B. Hill Britton

Carcinoma of the external auditory canal

Successful management of carcinoma of the external auditory canal depends upon four factors: 1. early diagnosis is imperative if a high cure rate is to be expected; 2. correct evaluation of the extent of the malignancy; 3. adequate surgery based upon correct evaluation; and 4. postoperative radiation in certain selected cases.

An evaluation of revision stapes surgery

The expected success rate in primary stapedectomy is well documented in recent literature, but few reports have commented on the difficulties or the expected results in revision stapes surgery. Reports have dealt with different techniques, but the surgeon and the patient should be aware of the problems and risks involved in revision stapedectomy.

Microscopic characteristics of the acoustic tumor in relationship of its nerve of origin

The microscopic characteristics of a 0.9 cm vestibular schwannoma en bloc resected with its nerve of origin which occurred in a 54‐year‐old white woman presenting with a two‐year history of a unilateral progressive sensori‐neural hearing loss is described. The tumor originated in the inferior vestibular portion of the vestibular division of the VIIIth cranial nerve just medial to the internal auditory canal meatus at approximately the level of the glial‐non‐glial junction. The tumor demonstrated two distinctly different, yet simultaneous, modes of involvement with its nerve of origin: 1. inseparable cellular continuity; and 2. peripheral compression of the remainder of the nerve within the tumor capsule. Despite only slight microscopic continuity of the nerve histologically, electronystagmography showed no unilateral weakness on bithermal caloric testing, and pure tone and speech audiometry was only moderately depressed.

Schwannoma of the facial nerve in the cerebellopontine angle presenting with hearing loss

Schwannomas of the facial nerve in the cerebellopontine angle are unusual. The authors describe a 43-year-old woman with progressive hearing loss and dizziness who had a small schwannoma of the facial nerve in the cerebellopontine angle without extension into the internal auditory canal. The tumor was completely removed with preservation of facial nerve function. The diagnosis and management of facial nerve schwannomas are discussed.

Lateral Temporal Bone Resections

Eighteen consecutive patients underwent a lateral temporal bone resection for the treatment of tumors originating in the auricle, the external auditory canal, the periauricular skin, or the parotid and were retrospectively analyzed. The different lateral temporal bone resections performed have been categorized into four types. The type I resection consists of the removal of the tympanic bone and the external auditory canal lateral to the tympanic membrane. The type II resection consists of the removal of the entire tympanic bone, the tympanic membrane, the incus, and the malleus, preserving the facial nerve and the inner ear. Type III resections remove, in addition to the those structures removed in type II resections, the distal facial nerve and fallopian canal, the mastoid tip, the styloid process, and the stylomastoid foramen. The type IV resection consists of the removal of only the mastoid tip and the inferior portion of the tympanic bone. When the techniques of lateral temporal bone resection are used appropriately, adequate surgical treatment of patients with selected advanced and recurrent malignant tumors of the external ear, the periauricular skin, and the parotid is possible with low morbidity and a high probability of local regional control.

Vertigo in the pediatric and adolescent age group

Since episodic vertigo in the pediatric and adolescent age group is unusual and therefore not well known to most otolaryngologists, we present six cases to show some of the various presentations and different underlying causes. These cases covered a wide diagnostic spectrum: meningioma, medulloblastoma, childhood migraine with vestibular symptoms, childhood Menieres syndrome (one case due to perilymph fistula), and benign paroxysmal vertigo of childhood. The two patients with tumor and the patient with perilymph fistula were treated surgically; the other patients are being managed conservatively since these childhood conditions usually tend to diminish with time.

Vestibular Responses to Pressure Variations: A Review

A selected review of the literature concerning different forms of pressure stimulation of the normal and abnormal vestibular labyrinth is presented. On the basis of this review, it can be stated that there are definite vestibular signs and symptoms associated with pressure stimulation. The exact mechanisms remain in doubt. The responses, however, appear to be mediated through the vestibular hair cells.

Bruit caused by aberrant carotid artery in the middle ear

An aberrant course taken by the internal carotid artery during its development may lead it through, rather than anterior to, the middle ear space. The resulting symptoms and signs, including a pulsatile bruit in and around the ear and the presence of a mass behind the tympanic membrane, require differentiation from those of glomus jugulare tumor.