Complications of three methods of stapedectomy

In a group of 270 partial stapedectomies performed by one surgeon using teflon-piston prosthesis it was assessed whether incidence of complications depended on sequence of surgical steps. In group I of 50 ears classical stapedectomy was performed: 1. removal of stapes superstructure, 2. making a hole in the footplate, 3. placing the prosthesis on the incus. In group II of 167 ears the hole in the footplate was made before removal of stapes arch. In group III of 53 ears: 1. the hole in the footplate, 2. placing the prosthesis on the incus, 3. removal of stapes arch, was performed. Total deafness had one patient of the whole group. No patient had perilymphatic fistula and facial nerve palsy. Floating footplate developed in 4 patients of group I, in one patient of group II and in none patient of group III. Subluxation of incus developed in 3 patients of group I, in 12 patients of group II and in none patient of group III. Comparison of three stapedectomy methods showed that making the hole in the footplate before removal of stapes arch prevents floating footplate and placing the prosthesis on the incus before removal of stapes arch prevents subluxation of the incus.     

保留喉功能喉咽癌的手术切除与修复

目的 评价喉咽癌保留喉功能手术临床治疗效果和影响预后因素.方法 回顾性分析1974年9月至2003年7月收治的45例喉咽癌保留喉功能手术临床治疗效果.其中梨状窝癌23例,环后癌13例,喉咽后壁癌9例.术前放疗2例,放疗量40～50 Gy;术后放疗32例,放疗剂量60～70 Gy.分析影响患者生存率的危险因素.结果 45例保留喉功能术后发音清晰者88.9%,发音轻度含混者占11.1%;23例拔除气管套管,拔管率51.1%,全部能进普食.出现术后并发症19例(42.2%);术后颈部淋巴结转移20例,占44.4%.Kaplan-Meier法统计全组患者5年生存率为53.3%.T1+T2组和T3+T4组患者术后5年生存率分别为66.7%和43.3%;cN0和cN1、cN2组生存率分别为65.2%和46.7%、28.6%;病理分化程度高、中和低组生存率分别为62.3%、42.1%和30.8%.单因素分析生存率与术前有无颈淋巴转移及病理分化程度有关(x2值为5.297和11.556,P值为0.021和0.003).Cox回归多因素分析显示,术前有无颈淋巴转移和病理分化程度是影响预后的独立危险因素(x2值为4.365和4.600,P值为0.041和0.032,OR值1.151和0.610).结论 喉咽癌保留喉功能手术为T1、T2患者的最佳术式,部分T3、T4晚期喉咽癌也可以采用保留喉功能手术.正确选择颈清扫的方法,有助于提高喉咽癌保留喉功能手术的生存率.     

Endonasal flexible fiberoptic endoscopy

By the introduction of the flexible fiberscope in the field of endonasal diagnostics and treatment, the following reasonable usefulness was obtained, and the results ascertained the great clinical value this method possesses. 1. Easier approach to the ostia of all paranasal sinuses. 2. Observation of the inside of all paranasal sinuses by the use of minor endonasal surgical procedures. 3. Detailed examination of the nasopharyngeal structures by the pernasal approach. 4. Observation of the orifice and the internal portion of the Eustachian tube. 5. Detailed evaluation of velopharyngeal closure mechanism in cleft palate cases. 6. All of these can be performed on an outpatient basis.     

Expression of p53 in inverted papilloma and malignancy associated with inverted papilloma

OBJECTIVE: To determine the association of p53 protein in malignant cases of inverted papilloma compared with cases of benign inverted papilloma of the sinonasal tract. DESIGN: Case-control study of archived pathologic material. SETTING: Tertiary care hospital. METHODS: Archived pathologic material of cases of malignancy associated with inverted papilloma and controls of benign inverted papilloma were obtained from Mount Sinai Hospital. These were subjected to immunohistochemistry for p53. Clinical correlation was obtained by retrospective chart review. MAIN OUTCOME MEASURES: Staining of pathologic specimens for p53 and survival or recurrence. RESULTS: Four of the five cases of malignancy associated with inverted papilloma demonstrated overexpression of p53. None of the benign cases of inverted papilloma demonstrated overexpression. Only two of the five patients with malignancy associated with inverted papilloma were alive at 2 years. CONCLUSIONS: Overexpression of p53 may serve as a marker for malignant transformation of inverted papilloma.     

