaryngology

doi: 10.1001/archotol.1960.03770020004002

This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables. Abstract Last summer, I was visiting Professor Wullstein when I learned that he was going to speak before the Royal Society in England the first week of March. I suggested that he prolong his journey a few miles westward and end up in Chicago to speak to the students we were going to have in a course in endaural surgery. He consented to come. Then we added a few other speakers who were interested in the same area, namely, reconstructive middle ear surgery, and little by little, we had a program which was interesting enough that we thought we should invite other people to come if they wished. To our amazement, we were overwhelmed with requests. We had to turn down about 100 people whom we couldn't take because of the size of the space which we had available and because we wanted to make this a real workshop, a session

LAWRENCE, MERLE

1960 A.M.A. Archives of Otolaryngology

doi: 10.1001/archotol.1960.03770020005003pmid: 14414722

Abstract If one had a water-filled balloon containing living auditory sensory cells and placed this in a larger container of water, any vibrations that passed through the larger container would pass right on through the balloon and its contents. The vibrations would undoubtedly shake the cells and if there were nerve fibers connected to them a stimulation would result. If the balloon were brought out of the water so as to be surrounded by air, any vibrations occurring in the air would, mostly, be reflected back from the surface of the balloon. Because of the great difference in the physical properties of air and liquid, only very small vibrations (compared to those in the air) would be produced in the water-filled balloon. The situation could be complicated even further by encasing this water-filled balloon in some rigid material, such as bone, and covering this with a sound-absorbent material. Under these conditions, References 1. von Békésy, G.: Über die Messung der Schwingungsamplitude der Gehörknochelchen mittels einer kapazitiven Sonde , Akust. Ztschr. 6:116, 1941. 2. von Békésy, G.: The Sound Pressure Difference Between the Round and the Oval Windows and the Artificial Window of Labyrinthine Fenestration , Acta oto-laryngol. 5:301-315, 1947.Crossref 3. Wever, E. G., and Lawrence, M.: The Transmission Properties of the Stapes , Ann. Otol. Rhin. & Laryng. 59:322-330, 1950.

CARHART, RAYMOND

1960 A.M.A. Archives of Otolaryngology

doi: 10.1001/archotol.1960.03770020013004pmid: 13807697

Abstract The problem of determining the cochlear reserve of the otosclerotic patient is of critical importance to the otologic surgeon. There are two reasons for this fact. In the first place, it is impossible to predict accurately the postsurgical level of a patient's hearing unless a reasonable estimate of cochlear reserve can be made preoperatively. The surgeon cannot calculate the outcome anticipated for his patient unless he knows the patient's sensorineural acuity. Only if he has this information at hand is he in a position to take into account figures such as Dr. Lawrence has been giving us regarding the acoustic contribution of the conductive mechanism. Secondly, there is the equally important task of evaluating different surgical procedures. The determination of the relative success of each new procedure can be more precise if one can state how nearly it restores patients to the level of their sensorineural capacity. The surgeon can References 1. Davis, H., and Walsh, T. E.: The Limits of Improvement of Hearing Following a Fenestration Operation , Laryngoscope 60:273-295 ( (March) ) 1950. 2. Rainville, M. J.: Nouvelle Méthode d'assourdisement pour le relève des courbes de conduction osseuse , J. franc. oto-rhino-laryng. 4: 851-858 ( (Dec.) ) 1955. 3. Jerger, J. F.: A New Test for Cochlear Reserve in the Selection of Patients for Fenestration Surgery , Ann. Otol. Rhin. & Laryng. 62:724-734 ( (Sept.) ) 1953. 4. Thurlow, W. R.; Davis, H.; Silverman, S. R., and Walsh, T. E.: Further Statistical Study of Auditory Tests in Relation to a Fenestration Operation , Laryngoscope 59:113-129 ( (Feb.) ) 1949. 5. Lawrence, M., and Yantis, P. A.: Thresholds of Overload in Normal and Pathological Ears , A.M.A. Arch. Otolaryng. 63:67-77 ( (Jan.) ) 1956. 6. Jerger, J.; Shedd, J. L., and Harford, E.: On the Detection of Extremely Small Changes in Sound Intensity , A.M.A. Arch. Otolaryng. 69: 200-211 ( (Feb.) ) 1959.

COMPERE, W. E.

1960 A.M.A. Archives of Otolaryngology

doi: 10.1001/archotol.1960.03770020022005pmid: 13811431

Abstract The association of hearing loss with stapes fixation was apparently demonstrated by Valsalva, and recognized by Morgagni and Meckel,8 but it remained for Toynbee,19 in 1857, to establish the fact that osseous ankylosis of the stapes to the fenestra ovalis is, pathologically, one of the commonest causes of deafness. Von Tröltsch20 was the first to give "otosclerosis" a separate place in the category of clinical diseases of the ear. Now the otologic journals are filled with articles discussing the operative treatment of hearing loss due to stapes fixation, and the world's otolaryngologists are preoccupied with the techniques of mobilization surgery. From the standpoint of pathology, however, what can we add to this statement made by Pritchard15 in 1891? "Progressive Tympanic Deafness, Non-Proliferative Aural Catarrh, Otosclerosis—All the above names have been given to a certain form, or possibly, to many forms of middle ear deafness, the pathology References 1. Bezold, F., and Siebenmann, F.: Textbook of Otology for Physicians and Students , in 32 Lectures , translated by J. Holinger, Chicago, E. H. Colegrove Co., 1908, p. 284. 2. Brühl, G., in Duel, A. B., Editor: Otosclerosis: A Résumé of the Literature to July, 1928. Compiled under the direction of the Committee on Otosclerosis , American Otologic Society , New York, Paul B. Hoeber, Inc., 1929, Vol. (I) , p. 75. 3. Brunner, H.: Otosclerosis Associated with Osteoporosis and Labyrinthitis Chronica Ossificans , Arch. Otolaryng. 49:184-195 ( (Feb.) ) 1949.Crossref 4. Eckert, A., in Duel, A. B., Editor: Otosclerosis: A Résumé of the Literature to July, 1928. Compiled under the direction of the Committee on Otosclerosis , American Otologic Society , New York, Paul B. Hoeber, Inc., 1929, Vol. I, p. 197. 5. Graham-Hodgson, H. K.: The Radiology of the Normal and Abnormal Labyrinth , J. Laryng. & Otol. 43:92-97 ( (Feb.) ) 1928. 6. Graham-Hodgson, H. K.: The Diagnostic Value of X-Ray Examination of the Temporal Bone , Proc. Roy. Soc. Med. 23:717-718 ( (Dec. 6) ) 1929. 7. Graham-Hodgson, H. K., in Shanks, S. C., and Kerley, P. J.: A Textbook of X-Ray Diagnosis , Ed. 3, London, H. K. Lewis & Co., Ltd., 1957, Vol. 1, Head and Neck, p. 480. 8. Gray, A. A.: The Ear and Its Diseases , London, Baillière, Tindall & Cox, 1910, p. 311. 9. Gray, A. A.: Otosclerosis , London, H. K. Lewis & Co., Ltd., 1917, p. 123. 10. Hutchinson, C. A.: Radiography as an Aid to Differential Diagnosis Between Otosclerosis and Chronic Adhesive Process , J. Laryng. & Otol. 69: 617-624 ( (Sept.) ) 1955. 11. Keeler, J. C.: Modern Otology , Philadelphia, F. A. Davis Co., 1930, p. 703. 12. Moos, S., in Duel, A. B., Editor: Otosclerosis: A Résumé of the Literature to July, 1928. Compiled under the direction of the Committee on Otosclerosis , American Otologic Society , New York, Paul B. Hoeber, Inc., 1929, Vol. I, pp. 21 and 23. 13. Nager, F. R., and Fraser, J. S.: On Bone Formation in the Scala Tympani of Otosclerotics , J. Laryng. & Otol. 53:173-180 ( (March) ) 1938. 14. Nylen, B.: Histopathological Investigations on the Localization, Number, Activity, and Extent of Otosclerotic Foci , J. Laryng. & Otol. 63: 321-327 ( (June) ) 1949. 15. Pritchard, U.: Handbook of Diseases of the Ear for the Use of Students and Practitioners , London, H. K. Lewis & Co., Ltd., 1891, p. 113. 16. Roosa, D. B. St. J.: A Practical Treatise on the Diseases of the Ear, Including the Anatomy of the Organ , New York, William Wood & Co., 1873, p. 283. 17. Seligman, E., and Shambaugh, G. E., Jr.: Otosclerosis of the Osseous Horizontal Semicircular Canal , Ann. Otol. Rhin. & Laryng. 60:375-381 (June) 1951. 18. Stenvers, H. W.: Roentgenology of the Os Petrosum , Arch. Rad. & Elec. 22:97-119 ( (Sept.) ) 1917. 19. Toynbee, J.: A Descriptive Catalogue of Preparations Illustrative of the Disease of the Ear, in the Museum of Joseph Toynbee , London, John Churchill, 1857, p. ix. 20. von Tröltsch, A.: Diseases of the Ear , translated by D. B. St. John Roosa, New York, William Wood & Co., 1869, p. 282.

