Edward L. Applebaum

An endoscopic method of tympanic membrane fluorescein angiography.

Fluorescein angiography is a recently developed method of studying the tympanic membranes dynamic vasculature. Our preliminary studies using an ophthalmic fundus camera and aural speculum did not always permit visualization of the entire tympanic membrane, and the electronic flash unit used in our initial studies did not cycle fast enough to visualize effectively the rapid arterial phase of blood flow. In this report, we describe an endoscopic method of tympanic membrane fluorescein angiography that uses a continuous xenon light source. A representative angiogram from a normal subject is described. The mallear artery apparently is the major blood supply to the posterior half of the tympanic membrane, which is consistently better perfused than the anterior half. Branches from the annular ring of blood vessels supply the anterior half of the tympanic membrane. Preliminary studies of two temporalis fascia tympanoplasty patients indicate that the graft becomes revascularized 2 to 4 weeks after surgery and that posterior grafts may revascularize earlier than anterior grafts.

Virtual temporal bone: Creation and application of a new computer-based teaching tool☆☆☆

The human temporal bone is a 3-dimensionally complex anatomic region with many unique qualities that make anatomic teaching and learning difficult. Current teaching tools have proved only partially adequate for the needs of the aspiring otologic surgeon in learning this anatomy. We used a variety of computerized image processing and reconstruction techniques to reconstruct an anatomically accurate 3-dimensional computer model of the human temporal bone from serial histologic sections. The model is viewed with a specialized visualization system that allows it to be manipulated easily in a stereoscopic virtual environment. The model may then be interactively studied from any viewpoint, greatly simplifying the task of conceptualizing and learning this anatomy. The system also provides for simultaneous computer networking that can bring distant participants into a single shared virtual teaching environment. Future directions of the project are discussed.

Lung Cancer After Head and Neck Cancer: Role of Chest Radiography †

Objective To e‐amine whether screening chest radiographs lead to significantly longer life span in patients found to have pulmonary lesions than in those in whom lung cancer was detected after symptoms developed.

The submandibular triangle in squamous cell carcinoma of the larynx and hypopharynx.

A 15‐year retrospective analysis was carried out at the University of Illinois College of Medicine, Chicago, reviewing the tumor staging and pathology data of 239 patients treated for carcinoma of the larynx and hypopharynx requiring laryngectomy alone, laryngectomy with neck dissection, or laryn‐gopharyngectomy and neck dissection. Surgery was the primary treatment modality in 205 of the 239 cases, with the remaining 34 having surgery to treat radiation therapy failure. Primary tumors were located within the supraglottic region, the glottic region and, less commonly, the pyriform sinus. Ninety‐five of the 239 patients either presented with or developed nodal metastases following initial treatment. Of these, only two had tumors within the lymph nodes of the submandibular triangle. This data corroborates impressions that tumors of the larynx and hypopharynx rarely metastasize to the submandibular triangle and that sparing this area during neck dissection for lesions of the larynx would seem justified.

Surgical Management of Isolated Malleus Handle Fractures

INTRODUCTION A recent review of isolated malleus handle fracture lesions by Iurato and Quaranta1 suggests that this lesion may be more common than previously assumed. Harris and Butler2 and Pederson3 also suggested that isolated malleus handle fractures are frequently misdiagnosed because the tympanic membrane appears intact, so the diagnosis is easily overlooked. The clinical diagnosis of malleus handle fracture should be suspected in a patient with a conductive hearing loss, evidence of abnormal malleus motion on pneumomassage, a type A tympanogram with an abnormally high compliance, and a supporting clinical history. The common causes of isolated malleus handle fracture reported in the literature include head trauma, barotrauma, removal attempts of foreign body from the ear, penetration by foreign objects, and the generation of a large negative pressure during the rapid removal of a finger from the external auditory canaJ.l In some cases, however, the history is not remarkable for any of these suspected causes. Historically, surgical treatment outcome for isolated malleus handle fracture has been only partially successful. Surgical treatments to repair the malleus handle fracture generally utilize bony chips around the fracture site with or without Gelfoam to stabilize the fracture and facilitate callus healing. This type of surgical repair to stimulate callus formation is limited in efficacy by tympanic membrane vibration, the low rate of bone turnover, and the slow remodeling rate of the malleus. Harris and Butler2 suggested performing an ossicular reconstruction

Otosclerotic involvement of the cochlea: a histologic and audiologic study.

