A.M.A. Archives of Otolaryngology

Shambaugh, George E.

1960 A.M.A. Archives of Otolaryngology

doi: 10.1001/archotol.1960.03770030003001pmid: 14445423

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 George Morrison Coates, the son of Joseph and Elizabeth Coates, was born March 24, 1874. He attended the University of Pennsylvania, from which he received his A.B. degree in 1894 and his medical degree in 1897. Dr. Coates spent his intern year at St. Christopher's Hospital for Children. He was certified in Otolaryngology in 1925. He was a colonel in the U.S. Army (R) and an otolaryngological consultant to both the Army and the Veterans Administration. In 1937, Dr. Coates was appointed Chief Editor to succeed Dr. George E. Shambaugh Sr., who had held the position from the time that the Archives of Otolaryngology was established in 1925. Thus Dr. Coates had been Chief Editor for nearly two thirds of the Archives entire existence. Dr. Coates, who at the time of his death, Feb. 7, 1960, had reached the age of 85, still conducted an active office practice two days

WULLSTEIN, HORST

1960 A.M.A. Archives of Otolaryngology

doi: 10.1001/archotol.1960.03770030005002pmid: 13846223

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 When I and a few other people in my country started this surgery of reconstruction of defects of the middle ear, we were really astonished that nobody in your country had yet begun to occupy himself with this very interesting kind of surgery. As I told you yesterday, it was in 1881 and 1884, after Berthold, that Ely and Tangeman made the first attempt, but never again have you touched the problem. I believe it is partly because you were so occupied with the problem of otosclerosis and with the fear of infection. Maybe at that time, just after the use of antibiotics had started, the ear surgeon was still very glad that he could do some surgery in an uninfected case but was afraid to start in an infected case. Please understand that I am proceeding slowly with the fundamentals at first because if the introduction is well done,

WRIGHT, WILLIAM K.

1960 A.M.A. Archives of Otolaryngology

doi: 10.1001/archotol.1960.03770030011003pmid: 13846119

Abstract Myringoplasty, which could better be called "Wullstein Type I Tympanoplasty," is used where a perforation of the tympanic membrane is the only defect in the ear structures. Most authorities consider it the most successful of the various tympanoplasties. Unfortunately, there is growing evidence that myringoplasty is frequently mishandled. This may be owing to faulty technique, but it is usually because an inadequate preoperative work-up failed to recognize certain complicating situations. If there is one thing I would like to get across, it is that you should not close every perforation that you see in your patients. For instance, when a non functioning Eustachian tube is present, myringoplasty will produce a very annoying secretory otitis media, and the patient will be much more miserable than he was with his perforation. Or, there is a possibility of burying squamous epithelium underneath the graft by mistakenly skin grafting over the mouth of a References 1. Padgett, S. C.: Skin Grafting from a Personal and Experimental Viewpoint , Springfield, Ill., Charles C Thomas, Publisher, 1942. 2. Conway, H.; Stark, R. B., and Joslin, D.: Observations on the Development of Circulation in Skin Grafts: Physiologic Pattern of Early Circulation in Auto-Grafts , Plast. & Reconstruct. Surg. 9:312-319, 1951. 3. Wright, W. K.: Repair of Chronic Central Perforations of the Tympanic Membrane: By Repeated Acid Cautery; by Skin Grafting , Laryngoscope 66:1464-1487, 1956. 4. McLaughlin, C. R.: Composite Ear Grafts and Their Blood Supply , Brit. J. Plast. Surg. 7: 274-278, 1954. 5. Davis, J. S., and Traut, J. F.: Origin and Development of the Blood Supply of Whole-Thickness Skin Grafts , Ann. Surg. 82:871-879, 1925. 6. Compere, W. E., Jr.: Tympanic Cavity Clearance Studies , Tr. Am. Acad. Ophth. 62:444-454, 1958. 7. Derlacki, E. L.: Repair of Central Perforations of the Tympanic Membrane , A.M.A. Arch. Otolaryng. 58:405-420 1953.

JUERS, ARTHUR L.

1960 A.M.A. Archives of Otolaryngology

doi: 10.1001/archotol.1960.03770030018004pmid: 14408097

Abstract In the course of performing modified radical mastoidectomy (atticomastoidectomy) on patients with attic cholesteatoma, I observed a number of instances in which serviceable preoperative hearing in the absence of the incus was accounted for by the pathological approximation of the posterior pars tensa against the stapes.1 In many such cases the upper part of the tympanic cavity was largely obliterated. However, there was always an inflatable air space extending from the Eustachian tube to the round window niche. The best air-conduction pure-tone threshold noted in such cases was at a 20 db. level. It occurred to me that a similar conduction-mechanism could be created surgically when the pathology was such as to necessitate removal of a portion of a functioning ossicular chain. In the past the surgeon in such instances had to compromise, either by incompletely removing the diseased area in order to preserve serviceable hearing or by removing References 1. Juers, A. L.: Modified Radical Mastoidectomy: Indications and Results , A.M.A. Arch. Otolaryng. 57:245-256, 1953.Crossref 2. Zöllner, F.: The Principles of Plastic Surgery of the Sound-Conducting Apparatus , J. Laryng. & Otol. 69:637-652, 1955. 3. Wullstein, H.: Theory and Practice of Tympanoplasty , Laryngoscope 66:1076-1093, 1956. 4. Shambaugh, G. E., Jr.: Movie. 1958 American Academy of Ophthalmology and Otolaryngology Meeting. 5. Juers, A. L.: Observations on Bone Conduction in Fenestration Cases: Physiological Considerations , Ann. Otol. Rhin. & Laryng. 57:28-40, 1948. 6. Juers, A. L.: Preservation of Hearing in Surgery for Chronic Ear Disease: A Consideration of the Factors Involved , Laryngoscope 64: 235-251, 1954.

WULLSTEIN, HORST

1960 A.M.A. Archives of Otolaryngology

doi: 10.1001/archotol.1960.03770030022005pmid: 13846217

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 would like to discuss the indications and factors which must be considered in advising a tympanoplasty. Every type of lesion of the sound-conducting system which is not due to otosclerosis is, I believe, part of the larger problem of tympanoplasty—of reconstructive middle ear surgery. I have already mentioned that not only dry perforations but also perforations with suppuration, adhesions, or fractures, and even cases of facial nerve trauma and facial nerve neuroma are included in tympanoplasty. For example, I once opened the ear of a patient with middle ear conductive deafness and found some tissue between the facial nerve and the ossicular chain, with absence of the long process of the incus and destruction of the stapes crura. I made a small biopsy of this tissue next to the facial nerve and found that it was a neuroma of the horizontal portion of the facial nerve. A neuroma of

PERLMAN, HENRY B.

1960 A.M.A. Archives of Otolaryngology

doi: 10.1001/archotol.1960.03770030026006pmid: 14431895

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 role of the tube in normal and pathological states of the middle ear is not clearly defined. The tube function is considered normal when the drum and middle ear appear normal. It is considered abnormal by implication in some states of middle ear disease. While we know that ventilation of the middle ear is necessary for normal function, we do not have the means to measure it directly. It can be done experimentally, however, by recording sound transmission through the tube which reflects the duration, amplitude, and shape of opening and closing of the tube during swallowing. Even if we had the means of making this measurement in the clinic, it would be difficult to define an adequate or inadequate opening to maintain normal air pressure behind the drum. This is because the tube, even under normal conditions, only opens occasionally during swallowing and probably with different degrees of

COMPERE, W. E.