HOUSE, WILLIAM F.

1960 A.M.A. Archives of Otolaryngology

doi: 10.1001/archotol.1960.03770020028006pmid: 14403390

Abstract The conquest of hearing loss due to otosclerosis is one of the most fascinating and unfinished parts of otology. The unsolved problems of otosclerosis call for continued search for medical and surgical methods of alleviating the handicap caused by this disease. It is the purpose of this paper to present a method of opening the oval and round windows in cases of extensive otosclerosis. Oval Window Surgical Techniques Stapes mobilization as proposed by Rosen1 was a method of fracture through the otosclerotic focus of the oval window by pressure through the head and crura of the stapes. Later footplate techniques developed by a number of surgeons have made it possible to mobilize the majority of otosclerotically fixed footplates. There still remain, however, those patients with extensive otosclerosis in whom the thickness of the footplate is so great that it cannot be mobilized with any of the currently used needle, References 1. Rosen, S.: Mobilization of the Stapes to Restore Hearing in Otosclerosis , New York J. Med. 53:2650-2653 ( (Nov. 15) ) 1953. 2. Shea, J. J., Jr.: Personal communication to the author. 3. Guild, S. R.: Histologic Otosclerosis , Ann. Otol. Rhin. & Laryng. 53:246-266 ( (June) ) 1944. 4. Lindsay, J. R., and Hemenway, W.: Occlusion of the Round Window by Otosclerosis , Laryngoscope 64:10-19 ( (Jan.) ) 1954. 5. Nager, F. R., and Fraser, J. S.: On Bone Formation in the Scala Tympani of Otosclerotics , J. Laryng. & Otol. 53:173-180 ( (March) ) 1938. 6. Wever, E. G., and Lawrence, M.: Physiological Acoustics , Princeton, N.J., Princeton University Press, 1954. 7. Goodhill, V.; Holcomb, A. L.; Rehman, I., and Brockman, S. J.: Cochlear Microphonic Measurements in Experimental Labyrinthine Occlusion and Fenestration , Laryngoscope 64:333-334 ( (May) ) 1954.

1960 A.M.A. Archives of Otolaryngology

doi: 10.1001/archotol.1960.03770020032007

This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables.

GUILFORD, FREDERICK R.

1960 A.M.A. Archives of Otolaryngology

doi: 10.1001/archotol.1960.03770020037008pmid: 13830142

Abstract Prompt, complete, spontaneous coverage of the postoperative mastoidectomy, tympanoplasty, or fenestration cavity by a continuous sheet of healthy keratinized squamous epithelium is the ideal result desired by the otologic surgeon. However, several factors may prevent the attainment of this goal. We know that incomplete epidermization of the cavity, recurrent contamination, and aural drainage are relatively common occurrences. Adequate and proper postoperative treatment will salvage some of these cavities and complete healing may occur. However, in spite of treatment, a fair proportion of them do not completely heal and recurrent drainage leads to dissatisfaction of the patient, even though an excellent result was otherwise obtained. We maintain that the healing of these cavities can be controlled and postoperative purulent aural drainage avoided in the large majority of cases. Our definition of a healed cavity is one that is completely lined by a continuous sheet of keratinized squamous epithelium, as stated in References 1. Guiford, F. R., and Wright, W. K.: Secondary Skin Grafting in Fenestration and Mastoid Cavities , Laryngoscope 64:626-631, 1954. 2. Watkyn-Thomas, F. W., Editor: Diseases of the Throat, Nose and Ear , Springfield, Ill., Charles C Thomas, Publisher, 1953. 3. Kerrison, P. D.: Diseases of the Ear , Ed. 4, Philadelphia, J. B. Lippincott Company, 1930. 4. Singleton, J. D.: Pneumatization of the Adult Temporal Bone, The Mastoid Portion: An Anatomic and Clinical Study , Laryngoscope 54:324-344, 1944.Crossref 5. Padgett, E. C.: Skin Grafting , Springfield, Ill., Charles C Thomas, Publisher, 1942.

SHAMBAUGH, GEORGE E.;COMPERE, W. E.;GUILFORD, FREDERICK R.;HOUSE, WILLIAM F.;LAWRENCE, MERLE

1960 A.M.A. Archives of Otolaryngology

doi: 10.1001/archotol.1960.03770020044009pmid: 14445421

This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables. Abstract Moderator Shambaugh: We are going to run our round table in an informal manner, and to start the ball rolling, I am going to call on Dr. Lawrence. I would like him to tell us if he has any clues as to how we are going to preoperatively diagnose a round window closure. It seems as though there must be some type of tests—hearing tests or other tests—which could be done to help us diagnose these cases ahead of time. As far as I know—and Bill House made this statement in his talk—until now, we have no way of knowing whether a patient has a round window closure, an oval window closure, or closure of both windows. Would you like to start the discussion with a comment? Dr. Lawrence: I am afraid I am not going to have too much to offer in answer to this question. Apparently, the obvious

