Faculty Bibliography

The diagnosis of non-Hodgkin's malignant lymphoma of the nasal cavity, paranasal sinuses, and nasopharynx was made in 15 patients over a 7 year period (nasopharynx, 9; nasal cavity, 3; maxillary sinus, 2; frontal sinus, 1). A wide variety of head and neck symptoms, often characteristic of benign disease, was reported ranging from 2 weeks to 4 months prior to presentation. Of the 15 cases, the original diagnosis was inconclusive in 6; 4 of the 6 required rebiopsy, while the diagnosis in the other 2 was confirmed on further pathologic consultation. Tissue marker studies, which have recently become available, were performed in 7 cases and were crucial in the diagnosis of 2. B-cell lymphoma was diagnosed in the 7 patients who had tissue marker studies. Five patients had palpable cervical nodes, and none had distant adenopathy or masses. With further staging, 4 of the 15 patients were found to have disseminated disease. The paper emphasizes the need for early biopsy of suspicious lesions presenting in areas in which physical examination is limited. Recommendations are made for handling the biopsy specimen when malignant lymphoma is suspected, as well as for the evaluation of local and distant sites. The role of surgery is primarily diagnostic in patients with malignant lymphoma

Neonatal mice were reared in an acoustic environment that repetitively entrained activity in a large proportion of primary auditory afferents during the period when the frequency tuning of auditory neurons normally develops. The tuning curves obtained from these mice were significantly broader than those of normally reared mice of the same age. This suggests that the normal frequency tuning of neurons was prevented or delayed by synchronizing the pattern of activity imposed on the auditory pathway

Pneumatic dilatation under fluoroscopic control has proven highly successful in the treatment of achalasia. This procedure involves minimal morbidity, local anesthesia is employed, and hospitalization is brief, usually only two days. Surgical myotomy of the lower esophageal sphincter, the Heller procedure, requires a thoracotomy under general anesthesia with its attendant morbidity and at least ten days of hospitalization. In addition, there is a significant incidence of postoperative gastric reflux. We have employed pneumatic dilatation as the sole primary treatment for 30 patients over the last 10 years. The results have been highly successful with marked relief of symptoms and weight gain. Pneumatic dilatation is an effective treatment for achalasia and is recommended as the initial procedure of choice

Forty-seven infants and children with tracheotomies were cared for at home for a follow-up period of 1,581 months. There were two relevant fatalities which gave a death rate of 0.13 deaths per 100 months. The average age at the time of tracheotomy was 13 months and the tracheotomy was in place for an average of 33 months per patient. The ability to care for these children was provided through coordinated, intensive training and a home-care program in which the inpatient nurse, nurse practitioner, social worker, pediatrician, and otorhinolaryngologist worked as a team.

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.

Eighteen healthy 8- to 11-year-old children with normal hearing and histories of recurrent middle ear effusion (MEE) before the age of 5 years were evaluated by a battery of audiologic, psychologic, language, and achievement tests. Each of these children was compared to a non-MEE sibling who was tested at the same age. None of the children had been diagnosed as learning disabled. Both groups tested in the bright normal range of verbal ability on the WISC-R. Paired comparison of sibling data revealed that the MEE subjects had deficits in verbal ability, auditory decoding, and spelling skills compared with control siblings. Significant strength in visual sequential memory in the MEE subjects suggests that the availability of compensatory strategies for auditory deficits in these subjects. Sex and/or birth order differences did not explain the differences observed between siblings.

A retrospective study of patients intubated for more than 24 hours was undertaken to assess the possibility of predicting the length of intubation. Patients requiring intubation for injuries secondary to motor vehicle accidents were scored according to a well-documented grading system which enables a numerical assessment of the severity of injury. There appears to be a significant relationship between this score and the length of intubation. It also appears possible to estimate the duration of intubation within the first 24 hours after injury in this group of patients. This information could provide an objective criterion for the clinician who must choose between prolonged intubation or tracheotomy in the management of severely injured patients.

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.