1960 A.M.A. Archives of Otolaryngology

doi: 10.1001/archotol.1960.03770030028007pmid: 13811432

Abstract There has been very little change in our understanding of the anatomy of the auditory tube since it was described by Bartholomaeus Eustachius in 1563.3 Considerable controversy has existed, however, concerning the physiology of the tube, in spite of the accurate observations of Toynbee, who in 1853 insisted that the pharyngeal portion of the tube is normally closed in the resting state, opening during deglutition for the inflow of air.8 Present opinion concerning the physiology of the tube rests upon a careful experimental and clinical study reported by Rich in 1920.6 In spite of the miracles of modern medicine, it must be admitted that very few refinements have been added to our practical methods of evaluating tubal function since the time of Valsalva (1717), Cleland (1741), and Politzer (1883). Although Toynbee, by 1860, realized that the Eustachian tube has two functions, namely, to allow the ingress of References 1. Compere, W. E., Jr.: Tympanic Cavity Clearance Studies , Tr. Am. Acad. Ophth. 62:444-454 ( (May) -June) 1958. 2. Compere, W. E., Jr.: Eustachian Tube Foreign Body , Laryngoscope 69:90-93 ( (Jan.) ) 1959.Crossref 3. Eustachius, B.: Epistle on the Organs of Hearing: (Reprint translated by G. O. Graves and M. E. Galante) , Arch. Otolaryng. 40:123-132 ( (Aug.) ) 1944.Crossref 4. Hildyard, V.: Osteoma of the Eustachian Tube, to be published. 5. Rees-Jones, G. F., and McGibbon, J. E. G.: Radiologic Visualization of the Eustachian Tube , Lancet 2:660-662 ( (Nov. 29) ) 1941.Crossref 6. Rich, A. R.: A Physiological Study of the Eustachian Tube and Its Related Muscles , Bull. John Hopkins Hosp. 31:206-214 ( (June) ) 1920. 7. Spielberg, W.: Visualization of the Eustachian Tube by the Roentgen Ray , Arch. Otolaryng. 5: 334-340 ( (Apr.) ) 1927.Crossref 8. Toynbee, J.: The Diseases, of the Ear , London, John Churchill, 1860, p. 189, 190. 9. Reverchon and Worms, cited in Welin.10 10. Welin, S.: On the Radiological Examination of the Eustachian Tube in Cases of Chronic Otitis , Acta radiol. 28:95-103, 1947.Crossref

1960 A.M.A. Archives of Otolaryngology

doi: 10.1001/archotol.1960.03770030032008

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

HOUSE, WILLIAM F.

1960 A.M.A. Archives of Otolaryngology

doi: 10.1001/archotol.1960.03770030041009pmid: 14403389

Abstract Myringoplasty is the procedure of surgically closing a perforation in the eardrum. Myringoplasty is indicated when one desires to accomplish one of two things; to improve the hearing or to seal the middle ear. Diagnostic Survey of the Patient for Myringoplasty The primary question to be answered by the surgeon in his preoperative evaluation of the patient for myringoplasty is, "Is the perforated tympanic membrane the only defect in the patient's ear mechanism?" He must rule out cholesteatoma or disease in the attic, aditus, or antrum, damage to the ossicular chain, or obstruction of the Eustachian tube. History The patient's history is of primary importance. One must determine the length of time the patient has had a hearing loss, whether or not there has been recent drainage, and whether the patient has any vertigo or pain. Usually the patient who is suitable for myringoplasty has had his perforation for several References 1. Compere, W. E., Jr.: Tympanic Cavity Clearance Studies , Tr. Am. Acad. Ophth. 62:444-454 ( (May) -June) 1958. 2. Wullstein, H.: Tympanoplastic Operation for Improving Hearing in Otitis Media, Chronic, and the Results. From the Proceedings of the Fifth International Congress of Otolaryngology, Amsterdam, 1953. 3. Link, R.: Über die Gefässversorgung des Trommelfelles und des äusseren Gehörganges , Arch. Ohren- Nasen- u. Kehlkopfh. 160:561-572, 1952.Crossref 4. Nager, G. T., and Nager, M.: The Arteries of the Human Middle Ear with Particular Regard to the Blood Supply of the Auditory Ossicles , Ann. Otol. Rhin. & Laryng. 62:923-949 ( (Dec.) ) 1953. 5. Hamberger, C. A., and Lindgren, A. G. H.: Über die Gefässversorgung des Trommelfells , Acta oto-laryng. 29:99-112, 1941. 6. Padgett, E. C.: Skin Grafting from a Personal and Experimental Viewpoint , Springfield, Ill., Charles C Thomas, Publisher, 1942. 7. Hynes, W.: Early Circulation in Skin Grafts with a Consideration of Methods to Encourage Their Survival , Brit. J. Plast. Surg. 6:257-263 ( (Jan.) ) 1954. 8. Davis, J. S., and Traut, J. F.: Origin and Development of the Blood Supply of Whole-Thickness Skin Grafts , Ann. Surg. 82:871-879 ( (Dec.) ) 1925. 9. Guilford, F. R., and Wright, W. K.: Secondary Skin Graft in Fenestration and Mastoid Cavities , Laryngoscope 64:626-631 ( (July) ) 1954.

HOUSE, WILLIAM F.

1960 A.M.A. Archives of Otolaryngology

doi: 10.1001/archotol.1960.03770030047010pmid: 14403388

Abstract An air-containing middle ear is necessary for normal hearing, both because it allows free vibration of the eardrum and ossicles so that sound pressure can be transmitted to the inner ear fluid and because it affords protection from sound to the round window. This air-containing space is maintained by the Eustachian tube, which opens intermittently to equalize the intratympanic air pressure with the pressure in the external auditory canal. It also removes secretion and epithelial debris from the middle ear by ciliary motion and gravity. Pathology of the Eustachian Tube in Chronic Otitis Media Acute otitis media causes edema of the membrane lining, the Eustachian tube, and the middle ear. This edema may be maintained as long as there is infection in the ear spaces, and it produces the simplest form of Eustachian tube blockage. In this type of case, it may be possible to inflate the tube by the References 1. Compere, W. E., Jr.: Tympanic Cavity Clearance Studies , Tr. Am. Acad. Ophth. 62:444-454 ( (May) -June) 1958.

WULLSTEIN, HORST

1960 A.M.A. Archives of Otolaryngology

doi: 10.1001/archotol.1960.03770030050011pmid: 13846215

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 was hoping that I would hear of some solution to the problem of the Eustachian tube, but so far, I see that you have the same trouble that we have. Let us consider the Eustachian tube before surgery, during surgery, and after surgery. If there is a perforation in the drum, it is not difficult to control the Eustachian tube before surgery. You use the old method of Zöllner. You know, perhaps, that Zöllner was very interested in the Eustachian tube before he started tympanoplasty. You also know, perhaps, that he and I were residents together and assistants in the same hospital in Vienna, and for years we lived on the same floor. At that time he learned a lot about the function and anatomy of the tube, and devised the method of measuring the function of the tube by controlled pressure and the manometer. We know that very

JUERS, ARTHUR L.;WULLSTEIN, HORST;WRIGHT, WILLIAM K.;PERLMAN, HENRY B.;COMPERE, WESLEY E.;HOUSE, WILLIAM F.

1960 A.M.A. Archives of Otolaryngology

doi: 10.1001/archotol.1960.03770030054012

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 Juers: As listed on the program, the discussion this afternoon is to be on tympanoplasty, Types I and II, and the Eustachian tube. There are several questions which have been brought to me on which people would like to have some discussion. We will cover those first, and during the remaining part of our time we will ask for any questions on Types I and II tympanoplasty and the Eustachian tube which may come from the floor. One of the things about which several members have asked is the selection of cases—purely from the standpoint of the size of the perforation and location—with respect to whether or not that particular ear should be considered for office closure treatment before considering tympanoplasty. We will disregard the two or three thousand miles a patient has to travel in Texas in order to get to the medical centers there as well

DERLACKI, EUGENE L.

