Faculty Bibliography

The diagnosis of hearing loss in children with speech and language deficits by the otorhinolaryngologist involves a large allocation of sources. The ability to assess the efficacy of intervention in order to minimize speech and language deficits is an aspect in the care of these children which has not been generally considered as part of the child's ongoing medical care. These children have speech and language deficits predominantly from hearing impairment and occasionally from a primary language disorder. The effect of intervention (usually a hearing aid), the special education program for the hearing impaired child, and the language therapy for the child with a primary language disorder are seldom measured. The ability to assess and monitor the child's progress is essential for the care of these patients. The continual monitoring of the child's progress is accomplished by periodic assessment of the child's speech and language. An instrument to do this has been developed and used by the Department of Otorhinolaryngectomy at the Albert Einstein College of Medicine for a number of years. The utilization of this instrument, as demonstrated by a series of case reports, will be presented. These will include children in which intervention was successful and those for whom it was unsuccessful, with an analysis of the reasons underlying the effectiveness for each child. It is recommended that every child with a speech and language deficit should be monitored periodically so that the child's progress, or lack of progress, can be determined. If the child is not progressing, additional remediation can be instituted to attempt to prevent a permanent speech and language deficiency.

The longitudinal consistency of personality characteristics over a period of 45 years is examined. The data are drawn from the Kelly Longitudinal Study, a panel involving an original group of 300 men and 300 women. Measures of emotional disturbance (from the Bell and Bernreuter inventories) during the 1930s and the 1950s had significant correlations in the .25-.40 range with measures of psychiatric symptoms (from the Cornell Medical Index) taken in 1979-1981. Revised inventory scales with content related to neuroticism and social introversion-extraversion had moderate longitudinal consistency across several decades of adult life and demonstrated convergent and discriminant validity. This study demonstrates the utility of personality measurements in predicting significant psychological outcomes over the full interval of the normal adult lifespan.

Historically, parotid gland surgery has evolved from an operation of surgical enucleation to that of lateral lobectomy or total parotidectomy with facial nerve dissection. While the enucleation operation originally resulted in recurrence rates as high as 45% in some series, the technique of lateral lobectomy has resulted in recurrence rates of 2% in benign tumors. However, the currently recommended procedure of lateral lobectomy or total parotidectomy with facial nerve preservation for benign or low grade malignant tumors is not a pure en bloc resection in most cases, and in fact enucleation in part or total is often the reality of the operation. Tumor characterization, technical features, and operative findings of parotid gland surgery are examined in 100 consecutive cases. In over 60% of the cases, superficial or total parotidectomy with facial nerve preservation incorporated the principle of limited enucleation or capsular dissection at some point in the technique. The illusion that en bloc removal of parotid tumors with wide surgical margins is discredited. The reality of the procedure and the reasons for its success are examined.

Recent advances with aggressive vascular radiologic techniques have altered the methods of treatment of head and neck vascular malformations. High resolution CT scanning and superselective angiography with subtraction technique is now capable of defining the extent of these lesions and demonstrating blood flow dynamics. Careful joint evaluation by the vascular radiologist and the head and neck surgeon is necessary for the proper treatment of these patients. Preoperative embolization of these lesions effectively reduces intraoperative blood loss and provides for better exposure in those patients ultimately undergoing resection of these masses. Careful selection of those cases that are amenable to total or subtotal excision, with adherence to specific criteria and goals, usually produces gratifying results. We present five patients who have undergone combined treatment of their head and neck vascular lesions. Our treatment protocol is reviewed and emphasis is placed on the integral part that the vascular radiologist assumes in the treatment of these patients.

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.

Breakdown of the normal protective function of the larynx, either through primary laryngologic or neurologic causes, leads to chronic aspiration, recurrent pneumonitis and possibly death. In this paper we discuss the existing surgical treatments for chronic aspiration. Tracheal separation and trecheoesophageal diversion are discussed, as are the difficulties of using these procedures in patients with pre-existing tracheostomies. A modification of tracheoesophageal diversion is presented whereby this procedure can now be utilized in those patients with pre-existing tracheostomies. The modified tracheoesophageal diversion is performed in five patients successfully. Since most patients have already had tracheotomies in an attempt to control aspiration, we feel that our technique of modified tracheoesophageal diversion enables this group of patients to benefit from this procedure as well.