ROSEN, SAMUEL

1960 A.M.A. Archives of Otolaryngology

doi: 10.1001/archotol.1960.03770020054010pmid: 13854570

Abstract Perhaps the best way to describe the principles on which stapes surgery rests is the term "dynamic." Modern stapes surgery is not a standardized or fixed procedure; it is rather in process, constantly developing, growing, and expanding. Our measure of advance is the degree of success we meet in restoring and maintaining hearing by the best possible methods. In the seven years of its renaissance, it is not an exaggeration to say that stapes surgery has revolutionized our approach to the problems and surgical treatment of otosclerotic deafness. But since stapes surgery is yet in its infancy, experimentation, evaluation, and careful observation of all that is being done remain of paramount importance. Underlying all growth, change, and progress, there is inherent "order." A state of fluidity and experimentation does not mean chaos. Stapes surgery, for all its growth, also has its natural order, and we would do well not to References 1. Rosen, S.: Palpation of Stapes for Fixation: Preliminary Procedure to Determine Fenestration Suitability in Otosclerosis , A.M.A. Arch. Oto-laryng. 56:610 ( (Dec.) ) 1952.Crossref 2. Rosen, S.: Mobilization of the Stapes to Restore Hearing in Otosclerosis , New York J. Med. 53:2650 ( (Nov. 15) ) 1953. 3. Rosen, S.: Simple Method for Restoring Hearing in Otosclerosis: Mobilization of Stapes; Case Reports , Acta oto-laryng. 44:78, 1954.Crossref 4. Rosen, S., and Bergman, M.: Mobilization of the Stapes for Otosclerotic Deafness , Acta oto-laryng. , (Supp. 118) , p. 180, 1954. 5. Rosen, S., and Bergman, M.: Mobilization of the Stapes for Otosclerotic Deafness: Preliminary Report on 2 Years' Experience , A.M.A. Arch. Otolaryng. 61:197 ( (Feb.) ) 1955.Crossref 6. Rosen, S., and Bergman, M.: Improved Hearing After Mobilization of the Stapes in Otosclerotic Deafness , J. Laryng. & Otol. 69:297 ( (May) ) 1955. 7. Rosen, S.: Mobilization of the Stapes to Restore Hearing in Otosclerosis , New York J. Med. 55:69 ( (Jan. 1) ) 1955. 8. Rosen, S.: Restoration of Hearing in Otosclerosis by Mobilization of the Fixed Stapedial Footplate: An Analysis of Results , Laryngoscope 65:224 ( (April) ) 1955. 9. Rosen, S.: Mobilization at the Footplate of the Fixed Stapedial Footplate: Further Development of the Mobilization Technique for Restoration of Hearing in Otosclerotic Deafness , Acta oto-laryng. 45:532 ( (Sept.) -Oct.) 1955. 10. Rosen, S.: Fenestra Ovalis for Otosclerotic Deafness: An Adjunct to Stapes Mobilization , A.M.A. Arch. Otolaryng. 64:227 ( (Sept.) ) 1956. 11. Zollner, F., in Kobrak, H. G.: The Middle Ear , Chicago, The University of Chicago Press, Chapter XV , 1959. 12. Wever, E. G., and Lawrence, M.: The Functions of the Round Window , Ann. Otol. Rhin. & Laryng. 57:579 ( (Sept.) ) 1948. 13. Wever, E. G., and Lawrence, M.: Physiological Acoustics , Princeton, N.J., Princeton University Press, 1954. 14. Wever, E. G., and Lawrence, M.: The Acoustic Pathways to the Cochlea , J. acoust. Soc. Amer. 22:460, 1957. 15. Bell, C.: Anatomy and Physiology of the Human Body , London, Longman, Rees Orme, Brown & Green, 1826. 16. Weber, E. F.: Über den Zweck der Fenestra Rotunda und die Vorrichtung der Schnecke im Gehörorgane der Menschen und der Saugethiere . Amlicher Ber. tierärztl. Abt. Gesellsch. deutsch. Naturforsch. Ärtz , 19:83-84, 1841 17. Braunschweig, 83-84, 1842. 18. Weber, E. F.: Über den Mechanisms des Gehor Organs , Ber. sächs Gesellsch. (Äkad.) Wissensch. 3:29, 1851. 19. Symposium: The Operation for the Mobilization of the Stapes in Otosclerotic Deafness , Laryngoscope 66:729 ( (July) ) 1956. 20. Lawrence, M.: Function of the Middle Ear as Related to Stapes Mobilization. Presented at the ORL Society Symposium on Stapes Mobilization, San Francisco, May, 1958. 21. Tonndorf, J.: Remarks during the discussion at ORL Society Symposium on Stapes Mobilization, San Francisco, May, 1958.

ANSON, BARRY J.;BAST, THEODORE H.