1960 A.M.A. Archives of Otolaryngology

doi: 10.1001/archotol.1960.03770030064013

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 Before we start this morning's program, I thought I would take just a few minutes to share with you some experiences of yesterday afternoon. I had the good fortune of being able to go to surgery while still under the terrific stimulus of this concentrated Workshop meeting and everything that I have heard. I had three cases. The first case was a man around 50 who admitted to just a few years of hearing impairment but whose family told me on the side, "He hasn't been hearing for many years." So I am sure that he has had a loss of more than 30 db. for some time. The second was a 35-year-old woman with about a 10- to 12-year-old history of admitted hearing impairment. The third was a 20-year-old woman with one year of hearing impairment in the ear that I operated on. The other ear is around the

WULLSTEIN, HORST

1960 A.M.A. Archives of Otolaryngology

doi: 10.1001/archotol.1960.03770030066014pmid: 13846221

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 believe there has been enough talk about theories and methods, and now we should get down to business on the techniques of Types I, II, and III this morning, and then later, Types IV and V. First of all, there are a few cases of tympanoplasty which at first look like otosclerosis. One example is the patient in whom the incus had been removed during a simple mastoidectomy in childhood, and the patient has a normal drum with a marked loss of hearing of the conductive type. Then there are other cases which look like otosclerosis. The drum looks absolutely normal and is not retracted, and on testing tubal function there is a certain movement of the drum. On opening up such a case, in preparation for a mobilization, we find that the stapes is movable but the whole tympanic cavity is filled with soft adhesions. In my experience,

RAMBO, J. H. THOMAS

1960 A.M.A. Archives of Otolaryngology

doi: 10.1001/archotol.1960.03770030070015

Abstract Musculoplasty is a standardized operation for the restoration of hearing in deafness resulting from chronic otitis. Since it is an operation for deafness, it was never meant to be used where the ossicular chain is still intact and the patient has reasonably good hearing. In these cases, of course, one preserves the natural system of sound conduction and repairs the minor defects. Musculoplasty is intended to be used where the ossicular chain has been destroyed. In these ears there are major pathological defects and usually long-standing and well-established disease in the mastoid as well as in the middle ear, and it is not logical to attempt to repair or build on the existing structures. To do so carries with it the danger of burying sepsis or epithelium. To reconstruct these ears so that permanent hearing will be restored the surgery must accomplish the following three things: (1) All disease must References 1. Rambo, J. H. T.: A New Operation to Restore Hearing in Conductive Deafness of Chronic Suppurative Origin , A.M.A. Arch. Otolaryng. 66: 525-532 ( (Nov.) ) 1957.Crossref 2. Rambo, J. H. T.: Musculoplasty: A New Operation for Suppurative Middle Ear Deafness , Tr. Am. Acad. Ophth. 62:166-177 ( (March) -April) 1958. 3. Rambo, J. H. T.: Primary Closure of the Radical Mastoidectomy Wound: A Technique to Eliminate Postoperative Care , Laryngoscope 68: 1216-1227 ( (July) ) 1958.Crossref

HARRISON, WILEY

1960 A.M.A. Archives of Otolaryngology

doi: 10.1001/archotol.1960.03770030079016pmid: 14400055

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 With the advent of stapes mobilization and tympanoplasty, we have all become interested in the problem of restoring the continuity of the sound-conducting mechanism. Due to these operations, we have seen or perhaps become more aware of this problem than in the past. Interruption of the mechanism by disease is seen frequently in our tympanoplasties, and we have heard this week about congenital malformations and stapedial fractures. Certainly, we have been exposed to a lot of physiology in this Workshop. We have heard of Helmholtz and von Békésy, and this week Dr. Lawrence talked about the area factor, lever factor, hydraulic factor, and so forth. This all brings to us very clearly the importance of the sound transformer system. A little bit of history should be added. In 1948 Juers clinically began calling attention to the near-normal hearing achieved by applying the tympanic membrane to the stapes in myringostapediopexy operations.

FARRIOR, J. BROWN

1960 A.M.A. Archives of Otolaryngology

doi: 10.1001/archotol.1960.03770030085017pmid: 13821644

Abstract In tympanoplasty, ossicular repositioning and ossicular prostheses offer an opportunity to preserve the air space of the middle ear and improve the transmission of sound to the stapedial footplate. Depending upon the pathological circumstances, any convenient remaining portion of the auditory ossicles may be used to reconstruct a functioning ossicular chain. My interest in ossicular repositioning (transposition) developed following disappointment in the restoration of hearing by use of tympanoplasty Type IV (hypotympanoplasty) when the crura of the stapes had been destroyed. Therefore, I began to reconstruct stapedial crura using the incus, the head of the malleus, the long process of the malleus, the handle of the malleus, or a fragment of cancellous bone from the mastoid tip. This ossicular recruralization of the stapedial footplate converts a Type IV into a Type III, and some surgeons classify this as a Tympanoplasty Type III-B. As in all tympanoplastic surgery, I prefer to References 1. Schuknecht, H. F.: Personal communication to the author. 2. Shea, J. J., Jr.: Fenestration of the Oval Window , Ann. Otol. Rhin. & Laryng. 67:932-951 ( (Dec.) ) 1958. 3. Bell, H. L.: A Technique of Tympanoplasty (Tympanomalleolar Stapediopexy) , Tr. Am. Laryng. Rhin. & Otol. Soc. 572-576 ( (May) ) 1958. 4. Richtnér, N. G.: On Tympanoplasty , J. Laryng. & Otol. 72:67-77 ( (Jan.) ) 1958.

LAWRENCE, MERLE

1960 A.M.A. Archives of Otolaryngology

doi: 10.1001/archotol.1960.03770030092018

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 have been very happy and honored to be here and to have this opportunity to talk with you and contribute what little I could to solving some of the problems of otologic surgery. I do have some claim to the title of otologic surgeon, I think. When I first started research with Wever and Bray in 1938, they, of course, were working on animals, and I believe since then I have a pretty good case record. There must be many hundreds that I have operated upon. I have one distinction, however—they are all dead now. But one thing impressed me when we recorded the potentials that arise from the inner ear. Once the ear had been exposed and a sound tube so placed that we could stimulate this sensory organ and record from an electrode on the round window, we always used utmost care to prevent any damage to

WULLSTEIN, HORST

1960 A.M.A. Archives of Otolaryngology

doi: 10.1001/archotol.1960.03770030093019pmid: 13846222

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 We come now to the cases in which we have to proceed to a reconstruction without the benefit of an ossicular chain or a substitute chain with sound protection only. For example, we make our control of the ear to determine the situation and find no remnant of the stapes, only an open oval window niche. The incus is gone too, and the problem is whether we should try to use an artificial stapes. Well, there are two questions to be answered. First, what is in the oval window niche? If there is an atrophic drum, adherent to the surface, it must be removed. If we do so, bare bone is left and again there is the difficulty of having no mucosa on the bony surface. In another case, we may find part of one crus present but the rest missing, with a chronic osteitis of the remainder of the

HENNER, ROBERT

1960 A.M.A. Archives of Otolaryngology

doi: 10.1001/archotol.1960.03770030096020pmid: 14401070

Abstract My purpose today is to review modern trends of congenital ear malformation surgery. This presentation will be concerned primarily with the restoration of hearing in an ear with blocked sound conduction and secondarily with some of the cosmetic aspects of the surgery. In keeping with the advances of modern temporal bone surgery, the guiding theory is that potentially every patient with a conductive deafness can be improved surgically. Certainly, the meeting here this week has borne out this contention. In discussing the types of congenital anomalies of the external canal and middle ear, the following classifications from a previous publication by Dr. Buckingham and myself1 seems worth referring to so that we may understand the various types of problems. "Congenital defects of the ear may be catalogued into three clinical groups depending upon the severity of the anomalies."1 Class 1. The ears with the least abnormalities are listed References 1. Henner, R., and Buckingham, R. A.: Recognition and Surgical Treatment of Congenital Ossicular Defects , Laryngoscope 66:526-539 ( (May) ) 1956.Crossref

FARRIOR, J. BROWN

1960 A.M.A. Archives of Otolaryngology

doi: 10.1001/archotol.1960.03770030101021

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

BRANDOW, EDWARD C.

