Archives of Otolaryngology

SHAMBAUGH, —GEORGE E.

1966 Archives of Otolaryngology

doi: 10.1001/archotol.1966.00760020515001

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 WHILE not an otolaryngologic problem, coronary obstruction has its highest incidence among physicians, and otolaryngologists are not immune and must concern themselves with the causative factors. These are discussed by William Dock, professor of medicine at the State University of New York, in the February 1966, Resident Physician. "In the worry and strain of modern life arterial degeneration is not only very common but develops often at a relatively early age." Thus wrote Osler exactly 70 years ago as the horse and buggy era drew toward its close. While it is true that emotional stress, probably greater today than in Osler's day, can raise the levels of plasma lipids and accelerate clot formation, it is worth noting that in telephone and insurance company studies clerks have more coronary disease than executives. Among physicians, introspective full-time scholars, sedentary psychoanalysts (who presumably are freer of personal emotional stress than most of us),

PUTNEY, F. JOHNSON

1966 Archives of Otolaryngology

doi: 10.1001/archotol.1966.00760020516003

Abstract DURING the past decade the value of tracheostomy, particularly as an aid in controlling and assisting respiratory ventilation using cuffed tubes, cannot be overestimated. With its widespread use complications and problems have arisen, as evidenced by more numerous reports of these in the literature. The four cases of tracheal stenosis occurring within a year on one surgical service reported in the Annals of Thoracic Surgery in January 1966,1 prompts a review of the procedure. In this latest documentation, animal experimentation confirmed the opinion that the pressure from an occluding cuff would cause stenosis at the opening into the trachea, and placement of the cuff at the distal end of the tube away from the operative site was advantageous. The fact that a No. 8 tracheostomy tube might be the principal factor in the development of stenosis in a small trachea was overlooked, for an oversized tube increases the trauma References 1. Murphy et al: Tracheal Stenosis as a Complication of Tracheostomy , Ann Thor Surg 2:44-51 ( (Jan) ) 1966.Crossref

HILGER, JEROME

1966 Archives of Otolaryngology

doi: 10.1001/archotol.1966.00760020516002

Abstract OTOLARYNGOLOGISTS have a particular advantage in medical crisis in that the technique of direct laryngoscopy is an inherent part of their education and skill. Paluel Flagg, MD, and R. M. Hosler* have called attention to the fact that "when respiration and pulse disappear the mucous membranes of the lips and conjunctiva become a deep purple, the skin a bluish grey." They note that if the heart has stopped beating, intubation and oxygen insufflation produce no change in color. On the other hand, if the heart is beating, intubation and oxygen insufflation produce an almost instantaneous change in color. Intubation is not difficult at this moment of crisis, because the consensus of opinion holds that when the heart stops beating or goes into fibrillation, muscle tone and reflexes promptly disappear. In these relaxed circumstances, the otolaryngologist with his inherent skill has no problem in exposing the larynx for tracheal intubation. It

SHAMBAUGH, GEORGE E.

1966 Archives of Otolaryngology

doi: 10.1001/archotol.1966.00760020517004

Abstract THE WORLD now has nearly 6,000 medical journals, with an annual increase of about 100, containing a total of around 2 million printed pages a year. So much is printed in so many places that mere publication of a new fact or idea does not by any means ensure that it will reach all or most of those who need it in their practice or researches. This crisis in medical communication in England is considered by Sir Theodore Fox,1 retiring after 20 years as editor of Lancet. He divides medical journals in England into two types. One is the "medical recorder" whose function is to record new observations, experiments, and techniques. It is the mouthpiece of the laboratory or clinical investigator who is advancing medical knowledge. As a rule, it is the journal of a specialty. The other type is the "medical news" publication designed for the practitioner to References 1. Fox, T.: Crisis in Communication , Oxford: Oxford University Press, 1965. 2. Garland, J.: Crisis in Medical Communication , Med World News 6:122 ( (Oct 22) ) 1965.

