David Myers

Osteogenesis Imperfecta Tarda and Otosclerosis a Temporal Bone Histopathology Report

The histopathology of the temporal bones in a 59-year-old female with osteogenesis imperfecta tarda (OIT), complicated by otosclerosis, is presented. Advanced conduction and sensorineural deafness in the left ear and absence of a response to sound in the right ear had been recorded before she died and the temporal bones were acquired for histological study. Histopathological examination revealed a marked degree of porosity of the labyrinthine capsule, enlarged vascular spaces, and a deficiency in number and size of bony trabeculae in the marrow of the petrous apex. All layers of the otic capsule had been extensively replaced by otosclerotic material including the bony semicircular canals and the cochlear and vestibular walls. In the right ear, which had a profound hearing loss, the outline of the space which had been occupied by a piston prosthesis in the oval window was evident; in addition, a layer of new bone (labyrinthitis ossificans was present in the scala tympani in the region of the round window. In the left ear the stapedial footplate was otosclerotic with the base of the crura slightly displaced but fixed in the window. The severity of the OIT in this case was demonstrated by the patients history of repeated fractures, marked porosity of the nonotosclerotic areas of the labyrinthine capsule, and possibly by the females relatively early death at age 59. The unique features of the otosclerosis in this case were the extensive replacement of all layers of the cochlear and vestibular capsules and the relatively large areas of an osteoporotic type of degeneration in the more central areas of the otosclerotic bone While the etiology of otosclerosis remains unknown it is apparent that both the incidence and severity of the disorder as it occurs in association with OIT bear some as yet unknown but definite relationship to the pathologies occurring with OIT.

X. A Clinical and Experimental Study of the Action of Saliva on Blood Coagulation and Wound Healing in Surgery of the Oral Cavity and Throat

For many years saliva has had a prominent place in medical literature. Despite the profusion of these writings, most of them deal with the physical and chemical properties of the saliva, little stress being laid on its potentialities as a factor in the process of coagulation and healing. There is, indeed, an amazing dearth of information of this phase of the subject. vVe have made an attempt to delve into the subject and enlarge the fund of knowledge concerning it. A great deal may be learned from animals. Their functions, though simple in character, are effective in accomplishing their purposes. We know that the hurt animal will lick an injury back to health. Man, by instinct, puts an injured finger into his mouth. From a laboratory standpoint, saliva is of little interest to the clinician, but when utilized for clinical purposes the subject assumes an entirely different aspect. Volumes have been written on the subject of hemorrhages following operative procedures in the throat and oral cavity. Much has been said about the method of control, and the invaluable aid of clamps, sutures and various chemical and biologic coagulants. The salivary secretions, although they too have a specific function to perform in the control of hemorrhage, have been neglected. Our observations in vivo as well as in vitro have shown conc1u-

XVI Surgical Treatment of Deafness: Report of Experiences with the Endaural Labyrinthine Fenestration

Historically, surgery for the relief of deafness dates back to 1649, when Rolarius first attempted to improve hearing by rupturing the ear drum. In 1760 J. L. Pettit, and J asser in 1776, performed a mastoidectomy for the relief of deafness. Again in 1801 Ashley Cooper perforated the ear drum. In 1876 Kussel attempted to improve hearing by the removal of the stapes. A trephine of the promontory was first practiced by Passow in 1892, and this procedure was violently condemned by his contemporaries, Politzer, Denker, Maure, Cozzolineo and Seiberman. In 1904 Barany fistulized the posterior semicircular canal. Floderus in the same year made a fistula in the promontory and covered it with a Thiersch graft. In 1914 Jenkins reported two cases in which the horizontal canal was fistulized. In 1917 Holmgren introduced the technique of opening the superior semicircular canals, attempting to keep the fistula open by allowing the dura and arachnoid to cover it. In 1918 Barany attempted to improve hearing surgically by a two-stage operation in which the fistula was covered with a fat graft. In 1920 Holmgren again opened the promontory and covered it with mucoperiosteum. In 1924 Sourdille, the French surgeon, first performed the many-staged labyrinthopexy.

XXIX The Effects of Cochlear Orientation upon the Electrical Activity of the Ear

In a recent study! the magnitude of the cochlear response to constant stimulation was shown to be influenced by the withdrawal of perilymph from the scala tympani. Since the magnitude of the response depends upon the extent to which the hair cells of the organ of Corti are deformed, the question was raised as to whether the orientation of the cochlea relative to gravity would have any effect upon the transduction of mechanical energy into electrical energy in the partially evacuated cochlea. A differential response pattern might occur with varying cochlear orientations as a result of the distribution of the remaining cochlear fluid within the bony labyrinth.

CHARACTERISTICS OF MODERN ELECTRICALLY OPERATED AUDIOMETERS: A QUALITATIVE AND QUANTITATIVE ANALYSIS

For several years various audiometers intended for general diagnostic purposes have been manufactured and sold to physicians. The early instruments were operated from batteries, but in the last few years operation from the electrical power supply circuit has become general practice. Moreover, in the last few years a number of new manufactures have begun the sale of audiometers. The increase in competitive conditions has resulted in considerable sales pressure on otologists and in extensive advertising of audiometers. Although the value to the otologist of an accurate and otherwise satisfactory audiometer for diagnostic work is unquestioned, the attempt to form diagnoses on the basis of inaccurate audiograms can only be misleading and wasteful of time to both the physician and the patient. Audiograms taken with various commercial audiometers have not always agreed and, in fact, have been widely divergent in many cases. The question of how the various commercial audiometers compare