Faculty Bibliography

Condyloma acuminatum is one of four types of common human verrucous lesions that are of viral etiology. Also known as "moist wart," condyloma acuminatum is most often seen on the mucosal surfaces of the anogenital area. However, occurrences in the mucosal lined areas of the head and neck region are quite rare. Since 1901, 30 cases of condylomatous lesions have been reported in the upper aerodigestive tract, occurring mainly in the various regions of the oral cavity. Eighteen of the cases were confirmed by histopathologic documentation, while the remainder were anecdotal. We have recently encountered six new cases of condyloma acuminatum, verified by histologic examination. One occurred on the tongue, another in the tonsillar fossa, one in the hypopharynx and three on the vocal cords. We present these cases and review the previously reported cases. In addition, we will discuss the differential diagnosis of these lesions, and their importance to the practicing otolaryngologist.

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 comparison of the microbiologic safety of Merocel versus NuGauze nasal packing in 119 surgical patients is presented. Presurgical and postsurgical nasal cultures were obtained, analyzed, and compared. The importance of a preoperative nasal culture isolate of Toxic Shock Syndrome Toxin Number 1 (TSST-1) producing Staphylococcus aureus in predicting postoperative toxigenic S. aureus isolation and Toxic Shock Syndrome symptomatology is demonstrated. An in vitro comparison of the ability of NuGauze and Merocel to amplify TSST-1 production was performed

A case of intrasphenoidal meningoencephalocele is presented, representing the eighth case report in English language literature. The major presenting symptom was retro-orbital headache. The patient also had cerebrospinal fluid rhinorrhea and a history of recurrent meningitis. Diagnosis was suspected on the basis of plain radiographs of the sinuses and was confirmed by computed tomography scan. The meningoencephalocele was reduced via a sublabial, transseptal sphenoidotomy approach with improvement of the patient's symptoms. Management and treatment of isolated sphenoid sinus lesions are discussed as well as the pathophysiology of intrasphenoidal meningoencephaloceles

The concentration and relative distribution of glycine receptors were determined for gerbil brain stem auditory nuclei using 3H-strychnine and quantitative autoradiographic techniques. Significant binding was observed in the anteroventral cochlear nucleus, the dorsal cochlear nucleus, the lateral superior olivary nucleus, and the inferior colliculus. A non-uniform distribution of binding was seen in 3 of these nuclei, such that the greatest concentration of glycine receptors was located in the high-frequency regions. An analysis of neuron soma density suggested that the amount of post-synaptic membrane could partially explain the distribution of receptor

The concentration and relative distribution of glycine receptors were determined for the gerbil lateral superior olive at several postnatal ages. Quantitative autoradiographic techniques revealed significant 3H-strychnine binding to all regions of the nucleus from 4 to 90 d. However, during the first 20 d, a nonuniform distribution of binding emerged, such that the greatest concentration of receptor was found in the high-frequency region of the nucleus. An analysis of neuron packing density showed an approximate 2-fold distribution along the same axis at all ages. This evidence is consistent with an elimination of glycine receptors in the ventral region of the lateral superior olive as maturation progresses

This study addresses the question of whether patients who fly with otitis media with effusion (OME) are at risk for the development of barotitis. Fourteen patients with otitis media with effusion were followed before and after air travel. No ear with OME became symptomatic, though two contralateral, previously 'normal' ears did become symptomatic. An analysis of the physiology of this phenomenon is presented

Flexible endoscopy is assuming a role of increasing importance in the evaluation and diagnosis of upper aerodigestive tract disorders. With improved fiberoptic capabilities and miniaturization, these techniques are gaining in applicability to the pediatric population. At Children's Hospital, Boston, a newly designed Machida 1.9-mm bronchoscope has been employed in the evaluation of the upper airway. The use of this small caliber instrument has been investigated in 1) evaluation of endotracheal or tracheotomy tube position, thus decreasing the need for repeated chest radiographs to confirm location; 2) bedside evaluation of possible tracheal disease (eg, mucous plug, granuloma, tracheitis) in the intensive care unit patient to determine treatment plans and/or need for further rigid bronchoscopy, and 3) evaluation of airway dynamics in the awake patient. Our experience with the flexible fiberoptic minibronchoscope is reviewed, with a discussion of indications for its use, as well as possible limitations. Case studies are presented to demonstrate the usefulness of the instrument

Eight cases of metastatic hypernephroma to the head and neck are presented with CT documentation. Hypernephroma is the third most common infraclavicular tumor to metastasize to the head and neck. Such metastases occur in about 15% of patients with this neoplasm, and nearly 8% of patients with this tumor present with disease in the head and neck region. These metastases are usually vascular and may either clinically precede the diagnosis of the renal primary tumor or may occur many years after apparently successful surgery of the primary tumor. These unusual patterns of behavior are reviewed. One of the cases presented here is the first reported incidence of cervical lymph node metastasis with hemorrhage to be documented by CT, thus adding this entity to the list of imaging differential diagnoses of cystic-appearing neck masses.