Faculty Bibliography

Merkel cell carcinoma (MCC) of the skin is an uncommon, but highly aggressive neoplasm with a marked propensity for local and distant metastasis. Despite the fact that more than half of the 600 cases of MCC reported in the literature involved primary sites in the head and neck, MCC has rarely been discussed in otolaryngology publications. We present five new cases of MCC of the head and neck and summarize 89 additional cases from the literature in which detailed treatment and survival data were given. Our findings again emphasize the difficulty in making the initial histopathologic diagnosis of MCC and demonstrate the necessity of early diagnosis and multimodality treatment.

The goal of cochlear implant surgery is to insert the entire electrode array into the scala tympani. Incomplete insertion is usually attributable to the presence of new bone formation as a result of meningitis. Surgical techniques for dealing with obstruction include various degrees of drilling of the cochlea or alternative placement of the electrode array. We evaluated the postoperative performance of eight such patients implanted with the Nucleus multichannel cochlear implant at NYU Medical Center as well as data from adults and children nationwide. Scores ranging from marginal closed-set speech discrimination to 40 percent on open-set speech recognition tests were obtained. Surgical procedure, placement, and number of electrodes as well as number of channels in use affect the ultimate performance of these patients

Increasing experience with cochlear implantation has led to the identification of potential surgical pitfalls: improper patient selection, poor flap design and handling, facial nerve injury, improper electrode placement, and improper seating of the receiver stimulator. Each of these areas of potential difficulty are reviewed, emphasizing methods of avoidance and management of adverse outcome

BACKGROUND: Today's children will participate in a society whose economic basis will be information and communication and they must have optimal communication skills to be able to be functional optimally within the information society. Heretofore, in the United States, there has been no systematic attempt to diagnose and care for children with communication disorders. METHODS: It is essential that the child be diagnosed early because there appears to be a critical period for language development. CONCLUSION: If interventions do not occur early, in the area of communication disorders, there is a high probability of significant morbidity because of impaired communication abilities. This morbidity can manifest itself in a social activity and loss of economic opportunity.

Several lines of evidence suggest that excitatory synaptic transmission contributes to the maturation of precise neuronal connections. In the present study we determined whether the specific innervation pattern of single inhibitory arborizations was dependent upon neuronal activity during development. A homogeneous group of glycinergic inhibitory neurons in the central auditory system, the medial nucleus of the trapezoid body (MNTB), was functionally denervated in neonatal gerbils. The anatomical specificity of single MNTB terminal arborizations was subsequently measured along the tonotopic axis of a postsynaptic target, the lateral superior olive. Here we demonstrate that inhibitory terminal boutons spread a significantly greater distance along the frequency axis of the postsynaptic target following functional denervation. Although total arbor length remained unchanged, there was a significant increase in the number of branch points, suggesting de novo sprouting. The results indicate that normal inhibitory synaptic activity contributes to the developmental refinement of specific neuronal connections

The development of inhibitory synaptic transmission is difficult to assess because the afferents usually arise from intrinsic neurons that are difficult to stimulate independently. The postnatal maturation of excitatory and inhibitory synaptic function was compared in the gerbil lateral superior olive (LSO), where it is possible to stimulate physically discrete afferent projections. Intracellular recordings obtained in a brain slice preparation revealed that transmission was prominent at birth. The EPSPs and IPSPs were up to 2 orders of magnitude longer than in more mature animals. Brief trains of electrical stimulus pulses led to a temporal summation of postsynaptic potentials (PSPs) in 1-14 d animals resulting in prolonged depolarizations or hyperpolarizations. In neonates, the depolarization could exceed 1 sec following a 70 msec stimulus train. The IPSPs in neonates were often of sufficient amplitude to evoke a rebound depolarization or action potential. The number of converging afferents was estimated from the quantized increases in PSP size. There was a significant decrease with age, suggesting that both inhibitory and excitatory afferents were eliminated during the first 3 postnatal weeks. The integration of action potentials with IPSPs was examined with conjoint stimuli to the two afferent pathways, and demonstrated that the effective IPSP duration decreased approximately 20-fold during the first 3 postnatal weeks. The magnitudes and durations of electrical stimulus-evoked PSPs suggest that spontaneous discharge of afferents to the LSO could have a substantial impact on their development, even prior to the response to airborne sound at 12 d. Furthermore, the synaptic responses obtained at 12-14 d postnatal indicated that both amplitude and temporal processing remain compromised. These immature synaptic properties would be expected to compound the inadequacies present in the cochlea and cochlear nucleus