Faculty Bibliography

Fluosol-DA 20%, a synthetic perfluorocarbon emulsion first developed as a blood substitute, is currently being investigated as a radiation sensitizer. Theoretically, an oxygen-carrying perfluorocarbon emulsion combined with oxygen inhalation might be able to increase tumor response by decreasing the relative proportion of hypoxic tumor cells. Twenty-one patients with advanced head and neck malignancies receiving primary radiation therapy were evaluated for treatment-related toxicity. Mucosal reactions and weight loss during treatment in the group of patients who received the perfluorocarbon emulsion and the group who did not were comparable. Late sequelae appeared comparable. No patient in either group who completed radiation therapy required an interruption of the treatment course. We conclude that Fluosol-DA 20% is a tolerated adjunct to primary radiation therapy. Further study is needed to determine whether the agent will improve local/regional tumor control

Nine children received the Nucleus multichannel cochlear prosthesis. The preoperative evaluation consisted of assessments of auditory function, speech recognition, linguistic skills, and speech production. There were no surgical complications, and recovery in all patients was uneventful. The device was programmed 4 to 5 weeks following surgery, and all children were conditioned to the task. Postoperative training began immediately following device stimulation and is ongoing. Auditory skills and speech production scales were devised to monitor each child's progress. All children have shown varying degrees of improvement in auditory skills and speech production using the implant alone

This study assessed the contribution of the apical hair cells to hearing. Guinea pigs, chinchillas and monkeys were behaviorally trained using positive reinforcement to respond to pure-tone stimuli. When a stable audiogram had been determined, each subject received one of three experimental treatments: ototoxic drug administration, low-frequency noise exposure, or the application of a cryoprobe to the bony wall of the cochlear apex. After post-treatment audiograms stabilized, subjects were euthanized and the percentage of hair cells remaining was assessed by light microscopy. Results indicate that a redundancy of encoding mechanisms exist in the mammalian cochlea for low-frequency stimuli. They also suggest that a very small percentage of apical hair cells are sufficient for some low-frequency hearing. Finally, data from this and other studies suggest that the low-frequency threshold shift caused by the loss of a certain percentage of apical hair cells is less pronounced than the high-frequency threshold shift caused by the loss of a comparable percentage of basal hair cells. These data agree with anatomical and electrophysiological evidence that functional as well as anatomical differences may exist between the apex and base of the cochlea.

Members of the New York Head and Neck Society conducted a multi-institutional review correlating preoperative computed tomography (CT) of the neck with postoperative pathology in 59 patients with squamous cell carcinoma of the oral cavity, pharynx, and larynx, without palpable lymphadenopathy. All underwent CT followed by surgery that included partial or complete cervical lymphadenectomy. Sixteen (28%) patients had occult cervical metastases including 6 (17%) of 36 patients with 'early stage' (T1 and T2) primary tumors and 10 (44%) of 23 patients with 'advanced' (T3 or T4) lesions. There was agreement of CT scan findings with presence or absence of metastatic disease in 41 (69%) of 59 studies, with sensitivity 38%, and with specificity 81%. Findings of central lucency and nodal confluence were highly reliable indicators of malignancy, whereas nodal size bore a less direct relationship. Intravenous contrast medium was useful for anatomical delineation, but not for identification of malignancy. Review of films by a single radiologist did not produce greater diagnostic accuracy than the original interpretations. The authors conclude that while it is not possible to identify all instances of cervical node involvement, employment of CT in addition to physical examination and prognostication based on primary tumor stage will facilitate appropriate selection of patients for elective treatment of the neck

The ability to perceive for suprasegmental and eight segmental speech pattern contrasts was measured on 16 adult cochlear implantees using the Nucleus multichannel prosthesis with either F0-F2 (n = 9) or F0-F1-F2 (n = 7) coding. The results of this study indicated the following: (1) The Nucleus device provided significant access to the majority of suprasegmental and segmental speech contrasts. (2) Both one- and two-format coding strategies provided good access to speech pattern contrasts. (3) Considerable intersubject differences in performance were observed, but there was no evidence to suggest that these were related to either processing scheme. (4) Although the accessibility of speech contrasts varied, the pattern of perceptual performance was interpreted in terms of an acoustic/phonetic hierarchy. (5) The Speech Pattern Contrast (SPAC) test appears to be a practical procedure for analyzing the perception of phonologically salient information about the suprasegmental and segmental components of speech

Homograft materials have been employed to reconstruct the tympanic membrane and ossicular chain since the mid-1960s. Although the use of homograft materials remains somewhat controversial, this technique has been shown to provide excellent long-term results, both anatomically and functionally. This study reports on the long-term results of 477 ears undergoing homograft tympanoplasty and the modification of previously reported surgical techniques