Middle ear and cochlear receptors in the subterranean mole-rat, Spalax ehrenbergi

The eardrum and the auditory ossicles of the middle ear, and the population of cochlear receptors in subterranean mole-rats of Spalax ehrenbergi complex were qualitatively and quantitatively analyzed. The area of the eardrum was 10.2 (S.D. = 0.9) mm2, that of the stapedial footplate 0.6 (S.D. = 0.07) mm2, the malleus: incus lever ratio was 1.25:1. The malleus is simply built, not attached to the tympanic ring. The incus is large; its long process is almost parallel to the manubrium of the malleus. The short process of the incus is provided with a peculiar bony cap, a structure thus far undescribed in mammalian auditory ossicles. Firmness of mutual connection of the ossicles may vary among different forms of Spalax. The size and form of the stapes are characterized by a large variability as well. The length of the basilar membrane was 12.6 (S.D. = 0.7) mm. The mean density of inner hair cells amounted to 93.3 that of outer hair cells to 386.4 cells per mm of the basilar membrane length. In general, the density increased from the base towards the apex. On average there were 415 outer, 100 inner hair cells in the organ of Corti; the ratio being constant along the basal 65% of the length and decreasing in the apical part of the organ of Corti. The radial width of the triad of outer hair cells increased and remained constant along the apical half of the Corti organ. Based on available findings of comparative and functional morphology, most of the studied features may be considered correlates of low-frequency tuning of the hearing organ in mole-rats.     

Effects of recurrent otitis media in infancy on auditory perception and speech

INTRODUCTION: Recurrent otitis media is commonly encountered in children before 3 years of age. Conductive hearing loss up to 40 dB is frequently associated with suppurative otitis media. Good hearing is believed to be critical to the development of normal language. This study was undertaken to evaluate the effect of recurrent otitis media on auditory perception and speech. PATIENTS AND METHODS: The experimental group consisted of 33 children with a history of at least three episodes of acute otitis media before 2 years of age. A control group of 29 children experienced one or fewer episodes of otitis media in the first 2 years of age. At the time of investigation, all children were 8 to 10 years of age and had attended similar pre-school, kindergarten, and elementary school programs. None showed evidence of mental retardation nor behavioral or emotional disorders. Speech ability was assessed by a battery of tests specific for Slovene language. Subtests of the Wechsler Intelligence Scale for Children were used as well as the Reading and Writing Test. RESULTS: Auditory perception disorders were evident in 88% of children investigated who had a history of at least three episodes of otitis media by 2 years of age. Decreased auditory stimulation during the time of auditory maturation could prevent the development of these functions completely. No statistically significant differences were observed in the development of articulation. These observations underscore the importance of early management of recurrent otitis media during the first 2 years of age.     

Generalizability Theory II: Application to perceptual scaling of speech naturalness in adults who stutter.

Generalizability theory has been recommended as the most comprehensive method for assessing the reliability of observational data. It provides a framework for calculating the various sources of measurement error and allows further design of measurements for a particular purpose. This paper gives a practical illustration of how this method may be used in the analysis of observational data. We use the ratings of 15 unsophisticated raters using the 9-point speech naturalness scale of R. R. Martin, S. K. Haroldson, and K. A. Triden (1984) to evaluate the speech of adults before and after treatment for stuttering. We calculate various sources of measurement error and use these to estimate the minimum number of raters and ratings per rater for a reliable result. For posttreatment data, the average of three independent raters, and for pretreatment data, the average of five independent raters should give a result within one scale point of the hypothetical true score for the speaker in at least 80% of samples. The example illustrates the advantages of using this method of analysis.     

