Indications for surgery for Bell's palsy

Transmastoid surgical decompression of the facial nerve was found to have no positive effect in recovery from facial nerve function in patients with Bell's palsy. Since the risks of such surgery are greater than the benefits, this procedure should not be performed on patients with Bell's palsy unless a tumor is suspected. A mass lesion is suspected if there is complete paralysis and loss of response to evoked electromyography within the first 2 weeks after onset of the palsy or if there is recurrent facial paralysis on the same side. Rehabilitation surgical procedures should be reserved for patients with acute Bell's palsy with keratitis unresponsive to medical therapy or for those seen late in the course of the disease to correct undesirable sequelae.     

Normal threshold of hearing for cat for free-field listening

Summary A new normal threshold of hearing of cat (monoaural) for free field listening was determined by behavioural audiometry and this was compared with cat's hearing thresholds obtained by other techniques of behavioural audiometry. The absolute hearing thresholds obtained in the present study are slightly lower than those of other authors at many test frequencies. This appears to be due to different conditioning techniques and testing methods which are used to determine hearing thresholds. Any large interindividual variability in absolute hearing threshold at any test frequency resulted from differences in the technique and method of obtaining the thresholds and not from differences in hearing ability of the animals.

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Zusammenfassung An einseitig labyrinthektomierten Katzen wurde nach push-pull Konditionierung verhaltensaudiometrisch die normale Hörschwelle im freien Schallfeld bestimmt und mit den durch andere Methoden der Verhaltensaudiometrie ermittelten Katzenhörschwellen verglichen. Die in den vorliegenden Untersuchungen gefundenen absoluten Hörschwellen sind in vielen Prüffrequenzen geringgradig niedriger als die. von- anderen Autoren bestimmten. Das dürfte eine Folge der verschiedenen Konditionierungstechniken und Prufmethoden sein, die bei der Restimmung der Hörschwelle benutzt wurden. Die hier verwendete Technik der Verhaltensaudiometrie ermöglicht es, daß die Katze auf den schwächsten Schallreiz reagiert. Nach einem ausreichenden Konditionierungstraining lag bei den Audiogrammen aller Katzen eine auffallende Übereinstimmung vor (interindividuelle Übereinstimmung). Größere interindividuelle Abweichungen der absoluten Hörschwelle dürften also auf unterschiedliche Prüfmethoden und Konditionierungstechnik der Hörschwellenbestimmung und nicht auf Unterschiede in der Hörfähigkeit der Katzen zurückzuführen sein.

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Part of a Thesis approved by the University of London for the Ph. D. Degree in Medicine, 1969.     

Screening for middle-ear disease in schools for hearing-impaired children

The aim of the study was to determine the prevalence of middle-ear dysfunction in a group of hearing-impaired children attending schools for the deaf. Two groups of subjects between the ages of 4 and 16 years were selected. Group 1 consists of Caucasian and Group 2 of Negroid children. Otoscopic examinations, impedance and pure tone testing were performed on each child. The results indicated a prevalence of 43% failures on the impedance tests in the Caucasian group and 18% failures in the Negroid group. Chronic problems like perforations, otorrhoea, etc. were more common in Group 2. The results also suggest the existence of differences in the prevalence of middle-ear dysfunction between normal and hearing-impaired children.     

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.     

A model for multidisciplinary data collection for cervical metastasis

A system for multidisciplinary data collection for metastatic neck disease is discussed. Information from 87 neck dissections and 3218 lymph nodes is reported to illustrate the strength of the model. Clinical (endoscopic) assessment under general anesthesia, surgical assessment during the neck dissection, and radiographic (computed tomographic scan) assessment were compared with the pathological evaluation. All disciplines stratified the necks by region and node size. This model provides an effective stratagem for multi-institutional studies.     

