James L. Parkin

Advanced techniques in magnetic resonance imaging in the evaluation of the large endolymphatic duct and sac syndrome.

The purpose of this report is to compare temporal bone computed tomography (CT) to high‐resolution magnetic resonance (MR) imaging using a novel thin‐section fast spin echo (FSE) pulse sequence in identifying and characterizing patients with large vestibular aqueduct syndrome. Sixteen patients with sensorineural hearing loss and a CT diagnosis of large vestibular aqueduct(s) underwent high‐resolution fast spin echo magnetic resonance imaging with dual, 3‐in phased array receiver coils centered over the external auditory canals. Magnetic resonance imaging parameters included axial and oblique sagittal fast spin echo with an effective slice thickness of 1 mm contiguous. Thirty‐eight patients with 76 normal inner ears who underwent MR imaging using this technique had their endolymphatic duct measured.

Acquired and congenital subglottic stenosis in the infant.

During the calendar year of 1974, the Intermountain Newborn Intensive Care Center at the University of Utah Medical Center had 603 admissions. A representative group of 293 charts were reviewed which indicated that 44% of these children were intubated from hours to weeks. The overall mortality rate for the 293 children was 29%. Eighteen of the 603 children were diagnosed as having subglottic stenosis. Fifteen of these children appeared to have acquired subglottic stenosis secondary to endotracheal intubation. Three children had congenital subglottic stenosis. Tracheostomy was necessary in the management of 15 patients. Ten of the 18 patients have survived and two of these patients still have tracheostomy tubes in place. The survival and thickness of the stenotic area are inversely proportional to the birth weight and the duration of intubation. Endoscopic excision, dilatation and stenting were techniques utilized in the treatment of these stenotic lesions. The extubation technique utilized is described. The factors involved in the production of acquired subglottic stenosis are presented along with suggestions to decrease the incidence of this problem in the intubated child.

Argon Laser Treatment of Head and Neck Vascular Lesions

Port wine stains (PWSs), hereditary hemorrhagic telangiectasias (HHTs), hemangiomas, arterial venous malformations (AVMs), vascular granulomas and polyps, glomus tumors, and nasopharyngeal angiofibromas are vascular lesions of the head and neck potentially responsive to treatment with the argon laser. One hundred consecutive patients with PWSs, 25 patients with HHTs, three with subglottic hemangiomas, three with oral and/or lingual hemangiomas, two with labial AVMs, three with vascular laryngeal polyps, and one patient with inoperable glomus tumor were treated with the argon laser. Results were good to excellent in 94% of the facial PWS patients. All treated patients in the HHT group demonstrated improvement. Results with the other lesions were variable. The argon laser is a valuable treatment modality in vascular lesions of the head and neck. Posttreatment scarring and failure to achieve desired results are complications encountered. Pretreatment counseling will assist the patient in understanding the expected results.

Familial multiple glomus tumors and pheochromocytomas.

Isolated cases of cervical cranial glomus tumors have been reported in association with pheochromocytoma. Two family pedigrees are presented and four individual cases discussed indicating a hereditary syndrome of pheochromocytoma associated with multiple glomus tumors of the head and neck. The hereditary potential has not previously been described. In three of the patients, the pheochromocytomas were asymptomatic at the time of initial presentation. These pheochromocytomas were discovered by arteriography after one of the patients developed a hypertensive crisis with the induction of anesthesia. The silent presence of pheochromocytoma in patients with multiple glomus tumors should be considered in the evaluation of these patients.