1960 A.M.A. Archives of Otolaryngology

doi: 10.1001/archotol.1960.03770030109022pmid: 13803880

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 advent of the tympanoplastic operation by Wullstein and Zöllner has opened a new and fascinating field of otologic surgery. A full-thickness skin graft from behind the ear is used to repair the tympanic membrane and restore function to the middle ear. The graft is taken at the beginning of the operation. Removing it later causes too much bleeding for the crucial stages of the operation, when hemostasis is so important. The problem of what to do with the graft after taking it has been a point of considerable discussion. Tympanoplastic operations are extremely delicate; after removal of the graft considerable time may elapse before the surgeon is ready to place the graft on its bed. Guilford and Wright have demonstrated the harmful effects the graft may suffer when placed in saline or other solutions during the waiting period. Various preparations have been proposed in which the graft may be

PROCTOR, BRUCE

1960 A.M.A. Archives of Otolaryngology

doi: 10.1001/archotol.1960.03770030111023pmid: 14434998

Abstract Since the introduction of the concepts of tympanoplasty by Wullstein, Zöllner, and others, surgery for inflammation of the middle ear has undergone a veritable revolution. Previously, the chronic discharging ear was permitted to continue on indefinitely or was subjected to a radical mastoid operation. If a conservative (modified) radical mastoidectomy was not feasible, the end-result was an ear seriously impaired in hearing. In analyzing the end-results of 80 radical mastoidectomies, however, the hearing loss was still found to be serious—49.9 db. The otologist was often confronted with the important decision of whether or not to advise a radical mastoid operation in an ear with good hearing when the opposite ear had decreased hearing. In such situations the tendency was to delay surgery until complications occurred or the hearing loss had significantly increased. We are now in a position to offer surgery for the control of middle ear cleft suppurations References 1. Bocca, E.: Results of Tympanoplasty and the Age of the Patients , Arch. ital. otol. 69:1-7, 1958. 2. Imkamp, A. M., and Jongkees, L. B.: On the Functional Results of Reconstructive Surgery upon the Middle Ear in Active Chronic Otitis Media , Pract. oto-rhino-laryng. 20:129-138, 1958. 3. Jongkees, L. B.: Reconstructive Surgery of the Middle Ear in Active Chronic Otitis , Pract. oto-rhino-laryng. 19:107-124, 1957. 4. Maspétiol, R.: Particular Problems of Tympanoplasty , Ann. oto-laryng. 74:515-525, 1957. 5. Miodonski, J.: Fenestration in Non-Otosclerotic Cases, Atypical Fenestration Drainage of the Cisterna , Otolaryng. polska 10:235-242, 1956. 6. Pompé, J.: A Study on the Functional Surgery of the Middle Ear , Rev. laryng. 79:193-203, 1958. 7. Richtner, N. G.: On Plastic Middle Ear Operations with Particular Attention to the Cavum Minor Technique , Acta oto-laryng. 48:302-318, 1957.Crossref 8. Schuknecht, H.: Personal communication to the author. 9. Taniewski, J.: Excitability of the Labyrinth in Chronic Otitis Media , Otolaryng. polska 11:27-33, 1957. 10. Wullstein, H., cited in H. G. Kobrak: The Middle Ear , Chicago, University of Chicago Press, 1959. 11. Wullstein, H.: The Restoration of the Function of the Middle Ear, in Chronic Otitis Media , Ann. Otol. Rhin. & Laryng. 65:1021-1041, 1956. 12. Zöllner, F.: Surgical Operations to Improve Hearing in Inflammatory Disorders of the Middle Ear , Arch. Ohren- Nasen- u. Kehlkopfh. 171:1-62, 1957.

WULLSTEIN, HORST

1960 A.M.A. Archives of Otolaryngology

doi: 10.1001/archotol.1960.03770030120024pmid: 13846219

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 will occupy myself with the otological results of tympanoplasty as I see them today. In Figure 1, I remind you of the classification which I have suggested. There is a certain mix-up in classifications, and each of us tries to have his own. This makes it very difficult to compare results. In my type, I have tried to classify only according to the physiology of the reconstructed middle ear. There is nothing in my classification about pathology. In Type I, there is just a defect of the drum, and I have only to restore the drum membrane; the ossicular chain is intact. In Type II, there is not only a defect in the drum but a little defect in the chain, where we lose theoretically 2.5 db., owing to disturbance of the leverage. The same loss theoretically occurs in Type III. In Types II and III there is very

PROCTOR, BRUCE;WULLSTEIN, HORST;RAMBO, THOMAS;FARRIOR, J. BROWN;HENNER, ROBERT;HARRISON, WILEY;SCHUKNECHT, HAROLD F.

1960 A.M.A. Archives of Otolaryngology

doi: 10.1001/archotol.1960.03770030128025

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 Proctor: The program for the rest of the afternoon will be devoted to a consideration of the leftover problems in tympanoplasty. The most important thing which I think we have to settle this afternoon is the problem of this classification business. This is important not only for communication between ourselves but also for records; for hospital records, for insurance companies, and to evaluate this type of work. We are fortunate that Harold Schuknecht is here. He has been working on the classification of tympanoplasty for the American Medical Association's "Standard Nomenclature." I would like to ask Dr. Schuknecht to come up and sit with the panel. We will ask him, first of all, to give us the classification of tympanoplasty as Dr. Zöllner uses it. Dr. Schuknecht: I am interested in acquiring the reaction of the panel to Professor Zöllner's classification with the view to possibly introducing it into

SHAMBAUGH, GEORGE E.

1960 A.M.A. Archives of Otolaryngology

doi: 10.1001/archotol.1960.03770030141026

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 Dr. Howard House, in his beautiful presentation on the unfavorable results of stapes mobilization, brought out the importance of endolymphatic hydrops as a complication; that certainly has been our experience. It is a very important complication every time the labyrinth is opened either for fenestration or for stapes mobilization. I would like to mention an interesting observation that we have made on several revisions of stapes mobilizations. When the footplate was cracked, a large amount of perilymph welled up in the oval window niche—far more than I have ever seen in an initial mobilization—suggesting that these patients had an increased amount of intralabyrinthine fluid, apparently perilymph. Possibly the term "labyrinthine hydrops" would be more appropriate for these postoperative cases than "endolymphatic hydrops," because both the perilymph and endolymph may be increased in amount. It would be interestng to know if others have made the same observation. There is a close

LINDSAY, JOHN R.

