Faculty Bibliography

Vocal cord paralysis may follow intracranial operation if the vagus nerve is damaged intraoperatively. If the resulting laryngeal incompetence is severe, hoarseness, dysphagia, and aspiration may develop. This is often followed by a pneumonitis requiring chronic gastric tube feeding. Teflon vocal cord injection has been shown to restore the sphincteric action of the larynx and enable patients to phonate and swallow properly again. Nine patients underwent this procedure for chronic aspiration and hoarseness. All had vagus injury attributable to antecedent intracranial operation, and all experienced relief of their symptoms with only minor complications. Teflon vocal cord injection is advocated as a safe, effective means of managing patients with aspiration and dysphagia secondary to vagus nerve injury

An implantable magnet is now available for patients who have received the standard Nucleus 22-channel cochlear implant and who are not able to wear the headband satisfactorily. This magnet is attached in piggy-back fashion to the previously implanted receiver/stimulator by means of a brief operation under local anesthesia. Two patients have received this magnet retrofit, and are now wearing the headset with greater comfort and satisfaction. It is felt that the availability of this magnet will increase patient compliance in regard to hours of implant usage

Destructive lesions of the clivus produce symptoms related to adjacent anatomic structures. Radiographic evaluation of a patient presenting with cranial neuropathies revealed a cystic lesion of the clivus, and surgical and histologic findings established a diagnosis consistent with a mucocele. There have been no previous reports in the literature describing a primary mucocele of the clivus. Appropriate treatment for these fluid-filled structures is marsupialization or exteriorization into the sphenoid sinus. A trans-septal sphenoidal approach was used in this case and is advocated as an effective means of managing cystic lesions in this area

The prognosis of metastatic thyroid carcinoma is dependent on the age of the patient, the histologic characteristics of the neoplasm, and the site of metastasis. A more favorable prognosis is found in patients less than 40 years old with follicular carcinoma and without any bony metastases. Metastatic thyroid carcinoma presenting as distal spinal cord compression is extremely rare. We report one such case and review the literature. As reported in the literature, the combination of decompressive laminectomy followed by total thyroidectomy and radioactive iodine therapy has proved to be effective in the treatment of patients with thyroid carcinoma metastatic to the distal vertebral bodies

Extrapulmonary infection with Pneumocystis carinii is rare and is usually associated with severe systemic illness. We report, in two patients, the histologic, ultrastructural, and monoclonal cell surface antibody identification of P carinii in otic polyps. Both patients had serum antibody to human immunodeficiency virus. These P carinii infections in the temporal bone are unusual in their location and in the apparent absence of associated pulmonary infection. This otologic presentation was the primary manifestation of the acquired immunodeficiency syndrome

Forty-six infants born at very-low birthweight were followed prospectively for a one-year period after their discharge from a neonatal intensive care unit. Pneumatic otoscopy was used to diagnose otitis media at periodic visits to a medical/developmental follow-up program. Twenty-one normal, full-term infants routinely cared for in a well-baby nursery served as control subjects and were followed similarly for the same time period. No difference was found between the two infant groups for the either the percentage of visits infants were considered to have normal middle ears bilaterally or otitis media unilaterally or bilaterally. Further, for the premature infants, no relationship was found between gestational age at birth, birthweight, or length of stay in the intensive care unit and percent-visits with otitis media during the first year.

For reinnervation of facial paralysis, the XII-VII nerve anastomosis provides tone and mass contraction but rarely allows selective muscle control. The efficacy of EMG rehabilitation was evaluated in 30 patients who had no coordinated control of facial muscles. EMG signals from bilateral homologous facial muscle sites were converted into computer-compatible waveform traces and displayed on a video monitor. This facilitated modification of neuromuscular responses using behavioral shaping techniques. A six-point Facial Nerve Grading Scale was introduced for hypoglossal-facial nerve anastomosis to assess the results of EMG rehabilitation. Rehabilitation lasted from 3 to 18 months. Ten patients (33%) achieved the highest possible grading (II) with symmetry and synchrony of function and spontaneity of expression; 17 (57%) reached grade III, which allowed voluntary control of eye and mouth function; 3 (10%) showed minimal gains. It is suggested that neural plasticity allows therapeutic manipulation of central facilitory and inhibitory mechanisms, and possible unmasking of neural connections between the ipsilateral VII and XII nerve motor nuclei which leads to improved facial function

Asymmetry in the auditory brain stem evoked response (ABR) and its effect on measurements of binaural interaction were studied. Monaural and binaural ABRs were recorded from 24 normal hearing subjects at two sensation levels: 70 and 50 dB. Monaural responses were judged to be asymmetrical when the right response minus the left response resulted in a difference trace which was significantly greater than the level of the background noise in the ABR. It was found that sensation level significantly affected the frequency of monaural response asymmetry and that the amplitude of the derived binaural interaction component (BIC) was positively correlated with the degree of asymmetry present. Offsetting the asymmetry by introducing an interaural intensity difference resulted in a significant reduction in the amplitude of the BIC. It was concluded that the BIC is affected by factors other than those which can be attributed solely to binaural interaction.