攻克感音神经性耳聋治疗难题的基础研究

内耳感觉细胞的损伤会导致永久性的感音神经性耳聋。人工耳蜗植入等替代治疗方法不能重建受损的听觉生理结构并最终恢复正常的听觉生理功能。感音神经性耳聋治疗的根本方法,是内耳感觉细胞的修复或再生,国内外大量的研究取得诸多令人可喜的进展。已有多种方式通过对听觉系统发育的关键调控基因进行操作,获得了内耳感觉细胞的保护、增殖和分化,并进一步实现了听功能的部分恢复。本篇述评将结合国际最新研究动态,集中介绍杨仕明课题组近10年为攻克感音神经聋治疗难题的基础研究工作。首先课题组在国家自然科学基金青年基金、面上项目以及重点项目支持下,建立了耳聋动物新模型,并以此作为切入点为耳聋干预提供了必要的研究平台;第二,在国家863和国家自然科学基金重点项目联合资助下,探索了内耳基因治疗的可能性,为了最终临床应用正在解决诸多技术瓶颈,如高效安全的内耳递送技术,尤其是生物活性分子的递送载体;第三,在国家973听觉干细胞项目以及973重大科学问题导向项目资助下,基于耳聋干细胞治疗基础研究也取得了较多突破。我们的研究发现,无论是基因操作、基因治疗、分子治疗还是干细胞治疗,有效干预策略的建立都需要充分阐述内耳分子病理的发病机制,从而有针对性选择合适的干预方式和最佳的干预时间窗。感音神经性耳聋治疗将倾向于多元素联合和个体化干预模式,并成为多学科交叉发展的最前沿领域。     

Need for an urgent ultrasound examination for neck lump

Thromboembolic phenomenon is rare but serious consequence of ovarian hyperstimulation syndrome (OHSS) and in vitro fertilization (IVF) treatment. We present a case of thrombosis of the right internal jugular vein presenting as a neck lump to the ENT department. Ultrasonography of the neck and upper extremity revealed thrombosis of right internal jugular vein. The patient was started on low molecular weight heparin, which resulted in resolution of her clinical condition. Interestingly, the majority of cases after OHSS involve thrombosis of the upper extremities. ENT surgeons, general physicians, and infertility experts should consider this in the differential diagnosis of neck swellings, particularly after OHSS and IVF treatment, and in this case report, we emphasis the need for an urgent ultrasound of the neck in such patients.     

Considerations for the design of clinical trials for tinnitus

CONCLUSION: There are many possible control conditions to consider in designing research on tinnitus treatments. Some of the counseling procedures involve more than simply 'talking' or providing information, and it is important to make this distinction. Several good handicap scales are available, but we believe that 100-point interval scales have some superior attributes. Both primary and secondary measures of benefit should be used. Open trials have some merit, but should only be used cautiously. Several recent guidelines have been suggested for improving the design and reporting of clinical trials. OBJECTIVES: This paper reviews some basic considerations in the design of research to evaluate tinnitus treatments, particularly counseling and sound therapies. METHODS: We have reviewed some of the basic issues, referenced some relevant work, and provided some data supporting some of our assertions. RESULTS: We provide some recommendations for consideration for the design of clinical trials.     

Age criteria for polysomnography and inpatient management for adenotonsillectomy

ObjectiveClinical practice guidelines (CPG) by the American Academy of Otolaryngology recommend that children <2yo with sleep disordered breathing (SDB) undergo preoperative polysomnography (PSG) and children <3yo be admitted following adenotonsillectomy (TA) for inpatient management. As the rationale for preoperative PSG and postoperative admission in the CPG are the same, there is an inconsistency in the age recommendations between <2yo and two to three-years-old (2-3yo). This study compared the characteristics of <2yo versus 2-3yo patients undergoing workup and treatment for SDB, with the goal of determining whether 2-3yo should be classified with <2yo.Study designCase series with retrospective review.SettingBoston Medical Center, a tertiary academic hospital.MethodsPatients ≤3yo who underwent PSG 2015 to 2019 were identified using a filter through the electronic medical record. 448 patients underwent PSG. Bivariate analysis via Pearson chi-square test and multivariate analysis via multinomial logistic regression were performed using SPSS.ResultsOf the 427 patients included in this study, 217 patients were in the age group of <2yo while 210 patients were in the age group of 2-3yo. Severity of OSA (p = 0.069) and surgical outcomes (defined by presence or resolution of OSA on follow-up PSG) (p = 0.260) were similar between the two groups. Children <2yo were more likely to have smaller tonsils (p < 0.024) than 2-3yo.ConclusionCharacteristics, such as severity of OSA, were similar between the age groups. Further studies should be conducted to determine if consideration should be taken for routine preoperative PSG children <3yo.Level of evidence: IV.     

