Bruce W. Jafek

Middle ear effusions in neonates

Suppurative middle ear effusions (MEE) have been shown to occur commonly in neonates. In spite of this, otoscopy is not routinely performed on septic infants in the neonatal intensive care unit (ICU). This is clinically significant since unrecognized suppurative MEE may act as a focus for dissemination of bacteria into the circulation and/or central nervous system (CNS).

Fast and accurate measurement of taste and smell thresholds using a maximum-likelihood adaptive staircase procedure.

This paper evaluates the use of a maximum-likelihood adaptive staircase psychophysical procedure (ML-PEST), originally developed in vision and audition, for measuring detection thresholds in gustation and olfaction. The basis for the psychophysical measurement of thresholds with the ML-PEST procedure is developed. Then, two experiments and four simulations are reported. In the first experiment, ML-PEST was compared with the Wetherill and Levitt up-down staircase method and with the Cain ascending method of limits in the measurement of butyl alcohol thresholds. The four Monte Carlo simulations compared the three psychophysical procedures. In the second experiment, the test-retest reliability of ML-PEST for measuring NaCl and butyl alcohol thresholds was assessed. The results indicate that the ML-PEST method gives reliable and precise threshold measurements. Its ability to detect malingerers shows considerable promise. It is recommended for use in clinical testing.

Detection of occult cervical micrometastases in patients with head and neck squamous cell cancer.

Objective The incidence of occult nodal metastases associated with head and neck squamous cell carcinoma (HNSCC) and the clinical significance of nodal micrometastases by cytokeratin immunohistochemical analysis are examined.

Elective carotid artery resection for advanced squamous cell carcinoma of the neck

The authors performed a retrospective review of their 10‐year experience of carotid artery resection without revascularization for advanced squamous cell carcinoma of the neck. From 1982 to 1991, seven patients underwent elective carotid artery resection without reconstruction at the University of Colorado Health Sciences Center in Denver. A vascular clamp with gradual carotid occlusion was placed preoperatively on four patients and awake temporary balloon occlusion of the carotid was used on three patients. The primary lesions were three laryngeal carcinomas, two oral cavity carcinomas, and two hypopharyngeal carcinomas. All seven resected specimens showed invasion of the carotid fascia on pathological exam, while five specimens exhibited actual destruction of the arterial wall. Cerebrovascular accidents occurred in two patients (one immediate and one delayed), and the perioperative mortality was 29% (one cerebrovascular accident and one gastrointestinal bleed). The five remaining patients died of locoregional recurrence or metastatic disease within 1 year after their carotid artery resection.

Ossicular abnormalities in Down's syndrome.

Downs syndrome has been associated with hearing loss and otitis media. Because of difficulty in examination, however, there have been few detailed otologic studies on this population. An understanding of the nature and frequency of ear disease in Downs syndrome is important, since it is common and occurs in more than one in every 600 live births. To define the aural manifestations of Downs syndrome, complete otologic and audiometric examination was performed on 107 consecutive patients. This included micropneumatic otoscopy, pure-tone and speech audiometry, impedance tympanometry, and, in some cases, electronystagmography. Deficient hearing was found in 64% of these patients, and of these hearing losses, 83% were conductive. Surprisingly, middle ear effusion or tympanic membrane perforation accounted for only 60% of the conductive hearing losses. This finding prompted us to examine five temporal bones of children with Downs syndrome. These histologic sections revealed middle ear abnormalities including fixation and superstructure deformity of the stapes and dehiscence of the fallopian canal. Operative findings in 16 procedures on patients with Downs syndrome and conductive hearing loss support those findings.

Cricothyroidotomy: A Decade of Experience in Denver

In an attempt to evaluate cricothyroidotomy as described by Brantigan and Grow in 1976, the authors have reviewed the literature and compared it to the decade of experience following Brantigan and Grows report. The records of over 1,000 patients requiring ventilatory assistance were reviewed. A comparison of this experience with Brantigan and Grows original series and subsequent reports was used to establish the criteria and technique for cricothyroidotomy. It appears that while cricothyroidotomy has specific advantages, it also has disadvantages and a higher incidence of airway stenosis than either of the procedures it was designed to replace (low tracheotomy or endotracheal intubation). For this reason, its use has been severely restricted in Colorado, where it was popularized.

The Vomeronasal Organ of Jacobson in the Human Embryo and Fetus

The early morphogenesis of the vomeronasal organ of Jacobson is documented in the human embryo and early fetus using light and electron micrographs. Differences between its structure and that of the olfactory epithelium are discussed.

An Immuno-electron Microscopic Comparison of Olfactory Marker Protein Localization in the Supranuclear Regions of the Rat Olfactory Epithelium and Vomeronasal Organ Neuroepithelium

Immuno-electron microscopy was used to examine olfactory marker protein (OMP) ultrastructural localization in the supranuclear regions of the rat olfactory epithelium (OE) and vomeronasal organ (VNO) neuroepithelium. In the OE, OMP immuno-reaction product was observed within the cytoplasm of olfactory chemoreceptor cell dendrites, vesicles and cilia. Reaction product was absent from olfactory microvillar cells and their unique microvillar projections. In the neuroepithelium of the VNO, immuno-reaction product was seen within the dendrites of the chemoreceptor cells, and in the bases of their attached microvilli; the remaining distal portions of these microvilli were unlabeled. These results demonstrate a difference in the distribution of OMP immunoreactivity over the surfaces of the rat OE and VNO. They also show that OMP immunoreactivity does not exist in the rat olfactory microvillar cells.

Vascularized Hyoid Interposition for Subglottic and Upper Tracheal Stenosis

Chronic subglottic and upper tracheal stenosis can be treated successfully with lumenal augmentation using a vascularized hyoid-sternohyoid muscle interposition into the stenotic area. Successful decannulation was achieved in eight of nine patients. Follow-up periods varied from 6 months to 36 months. Concomitant laryngeal stenosis and vocal cord paralysis were treated successfully at the same time. The major complication was occasionally delayed but successful decannulation due to granulation tissue. Minimal wound and peritracheal stoma infections probably accounted for the granulation tissue.

The intraoperative management of the thyroid gland during laryngectomy

The standard of care of laryngeal cancer surgery is wide field excision of the larynx combined with ipsilateral thyroid lobectomy. A retrospective review of 247 laryngectomies performed between 1979 and 1989 was undertaken to determine specific intraoperative indications for thyroid gland removal. The incidence of thyroid disease in our patients with laryngeal cancer was compared to the normal population. Eight percent of thyroid specimens removed during laryngeal cancer surgery demonstrated invasion by squamous cell carcinoma. All patients having thyroid invasion had T3 or T4 laryngeal lesions that were stage IV at the time of surgery. All these lesions were found to have transglottic growth and laryngeal cartilage invasion by the pathologist. All of these patients also had abnormal thyroid glands intra‐operatively and laryngeal cartilage destruction that was evident intraoperatively. Total thyroidectomy with bilateral paratracheal and pretracheal lymph node dissection is indicated when squamous cell carcinoma of the larynx involves the thyroid gland. Prophylactic ipsilateral thyroid lobectomy and isth‐musectomy is warranted for large laryngeal cancers (T3, T4) that involve the anterior commissure, the subglottic area, or extend transglottically. Routine thyroid gland removal is not indicated for the majority of laryngeal cancers that do not meet the aforementioned criteria. Finally, abnormal thyroid histopathology was diagnosed in 37% of the surgical thyroid gland specimens removed during laryngectomy.