Faculty Bibliography

The relationship among otitis media, auditory sensitivity, and emerging language was examined in a group of 1-year-old children who were prospectively followed since birth. Pneumatic otoscopy was used to document the otologic status of the children's ears at each medical visit. There were 13 babies with normal ratings in each ear at 80% more of their visits (designated as "otitis free") and 12 babies with bilaterally positive otoscopy results at 30% or more of their first year visits (designated "otitis positive"). In comparison to the otitis free infants, the group of otitis positive babies demonstrated reduced auditory sensitivity as measured by auditory brain stem response (ABR) and poorer expressive language abilities. However, differences in receptive language were not detected. These results suggest that otitis media may have an impact on auditory sensitivity and developing language as early as 1 year of age.

The early phase of synapse formation was studied in cultures of Xenopus laevis spinal neurons and myotomal muscle cells. Two early events are described: the pulsatile secretion of acetylcholine from the nerve terminal in response to myocytic or neuronal contacts, and the development of nerve-myocyte adhesion during the first few minutes of contact. The specificity in these early events in synaptogenesis was assessed with respect to the positional and clonal relationships of the neurons and myocytes. Axial position and lineage were determined by injecting embryos with a fluorescent dye, such that dissociated cells could subsequently be identified in culture. We examined the efficacy of spontaneous synaptic currents, and the relative preponderance of growth cone-myocyte associations, for neurite-myocyte pairs of the same or dissimilar origin. Neither of these two assays revealed a dependence on the axial position or the lineage of the cells. Although these studies indicate that early nerve-muscle interactions show little positional or clonal selectivity, myocytes clearly influence the onset of synaptic function

Paired-comparison judgments of intelligibility of speech in noise were obtained from eight hearing-impaired subjects on a large number of hearing aids simulated by a digital master hearing aid. The hearing aids which comprised a 5 X 5 matrix differed systematically in the amount of low-frequency and high-frequency gain provided. A comparison of three adaptive strategies for determining optimum hearing aid frequency-gain characteristics (an iterative round robin, a double elimination tournament, and a modified simplex procedure) revealed convergence on the same or similar hearing aids for most subjects. Analysis revealed that subjects for whom all three procedures converged on the same hearing aid showed a single pronounced peak in the response surface, while a broader peak was evident for the subjects for whom the three procedures identified similar hearing aids. The modified simplex procedure was found to be most efficient and the iterative round robin least efficient

A prospective analysis of 124 consecutive adult patients undergoing tracheotomy was performed to examine the incidence of resulting complications. All tracheotomies were performed by a junior otolaryngology resident under the supervision of a member of the attending staff or a chief resident. The vast majority were performed at the bedside in an intensive care unit. The complications were divided into two groups: early (within 2 days) and late (2 to 14 days). Seven patients had complications directly related to tracheotomy. Four of these complications occurred in three patients and were considered significant. There were no mortalities. Despite the fact that our tracheotomies were routinely performed by residents at the bedside, our complication rate was comparable to those reported from other centers. We believe that bedside tracheotomy, properly supervised and performed, is a safe procedure