KETTEL, KARSTEN

1966 Archives of Otolaryngology

doi: 10.1001/archotol.1966.00760020519005pmid: 5937791

Abstract IN FACIAL palsy due to operative trauma or to fracture of the temporal bone, the nerve may be completely torn across and the patient will never recover facial movements unless nerve grafting is performed. In other cases of facial palsy the nerve looks perfectly healthy, and in these the palsy is probably due to an interference with the blood supply of the nerve. Most of these palsies will clear up spontaneously but some may not. If the blood supply to the facial nerve is interrupted an ischemic facial palsy follows. If the circulation is blocked for a prolonged period the neural tissue will degenerate and extraneural and intraneural scar tissue will develop. In this case the conductive power will be just as effectively destroyed as if the nerve had been cut. The degree and the duration of the impairment of circulation determines the pathological processes which arise in and around

KELEMEN, GEORGE

1966 Archives of Otolaryngology

doi: 10.1001/archotol.1966.00760020522006pmid: 5937792

Abstract HEARING defect in the progeny of mothers who suffered rubella in the first trimester of pregnancy is a well-studied phenomenon. To put on a histopathological basis the multitude of clinical observations, two groups of material are available. Elective hysterotomy, upon indication of maternal rubella, yields temporal bones; another group is formed by newborn, older children, or adults with rubella in the maternal history. Both groups offer advantages and disadvantages. Interruption material guarantees correct diagnosis in the mother, removal in the critical period, immediate fixation of the specimen. Material from the newborn may exhibit postrubella malformations, and that from older children or adults possibly is accompanied by audiometric findings. Lancaster1 traced back the postmortem evidence of the possible role of rubella in deafness, his tabulation comprising the years between 1895 and 1945. Up to 1953, ten pertinent reports could be collected from the literature. In 1959 it could be reported References 1. Lancaster, H.O.: Deafness as an Epidemic Disease in Australia , Brit Med J 2:1429-1432, 1951.Crossref 2. Gray, J.E.: Rubella in Pregnancy , Ann Otol 68:170-174, 1959. 3. Gray, J.E.: Rubella in Pregnancy , Brit Med J 1:1388-1390, 1960.Crossref 4. Richards, C.S.: Middle Ear Changes in Rubella Deafness , Arch Otolaryng 80:48-59, 1964.Crossref 5. Shambaugh, G.E., Jr.: Developmental Anomalies of the Sound-Conducting Apparatus and Their Surgical Correction , Ann Otol 61:873-883, 1952. 6. House, H.P.; House, W.F.; and Hildyard, V.H.: Congenital Footplate Fixation , Laryngoscope 68:389-402, 1958. 7. Schall, L.A.; Lurie, M.H.; and Kelemen, G.: Embryonic Hearing Organs After Maternal Rubella , Laryngoscope 61:99-112,1951.Crossref 8. Kelemen, G., and Gotlib, B.N.: Pathohistology of Fetal Ears After Maternal Rubella , Laryngoscope 69:385-397, 1959.Crossref 9. Kelemen, G.: The 4000-Dip; Anatomic Considerations , Acta Otolaryng 55:365-376, 1962.Crossref 10. Kelemen, G., and Neame, J.H.: Viral Pneumonia of the Mother With Hemorrhagic Otitis in the Fetus , Arch Otolaryng 72:162-169, 1960. 11. Ingalls, T.H.; Babott, F.L.; and Hampson, K.W.: Rubella: Its Epidemiology and Teratology , Amer J Med Sci 239:363-383, 1960.Crossref 12. Goodhill, V.: The Nerve Deaf Child: Significance of RH, Maternal Rubella and Other Etiologic Factors , Ann Otol 59:1123-1147, 1950. 