1960 A.M.A. Archives of Otolaryngology

doi: 10.1001/archotol.1960.03770030142027pmid: 14417204

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 think it is well to review briefly the clinical characteristics before starting to talk about the histopathology of hydrops, because in my experience there is still a good deal of confusion as to how to make the diagnosis. We will start by mentioning some of the auditory characteristics—the classical auditory characteristics that would indicate hydrops. For an early case of hydrops—found in a person in his 30's or 40's or earlier—some of the classical auditory findings are shown in Figure 1. This chart shows a number of hearing tests made on the same patient at different times. The seven air-conduction threshold curves show a wide variation. The hearing threshold has fluctuated up and down at varying periods. This is the usual fluctuation seen in an early case of hydrops. The bone-conduction threshold fluctuates along with the air-conduction one. It is classically a low-tone hearing loss. Along with this,

SHAMBAUGH, GEORGE E.

1960 A.M.A. Archives of Otolaryngology

doi: 10.1001/archotol.1960.03770030153028

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 would like to emphasize a few things to supplement what Dr. Lindsay said. We see cases of hydrops secondary to other types of inner ear disease, including congenital nerve deafness. We have several of these cases where the child was apparently born with a severe perceptive hearing loss and later on developed a fluctuating super-imposed hydrops. When that straightened out, the hearing resumed its previous level. We have also had cases of congenital syphilitic nerve deafness where the hearing stabilized at a certain level after adequate antisyphilitic treatment. Then hydrops was superimposed with its fluctuations in hearing, and again, with treatment for the hydrops the hearing stabilized at the pervious level. We have seen hydrops secondary to presbycusis, and Dr. Lindsay has shown us two cases of that. And, of course, we have hydrops secondary to otosclerosis. So hydrops can be secondary to other forms of inner ear disease

GODLOWSKI, Z. Z.

