Faculty Bibliography

We report a case involving the localization and surgical removal of a traumatically introduced foreign body deep within the infratemporal fossa. Needle-hookwire placement with computed tomographic guidance allowed the precise localization and marking of the foreign body. Surgical removal under local anesthesia and without extensive exploration was, therefore, possible. The details of the localization and marking techniques are described. Needle-hookwire localization under computed tomographic guidance should be considered for deeply located foreign bodies in the head and neck area

Eight patients with spontaneous cerebrospinal fluid leak of temporal bone origin are presented. Pertinent history and surgical findings are reviewed and contrasted with 33 previously reported patients. Unilateral ear fullness and mild hearing loss are the most common presenting symptoms. Profuse clear otorrhea following myringotomy is virtually pathognomonic. Diagnostic methods including high-resolution computed tomography, magnetic resonance imaging, and contrast cisternography are discussed. The indications for transmastoid and combined transmastoid/middle fossa surgical repairs are compared. Both surgical approaches were found to be equally effective. We favor the transmastoid as the initial approach because of simplicity, safety, and the ability to visualize both the middle fossa and posterior fossa plates as well as the middle ear

Multichannel cochlear implants currently provide the only modality for successful auditory rehabilitation of patients with bilateral profound sensorineural hearing loss who derive no benefit from amplification. We have developed a protocol for patients with neurofibromatosis and bilateral acoustic neuromas in which every effort is made to preserve hearing in at least one ear. Failing that, the cochlear nerve is spared, potentially allowing for the insertion of a cochlear implant. We present our data on one such patient whose auditory function was restored with a Nucleus mini 22-channel cochlear implant following removal of his acoustic neuroma

Glucose level was estimated in capillary blood of 16 patients, who had vasovagal syncope during exodontia with local anaesthesia. One consistent finding was the low blood sugar level in all patients during syncope, as compared with the level 1 hour after recovery. Hypoglycemia can be induced by parasympathetic activation; this may be the product of reflex conditioning. Modest lowering of blood sugar levels can also act in synergy with hypotension and hypocapnea to induce loss of consciousness. Psychogenic syncope may be mediated through a mechanism involving hypoglycemia. Reflex conditioning perhaps accounts for the small but consistent fraction of the adult population who have repeated fainting episodes

Spasmodic dysphonia has been successfully treated by thyroarytenoid muscle injections of botulinum toxin (Botox) with dosages ranging from 0.625 to 25 U. In some patients, excessive paralysis with resulting breathiness and aspiration have been noted. In order to maximize the efficiency of Botox injections, the histologic effects of various Botox dosages were examined in the dog. Nine canine thyroarytenoid muscles were injected with 0.5 to 12.5 U of Botox. After 24 hours, the recurrent laryngeal nerve to the injected muscle was electrically stimulated in order to deplete the glycogen within the muscle fibers. Frozen sections of this muscle were then stained for glycogen. Those fibers that retained their glycogen were presumed paralyzed by the Botox injection. The extent of paralysis was found to be dose-related from 1.0 to 7.5 U. At 10 U and above the muscle was completely paralyzed. Spread of the toxin to the lateral cricoarytenoid muscle was seen at doses as low as 1.0 U. Clearly, doses less than 10 U appear sufficient for clinical paralysis.

We have obtained the complete coding sequence of a highly conserved heparan sulfate proteoglycan which we previously characterized biochemically after isolation from rat brain. An open reading frame of 558 amino acids encodes a protein with a molecular mass of 62 kDa containing three peptide sequences present in the isolated proteoglycan. The total sequence obtained is 3.5 kb long, including 1.6 kb of 3'-untranslated sequence and 0.2 kb of 5'-untranslated sequence. The deduced amino acid sequence and the 3'- and 5'-untranslated sequences have 89% and 66-80% identity, respectively, with those of a phosphatidylinositol-anchored human lung fibroblast heparan sulfate proteoglycan (glypican) for which mRNA is detectable in a large number of human cell lines. Our data therefore demonstrate that this major heparan sulfate proteoglycan of brain is the rat form of glypican

This study examines the demographic, aetiological and clinico-pathological features of 37 patients with oral squamous cell carcinoma (SCC) who were less than 35 years old and a comparable number of patients who were greater than 60 years old. The study was undertaken at the Regional Cancer Centre, Trivandrum, India, between 1988 and 1990. In patients younger than 35 years old, oral SCC occurred more commonly in females, was apparent in all social classes and was associated with fewer aetiological factors. The tumours manifested predominantly as invasive lesions affecting the tongue and there was early spread to lymph nodes. By contrast, in patients older than 60 years of age, oral SCC was more common in males, occurred more frequently in social classes III and IV and was always seen in association with smoking, alcohol or pan chewing. These latter tumours presented as exophytic lesions of the buccal mucosa or gingivae and spread late to lymph nodes. The results indicate that the biological behaviour of oral SCC in young patients may be distinct from that occurring in older patients

Time series analysis of glottal airflow was carried out on 26 normal controls and 40 patients with voice disorders, using a modification of Isshiki's original technique which uses a hot-wire flowmeter, taking cycle-by-cycle fluctuations into consideration. The mean flow rate and mean AC/DC were shown to have significant differences among normal and patient groups. The standard deviations of AC/DC and AC/DC perturbation were calculated from the AC/DC value of 50 cycles and shown not to vary significantly among the normal and patient groups. The relationship between AC/DC and perceptual impression of voice was also studied among 20 selected patients with breathy voices. Using Spearman's rank correlation coefficient, this relationship was found to have statistical significance (P < .05)

Taking advantage of the extended dynamic range of digital analysis of voice the H-Index represents the first proposed acoustical measure of glottal efficiency. 'Hi' /hai/ was chosen to evaluate glottal efficiency since it provides an excellent test of glottal transformation from voiceless to voiced sound energy, the upper vocal tract having a neutral effect. Fifteen individuals with normal voices and 30 patients with hoarse voices were asked to say 'hi.' The power ratio of /h/ to /a/ was calculated from peak power of each measure from the power envelope. Voice quality had a highly significant effect on measured values (P < .001). A high degree of correlation (P < .001) was found with the AC/DC ratio, a standard aerodynamic measure of glottal efficiency. The results indicate that the H-Index represents an excellent measure of glottal efficiency, obviating the need of invasive techniques or expensive, highly specialized equipment

Hiccups (singultus) usually present as a common annoyance lasting for short periods. Rarely, they may be the harbinger of a serious disease. We present the case of a 19-year-old man in which intractable hiccups was the first and most prominent symptom of a serious underlying neurologic disorder. The patient had been examined by his pediatrician, and despite multiple medical regiments and physical maneuvers, his symptoms persisted. A thorough head and neck examination revealed a right-sided vocal cord paralysis. This finding prompted obtaining a magnetic resonance imaging scan, which demonstrated a type I Arnold-Chiari malformation associated with a large cervicothoracic syringomyelia. The patient was referred to the neurosurgical service and subsequently underwent a ventriculoperitoneal shunt placement. There was considerable initial improvement in his neurologic status and cessation of the hiccups. However, the symptoms recurred within 1 month. The case report as well as a brief review of the relevant pathophysiologic and etiologic considerations and several treatment modalities for hiccups is presented