Faculty Bibliography

This paper includes an overview of the research on late-onset auditory deprivation, an evaluation of the evidence from retrospective and prospective studies, recommendations for future research, and a consideration of the theoretical and clinical implications of the research. The studies reviewed offer convincing evidence of the late-onset auditory deprivation effect both in groups of listeners and in substantial numbers of individual listeners included in the group studies. The effect appears to be reversible in some cases with the use of amplification in the previously unaided ear. This preliminary evidence supports the recommendation of binaural amplification for persons with bilateral symmetric sensorineural hearing loss. There is much that is still unknown about the deprivation effect and recovery from deprivation. Longitudinal prospective studies are needed to obtain a better understanding of the role of subject-related variables and amplification-related variables on the magnitude and time course of the deprivation effect. Behavioral and electrophysiologic measures of monaural and binaural performance using speech and nonspeech stimuli would also further our understanding of the mechanisms underlying late-onset auditory deprivation

In a previous study, fluorescence labeling of a plasmalemmal ATPase protein with the 5F10 monoclonal antibody revealed prominent antigen in the cerebellar molecular layer surrounding the somata and dendrites of Purkinje cells. In the present study, this antibody labeled with silver enhanced nano-sized gold particles on semithin plastic sections revealed a clearly demarcated plasma membrane outlining the somata and entire dendritic arbors of Purkinje cells including their spines. Ultrastructural analysis of horseradish peroxidase preparations showed reaction product along the plasmalemma and extending on to the sub-plasmalemmal endoplasmic reticulum. In the granular layer, somata of granule cells were reactive, as were their dendritic extensions into glomeruli where reactive claws surrounded voids formed by mossy fiber rosettes. Somata and dendrites of cerebellar nuclear cells also had reactive zones that were limited to the plasma membrane and a narrow zone of the sub-plasmalemmal endoplasmic reticulum. Comparative labeling of this protein and P channel protein revealed similar plasmalemmal locations. This study shows that a specific calcium ATPase pump protein is located on the plasmalemma of certain types of cerebellar neurons. The ultrastructural distribution of calcium pump and P channel antibodies occurred in punctate sites along the plasma membrane of dendrites and spines of Purkinje cells. The close association between P-type calcium channels and the plasma membrane calcium pump is consistent with rapid extrusion of intracellular calcium from neurons endowed with large numbers of voltage-gated calcium channels

The predictive value of intraoperative stimulation thresholds for facial nerve function, using a constant-current system, was examined in 49 patients undergoing resection of cerebellopontine-angle tumors. Immediately after surgery, 75% of the 0.1-mA threshold group, 42% of the 0.2-mA group, and 18% of the 0.3-mA or greater group had good (grade I or II) facial nerve function. One year after surgery, 90% of the 0.1-mA group, 58% of the 0.2-mA group, and 41% of the 0.3-mA or greater group had grade I or II function. A statistically significant breakpoint of 0.2 mA was found to predict good postoperative facial function. Delayed facial paralysis occurred in 22% of patients, but the prognosis for these patients was favorable. Both current stimulation threshold and duration are necessary for a meaningful comparison of data between investigators

Neuron survival and axonal regeneration become severely limited during early postnatal development. In conjunction with our recent organotypic analysis of regeneration in the auditory midbrain, we wished to determine whether neurotrophins could serve as a trophic substance during the postnatal period. Therefore, the current study examines the development of three neurotrophin receptor tyrosine kinases (TrkA, TrkB, and TrkC) in the gerbil auditory brainstem. Immunoreactivity to TrkA, the nerve growth-factor receptor, was observed in nonneuronal cells during the first two postnatal weeks. In the cochlear nucleus of mature animals, however, there was a TrkA-positive neuronal subpopulation. In contrast, immunoreactivity to TrkB and TrkC (the receptors for brain-derived neurotrophic factor and neurotrophin-3, respectively) displayed a widespread distribution in the auditory brainstem. At postnatal day 0, TrkB and TrkC staining was virtually absent from auditory nuclei, although immunopositive neurons were present in the mesencephalic trigeminal nucleus. By postnatal day 7, TrkB- and TrkC-positive neurons were present in most brainstem auditory nuclei. At postnatal day 15, TrkB immunoreactivity was observed throughout the inferior colliculus (IC), the cochlear nucleus, the medial and lateral nuclei of the trapezoid body, and the lateral superior olive, whereas TrkC labeled only a subpopulation of neurons within the central nucleus of the IC. The TrkB immunoreactivity was present on both neuronal somata and dendrites, whereas TrkC was generally restricted to cell bodies. At postnatal day 30, TrkB immunostaining was observed on most neurons of the IC. The medial and lateral nuclei of the trapezoid body displayed extremely strong TrkB staining, followed by the cochlear nucleus. In contrast, the TrkC immunostaining was decreased dramatically by postnatal day 21. Observations at the ultrastructural level confirmed a neuronal localization of TrkB and TrkC. Immunostaining for both receptors was restricted largely to the postsynaptic density of synaptic profiles in both dendrites and somata. In summary, this study illustrates a differential pattern of immunoreactivity between three neurotrophin receptors during development. The general increase of TrkB expression is well correlated with the onset of sound-evoked activity in this system, and its synaptic localization suggests that it may be involved in the modulation or maintenance of postsynaptic physiology

The goal of surgical medialization of the vocal fold is to attain complete glottic closure. The purpose of this study is to quantify the glottal gap and to examine the relationship between glottal gap and vocal function perioperatively in thyroplasty type I. Glottal gap area was measured in 20 patients at the point of maximum closure of vocal fold vibration in digitized laryngeal stroboscopic images and was normalized by the square of vocal fold length. Glottal gap area thus measured was correlated with results obtained from well-accepted acoustic, aerodynamic, and perceptual measures of vocal function. The glottal gap was significantly reduced after thyroplasty type I. In patients with small preoperative glottal gaps, the amplitude of vocal fold vibration was significantly improved. This study verifies that quantitative videostroboscopic measurement of the glottal gap is a useful means of objective evaluation of glottic incompetence and of the results of thyroplasty type I

We are creating a bank of EBV immortalized lymphoblast cells and extracted DNA taken from the blood of deaf children and their relatives, in order to study the molecular basis of hereditary deafness. We have established a corresponding database for sensorineural hearing loss that records clinical data for each entered specimen. The purpose of this paper is to present the content and design of the computerized relational database. The data model is designed first to identify known etiologies of deafness, either acquired or syndromic, and then to characterize the clinical features of the deaf individual, and both their affected and non-affected family members. The application operates in a graphical environment of visual prompts and message panels. The database is organized by sections which record demographic data, presenting complaints, otologic history, birth and perinatal history, developmental history, symptoms of chronic airway obstruction, family history, neurologic history, congenital infections, hospitalizations and surgical history, medication history, vestibular findings, audiometry, radiology, medical conditions and syndromes and physical examination. The database was developed on a commercially available software product. Our database is presented as a model for use by other clinicians and investigators

Two of the most significant developments in neurosurgery over the past ten years have been the application of intraoperative navigational units and the widespread use of 'skull base' surgical techniques. These developments have independently revolutionized the way in which neurosurgeons approach intracranial pathology. The combination of these two developments has had a profound effect in our clinical practice to improve outcome and extend our capabilities. This ability to see around the corner, 'x-ray' vision as some have called it, provides an added measure of safety for the patient while allowing the surgeon to treat the lesion in a more aggressive fashion