13. Barton, M.E., and Court, S.D.: Causes of Severe Deafness in School Children in Northumberland and Durham , Brit Med J 1:351-355, 1962.Crossref 14. Nager, F.R.: Histologische Untersuchungen bei Kindern nach muetterlicher Rubella , Practica Otorhinolaryng 14:337-359, 1952. 15. Fraser, F.C.: Causes of Congenital Malformations in Human Beings , J Chron Dis 10:97-110, 1959.Crossref 16. Ormerod, F.C.: The Pathology of Congenital Deafness , J Laryng 74:919-950, 1960.Crossref 17. Lindsay, J.F., et al: Inner Ear Pathology in Children Following Maternal Rubella , Ann Otol 62:461-464, 1954. 18. Ward, P.H.; Kinney, G.E.; and Lindsay, J.R.: Inner Ear Pathology in Congenital Deafness , Laryngoscope 72:435-455,1962.Crossref 19. Thalhammer, O.: Praenatale Schaedigungen in Zusammenhang mit muetterlichen Infektionen , Bibl Microbiol 1:144-162, 1960. 20. Cajgfinger, H.: Oreille et rubeola: revue critique , J Franc Otorhinolaryng 8:1001-1035, 1959. 21. Davey, P.R.: Observations on Equilibrium in Deaf Children , J Laryng Otol 68:329-331, 1954.Crossref 22. Gregg, N.M.: Congenital Cataract Following German Measles in Mother , Trans Ophthal Soc 3:25-46, 1942. 23. Menière, P.: Mémoire sur des lésions de l'oreille interne donnant lieu a des symptômes cérébrales apoplectiformes , Gaz Méd Paris 16:597-601, 1861. 24. Baratoux, J.: Changes in the Internal Ear in Hereditary Syphilis , Congr Med 9:850-852, 1887. 25. Voss, O.: Klinische und pathologische Folgeerscheinungen geburtstraumatischer Schaedigungen des Felsenbeines , Monatschr Kinderheilk 34:568-594, 1926. 26. Johnson, W.W.: A Survey of Middle Ears: 101 Autopsies of Infants , Ann Otol 70:377-402, 1961. 27. Buch, N.H., and Jorgensen, M.B.: Congestion and Hemorrhage in Middle Ear of Newborn , Arch Otolaryng 80:60-68, 1964.Crossref 28. Kelemen, G.: Hemorrhage: a Specific Poison to Tissue of Ampullar Cupulae , Arch Otolaryng 77:365-375, 1963.Crossref 29. Mounier-Kuhn, P.; Gaillard, J.; and Cajgfinger, H.: A propos de 8 cas de surdité post-rubeolique , J Franc Otorhinolaryng 9:83-87, 1960. 30. Sandberg, D.H.: Drugs in Pregnancy—Their Effects on the Fetus and Newborn , California Med 94:287-291, 1961. 31. Miehlke, A., and Partsch, J.: Ohrmissbildung, Facialis- und Abducenslaehmung als Syndrom der Thalidomidschaedigung , Arch Ohr Nas Kehlkopfheilk 181:154-174, 1963.Crossref 32. Leicher, H.: Taubstummheit, Vestibularschaeden und Misbildungen des aeusseren Ohres als Symptom der Roeteln-Embryopathie , Z Laryng Rhinol Otol 31:128-138, 1952. 33. Partsch, J., and Maurer, H.: Zur formalen Genese von Orhmissbildungen bei der ThalidomidEmbryopathie , Arch Ohr Nas Kehlkopfheilk 182:594-598, 1963.Crossref 34. Jorgensen, M.B.; Kristensen, H.K.; and Buch, N.H.: Thalidomide-Induced Aplasia of the Inner Ear , J Laryng Otol 78:1095-1101, 1964.Crossref 35. Rosendal, T.: Aplasia-Hypoplasia of the Otic Labyrinth After Thalidomide , Acta Radiol 3:225-236, 1965. 36. Schwarz, M., and Becker, P.E.: " Anomalien, Missbildungen und Krankheiten der Ohren, der Nase und des Halses ," in Becker, P.E. (ed.): Humangenetik , Stuttgart: Georg Thieme, 1964, pp 248-345. 37. Flamm, H.: Die praenatalen Infektionen des Menschen , Stuttgart: Georg Thieme, 1959. 38. Toendury, G.: Embryopathien , Berlin: Springer Verlag, 1962. 39. Banatvala, J.E., et al: Rubella Syndrome and Thrombocytopenic Purpura in Newborn Infants , New Eng J Med 273:474-478, 1965.Crossref