1960 A.M.A. Archives of Otolaryngology

doi: 10.1001/archotol.1960.03770030155029pmid: 13850373

Abstract The discrepancies in the rationale of the antigen-antibody conjugation being the basic mechanism of allergy make an understanding of the problem of allergy more difficult; the contradictory findings which are often encountered in the antigen-antibody reaction make this theory unacceptable. Nonetheless, the majority of allergists still accept it as a working theory of the allergic reactions. It will be pertinent to mention a few of the contradictions: A constant and predictable anaphylactic response to the first injection of certain antigens (e.g., peptone shock in dogs,76,77 or intravenous injection of human γ-globulins into humans47) makes the concept of antigen-antibody interaction a logical impossibility because specific antibodies are not present at this stage. The presence of allergic diseases in persons with agammaglobulinemia who are unable to manufacture antibodies has been observed repeatedly.52,53,75,153 Allergic reactions occur so commonly that they might be looked upon as physiopathologic responses which exist in References 1. Albright, E. C.; Larson, F. C., and Tust, R. H.: In Vitro Conversion of Thyroxin to Triiodothyronine by Kidney Slices , Proc. Soc. Exper. Biol. & Med. 86:137, 1954. 2. Albright, E. C.; Tomita, K., and Larson, F. C.: In Vitro Metabolism of Triiodothyronine , Endocrinology 64:208, 1954. 3. Anderson, J. M.: Small Dosage Treatment for Hay Fever , J. Allergy 3:306, 1932. 4. Barker, S. B.: Biochemistry , in The Thyroid , edited by S. C. Werner, New York, Paul B. Hoeber, Inc. (Medical Book Department of Harper & Brothers) 1955. 5. Barnes, L. E. et al.: A Comparison of Myotrophic and Androgenic Activities of Testosterone Propionate with 19-Nortestosterone and Its Esters , Endocrinology 55:77, 1954. 6. Beck, J. 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Ophth. 61:728, 1957. 50. Godlowski, Z. Z.: Hormones Related to Allergy , Trans. Am. Acad. Ophth. 62:835, 1958. 51. Godlowski, Z. Z.: Clinical Management of Hypothyroid States , Bull. Nat. Med. & Dent. A. 31:37, 1959. 52. Good, R. A.: Agammaglobulinemia—A Provocative Experiment of Nature , Bull. Univ. Minn. Hosp. 26:1, 1954. 53. Good, R. A.: Homotransplantation Studies in Patients with Agammaglobulinemia , 2nd Tissue Homotransplantation Conference, New York Acad. Sc. (Biology), 1956. 54. Gotzl, F. R., and Dragstedt, C. A.: Effect of Thyroidectomy and of Experimental Hyperthyroidism Upon Histamine Content of Rat Tissues , Proc. Soc. Exper. Biol. & Med. 45:688, 1940. 55. Green, J. D.: Neural Pathways to the Hypophysis in Hypothalamic-Hypophysial Interrelationships , in Symposium: Hypothalamic-Hypophysial Interrelationships , compiled and edited by W. S. Fields, R. Guillemin, and C. A. Carton, Springfield, Ill., Charles C Thomas, Publisher, 1956. 56. Greene, R., and Farran, H. E.: The Physiological Activity of D-Thyroxine , Brit. M.J. 2:1057, 1958. 57. Greer, M. A.: The Role of the Hypothalamus in the Control of Thyroid Function , J. Clin. Endocrinol. 12:1259, 1952. 58. Greer, M. A., Evidence of Separate Hypothalamic Centers Controlling Corticotropin and Thyrotropin Secretion by the Pituitary , Endocrinol. 58:665, 1956. 59. Gross, J., and Leblond, C. P.: Metabolites of Thyroxine , Proc. Soc. Exper. Biol. & Med. 76:686, 1951. 60. Gross, J., and Pitt-Rivers, R.: Identification of 3:5:3′-L-Triiodothyronine in Human Plasma , Lancet 1:439, 1952. 61. Gross, J., and Pitt-Rivers, R.: Physiological Activity of 3:5:3′-L-Triiodothyronine , Lancet 1: 593, 1952. 62. Gross, J., and Pitt-Rivers, R.: 3:5:3 ′-L-Triiodothyronine: 1. Isolation from the Thyroid Gland , Biochem. J. 4:652, 1953. 63. Hamolsky, M. W.; Ellison, H. E.; Freedberg, S.: The Thyroid Hormone-Plasma Protein Complex in Man: I. Differences in Different States of Thyroid Function , J. Clin. Invest. 36: 1486, 1957. 64. Hamolsky, M. W.; Stein, M., and Freedberg, A. S.: The Thyroid Hormone-Plasma Protein Complex in Man: II. A New in Vitro Method for Study of "Uptake" of Labeled Hormonal Components by Human Erythrocytes , J. Clin. Endocrinol. 17:33, 1957. 65. Hansel, F. K.: The Treatment of Allergy of the Nose and Paranasal Sinuses by Hyposensitization with Dust Extracts , Tr. Am. Laryng. Rhin. & Otol. Soc. 46:156, 1940. 66. Hansel, F. K.: The Use of Staphylococcus Toxoid and Extracts of Pathogenic Molds in Otolaryngology and Ophthalmology , Tr. Am. Acad. Ophth. 56:267, 1952. 67. Hansel, F. K.: Clinical Allergy , St. Louis, C. V. Mosby, 1953. 68. Hansel, F. K.: Allergic and Other Untoward Reactions to Antibiotics and Drugs , Tr. Am. Acad. Ophth. 58:73, 1954. 69. Harris, G. W.: Hypothalamic Control of the Anterior Lobe of the Hypophysis , in Symposium: Hypothalamic-Hypophysial Interrelationships , compiled and edited by W. S. Fields; R. Guillemin, and C. A. Carton, Springfield, Ill., Charles C Thomas, Publisher, 1956. 70. Harrington, C. R.: Twenty Years of Research on the Biochemistry of the Thyroid Gland , Endocrinology 49:401, 1951.Crossref 71. Hayano, M., and Dorfman, R. I.: Studies on the Inhibition of Various Enzymes by Steroids , Ann. New York Acad. Sc. 54:608, 1951.Crossref 72. Heckel, G. P.: Endocrine Allergy and the Therapeutic Use of Pregnanediol , Am. J. Obst. & Gynec. 66:1297, 1953. 73. Hilger, J. A.: Otological Aspect of Hypometabolism , Ann. Otol. Rhin. & Laryng. 65:395, 1956. 74. Jaques, L. B., and Waters, E. T.: The Isolation of Crystallin Heparin from the Blood of Dogs in Anaphylactic Shock , Am. J. Physiol. 129:389, 1940. 75. Janeway, C. A.; Apt, L., and Gitlin, D.: Agammaglobulinemia , Tr. A. Am. Physicians 66: 200, 1953. 76. Jobling, J. W., and Petersen, W. F.: A Study of the Ferments and Antiferments of the Body and Their Relation to Certain Diseases , Bull. Johns Hopkins Hosp. 26:356, 1915. 77. Jobling, J. 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P., Jr.: Effectiveness of Triiodothyronine or Thyroxine Administered Orally in Treatment of Myxedema , J. Clin. Endocrinol. 15:285, 1955.Crossref 126. Sevag, M. G.: Immunocatalysis , Ed. 2, Springfield, Ill., Charles C Thomas, Publisher, 1951. 127. Sevag, M. G.: A New Theory of Allergic Phenomena, Mechanism of Hypersensitization, Immune Responses and Allergic Phenomena , Ann. Allergy 14:233, 1956. 128. Shambough, G. E., Jr.: Surgery of the Ear , Philadelphia-London, W. B. Saunders Co., 1959. 129. Schuman, C. R.: Hypothyroidism Due to Thyrotropin Deficiency Without Other Manifestations of Hypopituitarism , J. Clin. Endocrinol. 13: 795, 1953.Crossref 130. Smith, E. L.: The Glycylglycine Dipeptidases of Skeletal Muscle and Human Uterus , J. Biol. Chem. 173:571, 1948. 131. Smith, E. L.: Studies on Dipeptidases: III. Hydrolysis of Methylated Peptides: The Role of Cobalt in the Action of Glycylglycine Dipeptidase , J. Biol. Chem. 176:21, 1948. 132. Smith, R. H., and Williams-Ashman, H. G.: The Influence of Thyroxine on the Enzymic Activity of Rat Tissues , Biochim. et biophys. acta 7:295, 1951.Crossref 133. Spiegelman, S.: Modern Aspect of Enzymatic Adaptation , in Sumner, J. B., and Myrback, K.: The Enzymes , New York, Academy Press, 1950. 134. Spiegelman, S., and Kamen, M. O.: Genes and Nucleoproteins in the Synthesis of Enzymes , Science 104:581, 1946.Crossref 135. Stanbury, J. B.; Ohela, K., and Pitt-Rivers, R.: The Metabolism of Iodine in Two Goitrous Cretins Compared with That in Two Patients Receiving Methimasol , J. Clin. Endocrinol. 15:54, 1955.Crossref 136. Stanbury, J. B.: Synthesis, Storage and Release of Thyroid Hormone , in The Thyroid , edited by S. C. Werner, Paul B. Hoeber, Inc. (Medical Book Department of Harper & Brothers) 1955. 137. Spencer, R. P.; King, E. R.; Henkelmann, C. R., and Balbus, T. G.: A Discussion of Thyroid Parameters , Ann. Int. Med. 48:1046, 1958.Crossref 138. Starr, P.: Newer Thyroid Preparations: Action and Usage , West. J. Surg. 64:466, 1956. 139. Starr, P.: Thyroxin Therapy in Preventive Geriatrics , J. Am. Geriatric Soc. 3:217, 1955. 140. Sterling, K.; Lashof, J., and Man, E. B.: Turnover Rate of L-Thyroxin and L-Triiodothyronine in Euthyroid Subjects as Measured by Radioactive-Labeled Compounds , Clin. Res. Proc. 2:41, 1954. 141. Sterling, K.; Lashof, J., and Man, E. B.: Disappearance from Serum of I131-Labeled L-Thyroxine and Triiodothyronine in Euthyroid Subjects , J. Clin. Invest. 33:967, 1954. 142. Stiles, K. A., and Johnson, E. J.: A Study of the Inheritance of Respiratory Allergies , J. Allergy 17:11, 1946.Crossref 143. Thompson, W. O.; Thompson, P. K., and Dickie, L. F. N.: Monosodium Thyroxin, Desiccated Thyroid, and Impure Sodium Salts of Thyroxin: Comparison of Their Effects When Administered Orally; and Effect of Thyroxin Injected Intravenously in Alkaline Solution , Arch. Int. Med. 52:576, 1933.Crossref 144. Tittle, C. R., Jr.: Effects of 3:5:3′-L-Triiodothyronine in Patients with Metabolic Insufficiency , J.A.M.A. 162:271, 1956.Crossref 145. Thurman, F. M., and Thompson, W. O.: Low Basal Metabolism Without Myxedema , Arch. Int. Med. 46:879, 1930.Crossref 146. Travell, J.; Karp, D., and Rinzler, H.: Nonmyxedematous Hypometabolism and Muscular Pain: Treatment by 3:5:3′-L-Triiodothyronine, 3rd International Congress of Rheumatic Disease, Air-Les-Baines, France, June 29, 1956. 147. Travell, J.; Karp, D.; Rinzler, S. H., and Weeks, V. D.: Skeletal Muscles Pain as an Aspect of the Metabolic Insufficiency Syndrome , Sesquicentennial Convention of the Medical Society of the State of New York, (Feb. 18) , 1957. 148. Ungar, G.: Release of Proteolytic Enzyme in Anaphylactic and Peptone Shock in Vitro , Lancet 1:708, 1947.Crossref 149. Ungar, G.: Fibrinolytic System and Inflammation , in J. and A. Robert: Mechanism of Inflammation , Montreal Acta, 1953. 150. Ungar, G., and Parrot, J. L.: Mise en Évidences "in vitro" de la libération de substances histaminiques dans le choc anaphylactique , Ann. physiol. 13:939, 1937. 151. Ungar, G., and Mist, S. H.: Observations on the Release of Serum Fibrinolysin by Specific Antigen, Peptone, and Certain Polysaccharides , J. Exper. Med. 90:39, 1949.Crossref 152. Ungar, G., and Damgaard, E.: Tissue Reactions to Anaphylactic and Anaphylactoid Stimuli: Proteolysis and Release of Histamine and Heparin , J. Exper. Med. 101:1, 1955.Crossref 153. Varco, R. L.; MacLean, L. D.; Aust, J. B., and Good, R. A.: Agammaglobulinemia: An Approach to Homovital Transplantation , Ann. Surg. 142:334, 1955.Crossref 154. Waalkes, T. P. et al., cited by Weissbach, H., and Udenfriend, S.: Presence of Serotonin in Lung and Its Implication in the Anaphylactic Reaction , Science 125:235, 1957. 155. Watson, B. A.: Hypometabolic State: Clinical Entity , New York J. Med. 54:2045, 1954. 156. Winkler, A. W.; Lavietes, P. H.; Robbins, C. L., and Man, E. B.: Tolerance of Oral Thyroid and Reaction to Intravenous Thyroxin in Subject Without Myxedema , J. Clin. Invest. 22:535, 1943.Crossref 157. The Thyroid , edited by S. C. Werner, New York, Paul B. Hoeber, Inc., (Medical Book Department of Harper & Brothers) 1955, p. 130. 158. Wilson, P. W.: Mechanism of Symbiotic Nitrogen Fixation , Ergebn. Enzymfrsch. 8:13, 1939. 159. Winzler, R. J., and Burk, D.: Blood Proteose and Cancer , J. Nat. Cancer Inst. 4:417, 1944. 160. Zondek, B., and Bromberg, Y. M.: Endocrine Allergy: Clinical Reactions of Allergy to Endogenous Hormones and Their Treatment , J. Obst. & Gynaec. Brit. Emp. 54:1, 1947.

