Faculty Bibliography

A case of isolated orbital lymphoma presenting as blindness is reported. An unusual feature of bone erosion is highlighted and the difficulty in the histological interpretation is discussed

Currently, awareness is growing of child abuse in the medical and lay communities. To familiarize otolaryngologists with the head and neck findings in abused children, we retrospectively analyzed 85 patients admitted to an inner-city hospital with the diagnosis of abuse or neglect. Forty-eight children (56%) had abnormalities within the head and neck region. Excluding coincidental findings, 31 children (36%) had findings that could be directly linked to physical abuse or neglect. The face was the region with the most abnormal findings in our study (25 children [30%]). Soft-tissue findings were the most numerous (27 children [32%]). The literature is reviewed on the subject of otolaryngologic manifestations of abuse.

We have investigated the development of dendritic arbors in a central auditory nucleus in the Mongolian gerbil, the lateral superior olive (LSO). The morphology of these arbors has been shown to vary with tonotopic position in adults, with high frequency neurons having a more restricted field. In the present study, qualitative observations were made on horseradish peroxidase-filled neurons from animals 1-11 days postnatal, and quantitative results were obtained from Golgi-impregnated material from animals 10 days postnatal and older. The tonotopic position of each cell was computed as a percent of the total distance along the LSO. The dendritic arbors of high frequency neurons became spatially constrained along the frequency axis during the 3rd postnatal week, while those in the low frequency region retained a broader arborization into adulthood. This refinement was correlated with a decrease in total dendritic length and the number of branch points per neuron, particularly in the high frequency projection region. The distribution of octave bandwidths to which single LSO neurons responded in 13-16 day animals showed a similar course of maturation across the tonotopic axis: high frequency neurons responded to a larger number of octaves, and with greater variability, than those in adults. These data suggest that a specific alteration in dendrite morphology, which occurs after the onset of response to airborne sound, may contribute to adult frequency selectivity

Acoustic parameters were measured for vowels spoken in /hVd/ context by four postlingually deafened recipients of multichannel (Ineraid) cochlear implants. Three of the subjects became totally deaf in adulthood after varying periods of partial hearing loss; the fourth became totally deaf at age four. The subjects received different degrees of perceptual benefit from the prosthesis. Recordings were made before, and at intervals following speech processor activation. The measured parameters included F1, F2, F0, SPL, duration, and amplitude difference between the first two harmonic peaks in the log magnitude spectrum (H 1-H2). Numerous changes in parameter values were observed from pre- to post-implant, with differences among subjects. Many changes, but not all, were in the direction of normative data, and most changes were consistent with hypotheses about relations among the parameters. Some of the changes tended to enhance phonemic contrasts; others had the opposite effect. For three subjects, H 1-H2 changed in a direction consistent with measurements of their average air flow when reading; that relation was more complex for the fourth subject. The results are interpreted with respect to: characteristics of the individual subjects, including vowel identification scores; mechanical interactions among glottal and supraglottal articulations; and hypotheses about the role of auditory feedback in the control of speech production. Almost all the observed differences could be attributed to changes in the average settings of speaking rate, F0 and SPL, which presumably can be perceived without the need for spectral place information. Some observed F2 realignment may be attributable to the reception of spectral cues

Sinusitis in the immunocompromised person can be a fulminant or even fatal illness. Aggressive treatment with intravenous antibiotics and surgery is often warranted. We report 13 cases of sinusitis in immunocompromised patients who, having failed medical treatment, required surgical management of their sinus disease. Among the patients whose sinuses were cultured intraoperatively, 63% grew Staphylococcus aureus. Most of the patients showed improvement in their infections, and none had complications of surgery

Fourteen children and three adults, each congenitally and prelinguistically deaf, received the Nucleus multichannel implant. All underwent extensive evaluations and rehabilitation. The surgery was uneventful, and no patients have been lost to follow-up. Results have shown a significant increase in auditory and speech reception and perception skills in all children. Some children have open-set speech recognition using the prosthesis alone. The adults have shown an increased awareness of sound along with minimal improvement in perceptual skills. This supports the concept that early implantation of congenitally and prelinguistically deaf individuals results in improved performance

The retrosigmoid technique has evolved from the traditional suboccipital operation and, when combined with removal of the posterior wall of the internal auditory canal, affords a wide exposure of the cerebellopontine angle. This approach may be used for acoustic neuromas of all sizes, from intracanalicular to more than 4 cm from the porus acusticus. Hearing preservation may be attempted and is generally successful in a substantial minority of cases. The facial nerve is readily visualized at the lateral end of the internal auditory canal and is at no greater risk than in the translabyrinthine operation. We use this approach for all hearing preservation surgery as well as for tumors of more than 3 cm, regardless of hearing

Although adenoid cystic carcinoma may be found in multiple sites in the head and neck as well as other glandular sites throughout the body, nowhere is management of the disease more controversial than in the parotid gland. Here the facial nerve is at risk from both the disease and the treatment. Seventy-five cases of adenoid cystic carcinoma of the parotid were analyzed. Patients were placed in four groups, depending on the type of parotid surgery received as definitive therapy: (1) lateral lobectomy, (2) total parotidectomy, (3) radical parotidectomy without preoperative facial weakness, and (4) radical parotidectomy with preoperative facial weakness. Patients were assessed with regard to staging of the initial lesion, the status of surgical margins, and the use of postoperative radiotherapy. The incidence of local recurrence and distant metastases were also recorded. Survival statistics are presented for each group. Though associated with facial nerve sacrifice, radical parotidectomy appears to offer clear advantages in terms of long-term disease-free survival in patients with T2 and T3 lesions. The residual facial paralysis may be rehabilitated primarily or secondarily to reduce patient morbidity. Four of 16 patients (25%) with preoperative weakness achieved 10-year survival when radical parotidectomy was used. Obtaining clear margins at the initial setting appears to offer improved survival.

We are interested in the trophic influence of inhibitory synaptic transmission during neuronal maturation. The morphology of dendrites in the gerbil lateral superior olive (LSO) was examined following pharmacological blockade of glycine receptors during postnatal development. The normally occurring change in dendrite morphology during the third postnatal week was prevented. Dendrites had a significantly greater number of branch points, and their arbors were more spread out along the frequency axis in the region of LSO where glycine receptor density is greatest. An identical result has recently been obtained when the glycinergic projection to the LSO was functionally denervated during development. We conclude that glycinergic transmission modulates the maturation of dendrite form during development

DPH may result in protean head and neck manifestations (Table 1). In some cases these effects are dose related and in others they appear to be idiosyncratic; some occur only at toxic levels (Table 2). Many of the conditions are reversible and withdrawal of DPH or re-establishment of therapeutic levels is the only treatment necessary. Failure to recognize this fact can result in expensive workups or, worse, in aggressive treatment, both of which are unnecessary. The otolaryngologist should therefore be aware of these conditions and consider them in the differential diagnosis