Richard W. Babin

Cis-diamminedichloroplatinum (II) ototoxicity in the guinea pig.

Cochleas from 12 guinea pigs were evaluated using light, scanning, and transmission electron microscopy after systemic administration of cis-diamminedichloroplatinum (cis-DDP). Administration of cis-DDP resulted in loss of the Preyer reflex and degeneration of outer hair cells (OHC) with increased dose. The OHC degeneration was most pronounced in the basal turns of the cochlea with greatest severity in the inner row. Ultrastructural evidence of OHC degeneration included dilatation of the parietal membranes, softening of the cuticular plate, increased vacuolization and increased numbers of lysosome-like bodies in the apical portion of the cell. Supporting cells appeared more sensitive than OHC. Alteration of supporting cell ultrastructure preceded detectable change in OHC. Injury to the supporting cells was noted with intracellular vesiculation and increased autophagocytosis.

Histopathology of Neurosensory Deafness in Sarcoidosis

Sarcoidosis is an idiopathic systemic granulomatous disease which occasionally causes fluctuating auditory and vestibular dysfunction. The temporal bones from a 32-year-old man deaf for 5 years from CNS sarcoidosis were examined histologically and compared with other nervous system tissues. It was found that the acoustic, vestibular, and facial nerves were involved in a striking perivascular lymphocytic infiltration resulting in myelin and axonal degeneration. The cochlear and labyrinthine neuroepithelium and stria vascularis had degenerated. It is hypothesized that neurosensory deafness and vestibular dysfunction in sarcoidosis starts as a reversible neuropathy. In some patients, an ischemia secondary to the vasculitis results in irreversible damage to the inner ear neuroepithelium.

Intralabyrinthine Acoustic Neurinomas

Two temporal bones are presented that contain acoustic neurinomas unsuspected during life and anatomically limited to the perilymphatic labyrinth. One tumor occupies the modiolus and scala tympani of the cochlea without involving the internal auditory canal. The other tumor originates in the fibers below the utricular macula and spares both the macula and the lamina cribrosa. Neither case demonstrates bone destruction. Even if these tumors had been suspected during life, tomograms would have been normal and the posterior fossa myelogram would have shown complete filling of the internal auditory canal.

Survival of implanted irradiated cartilage.

The survival of irradiated homograft cartilage was investigated in cats at three- to nine-week and 14- to 16-month intervals. Compared to fresh homograft and autograft cartilage grafts, irradiated homografts showed significantly higher resorption and bony replacement. It was also clear that irradiated cartilage survived as a nonviable implant.

Endoscopic Surgical Management for Laryngomalacia Case Report and Review of the Literature

Laryngomalacia is the most common of the many causes of respiratory stridor in the newborn. It may be identified by fiberoptic nasopharyngoscopy in the nursery or office. Several anatomic mechanisms of supraglottic collapse have been reported in the literature. The most common is a narrowing of the supraglottic airway with blockage of the glottic opening by the redundant tissue of the aryepiglottic folds. Although surgery rarely is indicated, severe airway obstruction, necessitating surgical intervention, can occur. Resection of supraglottic tissue should be performed only as an alternative to tracheotomy. Surgical procedures ranging from tracheotomy to epiglottidectomy have been advocated. Direct visualization of the obstructing tissue by nasopharyngoscopy allows the planning of an appropriate surgical procedure. In a patient with lateral supraglottic collapse, deep resection of the epiglottis would be expected to weaken the support of the aryepiglottic folds and aggravate the airway condition. Similarly, resection of tissue along the aryepiglottic folds will be useful only if preoperative evaluation demonstrates the obstruction to be at this location.

Hypotension-induced neuropraxia in the cat facial nerve.

Pressure short of producing neuropraxia was applied to the facial nerve in 12 cats. In over half, a neuropraxia promptly developed when the animals were rendered hypotensive with nitroprusside. In six other animals, pressure was applied to the nerve following circulatory collapse. No added effect of the pressure on nerve conduction decay could be demonstrated. Pressure-induced neuropraxia appears to be dependent to some extent on ischemia.

Asymmetry of the internal auditory canals without acoustic neuroma.

During the past five years, nine patients with “significant” unilateral enlargement of one internal auditory canal by polytomography were subsequently found to have freely filling canals on contrast posterior fossa myelography. The radiographic appearance of the enlarged canals varied greatly and included all the various configurations usually suggestive of acoustic neuroma. Likewise, the clinical presentation varied greatly from asymptomatic to highly suggestive of cerebellopontine angle tumor. This series underscores the essential nature of posterior fossa studies in the evaluation of potential acoustic neuromas and the variability of the normal architecture of the internal auditory meatus.

The Freeze-Injection Method of Hypertrophic Scar and Keloid Reduction

Hypertrophic scars and keloids continue to plague the head and neck surgeon as an unpredictable consequence of trauma or incision. The myriad suggested methods of revising such lesions indicate that no one method is foolproof. The application of conventional cryotherapy to the lesion, followed by the dilute intralesional Iriamcinalone injection, offers several advantages over other methods.

Topognostic and Prognostic Evaluation of Traumatic Facial Nerve Injuries

If and when to intervene during the course of a traumatic facial palsy depends on the immediacy of the palsy, signs and symptoms of an associated temporal bone fracture, function of the various facial branches, and the results of electrical stimulation. Some facial nerve tests will be more valuable than others in a given case. The following is a philosophy of management that has proven useful to the author in the management of facial palsies of traumatic causes.

Management of Benign Fistulae between Zenker's Diverticulum and the Trachea

Cases of acquired benign fistula of the respiratory tree and esophagus have been reported in relation to Mycobacterium tuberculosis and trauma. Fistula formation between the trachea and a Zenkers diverticulum is a similar type of condition in which nutritional and immunological deficiencies can rapidly result in further complications which may mimic a malignancy. Spontaneous fistula formation and vocal cord paralysis may result. Surgical management of this condition includes interposing viable muscle between the esophagus and trachea at the repair site.