Faculty Bibliography

We studied the extrusion rate of Paparella type I tympanostomy tubes in the anterosuperior quadrant compared to those placed in the anteroinferior quadrant in a prospective study. Thirty-five patients were evaluated. The duration (mean +/- SEM) in the anteroinferior quadrant was 211 +/- 18 days, whereas the duration in the anterosuperior quadrant was 211 +/- 11 days. We conclude that placement in the anterosuperior quadrant does not prolong duration of these tympanostomy tubes

Digital technological advances have made detailed voice analysis possible. This report proposes, with the use of such equipment, a new method of quantifying differences in the high-frequency content of normal and breathy voices. The high-frequency power ratio, a ratio of high-frequency power versus total power, was calculated as the lower limit of the high-frequency range (Fc) and varied from 1 to 10 kHz. The high-frequency power ratio values of two groups, 16 normal and 24 breathy voice individuals, were then compared. Three breathy individuals were also studied after type I thyroplasty. High-frequency power ratio values measured at an Fc of 6 kHz significantly separated normal from breathy voices. The specifications provided are appropriate for both the commercial voice lab and for clinical resources. Furthermore, a high-frequency power ratio (6 kHz) is a useful tool for the evaluation of phonosurgery

This study examines the histologic and biochemical features of wound healing in a cleft lip model in the mid-third-trimester fetal rabbit. At days 1, 2, and 4 after the procedure, control, unrepaired, and repaired fetal heads were obtained, sectioned, and stained for histologic examination. The localization of hyaluronic acid in the wound was documented using a cartilage-derived hyaluronic acid-binding protein. In both repaired and unrepaired wounds, the fetal cleft healed without inflammatory cell infiltration or scar formation. Six months after birth, the repaired cleft showed complete regeneration of muscle across the wound and the collagen fibers were of normal density and orientation. Decreased hyaluronic acid deposition was observed in unrepaired clefts as compared with adjacent tissue; no such difference was detected in repaired clefts. Our findings support the hypothesis that a cleft lip repaired in utero heals without the scarring that accompanies postnatal repair. This may explain the lack of maxillary growth restriction after in utero cleft lip repair.

Ten patients over sixty years of age with no history of tobacco or alcohol use were treated for squamous cell carcinoma of the upper aerodigestive tract between 1979 and 1991. Nine of these ten patients were women with lesions confined to the oral cavity and oropharynx. Modes of treatment included surgery, radiation, or a combination of surgery and radiation. Followup from 1 to 10 years revealed two deaths from local and distant spread, and eight patients with no evidence of disease. Recurrences after treatment were aggressive and occurred within the same region as the primary lesion. Although most patients with upper aerodigestive squamous cell carcinoma are men with alcohol and/or tobacco exposure, this study demonstrates findings consistent with field cancerization in a group of older women with no risk factors

The effects of peripheral conditioning stimuli on the thresholds of the jaw opening reflex (JOR) and of trigeminal brain stem neurones to tooth pulp stimulation were examined in chronically prepared, anaesthetized cats. High intensity electrical conditioning stimuli applied to the ipsilateral forepaw produced an increase in the thresholds of both responses, with the JOR thresholds being elevated significantly more, and remaining elevated for significantly longer, than those of the neurones. These findings suggest that the elevation of the JOR cannot be explained just by inhibitory effects on the brain stem neurones

Lower tracheal and endobronchial lesions represent a difficult management problem. While there has been some success in the treatment of these lesions with the carbon dioxide laser, the limitations of its delivery system have restricted its use in infants and neonates. The potassium titanyl phosphate (KTP) laser, transmitted via a flexible quartz fiber, can be precisely manipulated even through rigid pediatric bronchoscopes as small as 3.0 mm. In addition, the Hopkins telescopic lens may be used to improve visualization and control. We report our experience using the KTP laser to treat 15 pediatric patients with tracheal and endobronchial lesions. The nature of the lesions, the details of the technique, and the results are presented

Necrotizing bacterial infections that occur in the head and neck are exceedingly rare and are often associated with a group A beta-hemolytic streptococcus (Streptococcus pyogenes). The disease is associated with soft tissue necrosis and vascular thrombosis. There appears to be an increasing incidence of hyperaggressive beta hemolytic streptococcal infections associated with high mortality rates. We report the survival of an otherwise healthy patient who developed a flu-like illness followed by a rapidly progressive toxic systemic illness associated with subtotal facial soft tissue necrosis down to bone. The recent literature related to this necrotizing bacterial infection is reviewed. Otolaryngologists must be aware of this entity since survival depends upon aggressive early wound management and high-dose intravenous antibiotics

The stria vascularis in the C3H/lpr autoimmune strain mouse was ultrastructurally examined in order to better understand the potential mechanisms by which systemic autoimmune disease affects the ear. The inner ear from C3H/lpr mice before disease onset and C3H/HeJ controls showed no apparent pathology. However, the stria vascularis from older C3H/lpr mice after systemic autoimmune disease onset showed considerable intercellular edema around the stria capillaries and thickening of the capillary basement membrane, compared to controls. These observations suggest that perivascular abnormalities, which are the hallmark of systemic autoimmune diseases, may underlie the stria dysfunction and hearing loss seen in autoimmune diseases in humans.