BERNSTEIN, LESLIE

1966 Archives of Otolaryngology

doi: 10.1001/archotol.1966.00760020535007pmid: 5937793

Abstract ABSENCE of the oval window is apparently a very rare phenomenon. In spite of the large number of middle ear explorations that have been carried out since the introduction of stapes surgery a decade ago—as well as other types of middle ear procedures performed nowadays—only eight cases have thus far been reported.1-5 Presented below is a case of congenital absence of the oval window with additional congenital abnormalities of the ossicular chain and of the auricle. Report of a Case A 59-year-old white farmer was first presented at the Department of Otolaryngology and Maxillofacial Surgery, University of Iowa, on May 22, 1963, with a history of hearing loss in the right ear since childhood. During the past 10 to 15 years the hearing in both ears had gradually deteriorated, more so on the right side. Apart from a roaring tinnitus, he had no other concomitant symptoms. There was no References 1. Fernandez, A.O., and Ronis, M.L.: Congenital Absence of the Oval Window , Laryngoscope 74:186-197 ( (Feb) ) 1964.Crossref 2. Hough, J.V.: Malformations and Anatomical Variations Seen in the Middle Ear During the Operation for Mobilization of the Stapes , Laryngoscope 66:1337-1379 ( (Aug) ) 1958.Crossref 3. Livingstone, G.: The Establishment of Sound Conduction in Congenital Deformities of the External Ear , J Laryng 73:231-241 ( (April) ) 1958.Crossref 4. Pou, J.W.: Congenital Absence of the Oval Window , Laryngoscope 73:384-391 ( (April) ) 1963.Crossref 5. Tabor, J.R.: Absence of the Oval Window , Arch Otolaryng 74:55-61 ( (Nov) ) 1961.Crossref 6. Anson, B.J.; Hanson, J.R.; and Richany, S.F.: Early Embryology of the Auditory Ossicles and Associated Structures in Relation to Certain Anomalies Observed Clinically , Ann Otol 69:427-447 ( (June) ) 1960. 7. Schuknecht, H.E.: Experimental Observations on the Fluid Physiology of the Inner Ear , Ann Otol 72:687-712 ( (Sept) ) 1963.

FONS, M.;OSTERHAMMEL, P. AABO

1966 Archives of Otolaryngology

doi: 10.1001/archotol.1966.00760020540008pmid: 5937794

Abstract EXAMINATION of the sense of taste should be considered an indispensable part of the cranial nerve diagnostics. Nevertheless, taste examinations play only a minor role in the otoneurological diagnostics. Undoubtedly this is due to methodological difficulties. Börnstein1 recommends the use of a number of taste solutions, but his method is semiquantitative and requires great care in order to keep the fluid within the area to be examined. From this department Krarup2,3 published a number of investigations on electrogustometry. This method allows an exact graduation of the stimulus and represents a definite improvement. On the other hand the use of an electric stimulus raises several technical, clinical, and theoretical problems. Krarup recommends galvanic stimulation with a flat, circular steel electrode with a diameter of 5 mm. It is applied to the edge of the tongue 1½ cm from the midline for a period of 1½ seconds. The threshold is References 1. Börnstein, W.S.: Cortical Representation of Taste in Man and Monkey: II. The Localization of the Cortical Taste Area in Man and a Method of Measuring Impairment of Taste in Man , Yale J Biol Med 8:133-156 ( (Oct) ) 1940. 2. Krarup, B.: Electrogustometry: A Method for Clinical Taste Examinations , Acta Otolaryng 49:294-305, 1958.Crossref 3. Krarup, B.: Kliniske smagsundersogelser, thesis, Copenhagen,1965. 4. Skramlik, E. von: Handbuch der Physiologie der niederen Sinne , Leipzig: George Thieme, 1926, vol 1. 5. Hahn, H., and Günther, H.: Uber die Reize und die Reizbedingungen des Geschmackssinnes , Pfüg Arch ges Physiol 231:48, 1933.Crossref 6. Pfaffmann, C.: " The Sense of Taste " in Handbook of Physiology: I: Neurophysiology , Washington: Field, Magoun & Hall, 1959, vol 1, chapter 20. 7. Bekesy, G. von: Experiments in Hearing , New York: McGraw-Hill Book Co., Inc., 1960, pp 222-227. 8. Bekesy, G. von: Rhythmical Variations Accompanying Gustatory Stimulation Observed by Means of Localization Phenomena , J Gen Physiol 47:809-825, 1955.Crossref 9. Graham, C.H., and Granit, R.: Comparative Studies on Peripheral and Central Retina: Inhibition, Summation, and Synchronization of Impulses in Retina , Amer J Physiol 98:664-673, 1931. 10. Beidler, L.M.: " Dynamics of Taste Cells " in Zotterman, Y. (ed.): Olfaction and Taste , London, New York, Paris, 1963, pp 133-144.

