Faculty Bibliography

An attempt has been made to compare the long-term results using preoperative radiation and surgery with radiation therapy alone in the treatment of squamous cell carcinoma of the pyriform sinus. There is a 33% survival for the combined therapy group and a 6% survival for the curative radiation group. Large primary lesions and the presence of cervical adenopathy portend a grave prognosis. The various surgical procedures used are presented with the extent of the primary lesion as the determining factor

Seven of the 7000 patients who underwent cardiopulmonary bypass at Bellevue and University Hospitals between 1969 and 1978 developed sudden loss of hearing in one ear immediately after surgery. Four of the seven patients showed subsequent improvement in hearing but none recovered completely. None had vertigo. All were male. The most likely cause is particulate microemboli generated by cardiopulmonary bypass

Contact granuloma of the vocal folds caused by physical trauma secondary to voice abuse has traditionally been treated by surgical removal. This mode of handling can be frequently disappointing since these lesions have a strong tendency to recur and may require additional operative procedures. This paper describes 17 patients in whom treatment of the primary problem was approached through voice therapy. Treatment consisted of a comprehensive history and voice evaluation, stress reduction, relaxation methods, auditory and kinesthetic feedback, pitch change and elimination of voice abuse. Patients were closely followed by the speech pathologist and laryngologist who worked together as a team. The results of voice therapy were evaluated by the laryngologist, the speech pathologist and the patient himself. As a result of voice therapy, the granuloma disappeared in 9 patients, was reduced in size in 4 and remained unchanged in 1. For the remaining three patients, posttherapeutic laryngoscopic findings were not available. The speech pathologist found voice and manner of phonation returned to normal in 4 patients, improved in 7 and remained unchanged in 6. Four patients felt that complete recovery had taken place, 10 felt that some improvement was noted, and 3 felt no change had taken place. Based on the assessments of all three evaluators, the success rate of treatment with voice therapy can be stated as 71% (12 of 17 cases) or 100% (eliminating 5 of 17 cases who terminated treatment very early).

We describe 19 cases of pulmonary disease due to Mycobacterium xenopi, a nosocomial infection related to the hospital water system. Pre-existing lung disease and prolonged environmental exposure during previous hospitalizations were apparent predisposing factors. Twelve patients had respiratory symptoms, including three with hemoptysis, at the time an abnormal chest roentgenogram was obtained. The predominant radiographic presentation of lung diseases caused by M. xenopi was a nodular or mass shadow, but cavitary disease and multiple nodular densities were also frequently observed. One subject had a solitary pulmonary nodule, and surgical resection was performed. In 12 patients who were skin tested with both M. xenopi sensitin and PPD-tuberculin, induration was consistently greater with M. xenopi. Initial isolates of M. xenopi were uniformly sensitive in vitro to 2.0 microgram of streptomycin, 1.0 microgram of isoniazid, and 10.0 microgram of para-aminosalicylic acid. In general, disease due to M. xenopi was successfully treated with standard antituberculosis drugs.

Temporal bones from five patients with hearing loss as a result of aminoglycoside treatment were examined by the method of microdissection and surface preparations, followed by celloidin embedding and serial sectioning of the modiolus. Three patients had received the newer antibiotics, gentamicin, tobramycin, and amikacin; the other two neomycin. In the cochleas from two patients of the first group there was only a small loss of hair cells, restricted to the lower end of the basal turn. The third, who had been treated with several antibiotics over a longer period of time, showed more extensive but strikingly asymmetrical patterns of degeneration in the two ears. This patient, as well as the fourth, who had received neomycin during peritoneal lavage, had numerous patchy areas of complete disappearance of Corti's organ in the basal turn, with incipient degeneration of the distal ends of the nerve fibers in adjacent portions of the osseous spiral lamina. The fifth patient, who had become deaf after prolonged treatment with neomycin by mouth, showed a complete loss of cochlear hair cells. Nerve fibers were present only in the middle and upper turns, where supporting cells remained. Midmodiolar sections showed a proportionately much greater loss of the distal than of the proximal processes of the cells of the spiral ganglion. These findings underscore once again the special hazard for the inner ear that is associated with the clinical use of neomycin, regardless of the route of administration.

Dichotic CV recognition at interaural temporal onset asynchronies (lag times) of 0, 30, 60, and 90 ms was investigated in normal hearing young and elderly subjects. The results for the young group were consistent with those reported in previous studies (Studdert-Kennedy et al., 1970; Berlin et al., 1973a). The older group demonstrated a mean right ear advantage (REA) at simultaneity of 12.7%, which was not significantly different from that of the young group (12.4%). This suggests that the processes subserving the REA are not affected by age. However, there was a significant reduction in the total (right ear plus left ear) dichotic scores of the elderly group compared to the young; suggesting an age-associated reduction in the channel capacity of the aging auditory system. Further, there were striking aberrations of the dictotic lag effect in the elderly group compared to the young subjects, consistent with age-related changes in auditory temporal processing. The findings are discussed with respect to the aging auditory system and the nature of dichotic speech processing

The death rate of brain abscesses in a recently reported series is high, ranging from 36% to 50% of all cases. This paper reports experiences with ten cases of intracranial abscesses secondary to ear and sinus infections. Six of these abscesses are secondary to otitic infections with three of them located in the cerebellum. Two of the cerebellar abscesses are surgically drained through the temporal bone by the otologic surgeon, with close neurosurgical cooperation. Computerized axial tomography has revolutionized the treatment of intracranial abscesses optimizing the timing for medical and surgical management.

A case of primary chordoma of the maxillary sinus is presented. The embryology of the notochord is reviewed and it is suggested that the frequently used adjective "ectopic" is a misnomer. The literature of primary paranasal sinus chordomas is reviewed and the clinicopathological features described. It is emphasized that these lesions can mimic other benign and malignant processes both clinically, radiographically and histologically. The treatment and prognosis is more favorable than the more common craniocervical chordoma.