Faculty Bibliography

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

Speech production parameters of three postlingually deafened adults who use cochlear implants were measured: after 24 h of auditory deprivation (which was achieved by turning the subject's speech processor off); after turning the speech processor back on; and after turning the speech processor off again. The measured parameters included vowel acoustics [F1, F2, F0, sound-pressure level (SPL), duration and H1-H2, the amplitude difference between the first two spectral harmonics, a correlate of breathiness] while reading word lists, and average airflow during the reading of passages. Changes in speech processor state (on-to-off or vice versa) were accompanied by numerous changes in speech production parameters. Many changes were in the direction of normalcy, and most were consistent with long-term speech production changes in the same subjects following activation of the processors of their cochlear implants [Perkell et al., J. Acoust. Soc. Am. 91, 2961-2978 (1992)]. Changes in mean airflow were always accompanied by H1-H2 (breathiness) changes in the same direction, probably due to underlying changes in laryngeal posture. Some parameters (different combinations of SPL, F0, H1-H2 and formants for different subjects) showed very rapid changes when turning the speech processor on or off. Parameter changes were faster and more pronounced, however, when the speech processor was turned on than when it was turned off. The picture that emerges from the present study is consistent with a dual role for auditory feedback in speech production: long-term calibration of articulatory parameters as well as feedback mechanisms with relatively short time constants

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

Sicca syndrome (SS), consisting of xerostomia and xerophthalmia, may be caused by various disease processes. We present a unique case of SS secondary to primary amyloidosis. Amyloidosis is a rare but definite cause of SS and should be included in the differential diagnosis of any patient who presents with sicca symptoms. A literature review comparing amyloidotic patients with SS and patients with amyloidosis only demonstrates that both of these groups of patients present similarly with regard to symptoms. However, the majority of patients with SS present with sicca symptoms initially in addition to symptoms of amyloidosis. These SS patients also present with proteinuria and negative serology test results. Therefore, patients presenting with sicca symptoms, proteinuria, and negative serologic findings should be suspect for amyloidosis. The importance of distinguishing the diagnosis of Sjogren's syndrome from SS in these patients cannot be overemphasized. There is a significantly higher incidence of developing a lymphoma in Sjogren's syndrome patients. This has important implications for the head and neck surgeon treating these patients

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

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

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