Faculty Bibliography

Cerebrovascular disease is a major cause of death in patients with end-stage renal disease, particularly in those with diabetes mellitus. Cardiac disease frequently presents itself atypically in diabetic patients. This awareness has led to earlier detection and treatment of cardiac disease in diabetic patients. Whether cerebrovascular disease may also present itself in a highly atypical fashion in the diabetic patient with end-stage renal disease has never been addressed. We report the case of a diabetic hemodialysis patient who had an extremely unusual manifestation of stroke. A 67-year-old diabetic hemodialysis patient had marked distress secondary to the sudden onset of a foreign body sensation in the oropharynx. Results of a laryngoscopy were negative; x-rays of the neck and computerized tomography of the head and neck showed no abnormalities. Neurologic evaluation revealed an inability to detect oropharyngeal stimuli and an absent gag reflex but no other deficits. Magnetic resonance imaging of the brain revealed an infarction in the left corona radiata that extended to the thalamocapsular region and external capsule, and a lacunar infarct in the right pons. Cerebrovascular disease in the diabetic patient with end-stage renal disease may present itself atypically, and we suggest that cerebrovascular disease in these patients merits the same level of suspicion as cardiac disease

Traditionally surgeons have avoided performing rhinoplasty in conjunction with sinus surgery for rhinosinusitis. With advances in rhinoplasty and endoscopic sinonasal surgery and its added benefits of precision, minimal trauma, and hemorrhage, the combined procedure is now feasible. The indications, management, and results are discussed in 40 patients who underwent the combined procedure. Patients were divided into three categories based on the location and severity of the sinus disease: mild, moderate, or severe. The majority of patients had mild or moderate sinus disease. The most common presenting symptoms were nasal obstruction and postnasal drip. All patients had a history of sinusitis recalcitrant to conservative medical management. Results demonstrate the combined treatment modality to be safe and effective in patients with mild to moderate sinus disease and in selected patients with severe sinus disease

Expressive language skills were assessed in two groups of prelingually-deafened children using the Reynell Developmental Language Scales (RDLS). Results from a group of 89 unimplanted subjects provided cross-sectional data which suggested that profoundly deaf children without implants, on average, could only be expected to make 5 months of expressive language growth in one year. Twenty-three children who received cochlear implants made up the second group of subjects and were administered the RDLS at three intervals: preimplant, 6-, and 12-months postimplant. The scores obtained at the post-implant intervals were then compared to scores that would be predicted on the basis of maturation alone, without the implant (these predictions were formulated based on the data obtained from the unimplanted subjects). At the 12-month postimplant interval, the observed mean language score was significantly higher than the predicted score. Although the mean group data were extremely encouraging, wide inter- subject variability was observed. Although the implant subjects, as a group, were substantially delayed compared with their normal hearing peers, their rate of language growth was found to match that of hearing peers, following implantation. Thus, the gap between chronological age and language age, which normally widens over time in deaf children, remained constant. Preliminary analyses over the first 2.5 years post-implant are consistent with this trend. These results suggest that early implantation (before age 3) might be beneficial to profoundly deaf children because the language delays at the time of implantation would be much smaller

This study investigates the relationship between rough voice and the presence of subharmonics, which correspond to smaller yet distinct peaks located between two consecutive harmonic peaks in the power spectrum. Spectrum analysis was undertaken in 389 pathologic voices, of which 20 had subharmonics. Although all 20 voices had roughness perceptually, 8 had normal jitter and/or shimmer. The degree of roughness had a significant inverse relationship with the frequency of subharmonics. By digital signal processing, sound samples with various types of subharmonics were synthesized and perceptually analyzed. Power and frequency of subharmonics in the synthesized sound also had significant relationships with the degree of roughness. Rough voice is acoustically characterized not only by jitter and shimmer but also by the presence of subharmonics in the power spectrum. Subharmonics are important acoustic properties for objective evaluation of rough voices