1960 A.M.A. Archives of Otolaryngology

doi: 10.1001/archotol.1960.03770020060011pmid: 13793786

Abstract The authors' purpose in presenting this report is twofold: First, to describe features in the developmental and adult structure of the stapes pertinent to problems that confront the otologist in attempting stapedial mobilization; second, to demonstrate the relation of the footplate to the otic (endolymphatic) labyrinth—a relationship which inescapably places the labyrinthine duct-system in jeopardy in the course of endaural surgery. In fact, in every variant of the fundamental approach there is danger of damage to some part of the stapes or to vital parts of the endolymphatic (otic) labyrinth. The literature on early attempts at stapes mobilization, reviewed by authors herinafter listed, need not be repeated here. Six years have elapsed since mobilization of the stapes became established as a practical procedure for the restoration of hearing in cases of otosclerotic deafness. Since then, this technique (according to Rosen, 1958) has been employed in an estimated 25,000 cases of References 1. Alexander, L. W.: Mobilization of the Stapes in Otosclerosis by a Transtympanic Technique , A.M.A. Arch. Otolaryng. 66:383-390, 1957.Crossref 2. Anson, B. J.; Bast, T. H., and Cauldwell, E. W.: The Development of the Auditory Ossicles, the Otic Capsule and the Extracapsular Tissue , Ann. Otol., Rhin. & Laryng. 57:603-632, 1948. 3. Anson and Bast, T. H.: Developmental and Adult Anatomy of the Auditory Ossicles in Relation to the Operation for Mobilization of the Stapes in Otosclerotic Deafness , Laryngoscope 66:785-795, 1956. 4. Besek, M., and Fowler, E. P., Jr.: Anatomical Factors in Stapes Mobilization Operations , A.M.A. Arch. Otolaryng. 63:589-597, 1956. 5. Bast, T. H.; Anson, B. J., and Richany, S. F.: The Development of the Second Branchial Arch (Reichert's Cartilage), Facial Canal and Associated Structures in Man , Quart. Bull. Northwestern Univ. M. School 30:235-249, 1956. 6. Beaton, L. E., and Anson, B. J.: Adult Form of the Human Stapes in the Light of its Development , Quart. Bull. Northwestern Univ. M. School 14:258-269, 1940. 7. Bellucci, R. J.: Present Status of the Operation for Mobilization of the Stapes , Laryngoscope 66:269-292, 1956. 8. Cawthorne, T.: Adventures with the Stapes , Ann. Otol., Rhin. & Laryng. 66:514-520, 1957. 9. Daly, S.; Goldstein, L. J.; Heller, M.; Anderman, B., and Ezekiel, M. M.: Mobilization of Middle-ear Structures through the Eustachian Tube , A.M.A. Arch. Otolaryng. 62:187-197, 1955. 10. Derlacki, E.; Shambaugh, G. E., Jr., and Harrison, W. H.: The Evolution of a Stapes Mobilization Technique , Laryngoscope 66:420-447, 1957. 11. Fowler, E. P., Jr.: The Operation for the Mobilization of the Stapes in Otosclerotic Deafness Symposium , Laryngoscope 66:749-758, 1956. 12. Anterior Crurotomy and Mobilization of the Ankylosed Stapes Footplate , Acta oto-laryng. 46:318-322, 1957. 13. Goodhill, V.: Surgical Audiometry in Stapedolysis (Stapes Mobilization) , A.M.A. Arch. Otolaryng. 62:504-508, 1955. 14. Trans-incudal Stapedolysis for Stapes Mobilization in Otosclerotic Deafness , Laryngoscope 65:693-710, 1955. 15. Present Status of Stapedolysis (Stapes Mobilization) , Laryngoscope 66:333-381, 1956. 16. Stapes Mobilization—Problems and Prospectives , A.M.A. Arch. Otolaryng. 67:142-147, 1958. 17. Heermann, H.: Mobilisierung des Steigbugels durch Ausmeisseln und Einwartsverlagern der Fussplatte , Ztschr. Laryng. Rhin. Otol. 35: 415-420, 1956. 18. House, H. P.: Personal Experiences with Stapes Mobilization , A.M.A. Arch. Otolaryng. 65: 235-244, 1957. 19. Kos, C. M.: Transtympanic Mobilization for Impaired Hearing Due to Otosclerosis , Ann. Otol., Rhin. & Laryng. 64:995-1008, 1955. 20. Lindsay, J. R.: ( Participant in Symposium on the Operation for the Mobilization of the Stapes in Otosclerotic Deafness ), Laryngoscope 66:732-739, 1956. 21. Meurman, Y.: Stapesmobilisierung nach attikotomie mit Lösung der Fussplate (Kongressbericht 1955) , Arch. Ohren-Nasen-u. Kehlkopfh. 167: 531-540, 1955.Crossref 22. Stapes Mobilization in Otosclerosis , A.M.A. Arch. Otolaryng. 66:464-479, 1957.Crossref 23. Meurman and Meurman, O.: Stapes Mobilization in Otosclerosis: Primary Result and a Review of 63 Cases , A.M.A. Arch. Otolaryng. 62:164-172, 1955.Crossref 24. Myers, D., and Ronis, B. J.: Improvement of Hearing in Otosclerosis by Means of Stapes-Mobilization Operation , A.M.A. Arch. Otolaryng. 64:307-323, 1956.Crossref 25. Myerson, M. C.: Mobilization of the Stapes for Otosclerosis , A.M.A. Arch. Otolaryng. 64:85-90, 1956.Crossref 26. Considerations on Mobilization of the Stapes for Otosclerosis , A.M.A. Arch. Otolaryng. 67: 148-151, 1958.Crossref 27. Pick, E. I.: Indications and Predictions in Stapes Mobilization. (New Method to Test Hearing During Surgery) , A.M.A. Arch. Otolaryng. 65:586-590, 1957.Crossref 28. Portman, M., and Claverie, G.: Surgery of the Windows of the Labyrinth in Otosclerosis , Ann. Otol., Rhin. & Laryng. 66:49-66, 1957. 29. Richany, S. F.; Anson, B. J., and Bast, T. H.: The Development and Adult Structure of the Malleus, Incus and Stapes , Quart. Bull. Northwestern Univ. M. School 28:17-45, 1954. 30. Richany Bast, T. H., and Anson, B. J.: The Development of the First Branchial Arch in Man and the Fate of Meckel's Cartilage , Quart. Bull. Northwestern Univ. M. School 30:331-355, 1956. 31. Rosen, S.: Palpation of the Stapes for Fixation , A.M.A. Arch. Otolaryng. 56:610-615, 1952. 32. Mobilization of the Stapes to Restore Hearing in Otosclerosis , New York J. Med. 53:2650-2653, 1953. 33. Simple Method for Restoring Hearing In Otosclerosis: Mobilization of Stapes , Acta oto-laryng. 44:78-88, 1954. 34. Rosen and Bergman, M.: Mobilization of the Stapes for Otosclerotic Deafness , Acta oto-laryng. , (Suppl. 118) p. 180-201, 1954. 35. Rosen and Bergman, M.: Mobilization of the Stapes for Otosclerotic Deafness , A.M.A. Arch. Otolaryng. 61:197-206, 1955. 36. Rosen and Bergman, M.: Improved Hearing After Mobilization of the Stapes in Otosclerotic Deafness , J. Laryng. & Otol. 69:297-307, 1955. 37. Restoration of Hearing in Otosclerosis by Mobilization of the Fixed Stapedial Footplate , Laryngoscope 65:224-269, 1955. 38. Mobilization at the Footplate of the Fixed Stapedial Footplate: Further Development of the Mobilization Technique for Restoration of Hearing in Otosclerotic Deafness , Acta oto-laryng. 45:532-543, 1955. 39. Mobilization of the Stapes: Simple Procedure for Otosclerotic Deafness , J. Mt. Sinai Hosp. New York 23:200-226, 1956. 40. Fenestra Ovalis for Otosclerotic Deafness: An Adjunct to Stapes Mobilization , A.M.A. Arch. Otolaryng. 64:227-237, 1956. 41. Fenestration of the Oval Window for Increasing Sound Induction to the Cochlea , A.M.A. Arch. Otolaryng. 65:217-220, 1957. 42. Mobilization of Stapes for Otosclerotic Deafness , A.M.A. Arch. Otolaryng. 65:652-656, 1957.Crossref 43. The Development of Stapes Surgery After Five Years , A.M.A. Arch. Otolaryng. 67:129-141, 1958.Crossref 44. Scheer, A. A.: Restoration of Hearing in Otosclerosis by Transtympanic Mobilization of the Stapes , A.M.A. Arch. Otolaryng. 61:513-534, 1955.Crossref 45. Observations of 500 Cases of Transtympanic Mobilization of the Stapes , A.M.A. Arch. Otolaryng. 65:245-254, 1957.Crossref 46. Further Development of the Mobilization Operation , A.M.A. Arch. Otolaryng. 67:152-155, 1958.Crossref 47. Schneider, D. E.: Revision of the Miot Technique in Mobilization of the Ossicle System; Its Otoneurologic and Acoustic Basis , A.M.A. Arch. Otolaryng. 61:207-211, 1955.Crossref