Pathological and clinical assessment of polypoid hypertrophy of the vocal cords

Polypoid hypertrophy of mucosa of the vocal cord is the most common non-neoplastic disease of the larynx. This hypertrophy has a form of simple polyp of vocal cord or polypoid hypertrophy of the whole length of one or both vocal cords. In most cases a course of the disease is typical. In a few cases we can observe changes in polyp epithelium, i.e. hyperplasia or even dysplasia. Clinical and histological analysis of 809 patients treated because of laryngeal polyps (by Kleinsasser microsurgical procedure) within the period of 1981-1995 at ENT Clinic in Gdańsk was made. Sex and age of the patients, macroscopic picture of the disease as well as treatment and results were assessed. Special attention was paid to the problem of polyp epithelium rebuilding. In a few cases, polyp of the vocal cord should be assessed as praecancerous state.     

瞬态诱发耳声发射频域分析的临床意义

目的：确定瞬态诱发耳声发射（ＴＥＯＡＥ）频域分析的应用价值。方法：对正常耳，噪声暴露耳，梅尼埃病耳，中耳病变耳及对侧抑制耳，进行ＴＥＯＡＥ频域测试。结果（１）噪声暴露耳，一些频率带的频信噪比降低，主频出现移动变化；（２）梅尼埃病一些甘油摄入后，频带信噪比增高，未引出ＴＥＯＡＥ的部分耳出现ＴＥＯＡＥ，主频也有移动变化；（３）中耳病变耳，不同的鼓室病变耳的频带信噪比降低，程度各异，其变化与声导纳改变有     

Bilateral choanal atresia: key to success with the transnasal approach

The intranasal approach is generally accepted as the route of choice in the correction of bilateral choanal atresia but unfortunately it is associated with a significant incidence of stenosis. Over a five-year period, we have diagnosed bilateral choanal atresia in 30 neonates. Trans-nasal surgery was performed on 27 of them. All belonged to the Black race group. The incidence was 1:8,300 live births. There was a female predominance of 5:1. Four (13 per cent) had other associated anomalies. One was a twin. Various factors were analysed to determine the cause of the stenosis. These were: 1. Drilling compared with curettage of the bony atretic plate. 2. Stenting versus non-stenting. 3. Soft versus hard Portex tube stenting. 4. Variation of stenting period--six, eight and twelve weeks. 5. The use of prophylactic broad spectrum antibiotic for the whole of the stenting period. The conclusion derived from this study is that curettage of bony atresia, stenting with soft Portex tube for a period of six weeks and the use of broad spectrum antibiotic for the entire stenting period eliminates the problem of stenosis associated with the trans-nasal approach for the correction of bilateral choanal atresia.     

Understanding the deafened brain: implications for cochlear implant rehabilitation

The cochlear implant (CI), by enabling oral communication in severely to profoundly deaf subjects, is one of the major medical advances over the last fifty years. Despite the globally very satisfactory results, individual outcomes vary considerably. The objective of this review is to describe the various factors influencing the results of CI rehabilitation with particular emphasis on the better understanding of neurocognitive mechanisms provided by functional brain imaging. The following aspects will be discussed: 1. Peripheral predictors such as the degree of preservation of nerve structures and the positioning of the electrode array. 2. The duration of auditory deprivation whose influence on brain reorganization is now becoming more clearly understood. 3. The age of initiation of hearing rehabilitation in subjects with pre-lingual deafness influencing the possibility of physiological maturation of nerve structures. 4. The concepts of sensitive period, decoupling and cross-modality. 5. In post-lingually deaf adults, brain plasticity can allow adaptation to the disability induced by deafness, subsequently potentiating CI rehabilitation, particularly as a result of audiovisual interactions. 6. Several studies provide concordant evidence that implanted patients present different phonological analysis and primary linguistic capacities. The results of CI rehabilitation are dependent on factors situated between the cochlea and cortical associative areas. The importance of higher cognitive influences on the functional results of cochlear implantation justify adaptation of coding strategies, as well as global cognitive management of deaf patients by utilising brain plasticity capacities.     

