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.