FARRIOR, J. BROWN

1960 A.M.A. Archives of Otolaryngology

doi: 10.1001/archotol.1960.03770020079012pmid: 13821645

Abstract The thesis of this article is that there are specific pathological indications for each of the varied types of operations upon the stapes, the oval window, and the ampulla of the horizontal semicircular canal. The purpose of this article is to describe these specific anatomical and pathological indications for the varied operations which are as follows: The direct attack on the otosclerosis itself,1-3 at the anterior footplate, is indicated only in very thin otosclerosis with fixation limited to the level of the footplate, and when the crura stand free in the middle ear. The original indirect attacks on the incus, head, or neck of the stapes4-8 is now indicated only in footplate otosclerosis when the stapes is deeply placed in the oval window niche. Anterior crurotomy9 and mobilization and impaction of the posterior half of the stapes is indicated in the thicker anterior lesions which fix the References 1. Rosen, S.: Mobilization at the Footplate of the Fixed Stapedial Footplate: Further Development of the Mobilization Technique for Restoration of Hearing in Otosclerotic Deafness , Acta oto-laryng . 45:532 ( (Sept.) -Oct.) 1955.Crossref 2. Goodhill, V.: Present Status of Stapedolysis (Stapes Mobilization) , Laryngoscope 66:333 ( (April) ) 1956.Crossref 3. Derlacki, E. L.; Shambaugh, G. E., Jr., and Harrison, W. H.: The Evolution of a Stapes Mobilization Technique , Laryngoscope 67:420 ( (May) ) 1957.Crossref 4. Rosen, S.: Mobilization of the Stapes to Restore Hearing in Otosclerosis , New York J. Med. 53:2650 ( (Nov. 15) ) 1953. 5. House, H. P.: Personal Experiences With Stapes Mobilization , A.M.A. Arch. Otolaryng. 65:235 ( (March) ) 1957.Crossref 6. Bellucci, R. J.: A Guide for Stapes Surgery Based on a New Surgical Classification of Otosclerosis , Laryngoscope 68:741 ( (April) ) 1958.Crossref 7. Scheer, A. A.: Observations of 500 Cases of Transtympanic Mobilization of the Stapes , A.M.A. Arch. Otolaryng. 65:245 ( (March) ) 1957.Crossref 8. Campbell, E. H.: Stapes Mobilization: Analysis of Results in 250 Operations , A.M.A. Arch. Otolaryng. 68:663 ( (Dec.) ) 1958.Crossref 9. Besek, M., and Fowler, E. P., Jr.: Anatomical Factors in Stapes-Mobilization Operations , A.M.A. Arch. Otolaryng. 63:589 ( (June) ) 1956.Crossref 10. Farrior, J. B.: Crural Repositioning in Stapes Mobilization Surgery. Presented as part of "Interesting Ears in 3-D," Southern Section, American Triological, Atlanta, Ga., Jan. 24, 1959, to be published in Laryngoscope. 11. Juers, A.: Stapedioplasty: A New Concept for Stapes Surgery , A.M.A. Arch. Otolaryng. , this issue, p. 305. 12. Schuknecht, H. F.: Technique for Using Chisel in Stapes Mobilization , Academy Ophth. & Otolaryng. Course No. 505, Palmer House, Chicago, (Oct. 12) -16, 1958. 13. Shea, J. J., Jr.: Fenestration of the Oval Window , Ann. Otol. Rhin. & Laryng. 67:932 ( (Dec.) ) 1958. 14. Schuknecht, H. F.; Graham, A. B., and Costello, M. R.: Results with the Chisels in Stapes Mobilization , Laryngoscope 68:726 ( (April) ) 1958. 15. Farrior, J. B.: Stapes Operability: Pathological Indications for Mobilization and Fenestration Surgery , Laryngoscope 68:947 ( (June) ) 1958. 16. Rosen, S.: Fenestra Ovalis for Otosclerotic Deafness: An Adjunct to Stapes Mobilization , A.M.A. Arch. Otolaryng. 64:227 ( (Sept.) ) 1956. 17. Lempert, J.: Fenestra Nov-Ovalis: New Oval Window for Improvement of Hearing in Cases of Otosclerosis , Arch. Otolaryng. 34:880 ( (Nov.) ) 1941.

LINDSAY, JOHN R.

1960 A.M.A. Archives of Otolaryngology

doi: 10.1001/archotol.1960.03770020089013pmid: 14417203

Abstract The experiments about which I am going to speak have already been published. I am sure many of you have read about them in the November 1958 issue of the Laryngoscope. I must mention in the beginning that most of the credit for carrying out this work goes to Dr. César Fernández and Dr. George Allen. Also, the two student research trainees who were with us during the summer were kept very busy, doing part of the work on this project. This work was instigated by the rather remarkable finding of Dr. Rosen that in certain cases he was able to restore hearing by creating a fenestra ovalis, or a fenestra in the footplate of the stapes. The fact that he was able to restore hearing by this means, with the incus either absent or present and without mobilization of the stapes, seems to conflict with our previous understanding of

BELLUCCI, RICHARD J.;WOLFF, DOROTHY

1960 A.M.A. Archives of Otolaryngology

doi: 10.1001/archotol.1960.03770020096014pmid: 13798614

Abstract In medical science, the bridge is often crossed precariously between experimental results in animals and the clinical application of these findings in humans. Rarely is the surgeon permitted an opportunity to observe the healing processes in the human following trauma to the stapes and oval window induced in mobilization procedures. We believed that a study of the tissue reactions in experimental animals following trauma similar to that induced in the course of human surgery would reveal interesting and valuable information. It is recognized, however, that results obtained in experimental animals cannot be interpreted as the same as those which accrue in human surgery. Nevertheless, information is acquired when animals are exposed to specific trauma, and this may influence the line of thinking regarding similar conditions in human surgery. In experimental animals, nature's method of healing and repair, and the responses of the delicate inner ear end-organs can be studied in References 1. Bellucci, R., and Wolff, D.: Repair and Consequences of Surgical Trauma to the Ossicles and Oval Window of Experimental Animals , Ann. Otol. Rhin. & Laryng. 67:400-429, 1958. 2. Blake, C. J.: Operation for Removal of Stapes , Boston M. & S.J. 127;469, 551, 1892. 3. Jack, F. L.: Remarks on Stapedectomy , Trans. Am. Otol. Soc. 6:102, 1894. 4. Brunner, Hans: Attachment of the Stapes to the Oval Window in Man , A.M.A. Arch. Otolaryng. 59:18-29, 1954. 5. Bellucci, R., and Wolff, D.: Experimentally Induced Ankylosis of the Stapes , Laryngoscope 69:229-240, 1959.

WULLSTEIN, HORST

1960 A.M.A. Archives of Otolaryngology

doi: 10.1001/archotol.1960.03770020104015pmid: 13846220

This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables. Abstract At this time, I have been asked to mention a few things about otosclerosis surgery in Europe. Before beginning my formal lectures, let me mention a few interesting historical facts about Würzburg, the University from which I come. These pictures were made for my lecture in London. Figure 1 shows the title page of the first paper of Corti, published in 1851 when he worked with the anatomist Kölliker in Würzburg. He was a young man, working in Würzburg, coming from Italy and Vienna, but returned to his home country and left all scientific work—going back to his father's farm because he had arthritis of his fingers and could not work any more. Figure 2* shows the first perforated head mirror. This one was not used by von Tröltsch; it was used still earlier, in 1841, and is the first one with a perforation. You know, there were some mirrors

1960 A.M.A. Archives of Otolaryngology

doi: 10.1001/archotol.1960.03770020111016

This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables.