STEWART, B. MACDONALD

1966 Archives of Otolaryngology

doi: 10.1001/archotol.1966.00760020545009pmid: 5937795

Abstract FACIAL paralysis produced by compression or infiltration of the facial nerve by a tumor is slow in its development and unremitting in its course. The sudden onset of facial palsy with subsequent remissions and relapses is, therefore, not generally thought to result from involvement of the nerve by a neoplasm anywhere along its intracranial or extracranial course. This report describes the rare association of recurrent episodes of facial paralysis and intracranial tumor, and documents the seventh such case in medical literature. Report of a Case A 38-year-old garment worker was admitted to the Neurological Institute of New York in May 1964, because of increasingly recurrent attacks of visual blurring for five months. At the age of 12 he had suddenly developed a left facial paresis without previous symptoms of illness. The paresis cleared slowly over the following weeks, leaving minimal but perceptible facial weakness. When he was 18 years old References 1. Cawthorne, T., and Haynes, D.R.: Facial Palsy , Brit Med J 8:1197-1200, 1956.Crossref 2. Jefferson, G., and Smalley, A.A.: Facial Palsy Produced by Intratemporal Epidermoids , J Laryng Otol 53:417-443, 1938.Crossref 3. Miller, R.H., and Uihlein, A.: Intermittent Facial Palsy: Diagnosis and Treatment , Proc Mayo Clin 27:19-24, 1952. 4. Walsh, T.E.: Bell's Palsy: A Much Misused Diagnosis , Laryngoscope 71:761-764, 1961.Crossref 5. Altmann, F.: Zur Kenntnis der Tumoren des Absteigenden den Facialisteiles , Mschr Ohrenheilk 71:1287-1292, 1937. 6. Graf, K.: Neurinom des Nervus facialis , Pract-Otorhinolaryng 16:374-379, 1954. 7. Kettel, K.: Neurinoma of the Facial Nerve , Arch Otolaryng 44:253-260, 1946.Crossref 8. Kettel, K.: Peripheral Facial Palsy , Copenhagen: Munksgaard & Co., 1959, pp 341, 92. 9. Kettel, K.: Bell's Palsy: Pathology and Surgery , Arch Otolaryng 46:427-472, 1947.Crossref

