Faculty Bibliography

The trend toward function-conserving surgery in the treatment of squamous cell carcinoma of the head and neck has led to a progression from radical neck dissection to modified neck dissection and selective neck dissection has growing support. These surgical modifications have resulted from an effort to spare structures uninvolved with malignancy. Level V dissection can be associated with spinal accessory dysfunction in some patients even when the nerve remains intact. In this study, we have attempted to address the need for level V dissection by determining the prevalence of level V metastases in a large series of patients undergoing radical neck dissection. There were 1,123 patients who underwent 1,277 neck dissections between 1965 and 1986. A review of pathologic and clinical records revealed 40 patients (3%) with positive nodes at level V. The prevalence of level V metastases was greatest with hypopharynx and oropharynx primary tumors (7% and 6%, respectively). Level V metastases were found in 1% of patients with oral cancers and 2% of those with larynx cancers. Groups were divided into N0 (282), N+ (719), and subsequent N+ (276), depending on the clinical status at the time of surgery. Thirty-seven of 40 patients with posterior triangle metastases were clinically N+. The prevalence of metastases at level V was 1% for N0, 5% for N+, and 0% for subsequent N+. This large series shows minimal involvement of metastases at level V. The low likelihood of metastases at level V, even in N+ disease, should be considered when performing lymphadenectomy for squamous cell carcinoma of the upper aerodigestive tract

Four noise reduction methods for use in sensory aids for hearing impairment were evaluated. These include a two-microphone adaptive noise canceller, short-term Wiener filtering, a transformed spectrum subtraction technique, and sinusoidal modelling. The largest improvements in speech recognition were obtained with the two-microphone adaptive noise canceller in a moderately reverberant room. Significant improvements were also obtained for short-term Wiener filtering for some hearing-impaired subjects. The transformed spectrum-subtraction technique failed to improve performance as the front-end of a hearing aid, but yielded improvements in performance as a preprocessor for the Nucleus Cochlear Implant. Sinusoidal modelling resulted in significant improvements in signal-to-noise ratio, but without a corresponding improvement in speech intelligibility

A prospective randomized study comparing the effectiveness of triamcinolone acetonide and beclomethasone dipropionate nasal sprays in the treatment of allergic or vasomotor rhinitis was conducted at New York University Medical Center Both medications were used at their recommended dosages. Fifty patients were evaluated during a 2-month treatment period. Nasal airflow and resistance were quantified by anterior active rhinomanometry using the Rhinotest microprocessor rhinomanometer. The patients' subjective complaints were graded on a standard questionnaire. Both steroid inhalants were highly effective in relieving local symptomatology and the subjective improvement in nasal obstruction correlated with rhinomanometric assessment of the nasal airway. Triamcinolone acetonide used once daily represents an alternative to the twice daily beclomethasone dipropionate nasal steroid spray currently available for the treatment of rhinitis

Hyperbaric oxygen (HBO) promotes tissue healing by increasing oxygenation. Therefore, HBO therapy is clinically useful for some patients who have undergone major cancer resection and/or radiotherapy to the head and neck. For individual patients, however, there might be undetected viable tumor present at the time of therapy. This study was performed to determine if increased tissue oxygen had a measurable effect on the growth of squamous carcinoma xenotransplants which had been derived from head and neck cancers. After the successful growth of two well-established human squamous cell carcinoma cell lines (183 and 1483), each tumor was transplanted into 20 mice. Every mouse received four transplants of 10(6) cells. Ten mice with 40 xenotransplants in each group were treated with HBO daily for 90 minutes at a pressure of 2 atm, whereas the other 10 formed the control group. The mice transplanted with cell line 1483 were treated for 21 days; mice transplanted with cell line 183 were treated for 28 days. The tumor weight, volume, and histology were evaluated. No significant difference was found between experimental groups. This study suggests that increased tissue oxygen neither significantly increases nor decreases the growth of squamous cell carcinoma

Eosinophilic granuloma is a localized form of histiocytosis X, or Langerhans' cell histiocytosis, a benign lesion of proliferating Langerhans' cells. It is the least severe of the histiocytosis syndromes, and is characterized by lytic lesions of one or more bones. Temporal bone lesions usually occur in association with multifocal disease; however, isolated lesions may occur in either the mastoid bone alone, or in the entire temporal bone, without disease elsewhere in the body. We present the first case (to our knowledge) of eosinophilic granuloma, or unifocal Langerhans' cell histiocytosis, limited to the petrous apex. The patient, an 8-year-old girl, presented with facial nerve paralysis. Because of delay in definitive diagnosis, the disease extended beyond its original boundaries and resulted in complete destruction of the temporal bone. We will also review Langerhans' cell histiocytosis, with attention to its involvement of the temporal bone

This meta-analysis of 42 empirical studies assessed the effect of six constructs on self-esteem: hearing status, parents' hearing status, type of school attended, communication mode used at home and in school, and group identification. Differences in self-esteem between deaf and hearing people varied based on (a) the self-esteem measure and (b) its format, and (c) the communication mode in which tests were administered. People whose parents were deaf compared favorably to those whose parents were hearing, as did people whose parents used sign language at home compared to those who used oral communication. School setting and classroom communication were unrelated to self-esteem. Finally, group identification was positively related to self-esteem. Results inform recommendations for guiding hearing parents in fostering self-esteem in their deaf children

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