GOODHILL, VICTOR

1960 A.M.A. Archives of Otolaryngology

doi: 10.1001/archotol.1960.03770020118017pmid: 13851052

Abstract Surgical Audiometry Early in the renaissance of stapes mobilization surgery, I began to make audiometric observations in the operating room. Analysis of these observations revealed the possibility of using surgical audiometry as an intrinsic guide and valuable physiologic tool during such surgery. From this viewpoint emerged the concept of stapes mobilization "monitored" by surgical audiometry.Our current technique involves the use of the Fletcher formula for arriving at a single average threshold number (a single "figure of merit"). It includes the plotting of a "nomographic chart" with a "predictive guide line," and it provides a "built-in control" which alerts the surgeon to surgical physiologic errors such as incudostapedial discontinuity, inadvertent vestibular fenestra, and crural fractures. Evaluation of Results It is especially appropriate at this conference that attention be directed to methods for evaluating results, not only in stapes surgery but in tympanoplasty and fenestration as well.Members of the conference References 1. Goodhill, V.: Transincudal Stapedolysis for Stapes Mobilization in Otosclerotic Deafness (Under Audiometric Control) , Laryngoscope 65:693-710 ( (Aug.) ) 1955.Crossref 2. Surgical Audiometry in Stapedolysis (Stapes Mobilization) , A.M.A. Arch. Otolaryng. 62: 504-508 ( (Nov.) ) 1955.Crossref 3. Goodhill and Holcomb, A. L.: The Surgical Audiometric Nomograph in Stapedolysis (Stapes Mobilization) , A.M.A. Arch. Otolaryng. 63: 399-410 ( (April) ) 1956.Crossref 4. Present Status of Stapedolysis (Stapes Mobilization) , Laryngoscope 66:333-381 ( (April) ) 1956. 5. Goodhill and Holcomb, A. L.: A Study of 500 Stapes Mobilizations , Laryngoscope 67:615-642 ( (July) ) 1957.Crossref 6. The Peribasal Nomographic Technic of Stapes Mobilization , Ann. Otol. Rhin. & Laryng. 66: 743-753 ( (Sept.) ) 1957. 7. Stapes Mobilization—Problems and Perspectives , A.M.A. Arch. Otolaryng. 67:142-147 ( (Feb.) ) 1958. 8. Tr. Pacific Coast Oto-Ophth. Soc. 38:289-307, 1957. 9. Stapes Mobilization for Otosclerotic Deafness: The Monitored Peribasal Technic , California Med. 88:114-122 ( (Feb.) ) 1958. 10. Stapedolysis (Stapes Mobilization) and the Nomograph Technic , J. Speech & Hearing Res. 1:179-190 ( (June) ) 1958. 11. Symposium: Tympanoplasty; the Surgical Physiology of Tympanoplasty , Laryngoscope 68: 1455-1481 ( (Aug.) ) 1958. 12. Holcomb, A. L., and Goodhill, V.: Evaluation of Surgery in Conductive Deafness by "Percent Improvement," A.M.A. Arch. Otolaryng. 69: 163-169 ( (Feb.) ) 1959. 13. Goodhill, V.: Stapedolysis (Stapes Mobilization) in Otosclerosis, revised chapter for Prior's Looseleaf Otolaryngology, 1959, Vol. II, Section II, Chapter 6, pp. 29-94.

GOODHILL, VICTOR;WULLSTEIN, HORST;ANSON, BARRY;ROSEN, SAMUEL;FARRIOR, J. BROWN;LINDSAY, JOHN;BELLUCCI, RICHARD J.;LAWRENCE, MERLE

1960 A.M.A. Archives of Otolaryngology

doi: 10.1001/archotol.1960.03770020120018pmid: 13851051

This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables. Abstract Moderator Goodhill: I am going to start the order of the day's presentations with Dr. Rosen. I am going to ask him what he means by "window hearing," and whether he means that window hearing is normal hearing—simply minus the transformer action—or what other concepts he has on this score. Dr. Rosen: Well, truly, Vic, I do not believe I have any real concepts on this. I do not think any of us have any that are yet proved, but if a patient does not have an intact ossicular chain, if the incus is removed, if the crura are fractured and removed, and if the footplate is not mobilized, I will frequently—but not always—penetrate the footplate and make a tiny opening. If such a patient's hearing is improved considerably, then he is obviously not hearing by any transformer mechanism. It can always be said, "How do you know, later

SHEA, JOHN J.

1960 A.M.A. Archives of Otolaryngology

doi: 10.1001/archotol.1960.03770020129019pmid: 13854780

Abstract Otosclerosis is a compound metabolic disease characterized by the proliferation of abnormal bone in the otic capsule and hearing loss. It is unique to the human temporal bone. Basic Concepts of Surgery The proliferation usually begins in late adolescence, just anterior to the fissula ante fenestram,1 continues for a number of years, and then stops. This proliferation follows a distinct pattern in that it is most frequently either confined to the anterior 30% of the footplate and oval window or widespread throughout the footplate and surrounding oval window.The purpose of surgery in otosclerosis is to create a permanent passageway for sound—from the middle to the inner ear—once again. The entire stapes can be mobilized at surgery in a large percentage of cases by various means, but the basic pathology remains essentially unchanged and all too often ankylosis of the stapes recurs.It has been demonstrated by Fowler References 1. Guild, S. R.: Histologic Otosclerosis , Ann. Otol. Rhin. & Laryng. 53:246 ( (June) ) 1944. 2. Basek, M., and Fowler, E. P., Jr.: Anatomical Factors in Stapes Mobilization Operations , A.M.A. Arch. Otolaryng. 63:589 ( (June) ) 1956. 3. Kessel, J.: Über das Ausschneiden des Trommelfelles und Mobilisierin des Steigbugels , Arch. Ohrenheilk. 11:199, 1876 4. 12:237, 1877. 5. Kessel, J.: Über die vordere Tenotomie, Mobilizirung und Extraction des Stapes , Jena, 1894. 6. Miot, C.: De la mobilization de l'étrier , Rev. Laryng. 10:113, 200, 1890. 7. Blake, C. J.: Middle Ear Operations , Tr. Am. Otol. Soc. 5:306, 1892. 8. Blake, C. J.: Operation for Removal of the Stapes , Boston M. & S.J. 127:469; 551, 1892. 9. Jack, F. L.: Remarkable Improvement in Hearing by Removal of the Stapes , Tr. Am. Otol. Soc. 5:284, 1892 10. 474, 1893. 11. Jack, F. L.: Remarks on Stapedectomy , Tr. Am. Otol. Soc. 6:102, 1894. 12. Shea, J. J., Jr.: Symposium on the Operation for Mobilization of the Stapes in Otosclerotic Deafness , Laryngoscope 66:729 ( (July) ) 1956. 13. House, W. F.: Personal communication to the author. 14. Shea, J. J., Jr.: Fenestration of the Oval Window , Ann. Otol. Rhin. & Laryng. 67:932 ( (Dec.) ) 1958.

DERLACKI, EUGENE L.