Norms for the international outcome inventory for hearing aids

The International Outcome Inventory for Hearing Aids (IOI-HA) is a seven-item survey that was developed for use in research settings to facilitate comparison of data across diverse investigations. The inventory also has potential applications in clinical evaluation of hearing aid fitting outcomes. This article reports the development of norms for the inventory that are suitable for use with group data in research applications, and individual data in a clinical setting. The normative group was defined as adults fitted bilaterally with analog, single-channel, single-memory, compression processing, in-the-ear hearing aids. There were 154 subjects. Associations between outcomes and demographic variables (e.g., gender, hearing loss, etc.) were explored, and several relationships were seen. Based on these data, two sets of norms were derived. The appropriate set will depend on the individual's reported subjective hearing problems without amplification.     

Tonsillitis index: an objective tool for quantifying the indications for tonsillectomy for recurrent acute tonsillitis

This report is a preliminary exploration of the concept of a "Tonsillectomy Index" (TI) as an objective tool for quantifying the indications for tonsillectomy for recurrent acute tonsillitis (AT). The TI is derived by multiplying the number of episodes of AT by the number of years during which the episodes of AT occurred. Our objective in this study was to investigate whether there is a relationship between the natural history of AT, the immunological functions of tonsils and our proposed TI. For the natural history of AT, we medically followed 11 children with a history of AT for 5 years. When TI was equal to or greater than 8 (TI> or =8), the children suffered a significantly greater number of episodes of AT. For the immunological portion of our study, we enrolled 36 children and 46 adults undergoing tonsillectomy for either AT (study group) or tonsillar hypertrophy (control group, CG). We analyzed the co-stimulatory signals, CD80 and CD86 on tonsillar B-lymphocytes. The expression rates of CD80 and CD86 in the AT group with TI> or =8 were significantly decreased compared to those with TI was less than 8 (TI<8), as well as with those in control (tonsillar hypertrophy) group. Our preliminary findings suggest that when the TI> or =8, the tonsils have deteriorated immunologically and spontaneous resolution of recurrent AT is less likely to occur, hence tonsillectomy is appropriate. TI may be a useful tool for surgical decision making.     

Attenuation values for a supra-aural earphone for children and insert earphone for children and adults.

Earphone attenuation values were determined for 17 children (6-14 years old) using supra-aural (TDH-49P/Model 51 cushion) and insert earphones (E-A-Rtone 3A) terminated by an E-A-Rlink 3A (for normal size ear canals) or E-A-Rlink 3B (for small size ear canals) foam eartips, and for 10 adults having small ear canals using insert earphones and E-A-Rlink 3B foam eartips. The test signals were 1/3-octave bands of noise presented in a diffuse sound field (re: ANSI S12.6-1984). The supra-aural earphone attenuation values for the children were slightly higher (more attenuation) or similar to reported adult values, and always lower (less attenuation) compared with insert earphone/E-A-Rlink 3A (IE/3A) or 3B (IE/3B) values for both children and adults. The IE/3B attenuation values were similar between the children and adults and provided slightly more attenuation than the IE/3A. Overall, the results indicated that the ANSI S3.1-1991 maximum permissible ambient noise levels allowed in a test room for ears covered testing with a supra-aural earphone, which were determined using adult values, are appropriate for testing children. Future revisions of ANSI S3.1-1991 may include maximum permissible ambient noise levels for testing with insert earphones. The IE/3A and IE/3B attenuation values could be used for that purpose. In the meantime, because more attenuation was provided by the IE/3A and IE/3B, they can be used for testing both children and adults in higher ambient noise levels than specified in ANSI S3.1-1991.