Faculty Bibliography

Malignant external otitis (necrotizing otitis externa) is an infectious process which occurs most often in middle-aged and elderly diabetic patients and is characterized by cultures positive for Pseudomonas and granulation tissue at the junction of the bony and cartilaginous portion of the external auditory canal. Epidermoid carcinoma of the external auditory canal is also seen most often in the middle-aged and elderly population. To the best of our knowledge, no case of acute necrotizing otitis externa occurring concomitantly with epidermoid carcinoma of the external auditory canal has been documented. A case is presented and discussed here and the importance of biopsy of the external auditory canal is stressed. Theoretical considerations of the possible relationship between these two disorders are discussed. This case illustrates the need to discontinue the use of the term 'malignant external otitis' and replace it with the term 'necrotizing otitis externa.'

A bolus intravenous dose of 5-fluorouracil of 600 mg/M2 was added exactly 1 hour after methotrexate administration in an established combination program including bleomycin and cisplatin for advanced squamous cell cancer of the head and neck. Results were no better than those observed previously with the three drugs, and hematologic and mucosal toxicities were slightly worse. The overall response rate was 41% in 34 patients with recurrent or metastatic disease, with only 6% complete remissions. Median time to disease progression for responding patients was 14 weeks, compared with 10 weeks for nonresponders. Partial response had little impact on survival. Among 12 patients with far-advanced disease confined above the clavicles without prior radiotherapy, 9 (75%) achieved partial remission, but the median survival, even with later surgery or irradiation, was only 34 weeks

Pneumocephalus is usually seen after trauma or neurologic surgery. A rare presentation is after cerebrospinal fluid (CSF) shunting for rhinorrhea. This may be a manifestation of shunt malfunction or of the failure to close a preexisting fistulous tract. A common site of failure is the sphenoid sinus, where CSF may leak from a dehiscence in the middle cranial fossa floor. These dehiscences often communicate with lateral extensions of the sphenoid. This complication is best managed by craniotomy with direct inspection of the floor of the middle cranial fossa and correction of deranged CSF dynamics

Direct effects of the tracheotomy tube and cuff on glottic, subglottic and tracheal mucosa have been well described. Little work has been done on the effects of tracheotomy on the distal tracheobronchial tree. Ten beagle puppies underwent tracheotomy and were sacrificed at 18, 24, 36, 48 and 72 h. The trachea was studied for changes in cilia, epithelium, submucosal reaction and mucous production at the level of the tracheostome, tracheotomy tube tip, carina and right mainstem bronchus. Severe changes of epithelial erosion and ulceration with submucosal inflammatory reaction were noted as early as 18 h and persisted through 24 h. Some resolution of inflammation and progression to squamous metaplasia were seen at 36, 48 and 72 h. Changes in mucous gland activity varied widely. The traumatic effects of tracheotomy on normal tracheal anatomy and physiology and their clinical implications are discussed.

The use of computer simulation in evaluating conventional and experimental hearing aids is described. Two illustrative examples are provided. The first involves the simulation of a conventional master hearing aid and its application in evaluating different adaptive strategies in the prescriptive fitting of hearing aids. The second example involves the simulation of an experimental hearing aid embodying modern digital signal-processing techniques for the reduction of background noise. A high-speed array processor is used in order to accomplish these simulations in real time

During the past 10 years, 157 patients have been operated on at the New York University-Bellevue Medical Center for acoustic neuromas and other cerebellopontine angle tumors. We describe our diagnostic protocol with joint neurosurgical evaluation leading to either translabyrinthine (otology only) or suboccipital-transmeatal (combined otology-neurosurgery) surgery. The decision is made on the basis of tumor size, level of hearing, age, and health of the patient. Using these criteria, 105 suboccipital and 59 translabyrinthine operations were performed with eight patients having had two-stage operations. In 12 of 29 patients, hearing was successfully preserved. Of 18 patients with good hearing and extracanalicular tumors less than 2 cm, hearing was preserved in 11. We describe the surgical technique used in this suboccipital-transmeatal operation and present illustrative cases in detail

In our series of patients operated on for acoustic neuromas at New York University Medical Center between 1974 and 1983, 13% (17 of 133) had sudden hearing loss. Of these, approximately 23% (four of 17) had recovered auditory function before acoustic neuroma extirpation. Three patients spontaneously recovered, while one improved with steroid therapy. Contrast computerized tomography demonstrated a widened internal auditory canal and evidence of cerebellopontine angle tumor, respectively, in 88% and 59% of patients with sudden hearing loss and acoustic neuroma. Clinical characteristics suggesting acoustic neuroma as the cause of sudden hearing loss with or without auditory recovery could not be identified in our series. Our data support the rationale that patients with unilateral sudden hearing loss, even with recovery, must be evaluated for a possible cerebellopontine lesion

A multichannel cochlear prosthesis was evaluated using the method of Connected Discourse Tracking. Data were obtained from five subjects over a 10-week period. Significant learning effects were obtained both with and without the prosthesis. The method of orthogonal polynomials was used to obtain a statistically precise fit for each learning curve. The curves differed both in terms of shape and average rate of learning. The two best subjects showed substantial improvements, reaching tracking rates in excess of 90 words-per-minute. A method for representing prosthesis-based improvements, which takes learning effects into account, is developed and discussed