Experimental intravenous inoculation of Klebsiella rhinoscleromatis bacilli in albino rats: a histopathological and bacteriological study

Scleroma, chronic specific granuloma of the nose and upper respiratory tract, is endemic in Egypt and many other countries. The exact pathogenesis of the disease as regards the aetiological role of Klebsiella rhinoscleromatis is contradictory. This work investigated the effect of experimental intravenous injection of K. rhinoscleromatis in albino rats to demonstrate that the micro-organism can fulfil Koch's postulates. Micro-organisms were isolated from biopsy specimens taken from nasal lesions of 10 patients in the granulomatous stage of scleroma. Specimens were subjected to bacteriological and histopathological examinations to confirm the diagnosis. A 100 microl volume of freshly prepared bacterial inoculum containing 10(8) cfu/ml was injected weekly in the tail vein of each of 30 albino rats for 5 consecutive weeks. Biopsy specimens were taken from sacrificed animals and subjected to bacteriological and histopathological examinations. Positive histopathological diagnosis of scleroma was reported in the nose of 66.7% of rats, the larynx of 46.7%, the lungs of 26.7% and liver of 20% of rats. Bacteriological techniques were successful in revealing K. rhinoscleromatis from the nose of 36.7% of rats, the larynx of 30% and the lungs of 20% of rats. Various techniques were carried out to demonstrate the micro-organisms in tissue sections. Two histochemical stains for bacteria were employed: silver and Periodic Acid Schiff (PAS) stains. Immunoperoxidase technique using Klebsiella capsular type 3 antiserum was applied. It gave positive results in 66.7% of the 6 stained liver sections in spite of negative bacteriological cultures. The histiocytic nature of the Mikulicz cells was confirmed using alpha-1 antitrypsin, an immunohistochemical marker of histiocytes, and by studying the ultrastructural features of Mikulicz cells using the transmission electron microscope.     

Angiosarcoma of the external ear: a case report

A case of an angiosarcoma of the pinna in an 82-year-old male is reported. Variability of presentation and lack of clinical awareness may result in a delay in the diagnosis of this rare tumor. Initial confusion may arise because of the deceptively benign clinical appearance of the lesion, which may resemble a bruise or superficial infection. Early biopsy is mandatory in view of the prognostic significance of tumor diameter at the time of diagnosis. Untreated, the mean survival of patients with angiosarcoma is 7 months. This increases to 15 to 20 months in treated patients, 12 percent being alive at 5 years. A combination of surgery and radiotherapy offers the best chance of cure. The need for wide local treatment of apparently normal tissue has been advocated because of imperceptible local spread of the tumor. Apparent cure may be followed by late local recurrence or distant metastasis, so lifelong follow-up is necessary.     

Side-effects of cidofovir in the treatment of recurrent respiratory papillomatosis

Recurrent respiratory papillomatosis (RRP) is a chronic and difficult to treat disease of the larynx. In 1998, the first article was published that described the use of the antiviral substance cidofovir to treat this disease. Although the results are promising, there remains some concern about the potential carcinogenicity of cidofovir. There is a demand for a qualitative review of the side-effects of this medicine. In this review, the side-effects of cidofovir are investigated. Special attention was given to the potential carcinogenicity of cidofovir. For this review a search is performed in PubMed and EMBASE for relevant articles in which the use of intralesional cidofovir for patients with RRP is described. Eventually, 31 articles could be included for this review. In these articles a total of 188 patients with RRP were described who underwent therapy with intralesional cidofovir. Five of these patients have developed dysplasia of the larynx during the treatment with cidofovir. This is a percentage of 2.7. This percentage is concurrent with the incidence of spontaneous malignant degeneration of RRP (2-3%). Based on this review, it can be concluded that the use of intralesional cidofovir does not increase the risk of laryngeal dysplasia. Apart from the articles that describe the intralesional administration of cidofovir, some articles have been published in which the use of intravenous cidofovir is described as a therapy for RRP. Therefore, a summary is given on the side-effects of intralesional cidofovir as well as a summary on the reported side-effects of the intravenous administration of cidofovir. Based on the outcomes of this review, recommendations are given for a safe use of cidofovir for treatment of recurrent respiratory papillomatosis in the future.     