1960 A.M.A. Archives of Otolaryngology

doi: 10.1001/archotol.1960.03770020143020pmid: 13816043

Abstract I find myself in rather a difficult position because I am practically—in fact, I am the only non-bypasser speaking today. However, there is justification for this. I am talking about a technique that we have used for more than three years, but which is now only one of several methods in our current approach to the problem of mobilization. As has already been stated several times, and will be restated, techniques in stapes mobilization surgery have not matured, but continue in their process of evolution. This was well demonstrated in the Symposium: Stapes Mobilization Two Years Later. The members of this panel, and those who discussed stapes mobilization pretty well defined its status as of Jan. 1, 1958. However, since this report, many of the same otologic surgeons have been using supplementary techniques which highlight the week-to-week, month-to-month, and year-to-year variations in surgical technique. Speaking for myself only, I find References 1. Shambaugh, G. E., Jr.: Surgery of the Ear , Ed. 1, Philadelphia, W. B. Saunders Company, 1959. 2. Shea, J. J., Jr.: Fenestration of the Oval Window , Ann. Otol. Rhin. & Laryng. 67:932-951 ( (Dec.) ) 1958. 3. Holcomb, A. L., and Goodhill, V.: Evaluation of Surgery in Conductive Deafness by "Per-Cent Improvement," A.M.A. Arch. Otolaryng. 69: 163-169 ( (Feb.) ) 1959.

SCHUKNECHT, HAROLD F.;OLEKSIUK, STANLEY

1960 A.M.A. Archives of Otolaryngology

doi: 10.1001/archotol.1960.03770020159021pmid: 14443731

Abstract Introduction Early oval window surgery for the treatment of stapes ankylosis due to otosclerosis was of the indirect type in which attempts were made to mobilize the footplate by forces transmitted through the crura.1 Very often, these procedures resulted in crural fracture, and for this reason a direct footplate approach soon was advocated by many otologists. These direct attempts consisted of the use of chisels, pneumatic hammers, and picks of various types. The direct attack on the footplate resulted in higher success rates because the number of crural fractures was reduced, but in many cases the hearing was lost again because of reankylosis of the footplate. It became evident, therefore, that there were two unsolved problems in oval window surgery; accomplishing adequate mobilization while creating or maintaining a "columnella effect," and avoiding reankylosis. Experimental Observations Mucoendosteal Membrane.—In an experiment on cats, Singleton3 has shown that footplate fractures References 1. Rosen, S.: Simple Method for Restoring Hearing in Otosclerosis: Mobilization of the Stapes; Case Reports , Acta oto-laryng. 44:78-88, 1954.Crossref 2. Schuknecht, H. F.; Graham, A. B., and Costello, M. R.: Results with the Chisels in Stapes Mobilization , Laryngoscope 68:726-740, 1958. 3. Singleton, G., and Schuknecht, H. F.: Stapes Fractures in Cats, unpublished data. 4. Altmann, F., and Basek, M.: Experimental Fractures of the Stapes in Rabbits: Histopathological Studies , A.M.A. Arch. Otolaryng. 68:173-193, 1958.Crossref 5. Bellucci, R. J., and Wolff, D.: Repair and Consequences of Surgical Trauma to the Ossicles and Oval Window of Experimental Animals , Ann. Otol. Rhin. & Laryng. 67:400-429, 1958. 6. Shea, J.: Fenestration of the Oval Window , Ann. Otol. Rhin. & Laryng. 67:932-951, 1958.

FOWLER, EDMUND P.

1960 A.M.A. Archives of Otolaryngology

doi: 10.1001/archotol.1960.03770020168022pmid: 13824217

Abstract In 1952 and early 1953 when Dr. Samuel Rosen began telling us that he was mobilizing the footplate of the stapes by placing instruments against its neck in patients with otosclerosis—first privately and then publicly—I told him that I was sure that the footplate would reankylose. It was only after seeing an evulsed stapes, reported by Professor Zollner in 1954, it occurred to me that in stapes mobilization the modus operandi was by fracture of the normal portion of the footplate rather than by lysis of the stapediovestibular joint. It was reasoned at first that, since the otosclerotic focus is 9 out of 10 times at the anterior border of the oval window, the ankylosis must also occur there. Accordingly, the anterior crus was cut with various instruments with the idea of severing the ankylosis of the crus (which so commonly occurred in histological material) and at the same time References 1. Altmann, F., and Basek, M.: Histological Examination of a Case of Otosclerosis Fifteen Months After Stapes Mobilization Operation , A.M.A. Arch. Otolaryng. 68:314, 1958.Crossref 2. Basek and Basek, M.: Experimental Fractures of the Stapes in Rabbits: Histopathological Studies , A.M.A. Arch. Otolaryng. 68:173, 1958.Crossref 3. Basek and Waltner, J. G.: Slight Operative Injuries of the Stapes: Histopathologic Study of a Case , Arch. Otolaryng. 42:42, 1945.Crossref 4. Basek, M., and Fowler, E. P., Jr.: Anatomical Factors in Stapes Mobilization Operations , A.M.A. Arch. Otolaryng. 63:589, 1956.Crossref 5. Brunner, H.: The Attachment of the Stapes to the Oval Window in Man , A.M.A. Arch. Otolaryng. 59:18, 1954.Crossref 6. Clerc, P.: Platinofissure avec ou sans stapédolyse , Ann. oto-laryng. 75:220, 1958. 7. Fowler, E. P., Jr.: Anterior Crurotomy and Mobilization of the Ankylosed Stapes Footplate: Introduction to Motion Picture Demonstration , Acta oto-laryng. 46:317, 1956. 8. Symposium: The Operation for the Mobilization of the Stapes in Otosclerotic Deafness , Laryngoscope 66:729, 1956. 9. Histopathology of Ankylosis of the Stapes Footplate , Trans. Am. Acad. Ophth. 147, 1957 10. A.M.A. Arch. Otolaryng. 66:127, 1957.Crossref 11. Symposium: Stapes Mobilization Two Years Later , Trans. Laryngo. Rhino. Oto. Soc. 841, 1958 12. Laryngoscope 68:1403, 1958.Crossref 13. Goodhill, V.: Trans-Incudal Stapedolysis for Stapes Mobilization in Otosclerotic Deafness (Under Audiometric Control): A Surgical Technique for Improvement of Hearing in Otosclerosis Is Described, Utilizing New Methods in the Stapes Approach , Laryngoscope 65:693, 1955.Crossref 14. Greifenstein, A.: Vergleichende Untersuchungen zur Histologie der Otosklerose , Arch. Ohren-Nasen- u. Kehlkopfh. 139:14, 1935.Crossref 15. Hallpike, C. S.: On a Case of Deaf-Mutism of Traumatic Origin , J. Laryng. & Otol. 52:661, 1937. 16. House, H. P., et al.: Symposium: The Operation for the Mobilization of the Stapes in Otosclerotic Deafness , Laryngoscope 66:729, 1956. 17. Juers, A. L.: Personal communication to the author. 18. Oppenheimer, B. S., et al.: Carcinogenic Effect of Metals in Rodents , Cancer Res. 16:439, 1956. 19. The Latent Period in Carcinogenesis by Plastics in Rats and Its Relation to the Presarcomatous Stage , Cancer 11:204, 1958. 20. Rosen, S.: Mobilization of the Stapes to Restore Hearing in Otosclerosis , New York J. Med. 53:2650, 1953. 21. Zollner, F.: Diskussion zu Vortrag 32, Zur Indikationsstellung bei der Fenesterungsoperation , in discussion on K. Schubert, Arch. Ohren-Nassen- u. Kehlkopfh. 165:393, 1954.