JORDAN, RAYMOND E.

1960 A.M.A. Archives of Otolaryngology

doi: 10.1001/archotol.1960.03770030200030pmid: 14407881

Abstract It is the purpose of this paper to present some otologic problems caused or complicated by allergy. In this presentation the term allergy is used to describe either an antigen-antibody reaction or an autonomic dysfunction. This study was stimulated by an effort to find the etiology of serous otitis media. During this study several additional otologic conditions complicated by allergy came to light. There has been and still remains considerable confusion regarding the different types of middle ear fluid; in this presentation the term serous otitis media will be used to indicate that the fluid in the middle ear is a transudate. During this study routine nasal smears were done at each visit on approximately 164 patients. The material was usually taken from the nasopharynx by aspiration and stained with eosin and methylene blue. Positive nasal smears were found in about 70% of these cases. Further, in those cases in References 1. Dean, L. W.; Agar, J. S., and Linton, L. D.: Allergic Diseases of the Ear , Laryngoscope 47: 707-728, 1937.Crossref 2. Jones, M. F.: Manifestations of Allergy in the Ear , Ann. Otol. Rhin. & Laryng. 47:910-916. 1938. 3. Ashley, R. E.: Medical Care and Prophylaxis in Hearing Losses with Special Attention to Allergies , Tr. Am. Otol. Soc. 3:169-177, 1949 4. Ann. Otol. Rhin. & Laryng. 58:837-851, 1949. 5. Dohlman, F. G.: Allergiska processer i mellanörat , Nord. med. 20:2231, 1943. 6. Hansel, F. K.: Clinical Allergy , Ed. 1, St. Louis, C. V. Mosby Company, 1953. 7. Williams, H. L.: Ménière's Disease , Springfield, Ill., Charles C Thomas, 1952. 8. Jordan, R. E.: Deafness Due to Allergy , Laryngoscope 60:152-160, 1950. 9. Jordan, R. E.: Role of Allergy in Otology , A.M.A. Arch. Otolaryng. 55:363-368, 1952. 10. Jordan, R. E.: Symposium: Allergy of the Ear; the Inner Ear , Tr. Am. Acad. Ophth. 61: 97-98, 1957.

SCHUKNECHT, HAROLD F.

1960 A.M.A. Archives of Otolaryngology

doi: 10.1001/archotol.1960.03770030204031pmid: 14443733

Abstract It is not my intention here to discuss in full detail the various pertinent questions relating to this important problem or to describe completely the techniques by which the labyrinth can be destroyed. However, on the basis of personal experiences, I will endeavor to set down some of the pertinent facts regarding destructive therapy. A sudden attack of severe vertigo accompanied by nausea and vomiting is a terrifying experience. When the episodes in Ménière's disease recur frequently, patients are fearful of having attacks while at work or on the street. At this stage, they are incapacitated and willing to make some sacrifice to acquire relief of symptoms. Before destructive therapy can be advised, it is essential that the following criteria for conclusive diagnosis be met: (1) attacks of vertigo and vomiting; (2) perceptive type hearing loss manifested by threshold loss for bone and air conduction (Fig. 1); (3) loudness recruitment in the involved ear, and (4) diminution of caloric response in the in volved ear. References 1. Shelden, C. H., and Horton, B. T.: Treatment of Ménière's Disease with Histamine Administered Intravenously , Proc. Staff Meet. Mayo Clin. 15:17-21, 1940. 2. Atkinson, M.: Observations on the Etiology and Treatment of Ménière's Syndrome , J.A.M.A. 116:1753-1760, 1941.Crossref 3. Furstenberg, A. C.; Lashmet, F. H., and Lathrop, F.: Ménière's Symptom Complex, Medical Treatment , Ann. Otol. Rhin. & Laryng. 43: 1035-1046, 1943 4. Ohio State M.J. 31:263-267, 1935. 5. Williams, H. L.: Ménière's Disease , Springfield, Ill., Charles C Thomas, Publisher, 1952. 6. Portmann, G.: Vertigo: Surgical Treatment by Opening the Saccus Endolymphaticus , Arch. Otolaryng. 6:309-319, 1927. 7. Passe, E. R. G.: Sympathectomy in Relation to Ménière's Disease, Nerve Deafness and Tinnitus: A Report of 110 Cases , Proc. Roy. Soc. Med. 44:760-772, 1951. 8. Rosen, S.: Surgery in Ménière's Disease: A New Operation Which Preserves the Labyrinth; a Report of Cases , Ann. Otol. Rhin. & Laryng. 60:657-667, 1951. 9. Schuknecht, H. F., and Woellner, R. C.: An Experimental and Clinical Study of Deafness from Lesions of the Cochlear Nerve , J. Laryng. & Otol. 59:75-97, 1955. 10. Arslan, M., and Baccaglini, M.: L'applicazione dirette degli ultrasuoni sull'apparato vestibulare quale cura della malattia di Ménière , Medico-Surgical Society of Padova, University of Padova, 1953, Vol. 31. 11. Day, K.: Symposium: Surgical Treatment of Hydrops of the Labyrinth; Surgical Destruction of the Labyrinth for Ménière's Disease , Laryngoscope 62:547-555, 1952. 12. Lindsay, J. R., and Siedentop, K. H.: Labyrinthine Surgery in the Treatment of Ménière's Disease , Ann. Otol. Rhin. & Laryng. 64:69-78, 1955. 13. Frenckner, P.: Some Viewpoints on Operative Treatment in Ménière's Disease , A.M.A. Arch. Otolaryng. 155:420-433, 1952. 14. Wright, A. J.: Ménière's Disease: Alcohol Injection of the Labyrinth , J. Laryng. & Otol. 57:120-122, 1942. 15. Cawthorne, T.: Ménière's Disease , Ann. Otol. Rhin. & Laryng. 56:18-38, 1947. 16. Lempert, J.: Lempert Decompression Operation for Hydrops of the Endolymphatic Labyrinth in Ménière's Disease , Arch. Otolaryng. 47: 551-570, 1948. 17. Fowler, E. P., Jr.: Streptomycin Treatment of Vertigo , Tr. Am. Acad. Ophth. 52:293-301, 1948. 18. Hamberger, C. A.; Hyden, H., and Koch, H.: Streptomycin bei der Meniereschen Krankheit , Arch. Ohren- Nasen- u. Kehlkopfh. 155:667-682, 1949. 19. Rüedi, L.: Therapeutic and Toxic Effects of Streptomycin in Otology , Laryngoscope 61:613-636, 1951. 20. Hanson, H. V.: The Treatment of Endolymphatic Hydrops (Ménière's Disease) with Streptomycin , Ann. Otol. Rhin. & Laryng. 60:676-691, 1951. 21. Schuknecht, H. F.: Ablation Therapy in the Management of Ménière's Disease , Acta Otolaryng. , (Supp. 132) , pp. 1-42, 1957.

ARIAGNO, RICHARD P.