Nasal septal abscess and palatine process of the maxilla abscess complicating acute rhinosinusitis in a 12-year old boy

We report a case of nasal septal abscess and palatine process of the maxilla abscess secondary to acute rhinosinusitis in an 12-year-old boy. Rare complication of acute sinusitis is the nasal septum abscess; even rarer is the abscess of the palatine process of the maxilla, which our patient presented. Nasal septum abscess is an reservoir of suppurative secretion between cartilage or bone of the septum and their periostium or perichondrium. Nasal septum abscess is most often bilateral, causing nasal cavities obstruction. Other symptoms are: nasal pain, fever, headache, nasal tenderness, bad general feeling. Spontaneous abscesses of nasal septum are rare and occur due to acute ethmoid or sphenoid sinusitis and inflammations originating from teeth. Patophysiology of nasal septum abscess depends on its etiology. The isolated acute sphenoid sinusitis may lead to occurrence of nasal septum abscess by spreading of inflammatory changes under periostium along the anterior surface of sphenoid bone and damaging the periostium of vomer and perpendicular lamina of ethmoid bone into subperichondrial space of quadrangular cartilage. Inflammation of inferior wall of sphenoid sinus located over fornix of nasopharynx might have lead to appearance of the palatine process of the maxilla abscess. We consider this mechanism of abscess creation occurred in our patient. Another possible mechanism comprehends spreading of inflammatory process through bone fissures, congenital bone malformations of due to thrombophlebitis. Recommended procedure in cases of confirmed nasal septum abscess is surgical decompression from semitransverse incision of the column and abscess drainage. Aspiration and bacteriological culture allow for exact establishment of proper antibiotic treatment. Antibiotic therapy should be conducted for 2-3 weeks according to bacterial sensitivity to chemotherapeutics. In reexamination of our boy's nasal septum cavity of abscess was assessed and a small cartilage defect was noted. Necrotic changes in nasal septum cartilages arise due to ischemia and compression by residual pathological contents between perichondrium and cartilage. Proper recognition and surgical and preservative treatment lead to total recovery. In our boy, control examinations after 2 and 6 months confirmed recovery without recurrence and later complications.     

Smad5 基因敲除小鼠耳蜗扫描电镜观察

目的观察Smad5基因敲除杂合（3月组2只小鼠4只耳蜗）子小鼠内耳形态学超微结构变化。方法野生型动物组：1个月组4只小鼠5只耳蜗，2个月组及3个月组各有2只小鼠4只耳蜗：杂合子动物组1个月组3只小鼠3只耳蜗，2个月组2只小鼠4只耳蜗，3个月组3只小鼠6只耳蜗。按常规方法制成标本作扫描电镜观察。结果Smad5基因敲除杂合子小鼠扫描电镜观察：1月组耳蜗中均观察到耳蜗第一和第二圈外毛细胞有不同程度的静纤毛融合，未见外毛细胞缺失，内毛细胞未见明显地病理变化。2月组耳蜗中观察到第一和第二圈均可见内外毛细胞静纤毛不同程度缺失，有的部位以内毛细胞静纤毛缺失为主，而有的部位以外毛细胞静纤毛缺失为主，有的以片状缺失为主，有的则以散在性缺失为主。3个月组3只小鼠6只耳蜗中均观察到不同程度第一和第二圈内外毛细胞静纤毛广泛性缺失，有外毛细胞缺失的部位多，以第一排外毛细胞的静纤毛缺失为主．第二和第三排外毛细胞静纤毛多以散在性缺失为主，有内毛细胞缺失的部位多伴有外毛细胞静纤毛的大片状缺失。野生型动物组扫描电镜观察：1个月组4只小鼠5只耳蜗，2个月组2只小鼠4只耳蜗均未观察到内外毛细胞缺失和静纤毛的变化，3月组有少量的外毛细胞缺失。结论野生型小鼠2个月以内耳蜗毛细胞无明显变化．杂合子小鼠随着月龄的增加内外毛细胞缺失的程度逐渐加重。     