JUERS, ARTHUR L.

1960 A.M.A. Archives of Otolaryngology

doi: 10.1001/archotol.1960.03770020177023pmid: 14408099

Abstract The recently revived technique for restoring functional stapes mobility in cases of clinical otosclerosis was directed initially toward breaking through the otosclerotic lesion.1 While a significant number of patients have maintained a serviceable level of hearing following this procedure, initial failure to obtain improvement and subsequent refixation have continued to frustrate the efforts of the otological surgeons. Various modifications of technique have been evolved with the hope of increasing the percentage of lasting hearing improvements. These have included (1) perforation (fenestration) of the footplate,2 (2) vein graft and polyethylene insert after stapedectomy,3 and (3) removal of the stapes crura with fragmentation of the central area of the footplate and insertion of a tantalum pin between the incus and footplate to replace the crura.4 The third method, which was conceived by Schuknecht, seemed to me to be the most logical and least hazardous but had the objection References 1. Rosen, S.: Palpation of the Stapes for Fixation , A.M.A. Arch. Otolaryng. 56:610-615, 1952.Crossref 2. Rosen, S.: Fenestra Ovalis for Otosclerotic Deafness , A.M.A. Arch. Otolaryng. 64:227-237, 1956.Crossref 3. Shea, J., Jr.: Discussion of Stapes Mobilization Symposium , Transactions of American Laryngological, Rhinological and Otological Society, 1958. 4. Schuknecht, H.: Discussion of Stapes Mobilization Symposium , Transactions of American Laryngological, Rhinological, and Otological Society, 1958. 5. Basek, M., and Fowler, E. P., Jr.: Anatomical Factors in Stapes Mobilization Operations , A.M.A. Arch. of Otolaryng. 63:589, 1956.Crossref 6. Altman, F., and Basek, M.: Histological Examination of a Case of Otosclerosis Fifteen Months After Stapes-Mobilization Operation , A.M.A. Arch. Otolaryng. 68:314-324, 1958.Crossref

HOUSE, HOWARD P.

1960 A.M.A. Archives of Otolaryngology

doi: 10.1001/archotol.1960.03770020184024pmid: 14403383

Abstract Before discussing the unfavorable results of stapes mobilization surgery, it is necessary to determine just what constitutes a favorable or unfavorable result. Many methods have been used to report favorable results. Such methods include a certain amount of decibel improvement, averaged in the three speech frequencies or in the two best of the three speech frequencies; closure of the air-bone gap in varying degrees, and attainment of the 30 db. level averaged in the three speech frequencies. After the patient has been completely evaluated psychologically, physically, and audiometrically, a decision can be made by the surgeon as to just what he is striving to attain by mobilization surgery for a particular patient. Perhaps success means to get rid of the hearing aid by attaining serviceable hearing. Perhaps the surgeon is striving to improve the patient's hearing so that hearing will be better with a hearing aid. Achieving whatever the surgeon References 1. Shea, J. J., Jr.: Fenestration of the Oval Window , A.M.A. Arch. Otolaryng. , this issue, p. 257. 2. Compere, W. E., Jr.: Radiologic Findings in Otosclerosis , A.M.A. Arch. Otolaryng. , this issue, p. 150. 3. Juers, A. L.: Stapedioplasty: A New Concept for Stapes Surgery , A.M.A. Arch. Otolaryng. , this issue, p. 305. 4. Fowler, E. P., Jr.: Anterior Crurotomy and Mobilization of the Ankylosed Stapes Footplate , Acta oto-laryng. 46:319, 1956.Crossref 5. House, W. F.: Oval Window and Round Window Surgery in Extensive Otosclerosis , A.M.A. Arch. Otolaryng. , this issue, p. 312.

1960 A.M.A. Archives of Otolaryngology

doi: 10.1001/archotol.1960.03770020193025

This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables.

WULLSTEIN, HORST

1960 A.M.A. Archives of Otolaryngology

doi: 10.1001/archotol.1960.03770020201026pmid: 13846218

This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables. Abstract I feel that I am going to have a hard time before me, not only today, but tomorrow, and the day after tomorrow. Especially today it will be difficult because we have been involved with problems of mobilization by new techniques, and it is hard to change our minds to these completely different problems which we shall discuss today and tomorrow. Today, I must once again bring up a few questions of physiology, pathophysiology, and what we wish our new drum to do. That is the first question, and the second question is how can a graft survive if it is used as a new drum? I will cover these today, and then tomorrow morning I shall go on with certain problems of plastic surgery of the middle ear, including the skin; what kind of a graft to use; what we do with the mucosa, and what we do when

HOUSE, HOWARD P.;WULLSTEIN, HORST;SHEA, JOHN J.;DERLACKI, EUGENE L.;SCHUKNECHT, HAROLD;FOWLER, EDMUND P.;JUERS, ARTHUR L.

1960 A.M.A. Archives of Otolaryngology

doi: 10.1001/archotol.1960.03770020210027pmid: 14403384

This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables. Abstract Moderator House: Those of us who have been fortunate enough to have visited Professor Wullstein in Würzburg came away with a tremendous feeling of stimulation regarding the wonderful work he has introduced and in which he is continuing to lead the way. I am sure that, as the remainder of the week unfolds, you will learn much more about tympanoplasty and myringoplasty under the tutelage of Professor Wullstein than you have ever conceived even existed. I have asked him if he would be kind enough to talk with us a little bit about his theories and philosophies of otosclerosis; how he selects his cases for mobilization; his indications for fenestration; what he has to say regarding constant growth or intermittent growth of the focus in otosclerosis, and any other thoughts he has brought to us from his active clinic in Germany. Professor Wullstein: I would try to add just a

1960 A.M.A. Archives of Otolaryngology

doi: 10.1001/archotol.1960.03770020226028

This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables.

1960 A.M.A. Archives of Otolaryngology

doi: 10.1001/archotol.1960.03770020229029

This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables. Abstract GENERAL NEWS National Index on Deafness, Speech, and Hearing.—Gallaudet College of the Ameriican Speech and Hearing Association have established a National Index on Deafness, Speech, and Hearing. This Index will combine the present indexing and abstracting functions of the Central Index of Research on the Deaf at Gallaudet College, and the projected indexing and abstracting functions of the American Speech and hearing Association.The general policies of the National Index on Deafness, Speech, and Hearing will be formulated by a committee composed of representatives of Gallaudet College and representatives of the American Speech and Hearing Association. The Index will be located at Gallaudet College. It will be directed by Dr. Stephen P. Quigley.The purpose of the National Index is to index and abstract all professional literature pertaining to deafness, speech, and hearing, and to make this material readily available to all interested persons. Not only will present and

1960 A.M.A. Archives of Otolaryngology

doi: 10.1001/archotol.1960.03770020231030