This study sought correlations between sensorineural hearing loss and otosclerotic endosteal involvement in 29 temporal bones examined histologically. The sensorineural hearing loss of the affected parts of the cochlea was determined by the last antemortum bone conduction audiogram available. There were eight temporal bones with only stapes footplate involvement, six with one discrete focus of otosclerotic endosteal involvement, and 15 with two or more foci of endosteal involvement. Analysis of audiometric data showed that the group of bones with two or more foci of endosteal involvement had a similar incidence of 45 dB sensorineural loss (9 of 15 or 60%) as did the group with no endosteal involvement (5 of 8 or 62%). The group with two or more foci had a greater incidence of 60 dB or greater sensorineural loss (46%) compared with the groups with none (12%) or one focus (16%) involved. Correlation between hearing toss and involvement of cochlear endosteum was poor. Correlation existed in only 2 of 15 ears with two or more foci involving the cochlear endosteum. There was no correlation in the other groups. It appears that cochlear endosteal involvement alone may not be sufficient explanation for the sensorineural hearing loss found with otosclerosis, except in the most severely involved ears.

Intracranial and Intratemporal Meningiomas with Primary Otologic Symptoms

Intratemporal extensions of cerebellopontine angle (CPA) meningiomas are unusual and primary intratympanic meningiomas are extremely rare. The initial symptoms of both types are otologic. The presenting symptoms of even large meningiomas of the cerebellopontine angle can also be otologic. In this article we report the clinical features, diagnosis, and management of five CPA meningiomas, three combined intratemporal and CPA meningiomas, and one primary intratympanic meningioma.

Treatment of Spastic Dysphonia without Nerve Section

Spastic dysphonia is a disorder characterized by strained, constricted phonation with excessively adducted vocal cords. Despite initial success with recurrent laryngeal nerve section, the search for other treatment continues. Our clinical study involved inserting a needle electrode percutaneously into the region of the recurrent laryngeal nerve in five patients with spastic dysphonia. Electrical stimulation resulted in dramatic improvement in three patients and minimal improvement in two. Our experimental study was designed to create an animal model for an implantable nerve stimulator to be used on a long-term basis. A Medtronic spinal cord stimulation system was implanted into a dog, and a cuff electrode was positioned around the recurrent laryngeal nerve. Vocal cord position could be altered by varying the stimulus frequency. Long-term stimulation of the recurrent laryngeal nerve was relatively safe and effective. Eventually, we plan to implant nerve stimulators into spastic dysphonia patients who respond well to percutaneous stimulation.

Ramsay-Hunt syndrome in a patient with HIV infection.

T h e acquired immune deficiency syndrome (AIDS) was first described in 1981 because of cases of impaired cell-mediated immunity, opportunistic infections, and malignancies in homosexual males. I Currently, it is estimated that 1 to 1.5 million persons are infected with the AIDS virus in the United States, and 40,051 cases that fulfill the Center for Disease Control (CDC) case definition for AIDS have been reported. While tremendous knowledge has been gained about the immunology, virology, and pathophysiology of the disease, measures for treatment, and prevention remain elusive. As the incidence of AIDS increases, more patients with the syndrome will be encountered by otolaryngologists. In a study by Marcusen and Sooy, 399 cases of AIDS were reviewed with respect to their head and neck manifestations. Forty-one percent of the patients reported symptoms referable to the head and neck. Kaposis sarcoma (both mucosal and cutaneous), candidiasis, and chronic cough were the most common findings. Herpes zoster infections have been long-recognized as occurring more frequently in immunocompromised hosts, and they have also been seen frequently in patients with AIDS.4 Herpes zoster has been shown in immunologic and biologic studies to be indistinguishable from varicella or the chickenpox virus.5 It is believed that the chickenpox virus remains dormant in neural tissue after primary infection. A patients immunocompromised state allows the virus to escape normal, immune surveillance, and it then causes secondary infection. Zoster most commonly involves the trunk in a dennatomal distribution consistent with neurogenic spread (i.e., shingle^).^ Herpes zoster oticus is a form of head and neck zoster that is associated with a motor neuropathy-namely,

The effect of isotretinoin on propylene glycol-induced cholesteatoma in chinchilla middle ears

Previous studies have shown that propylene glycol causes inflammatory changes and cholesteatoma when applied to chinchilla middle ears. Vitamin A and synthetic analogues are essential for the normal differentiation of epithelial tissues. The purpose of this study was to determine whether the administration of isotretinoin to chinchillas would prevent propylene glycol exposure from inducing middle ear cholesteatomas. Sixteen chinchillas received 90% propylene glycol to the left middle ear and normal saline to the right. Half the animals were placed in the experimental group and received a daily dose of isotretinoin of 2 mg/kg for 7 days prior to propylene glycol administration and then for 6 weeks until killed. At 6 weeks, cholesteatoma was found in six of eight ears treated with propylene glycol in animals receiving isotretinoin. Two animals in the control group died. Three of the remaining eight had cholesteatoma. No ears treated with saline had cholesteatoma. We conclude that isotretinoin, in our chinchilla model, does not prevent propylene glycol-induced cholesteatoma formation.