Laser Photocoagulation in Hereditary Hemorrhagic Telangiectasia

Recurrent epistaxis is usually the main symptom found in patients with hereditary hemorrhagic telangiectasia (HHT)—Osler Rendu Weber syndrome. Therapies have included intranasal cautery, septal dermoplasty, intra-arterial embolization, and arterial ligation. These procedures have met with limited success. Laser photocoagulation has achieved early success in the gastrointestinal (GI) telangiectatic lesions. In this report, cutaneous and intranasal lesions of eight HHT patients have been treated with laser photocoagulation using a flexible fiber delivery system connected to 3 W argon and 55 W neodymium:yttrium-aluminum-garnet (Nd:YAG) laser sources. The patients noted a great reduction in the frequency and severity of epistaxis, reduction in the need for blood transfusion, and reduction in iron therapy necessary to maintain adequate hemoglobin levels. Previously, five of these patients were considered treatment failures after extensive surgical therapy. No serious complications have been encountered. Laser photocoagulation of HHT patients appears to be a promising therapeutic advance. The progressive nature of HHT necessitates close follow-up and retreatment of new lesions as they appear.

Selective management of early glottic cancer.

Seventy patients with stage I and II glottic cancer were treated at the University of Utah School of Medicine hospitals from 1980 through 1987. Forty‐four patients had stage I cancer and 26 patients had stage II. The overall survival in the stage I group was 82%. Primary site control was 93% with only three deaths due to laryngeal cancer. Local control rates were 93% with CO2 laser excision, 80% with CO2 laser and irradiation, and 67% with radiation alone.

The pitch of electrically presented sinusoids

A patient who uses the Ineraid cochlear implant, and who has hearing thresholds less than 50 dB HL for frequencies under 500 Hz in his nonimplanted ear, was asked to match the pitch of low-frequency signals presented to his two ears. The patient produced pitch matches, for frequencies of 125, 200, and 300 Hz presented to his most apical electrode, that were slightly higher than the reference frequency. When signals of fixed frequency were presented to electrodes located in successively more basal cochlear locations, pitch increased in an orderly fashion--an average of 57 Hz (range = 31-87 Hz) for each change in electrode location.

Pitch scaling and speech understanding by patients who use the ineraid cochlear implant

Pitch scaling was assessed for 10 normal-hearing listeners and 8 patients who use the Ineraid multichannel cochlear implant. For two patients who were excellent users of the prosthesis, pitch increased over a wide range of frequencies (100 Hz to 2333-3000 Hz). For three patients who were above average users of the prosthesis, pitch increased with frequency over a smaller range (100 Hz to 1200-2300 Hz). For three patients who demonstrated poor word recognition ability, pitch increased with frequency over a very small range (100 Hz to 600-1000 Hz). These results suggest that differences in speech understanding among patients who use the Ineraid may be accounted for, in part, by the range of pitch available through the implant.

Frequency discrimination and speech recognition by patients who use the Ineraid and continuous interleaved sampling cochlear-implant signal processors

Patients who use the Ineraid cochlear implant were tested in four experiments with materials which assessed frequency discrimination and speech understanding. In each experiment both frequency discrimination and speech recognition varied among patients. Correlations between the two measures were significant and ranged from 0.60 to 0.83. Most generally, frequency discrimination was better in the frequency domain of F1 than in the domain of F2. In experiment 5, both the Ineraid signal processing strategy and a continuous interleaved sampling (CIS) strategy were implemented for a single patient. The CIS strategy improved frequency discrimination in the domain of F2 and improved speech understanding.

Prognosticating speech performance in multichannel cochlear implant patients.

Twenty patients received multichannel cochlear implants between April 1984 and May 1986 at the University of Utah Medical Center. All patients have been followed for at least 1 year postimplant. Preimplant screening included audiometric testing, electronystagmogram (ENG), promontory stimulation, computed tomography (CT) scanning, and psychological evaluation. Based on postimplant audio-only CID sentence discrimination scores, these patients were divided into three groups: good (CID > 79%), Intermediate (CID, 21% to 79%), and poor (CID < 21%). Preimplant factors that correlated with CID scores were hearing loss duration, previous use of hearing aids, lip-reading ability, tinnitus, positive ENG calorics, preimplant pure-tone average, promontory stimulation threshold, and understanding of the project. Only previous hearing aid usage approached statistical significance (p = 0.05). A larger patient sample is needed to verify these results.