COTTLE, ROBERT D.;TONNDORF, JUERGEN

1966 Archives of Otolaryngology

doi: 10.1001/archotol.1966.00760020549010pmid: 5937796

Abstract STAPEDIAL surgery has the aim of creating or, more frequently, restoring the stapedial mobility required for the transmission of sound across the middle ear. In general, as attested by a large number of clinical-statistical studies, normal middle ear function is restored to a high degree in a great majority of cases. Using an empirical approach, a variety of surgical techniques to improve stapedial function has been developed over the years by otologic surgeons. Most of these techniques achieve approximately equal degrees of success, although the reason is not often apparent. Investigations have been largely confined to surgical-anatomical studies,1-3 and to the determination of the surgical risk.4-7 The fate and tissue tolerability of various materials used for stapedial substitution were made the subject of further studies.8-11 However, comparatively few efforts have been made toward the assessment of the purely physical factors involved in stapedial replacement.12 The results References 1. Anson, B.J., and Bast, T.H.: Developmental Anatomy of the Temporal Bone and Auditory Ossicles in Relation to Some Problems in Endaural Surgery , Laryngoscope 68:1380-1388, 1958.Crossref 2. Anson, B.J., and Bast, T.H.: The Surgical Significance of Stapedial and Labyrinthine Anatomy , Quart Bull Northwest Univ Med Sch 32:307-325, 1958. 3. Anson, B.J.: Stapedial, Capsular and Labyrinthine Anatomy in Relation to Otologic Surgery , Ann Otol 70:607-631, 1961. 4. Schuknecht, H.F.; McGee, T.M.; and Coleman, B.H.: Stapedectomy , Ann Otol 69:597-609, 1960. 5. Schuknecht, H.F.: Experimental Fracture of the Stapes in Cats , Ann Otol 68:1069-1081, 1959. 6. Schuknecht, H.F.: Sensorineural Hearing Loss Following Stapedectomy , Acta Otolaryng 54:336-348, 1962.Crossref 7. Bellucci, R.J., and Wolff, D.: Repair and Consequences of Surgical Trauma to the Ossicles and Oval Window of Experimental Animals , Ann Otol 67:400-429, 1958. 8. Hohman, A.; Hilger, J.A.; and Carley, R.: Fate of Implants in Rats , Ann Otol 73:791-806, 1964. 9. Schuknecht, H.F., and Oleksiuk, S.: The Metal Prosthesis for Stapes Ankylosis , Arch Otolaryng 71:287-295, 1960.Crossref 10. Coleman, B.F.: Experimental Grafting of the Oval Window , J Laryng 74:858-869, 1960.Crossref 11. Robinson, M.: A Four-Year Study of the Stainless Steel Stapes , Arch Otolaryng 82:217-235, 1965.Crossref 12. Allen, G.W.; Dallos, P.J.; and Kuruvilla, T.K.: Experimental Stapedectomy in Cats—Acoustic Effects of Different Stapes Replacement Techniques as Measured by Cochlear Microphonics , Ann Otol 73:694-707, 1964. 13. Tonndorf, J., and Duvall, A.J.: Loading of the Tympanic Membrane: Its Effects Upon Bone Conduction in Experimental Animals , Acta Otolaryng , (suppl 213) , pp 39-54, 1966. 14. Bluestone, C.D.: Polyethylene-Stainless Steel Core in Middle Ear Surgery: One Year Audiologic and Radiologic Follow Up , Arch Otolaryng 76:303-311, 1962.Crossref 15. Lüscher, E.: Untersuchungen uber die Beeinflussung der Hörfähigkeit durch Trommelfellbelastung , Acta Otolaryng 27:250-266, 1939.Crossref 16. Lüscher, E.: Experimentelle Trommelfellbelastungen und Luftleitungsaudiogramme mit allgemeinen Betrachtungen zur normalen und pathologischen Physiologie des Schalleitungsapparates , Arch Ohr Nas Kehlkopfheilk 146:372-401, 1939.Crossref 17. Wever, E.G., and Lawrence, M.: Physiological Acoustics , Princeton: Princeton University Press, 1954, p 417. 18. Barany, E.: A Contribution to the Physiology of Bone Conduction , Acta Otolaryng , (suppl 26) , pp 96-120, 1938. 19. Kirikae, I.: The Structure and Function of the Middle Ear , Tokyo: University of Tokyo Press, 1960, pp 87-94. 20. Bekesy, G.V.: Experiments in Hearing , New York: McGraw-Hill Book Co., Inc., 1960, p 112. 21. Guinan, J.J., and Peake, W.T.: Stapes Movement in Anesthetized Cats, presented at the Eighth Annual Meeting, Committee for Research in Otolaryngology, American Academy of Ophthalmology and Otolaryngology, Chicago, Oct 17, 1964. 22. Schuknecht, H.F.: Personal communication to the author (J.T.), 1965. 23. Tonndorf, J.; Duvall, A.J.; and Voots, R.J.: Comparative Studies in Bone Conduction in Cats, Dogs, Guinea Pigs and Rats , Acta Otolaryng , (suppl 213) , pp 55-70, 1966.