Avrim R. Eden

An external reference to identify the internal auditory canal in middle fossa surgery.

Traditional middle fossa landmarks, such as the facial hiatus and arcuate eminence, are often unreliable. This study was performed to establish an external reference from which to identify precisely the surgical anatomy of the middle fossa. The head of the malleus was identified from the middle fossa in the temporal bones of 20 adults. The lateral cortex of the temporal squamosa at the zygomatic root was used as the external plane of reference. The head of the malleus was consistenty located 18 mm medial to the outer cortex on a line perpendicular to the reference plane. Medial extension of this line through the malleus head bisected the internal auditory canal. We recommend this method to precisely locate the malleus head as the first landmark in the middle fossa. Other structures, such as the geniculate ganglion, internal auditory canal, and superior semicircular canal can then be safely identified. We also present our results using this technique in six consecutive patients undergoing middle fossa surgery during the past 12 months.

A specialized innervation of the tensor tympani muscle inMacaca fascicularis

The innervation of the tensor tympani muscle of the middle ear in Macaca fascicularis (cynomolgus monkey) was studied using the horseradish peroxidase (HRP) neural tracing technique. A compact column of small trigeminal motoneurons was labeled ipsilaterally following intramuscular application of HRP to the tensor tympani muscle. This column is located ventral and lateral to the dorsolateral division of the trigeminal motor nucleus, and just medial to the descending trigeminal nerve rootlets. No labeled neurons were present in the trigeminal mesencephalic nucleus or any other brainstem nucleus. Results are compared with those previously reported in several non-primate mammalian species, and in detail with that of the cat. A possible differential role of the tensor tympani muscle in acoustic modulation/middle ear aeration between primate and non-primate mammals is discussed.

Ethics and the care of persons with Bell's palsy

Much of the bioethics literature focuses on dilemmas physicians face involving life and death issues. We articulate and apply a method of bioethics that can help both in resolving such dilemmas and in the appreciation of many situations and conditions. We apply the method to a case of a person with Bells palsy because such a condition does not involve life and death, has a low cure rate, involves poorly recognized value conflicts, involves several specialties with rival approaches to care and much uncertainty. We show the strengths of the method in the application, and recommend it as generally useful to organize the way one perceives cases and attempts to resolve dilemmas.

Diseases of the External Ear: An Otologic-Dermatologic Manual

This is a practical and concise book about diseases of the external ear. Precisely illustrated with excellent color photographs and filled with useful and practical information down to the very ointment to prescribe, this book will be useful to all physicians who are sometimes puzzled and occasionally confounded by matters dermatologic. The book appropriately begins with a brief review of the anatomy and histology of the external ear. Techniques of examination and a short chapter on general principles of therapy precede the main body of the text. This begins with a well-illustrated chapter (78 color photographs) on diseases caused by infection by bacteria, fungi, viruses, animal parasites, and insects. Subsequent chapters deal with diseases of the external ear ascribed to psychogenic causes, allergy, trauma, foreign bodies, metabolic and endocrine abnormalities, and cysts and tumors. There is also an excellent chapter on diseases of unknown cause, eg, keratosis obturans, lichen planus,

External Ear Malformations: Epidemiology, Genetics, and Natural History

This book, ninth in the Birth Defects Series published by The National Foundation-March of Dimes, is an excellent, thorough, and up-to-date review of external ear malformations, a birth defect with an overall incidence of 1%. The book is divided into two halves. In the first, the authors present a critical review of world literature on the epidemiology and etiology of this congenital defect. The introductory chapter on the intricate normal and abnormal morphogenesis of the branchial region is well illustrated, the constantly amazing fact being that 99% of human ears develop so perfectly. The excellence and strength of this book emerge in the second half, with the detailed analyses of the 600 children with external ear malformations in a seven-year prospective study of 56,000 pregnancies in the National Collaborative Perinatal Project (14 hospitals, 12 universities, 1959 to 1965) under the auspices of the National Institutes of Health. Many interesting

Aural Rehabilitation for the Elderly

This book is the proceedings of a symposium on aural rehabilitation for the elderly held at North Texas State University, Denton, Tex, in October 1978. The keynote chapter traces in some detail the history of aural rehabilitation in this country from its beginnings in the four training centers set up to deal with hearing casualties during World War II; sadly, the keynote speaker, Dr John J. Gaeth of Wayne State University, Detroit, died on the eve of the symposium, and this book (commencing with his historical review) is dedicated to his memory. Elderly persons are defined as individuals 65 years and older, and hearing loss is due mostly to presbyacusis. The relative and absolute magnitude of the task of providing effective aural rehabilitation for the elderly is beginning to emerge more clearly as the percentage of senior citizens in our population increases. In 1980, it is conservatively estimated that

Hearing and Hearing Impairment

The editors and publishers are to be congratulated on producing an extremely useful, affordable, and well-printed source book that presents, concisely and informatively, a basic overview and current status of the various disciplines that are intimately involved in the management of hearing-impaired patients. The two editors have assembled an impressive list of 57 contributing authors and have succeeded in their attempt to bring together and integrate the viewpoints of (to mention but a few) otologists, neurologists, psychiatrists, psychologists, audiologists, social workers, teachers of deaf persons, educators, biomedical engineers, community agency administrators, and public health officials. The book is divided into six sections: a historical review of otology and aural rehabilitation; the basic and clinical sciences of hearing and hearing impairment; current programs and practices with hearing-impaired persons; the behavioral and emotional problems of deaf persons; societal issues related to hearing-impaired persons; and last, rehabilitative delivery systems in the present and

Hearing and Aging: Tactics for Intervention,

Hearing impairment is the third most common chronic disorder (after arthritis and visual impairment) in the elderly; more than half the population with bilateral hearing loss are older than 65 years, making presbyacusis the most common auditory disorder in the Unites States. This book, intended primarily for audiologists and hearing-aid dispensers, attempts to define the ever-increasing extent of the problem of hearing loss in the elderly and to suggest techniques and tactics for useful intervention. There are no startlingly new statements or concepts in this book. The accurate audiologic assessment of the elderly includes conventional audiometry, listening tasks such as speech in noise, and tests of central auditory function such as auditory memory. The degree of auditory impairment usually dictates the primary technique of aural rehabilitation. The mainstay of rehabilitation remains a well-fitted hearing aid with advice on its correct use, speech (lip) reading, and the psychological support of the