Faculty Bibliography

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

The purpose of this longitudinal study is to document improvements in speech intelligibility in children who have received multichannel cochlear implants, to compare their performance to that of a matched group of children with different levels of hearing loss who use conventional hearing aids. Speech intelligibility was measured by panels of listeners who analyzed recorded speech samples preimplant and at 6-month intervals following implantation. The results of this study demonstrate that prelingually deafened children with the Nucleus multichannel cochlear implant achieved significant improvements in speech intelligibility. By the 4.5- to 7.5-year intervals, the speech intelligibility exceeded 40%. $$:

English-language skills were evaluated in two groups of profoundly hearing-impaired children with the Reynell Developmental Language Scales, Revised. The first group consisted of 89 deaf children who had not received cochlear implants. The second group consisted of 23 children wearing Nucleus multichannel cochlear implants. The subjects without implants provided cross-sectional language data used to estimate the amount of language gains expected on the basis of maturation. The Reynell data from the group without implants were subjected to a regression by age. On the basis of this analysis, deaf children were predicted to make half or less of the language gains of their peers with normal hearing. Predicted language scores were then generated for the subjects with implants by using the children's preimplant Reynell Developmental Language Scale scores. The predicted scores were then compared with actual scores achieved by the subjects with implants 6 and 12 months after implantation. Twelve months after implantation, the subjects demonstrated gains in receptive and expressive language skills that exceeded by 7 months the predictions made on the basis of maturation alone. Moreover, the average language-development rate of the subjects with implants in the first year of device use was equivalent to that of children with normal hearing. These effects were observed for children with implants using both the oral and total-communication methods

BACKGROUND: This study defines the clinical settings in which extended radical neck dissection (ERND) was performed and determines its impact on control of disease in the neck and on survival. METHODS: We reviewed the records of 106 patients undergoing ERND between 1984 and 1993. Most (76) had metastatic squamous cell carcinoma (SCC) that had extended to extranodal structures in the upper neck. RESULTS: Five-year disease-free survival was 39%, and disease was controlled in the neck in 72 patients (68%) with a median follow-up of 5.5 years. A trend toward better survival was seen in patients with SCC (47% at 5 years), compared with those with other histologies (24% at 5 years; P <0.12). Patients with levels I, II, or III involved had better survival (46% at 5 years) than those with level IV, V, or multiple levels involved (14% at 5 years; P <0.0088). Finally, when prior radiation therapy precluded additional irradiation of the neck, survival was only 22% at 5 years, compared with 47% for those who received postoperative radiation (P <0.017). CONCLUSIONS: Although advanced neck disease invading adjacent structures remains an ominous sign, neck control and 5-year survival were achieved in nearly one half of these patients when multimodality therapy was possible

The pathobiology of salivary neoplasms can best be studied in a model system that reflects the native state of the tumor. The present study describes the use of a three-dimensional collagen gel (organoid) system in which pleomorphic adenomas of the parotid gland were propagated in vitro. Five pleomorphic adenoma cultures were established as organoid gels and compared with touch-preparations or cryopreserved specimens of native tumor. The organoid cultures demonstrated normal DNA content, the expression of myoepithelial cell proteins, and the production of sulfated acid mucins; these cellular and secretory features mimicked those found in the archival specimens. Further, organoid cultures of pleomorphic adenoma could be initiated after monolayer culture, demonstrating that culture on a plastic support does not alter the nature of the cells. Development of an in vitro culture system that maintains the native state of pleomorphic adenoma is an important tool for studying the pathobiology of these tumors

The gamma band response (GBR) is a predominantly exogenous, sinusoidal evoked response that occurs usually between 20 and 130 msec following stimulus onset. This response is believed to represent the synchronization of neuronal assemblies that serve auditory feature integration. The objective of the present investigation was to describe the characteristics of the scalp-recorded auditory evoked gamma band potential (aeGBP) recorded from normal young adult subjects. Results showed the aeGBP to consist of up to four oscillations and were best recorded at the frontal-central midline. The aeGBP was present 80 percent to 100 percent of the time, appeared as onset responses, and was recorded at the shortest latency over the contralateral anterior temporal scalp

Decreased excitatory synaptic activity during development often leads to pre- and postsynaptic atrophy, as assessed anatomically. The present study considers the effect of decreased excitatory transmission on the maturation of synaptic strength. Towards this end, cochlear nucleus neurons, which project to the ipsilateral lateral superior olive (LSO), were denervated in gerbils at postnatal day 7, before the onset of hearing. This manipulation was intended to disrupt spontaneous glutamatergic transmission in the LSO while sparing the glycinergic afferents from the medial nucleus of the trapezoid body (MNTB). Afferent-evoked synaptic activity was assessed 1-6 days after ablation in a brain slice preparation using whole-cell current- and voltage-clamp recordings. In control animals, ipsilaterally evoked excitatory postsynaptic potentials (EPSPs) were present in 91% of neurons tested, but were observed in only 60% of neurons following cochlea removal. The maximum EPSP amplitude was significantly smaller in manipulated neurons compared with controls, and this was accompanied by a higher incidence of ipsilaterally evoked inhibitory postsynaptic potentials (IPSPs). To study the efficacy of excitatory synapses in greater detail, voltage-clamp recordings were made in the presence of strychnine and AP-5 [D(O)-2-amino-5-phosphonopentanoic acid]. The minimum excitatory postsynaptic current (EPSC) amplitude, presumed to reflect the efficacy of a single glutamatergic afferent, was approximately 40% smaller in manipulated neurons. In contrast, MNTB-evoked IPSPs were similar in neurons from control and ablated animals. However, manipulated neurons often exhibited a rebound depolarization after a hyperpolarizing current pulse or an afferent-evoked IPSP. In 70% of manipulated neurons, synaptically evoked rebound depolarizations were reduced, but not eliminated, by glutamate receptor antagonists. The glycine receptor antagonist strychnine did eliminate the IPSP-associated depolarization in these neurons. Collectively, these results suggest that functional denervation of excitatory afferents decreases their synaptic efficacy as result of both cell loss as well as decreased strength of individual surviving synapses