Faculty Bibliography

Surface paper strips containing hemin (X factor) were tested on Middlebrook 7H10 agar and Lowenstein-Jensen medium to determine if the growth requirement of Mycobacterium haemophilum for iron-containing complexes could be met by this simplified method. One reference strain and seven strains of this species isolated from patients showed good growth around the strips on 7H10 within 2 weeks but failed to grow on Lowenstein-Jensen medium with X-factor strips. Middlebrook 7H10 medium with X-factor strips may be a useful alternative to the preparation of specialized media for the recovery of M. haemophilum from clinical specimens.

Surface preparations of the stria vascularis from guinea pigs exposed to wide-band noise or intoxicated with quinine monohydrochloride dihydrate were studied by light microscopy and computerized image analysis in order to evaluate quantitatively the effects of these agents on two characteristics of the strial vasculature: vascular density and erythrocyte distribution. An image analyzer was used to measure the area of strial vessel lumen and erythrocyte distribution as a fraction of the total area of strial tissue under observation. The results demonstrate that changes in the strial vessels do occur in guinea pigs exposed to noise or given large doses of quinine. Localized vessel narrowings caused by swollen endothelial cells and possibly by contraction of pericytes were found in both experimental groups, but there was no apparent tonotopical relationship between these effects and the reduction in cochlear potentials. A significant reduction in the number of erythrocytes was found in all turns of the cochlea in both experimental groups. Although a significant difference in vascular density was found among turns of the cochlea in both experimental and control animals, there was no widespread change in vascular density as a result of either noise exposure or quinine treatment.

In the context of a busy reference laboratory, radiometric selective inhibition tests were evaluated for rapid differentiation of Mycobacterium tuberculosis and Mycobacterium bovis and of the M. tuberculosis complex from other mycobacteria. p-Nitro-alpha-acetylamino-beta-hydroxypropiophenone at 5 micrograms and hydroxylamine hydrochloride at 62.5 and 125 micrograms per ml of 7H12 medium were used to separate the M. tuberculosis complex from other mycobacteria (MOTT bacilli). Since it is important epidemiologically to distinguish M. tuberculosis from M. bovis, susceptibility to 1 microgram of thiophene-2-carboxylic acid per ml was also determined radiometrically. By using these three agents as selective inhibitors, M. tuberculosis, M. bovis, and MOTT bacilli were differentiated with a high degree of specificity by a BACTEC radiometric procedure. Results of tests performed on clinical isolates submitted on solid medium to our reference laboratory were available within 5 days.

Localized perivascular demyelinization of the peripheral processes of cochlear neurons was observed in surface preparations of the osseous spiral lamina in two neonates, one a premature infant with erythroblastosis fetalis, the other a full-term infant with cyanotic congenital heart disease. In both cases the cause of the demyelinization was unknown. Both infants had severe edema as a result of congestive heart failure and anoxia. The serum bilirubin level in the erythroblastotic child appeared too low to have caused injury to the nerve fibers. The demyelinization was most striking in the lower half of the basal turn. It was observed only in the immediate vicinity of meandering stretches of capillaries as they crossed the nerve fibers. In the premature infant there was hair cell loss throughout the cochlea; in the other there was no hair cell loss, but a malformed labyrinth of the Mondini type.

The variation of vocal efficiency for the mean values for normal subjects was investigated in patients with laryngeal disease. The relative contributions of mean flow rate and intrapulmonic pressure to the variation of efficiency were explored to explain aerodynamic aspects in voice disorders. Vocal efficiency was determined by use of expressions involving simultaneous values of sound pressure level, mean flow rate, and intrapulmonic pressure. The intrapulmonic pressure was noninvasively obtained by plethysmographic and pneumotachographic methods. Values of vocal efficiency were generally abnormally low for the types of larynges studied. An aerodynamic-biomechanical classification of laryngeal disease was inferred from the data: 1) large chink of glottis, associated with high flow rate; 2) mass on vocal fold, associated with high values of both flow rate and intrapulmonic pressure; and 3) high stiffness of vocal fold, associated with high values of intrapulmonic pressure.

It has been acknowledged that for many patients with spastic dysphonia, reflexive phonation remains essentially free of the spasticity that characterizes this disorder. The purpose of this paper is to document the extent to which various phonatory tasks change the patient's voice. We retrospectively reviewed 37 patients with spastic dysphonia evaluated at the Center for Communication Disorders of Lenox Hill Hospital, New York, between 1977 and 1981. The patients' responses to various phonatory tasks were observed. These tasks were grouped into the following ten categories: noncommunicative vocalization, primitive communication, speech superimposed on noncommunicative phonation, communicative phonation with varied mode of vocal fold vibration, normal communicative phonation with unusual pitch, normal communicative phonation with unusual emphasis, normal communicative phonation with normal laryngeal adjustments, use of the vocal folds in an artistic manner, speech in which normal auditory feedback was eliminated, and speaking with whisper which was not associated with vocal fold vibration. The results are summarized as follows: 1) whispered speech always resulted in an improvement of the symptom, in most cases markedly; 2) there was a tendency for a task that was more effective in reducing spasticity to be reduced in communicative function; 3) there was a tendency for a task that was more effective in reducing the spasticity to deviate more from the normal mode of phonation; and 4) there were some patients in whom an improvement occurred with elimination of auditory feedback.

In tympanoplasty, trauma to the cochlea is usually caused by the transmission of vibration induced during the removal of cholesteatoma, granulation tissue, and tympanosclerosis surrounding the ossicular chain. In 100 sequential cases 20 showed evidence of cochlear trauma. Hearing was recovered in 10 of these cases during the immediate postoperative period. In nine the hearing was partially recovered but remained below the preoperative bone-conduction level, and in one there was a total cochlear hearing loss. When the stapes footplate was fractured or dislocated and a perilymphatic fistula developed, profound cochlear hearing loss occurred. This complication usually can be avoided by inspection of the round and oval windows under high magnification and by tissue grafts over the fistula. An unanticipated pathologic fistula of the semicircular canals is another common source of major cochlear damage. Despite all precautions and sometimes without apparent cause, a total cochlear hearing loss may result after a tympanoplasty. Although this is rare, as evidenced by the fact that there were only 15 cases in some 1000 tympanoplasties, before surgery the surgeon must inform the patient of the risks involved.

Early recognition of potentially fatal complications of bacterial infections of the ears, sinuses, and pharynx is important for successful therapy. The clinical presentations of these infections are reviewed in this article, and the approach to initial diagnostic tests is outlined. Treatment recommendations are briefly discussed, with emphasis placed on early antibiotic therapy and indications for consultations from surgical colleagues.