1960 A.M.A. Archives of Otolaryngology

doi: 10.1001/archotol.1960.03770030215032pmid: 13794201

Abstract The practical application of ultrasound was initiated in France in 1916 with the study of underwater echo.1 Mulwert and Voss2,3 attempted to treat the hard of hearing with ultrasound from 1928 to 1933. Their apparatus produced waves of low intensity and afforded no convincing results. In 1948, Austrian investigators Wiethe, Wyt, and Vyslonzil4,5 reported the treatment of various ear diseases with ultrasound. The results of treatment varied considerably; they were usually doubtful, and treatment failed in several cases. A comparison of these results is difficult. Naumann6 concluded that the treatment of ear diseases with ultrasound was useless, as the total quantity of ultrasonic waves reaching the inner ear was insignificant. This was due to the fact that the air in the mastoid cells prevented the ultrasonic waves from reaching the inner ear. Only in patients with a sclerotic mastoid could a significant intensity of ultrasonic waves References 1. Lumsden, R. B.: Treatment of Ménière's Disease with Ultrasound , Proc. Roy. Soc. Med. 51:617-623, 1958. 2. Mülwert, H., and Voss, O.: Eine neue physikalische Behandlungsmethode chronischer Schwerhörigkeit und deren Ergebnisse , Arch. Ohren-Nasen- u. Kehlkopfh. 119:81-115, 1928.Crossref 3. Voss, O.: Ultraschallwellen im Dienste der Behandlung chronischer Schwerhörigkeit , Arch. Ohren- Nasen- u. Kehlkopfh. 135:258-287, 1933.Crossref 4. Vyslonzil, E.: Über die Beeinflussung des Vestibularapparates durch Ultraschall , Wein. klin. Wchnschr. 61:468-469, 1949. 5. Wiethe, C.; Wyt, L., and Vyslonzil, E.: The Therapeutic Use of Supersonic Waves , Acta oto-laryng. (1948) , (Supp. 78) , p. 111, 1949. 6. Naumann, H.: Ultraschall und Ohr-Region , Arch. Ohren- Nasen- u. Kehlkopfh. 160:240-292, 1951.Crossref 7. Portmann, M., and Barbe, L. J.: Les Ultrasons et les nerfs de l'oreille (étude morphologique) , Arch. Anat. Hist. et Embryol. 34:361, 1952. 8. Portmann, G.; Portmann, M., and Barbe, L. J.: Etude expérimentale (fonctionnelle et histologique) de l'action des ultra-sons sur l'audition , Acta oto-laryng. , (Supp. 100) , pp. 119-133, 1952. 9. Krejci, F.: Experimentelle Grundlagen einer extralabyrinthären chirurgischen Behandlungs-methode der Ménièreschen Erkrankung , Pract. oto-rhino-laryng. 14:18-37, 1952. 10. Arslan, M.: Treatment of Ménière's Syndrome by Direct Application of Ultra-Sound Waves to the Vestibular System, in Proceeding of the Fifth International Congress of Otolaryngology, Amsterdam, 1953, Assen Netherlands, Van Gorcum, 1953. 11. Arslan, M.: Direkte Applikation des Ultraschalls auf das knöcherne Labyrinth zur Therapie der Labyrinthose (Morbus Ménière) , HNO 4:166-168, 1954. 12. Arslan, M.: Neue Resultate der Applikation des Ultraschalles auf das Labyrinth: Ein Beitrag zur Therapie der Labyrinthose , Arch. Ohren-Nasen- u. Kehlkopfh. 167:559-574, 1955.Crossref 13. Friedland, F.: Present Status of Ultrasound in Medicine , J.A.M.A. 163:799-803, 1957.Crossref 14. de Stefani, G. B.: Gli ultrasuoni nell'otosclerosi , Arch. ital. otol. ( (Supp. 27) ) 67:3-114, 1956.

SHAMBAUGH, GEORGE E.

1960 A.M.A. Archives of Otolaryngology

doi: 10.1001/archotol.1960.03770030223033

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 Some of the men suggested that I try to simplify Dr. Godlowski's highly scientific explanation of the enzymatic concept of allergy. Picture a cell with its nucleus. We see here a foreign protein which enters the cell and stimulates the production of a specific enzyme called the adaptive enzyme, produced by the cell for that particular protein. This is a healthy cell of a person who has no inhibition of enzyme production or activity. His hormones are in balance. He has no fever, nor has he taken a coal tar derivative, antibiotic, or other enzyme inhibitor. Therefore, he produces nice, normal adaptive enzyme which proceeds to cause all-ornone proteolysis of the foreign protein, breaking it down into harmless amino acids which are then utilized by the cell to build up its own protein. Next to this normal cell, imagine the cell of the allergic person. Again, a foreign protein enters the cell, but this time the adaptive enzyme produced by the cell for this particular protein is of an abnormal type—due to either hormonal deficiency in the patient or the action of an enzyme inhibitor. This abnormal adaptive enzyme does not produce all-or-none proteolysis; rather, it produces a partial or piecemeal proteolysis, producing a number of toxic products, including histamine, serotonin, etc. These are the toxic products which

SHAMBAUGH, GEORGE E.

1960 A.M.A. Archives of Otolaryngology

doi: 10.1001/archotol.1960.03770030224034

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.1960.03770030230035pmid: 13846224

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 In opening this discussion, let me first ask the question, "Will there be a chance for tympanoplasty in the future?" Perhaps we see a lot of cases now, but they will disappear because there will be no more chronic ears. Well, there may be something in this if you examine the United States and the happy situation that you are in as compared to your colleagues from the poorer countries of Europe, Africa, Asia, Japan, and so on. You will find that in these countries there is an immense interest in tympanoplasty—even more than in otosclerotic surgery—because up to now, the problem of chronic otitis media has been much greater in these badly developed countries than here, and there is an immense number of patients needing help of this sort. However, I do not believe that cholesteatoma will disappear soon. There are causes of cholesteatoma which will continue even if we do not have the usual chronic draining ears. There will still be a need for tympanoplasty even under your good health conditions in this country.

1960 A.M.A. Archives of Otolaryngology

doi: 10.1001/archotol.1960.03770030240036

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 International Course in Reconstructive Nasal Surgery.—An international course on "The Fundamentals of Reconstructive Surgery of the External Nasal Pyramid and the Nasal Septum" will be presented in Mexico City, July 4-15, 1960. It will be presented under the auspices of the Escuela Nacional de Medicina e Division del Doctorado and with the cooperation of the American Rhinologic Society. The guest professor will be Dr. Maurice H. Cottle, professor of otolaryngology at the Chicago Medical School and founder of the American Rhinologic Society. Dr. Cottle will be assisted by a faculty of specialists from the United States and Mexico. The lectures will be presented simultaneously in English and Spanish. Applicants for the course must be certified by the American Board of Otolaryngology or have equivalent status. For application forms and other information, write immediately to Dr. Robert M. Hansen, Secretary, American Rhinologic Society, 1735 N. Wheeler Ave., Portland 12,

1960 A.M.A. Archives of Otolaryngology

doi: 10.1001/archotol.1960.03770030242037

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.1960.03770030242038

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 This reviewer has known Karsten Kettel for many years, and has been in close touch with the long, conscientious work that is here presented in this splendid monograph, the only one in existence devoted to this subject. Many of his numerous articles on this subject have been contributed to the A.M.A. Archives of Otolaryngology, beginning in 1943. This book is written in English, which the author both writes and speaks flawlessly. It covers in detail every aspect of the extracranial portion of the seventh nerve; the anatomy, physiology, diagnosis, and causes of paralysis; the treatment and results to be expected, and the numerous case histories showing how different types of palsy should be handled. The surgical procedures are given in full, with clarifying illustrations. The history of the study of facial palsy is outlined and the subject brought thoroughly up to date, with the conclusions and innovations of the auther.

1960 A.M.A. Archives of Otolaryngology

doi: 10.1001/archotol.1960.03770030243039