Cyst and pseudocyst lesions of the floor of the mouth with submental affectation

There are several lesions which can present as a cyst or pseudocyst of the floor of the mouth with submental repercussion. The aim of this paper is to review the diagnosis methods which can help us to differentiate these lesions such as the surgical peculiarities of every tumour. We are reporting two cases of cystic/pseudocystic lesions of the floor of the mouth with submental repercussion. Both of them were epidermoid cysts. Ranulas, lipomas and lymphangiomas should be considered in the differential diagnosis. Imaging diagnosis, fine needle aspiration and adequate treatment in all of the tumours are reviewed. Both cases were operated via intraoral. They are now free of disease after at least one year. Differential diagnosis of cystic lesions of the floor of the mouth is important because the recommended surgery technique is not exactly the same in all of them. The firmness of the wall of dermoid cysts let their exeresis via intraoral even when they are of a big size. Exeresis of sublingual gland is recommended by most authors to treat ranulas, although it is followed by an important percentage of morbidity.     

A technique for reembedding celloidin sections for electron microscopy

A new technique for reembedding celloidin sections of human temporal bones for transmission electron microscopy is described. It consists of four steps: 1. loosening of celloidin sections from glass slides with use of xylene and dissection of the area of interest, 2. removal of celloidin with use of clove oil, 3. staining with 1% osmium tetroxide and 1% tannic acid, and 4. embedding in epoxy resin. Autolytic changes were seen due to poor fixation. TEM of reembedded celloidin sections of optimally fixed tissue revealed that the celloidin-embedding procedure affected ul-trastructural preservation to some degree. This included less well-preserved cell membranes and some increased electron density of the cytosol decreasing the EM resolution of intracytoplasmic organelles. The technique allows TEM analysis of the intact labyrinth at all regions in the same specimen without dissection of the fragile tissue components of the membranous labyrinth. This might make the technique useful for processing freshly fixed human inner ear tissue and temporal bones for ultrastructural histo-pathological analysis.     

Treatment and treatment results of mouth floor cancers]

The records of 68 patients with cancer of the floor of the mouth were reviewed. 56 patients underwent surgical management, 51 of them got additionally postoperative radiation. The tumour-specific five years' survival for patients with operation was 46%, 57% of treatment failures developed from local recurrence of the tumour. In 52% of all cases there was a spread to the lymphatic system in the histological evaluation. There was high incidence of false negative clinical examinations of the neck. Conservative neck dissection was the procedure of choice for clinically positive lymph nodes and for the elective management of the neck. Only advanced tumours showed involvement of the mandibular bone. Therefore a conservative management of mandibular resection was preferred. Radical tumour extirpation and histological controlling with serial sectioned specimens are methods of avoiding local tumour recurrence.     

Electromyographic study on end-to-end anastomosis of the recurrent laryngeal nerve in dogs

The effectiveness of anastomosis of a divided recurrent laryngeal nerve was studied with electromyography as well as visual observation. Results obtained through this investigation permitted the following conclusions: 1. Regenerated potentials were recorded from both the involved thyroarytenoid and posterior cricoarytenoid muscles for an average of 5 to 6 weeks postoperatively. 2. Average onset of recovery of spontaneous adduction was 10 weeks following surgery, and four dogs regained complete recovery of adduction in 13 to 14 weeks. Average onset of recovery of spontaneous abduction was 11.8 weeks postoperatively, and none of the four dogs displayed complete recovery. 3. The time delay between the onset of regenerated potentials and onset of recovery of cord mobility averaged 4.2 weeks for adduction and 6.4 weeks for abduction. 4. Incomplete recovery of movements of the reinnervated vocal cord might be due to an inadequate number of effective motor units. 5. End-to-end anastomosis of the recurrent laryngeal nerve can be performed as one method of reinnervating the denervated intrinsic laryngeal muscles, and further histological studies should be carried out to determine if the regenerated nerve fibers actually have decreased.