Faculty Bibliography

Electromyographic (EMG) feedback has been proposed to enhance rehabilitation following hypoglossal-facial nerve anastomosis. Sixteen of 25 patients who underwent hypoglossal-facial nerve anastomosis with and without postoperative EMG rehabilitation were videotaped for evaluation of facial movement by four observers unaware of these patients' rehabilitation therapy. Using a House Facial Nerve Grading System and intragroup comparison, a trend discernible in this preliminary study indicates a chance for better facial function with EMG feedback rehabilitation

Carotid sinus hypersensitivity secondary to the presence of head and neck carcinoma has been recently reviewed in the otolaryngologic literature. We present a case of carotid sinus hypersensitivity coupled with glossopharyngeal neuralgia due to tonsillar carcinoma invading the parapharyngeal space. Medical management with atropine, carbamazepine, and transvenous pacing was only moderately successful in controlling the symptomatology. Surgery appeared to offer a more permanent solution to the problem

This is a preliminary report about the acoustic characteristics of the external ears of infants. A technique was developed to insert a probe tube that is attached to a miniature microphone into the external auditory canals of sleeping infants. The inlet to the microphone was positioned in the lateral half of the external auditory canal. A diffuse sound field (spectral density of approximately 45 dB SPL) was introduced. The microphone output was recorded, and its Fourier Transform was computed. Diffuse-field-to-ear canal sound pressure level transformations were determined for infants ranging in age from newborn to 37 months. Representative sound pressure level transformations are presented. These are shown to vary systematically with the age of the child. The resonance frequency of the external ear is high in the newborns and declines with age. The asymptotic value (approximately 2,700 Hz) is reached during the second year of life. These findings have potential implications for fitting hearing aids on infants and children.

Imaging plays an essential role in evaluating the cochlear implant candidate and the results of implantation. Eighteen candidates for cochlear implantation were reviewed for this study. Fourteen received implants; all but one, intracochlear devices. Based on the trial use of multiple techniques, a protocol has been established for the use of radiography in implant studies. The protocol suggests preoperative high resolution semiaxial computed tomographic scanning, intraoperative anteroposterior transorbital plain films if there is doubt concerning the electrode placement, and postoperative plain films in cases of unexpected poor device performance. In cases with complications, postoperative CT scanning may be required.

Based on a review of the literature and analysis of six new cases, three categories of enlarged, aerated sinuses are defined, namely: hypersinus, pneumosinus dilatans, and pneumocele. The information gained by our study of the area variation of the frontal sinuses in a normal population (part I of this paper) was utilized to define the term hypersinus. In this condition there is generalized enlargement of the sinus beyond the upper limit of normal in an asymptomatic patient. The principal difference between pneumosinus dilatans and a pneumocele is the presence of bony thinning or erosion in the latter entity. The clinical findings and the possible etiologies of these conditions are discussed.

One hundred normal Caldwell view radiographs were examined on patients who had no signs or symptoms referable to the frontal sinuses. Magnification factors were determined for Caldwell views obtained on a dedicated head unit and as part of a skull series. The areas of the frontal sinuses were actually measured with a Zeiss Videoplan 2 computer and corrected for magnification. The area variation in this normal population was determined. Four linear measurements were individually correlated with these areas. Two of these lines had excellent correlation with the sinus area and if either of these lines exceeds a calculated value, the sinus area exceeds the 99th percentile of the normal population and can be considered abnormally enlarged. This technique provides a rapid, easy, and reliable method for assessing abnormally enlarged frontal sinus areas.

Sonographic images of the vocal cords were obtained in 41 healthy human subjects using a phased array realtime ultrasound scanner. The thyroid cartilage provides the acoustic window for sonographic visualization of the vocal cords. The false vocal cords appear as hyperechoic structures, while the true vocal cords are seen as hypoechoic structures. The symmetry of movement of the vocal cords during respiration becomes apparent on examination in real time. Sonography may prove to be a potentially useful technique for the examination of the vocal cords