Faculty Bibliography

In the program described, the use of total communication (TC) did not impede speech development in preschool deaf children. Evidence indicates that sign language facilitated the young hearing-impaired child's acquisition of communicative oral speech. Exposure to sign language combined with speech enhanced the meaningfulness of residual hearing and lipreading. Milestones in sign language acquisition paralleled the milestones of spoken language. Young hearing-impaired TC children appeared to learn and express more language at an earlier age than is typical of orally trained hearing-impaired children. This implies that their cognition may not be as severely inhibited because their language acquisition is less severely delayed. This should have favorable consequences for later educational and social development. The families In the TC program were able to normalize their child-rearing activities and relationships.

Temporal bones from four patients with capsular otosclerosis were examined by microdissection. Otoconia and abnormal crystalline deposits were studied by scanning electron microscopy and x-ray analytical methods. One patient showed more or less symmetrical invasion of the basilar membrane and osseous lamina by connective tissue from thickened endosteum adjacent to the larger anterior foci. In one ear sensorineural degeneration was circumscribed; in the other it was extensive and associated with cochleosaccular hydrops. Two other patients were deaf, with severe sensorineural degeneration; one had multiple active foci and evidence of cochleosaccular hydrops. In the fourth patient, who had small anterior foci, no specific inner ear pathology was found related to otosclerosis. In the hydropic labyrinths, apatite was present as abnormal deposits in the cochlear duct and as rigid crusts replacing the otoconia. Apparently these changes had been associated with abnormal labyrinthine fluid dynamics rather than with the otospongiotic process per se.

Experience with 81 gas computed tomography (CT) cisternography procedures in 79 patients in searching for acoustic neuroma is reported. Twenty-one tumors, four exclusively intracanalicular, were demonstrated after standard contrast-enhanced CT was negative. Fifty-five examinations were negative; four were inconclusive. The high resolution scanner with digital localization and reconstruction zoom capability greatly improved image detail. In nine of the 12 normal patients examined with it, the intracanalicular bundle was demonstrated. Substitution of carbon dioxide for air greatly reduced the morbidity of acute post-spinal tap headache. The procedure takes 30--45 min and can be performed on an outpatient basis. It is recommended as the procedure of choice when standard CT is negative in subjects clinically suspected of having acoustic neuroma

Degree of hoarseness can be evaluated by judging the extent to which noise replaces the harmonic structure in the spectrogram of a sustained vowel. However, this visual method is subjective. The present study was undertaken to develop the harmonics-to-noise (H/N) ratio as an objective and quantitative evaluation of the degree of hoarseness. The computation is conceptually straightforward; 50 consecutive pitch periods of a sustained vowel /a/ are averaged; H is the energy of the averaged waveform, while N is the mean energy of the differences between the individual periods and averaged waveform. Recordings of 42 normal voices and 41 samples with varying degrees of hoarseness were analyzed. Two experts rated the spectrogram of each voice sample, based on the amount of noise relative to that of the harmonic component. The results showed a highly significant agreement (the rank correlation coefficient = 0.849) between H/N calculations and the subjective evaluations of the spectrograms. The H/N ratio also proved useful in quantitatively assessing the results of treatment for hoarseness.

Barium examination of the esophagus is often useful for evaluating the cause of dysphagia, a frequent condition in patients who have undergone total laryngectomy. The examination may be difficult to interpret, however, because a variety of anatomic changes may be produced by radiation, infection, fistula, recurrent tumor, or the operation itself. Radiographic and clinical information on 45 total-laryngectomy patients, whose follow-up periods ranged from six months to 17 years, were analyzed. A recurrent tumor was found in 15 patients and was evident radiographically as a mass deviating the neopharynx in 14. Benign strictures in 14 patients appeared either as a long symmetrical narrowing or as a very short, weblike narrowing. Fistulas were demonstrated in 13 patients and presaged the development of recurrent tumors in five. Cricopharyngeal muscular dysfunction accounted for dysphagia in five cases. An understanding of these patterns leads to more accurate interpretation of the postoperative barium examination of the esophagus, and the radiographic findings often indicate the correct diagnosis with a high degree of confidence