Faculty Bibliography

Adenomatous lesions of the temporal bone are seldom encountered in clinical practice. Four cases of primary adenocarcinoma of the middle ear are reported. All four patients presented with a mass behind an intact tympanic membrane. Two of the four patients had received radiation to the head and neck area 10 or more years prior to their developing adenocarcinoma of the middle ear space. Although this tumor is locally invasive, it does not appear to be highly aggressive and can be treated by local excision, i.e., mastoidectomy with tympanoplasty.

Oral florid papillomatosis is an uncommon condition that has been treated with various forms of therapy in the past. This lesion is considered to be premalignant by most authors, and surgical therapy has ranged from local excision to radical resection. A case of oral florid papillomatosis involving the entire hard palate and extending over the superior alveolar ridge into the buccal-gingival sulcus is presented. This patient was successfully treated by a two-stage carbon dioxide (CO2) laser excision with excellent functional results and minimal morbidity.

The time interval between the release and beginning of vocal cord vibration in word-initial /p/ and /b/ was measured. The data from subjects with laryngeal pathology are described. /b/ showed larger values compared with the data from normals. It is suggested that such a test of vocal initiation could provide a useful measure for the evaluation of laryngeal dysfunction

Auditory evoked potentials are nearly all on-effects and the 'effective stimuli' for them are necessarily brief. Their frequency specificity is therefore limited, especially for the brainstem responses, because of the well-known trade-off between duration and frequency specificity. Brainstem responses are of special interest because they are unchanged in the sleep-like sedation that is required for difficult-to-test children. The middle-latency responses do not meet this requirement. Two patterns of tone burst that are appropriate and promising for the slow cortical potentials and for brainstem potentials, respectively, have rise and fall times of 2 periods of the modulated tone and plateaus of 10 (or 7) periods and 1 period, respectively. Their behavioral thresholds are nearly insensitive to difference in repetition rate between 4 and 40 stimuli/s. Their peak equivalent SPL threshold values at 500, 1 000, 2 000 and 4 000 Hz have been determined for 16 otologically normal ears. Using these reference levels, audiograms have been obtained for subjects with impaired hearing. The audiograms for 'flat' hearing losses do not differ significantly from the corresponding conventional pure-tone audiograms. The slopes for steep high-frequency hearing losses are underestimated, however, particularly with the brief (2-1-2) pattern. Nevertheless, the 2-1-2 pattern appears to be close to the best possible compromise.

Facial nerve paralysis is an unusual manifestation of sarcoidosis and is frequently associated with parotitis and uveitis. This triad of symptoms constitutes uveoparotid fever (Heerfordt's disease). Until recently, diagnosis was primarily clinical, aided by histologic confirmation of sarcoidosis (sarcoid of Boeck). An enzymatic assay has now been developed that seems to be specific for sarcoidosis. A case is reported herein, in which the origin of the facial paralysis was confirmed by this serum angiotensin-converting enzyme assay

Severe pathological changes were observed in the inner ear tissues of a 2-month-old patient who died of Reye's syndrome after 5 days of hospitalization. In the organ of Corti, the inner hair cells appeared to be more severely damaged than the outer hair cells. Various degrees of degeneration were observed in all non-sensory epithelial cells lining the cochlear duct. In most turns of the cochlear duct, Reissner's membrane was ruptured and/or collapsed onto the organ of Corti. Likewise, both sensory and non-sensory cells of the vestibular end organs were markedly degenerated. These observations suggest that the inner ear tissues are acutely affected in patients with Reye's syndrome, and that the changes may cause impairment of hearing and/or equilibrium in patients who recover.

In a study of the MMPI personality types of hospitalized men and women alcoholics, the Neurotic and Classic types had the characteristics of reactive alcoholism, and the Psychopathic, Schizoform A and Schizoform B types had the characteristics of essential alcoholism. Demographic variables and treatment prognosis also varied according to MMPI personality types.

A sublabial approach to the nasal cavity, paranasal sinuses and the nasopharynx degloving the middle third of the face has been described. Its major advantages over the other approaches have been compared and the usefulness of this approach has been stressed. The incidence of complications from this approach has been described and found to be acceptable.