HYPOTHESIS: The hypothesis tested in this article is that if cholesteatomas are a low-grade squamous cell neoplasm, then evidence of genetic instability, in the form of abnormal or aneuploid amounts of DNA, should be evident. BACKGROUND: Cholesteatoma is a destructive lesion of the middle ear and/or mastoid process that produces complications by erosion of the temporal bone. The clinical hallmarks of cholesteatomas, namely invasion, migration, uncoordinated proliferation, altered differentiation, aggressiveness, and recidivism, are traits typically associated with the neoplastic cell. However, there is little evidence to support or refute the speculation that cholesteatomas are a low-grade squamous cell neoplasm. the existence of defects in the genetic complement of the major cellular constituents comprising a cholesteatoma, fibroblasts and keratinocytes, would support the speculation that cholesteatomas are a neoplasm, since cancers commonly manifest quantitative and qualitative alterations in the normal euploid complement of genetic information, resulting in a cell that has an abnormal or aneuploid amount of DNA. METHODS: DNA content (ploidy) within cholesteatoma tissues was measured by flow cytometry and image analysis. RESULTS: The DNA content of 11 human cholesteatomas and nine postauricular skin specimens was analyzed using flow cytometry, while the DNA content of 10 cholesteatoma specimens was analyzed using image analysis. Interpretable data was obtained from 10 cholesteatoma specimens and six postauricular skin specimens. One cholesteatoma specimen demonstrated an abnormal aneuploid DNA content, whereas the remaining nine cholesteatomas and the six postauricular skin specimens demonstrated a normal euploid DNA content. CONCLUSIONS: We conclude that, due to the lack of overt genetic instability, as evidenced by the presence of a normal euploid DNA content, cholesteatomas are not low-grade neoplasms

OBJECTIVE: To address the surgical and habilitative issues raised by cochlear implantation in children with cochlear dysplasia. STUDY DESIGN: The English-language literature is reviewed and the New York University Medical Center experience with three patients is detailed. Two hundred institutions performing cochlear implants were queried by questionnaire. SETTING: Hospitals performing cochlear implantation. PATIENTS: Pediatric patients with a cochlear implant in an ear with a dysplastic cochlea. MAIN OUTCOME MEASURES: Preoperative computed tomography analysis of cochlear anatomy was compared with operative findings, complications, and postoperative device use. RESULTS: Facial nerve anatomy was anomalous in 16% of patients, and there were two surgical injuries. There were no cases of meningitis. All patients who received multichannel implants derive benefit and wear their devices. CONCLUSIONS: All degrees of cochlear dysplasia, ranging from incomplete partition to common cavity, can be safely implanted and auditory responses expected

By a focus on three essential elements of language: phonology, semantics, and syntax, a time frame for critical/sensitive periods of language development is presented as a model of central auditory nervous system flexibility. Several studies support the hypothesis that the critical/sensitive period of phonology is from the 6th month of fetal life through the 12th month of infancy. Data indicate that the critical/sensitive periods for syntax run through the 4th year of life, and for semantics through the 15th or 16th year of life. The data indicate that there is a time dependent series of functions in sequence that is based on responsive adaptations made by the CNS to pyschophysical and electrophysiological stimuli.

A high jugular bulb is often discovered as an incidental finding that is asymptomatic. Conductive hearing loss in association with this anomaly may occur, but has been reported infrequently in the literature. We report five cases of high jugular bulb and associated conductive hearing loss. Mechanisms to explain the conductive hearing loss include contact of the jugular bulb with the tympanic membrane, interference with the ossicular chain, and obstruction of the round window niche. The operative findings, radiographic and audiometric data that support these mechanisms of conductive hearing loss are presented.

Six profoundly deaf patients were studied with mapping evoked potentials (MEP) using an acoustic signal passed through the vibrotactile prosthesis. This stimulus produced an activation of the central sulcus brain cortex. When the proSthesis was placed in the presenternal area it showed N1 P1 potentials with higher voltage and a more defined cortical dipole inversion than when the prosthesis was placed in the arm or abdomen: thus the presternal stimulation is considered an adequate place for the use of vibrotactile stimulation. The MEP were recorded in 2 patients after a period of audiological training and they showed new earlier potentials. These suggest plastic changes in the processing of an acoustic signal sent from the presternal skin by the somatosensory pathway after training and involving learning procedures.