Steven M. Silver

Patterns of swallowing after supraglottic laryngectomy.

Objective To understand the anatomical and physiological basis for early recovery of swallowing function after supraglottic laryngectomy.

Repetitive transcranial magnetic stimulation in veterans with debilitating tinnitus : A pilot study

OBJECTIVE: Available evidence suggests tinnitus arises from excessive spontaneous activity in the left superior temporal gyrus, and repetitive transcranial magnetic stimulation (rTMS) may suppress this activity. Our hypothesis is that rTMS applied to this region would decrease tinnitus complaints in veterans. STUDY DESIGN: Prospective, nonrandomized trial. SUBJECTS AND METHODS: Eight patients with tinnitus received 5 consecutive days of rTMS (0.5 Hz, 20 minutes) to the left temporoparietal area. Tinnitus Handicap Inventory (THI) measures before sessions 1 and 3 and after session 5 were used to evaluate efficacy. RESULTS: Patient 1s THI decreased 40 to 34 to 26, patient 4 reported a subjective improvement, patient 8 withdrew, and the remaining patients reported no improvement. Adverse effects included temporary soreness, restlessness, and photophobia. CONCLUSION: The parameters for this rTMS study are different from those that reported success with its use. With these current parameters, rTMS did not improve tinnitus in veterans. There were no permanent adverse outcomes.

Applications of magnetic resonance spectroscopy to tinnitus research: initial data, current issues, and future perspectives

Conducting tinnitus research on humans poses challenges for investigators because of its subjective nature, the complexities involved in establishing underlying generator sites, the diversity of potential causes, and the inherent difficulties in dissociating reactive changes in the central nervous system (CNS), secondary to peripheral hearing loss, from those effects that may be due to tinnitus. One area of considerable interest concerns biomarker development, particularly in the areas of metabolism and biochemistry. Establishing a biomarker or a profile of metabolic and neurobiochemical constituents of tinnitus-related activity within the CNS could be of considerable importance for understanding the fundamental properties of this disorder. Therefore, in an effort to gain greater insight into mechanisms of tinnitus, magnetic resonance spectroscopy (MRS) is being proposed as one of the several tools that can address pertinent issues. Apart from its long-standing use in analytical chemistry and physics, MRS is also being applied with greater frequency in the neurosciences to gain insight into human brain function under normal and pathological states. By considering the history of this method and advances made to date, MRS has the potential to: (1) identify unique in vivo metabolic and neurobiochemical biomarkers associated with tinnitus in specific regions of the CNS, (2) clarify and track disease pathogenesis, (3) monitor short and long-term treatment effects, and (4) serve as a tool in testing of drugs that may be used in treatment of tinnitus.

Tubed, folded radial forearm free flap for pharyngeal reconstruction and voice rehabilitation

Reconstruction after total laryngectomy ideally includes restoration of voice with protected swallowing. Local flaps and tracheo-esophageal puncture with a prosthesis are widely used to accomplish this. Persistent problems, perhaps inherent to this solution, have led to the recent use of a tubed, folded radial forearm free flap for postlaryngectomy reconstruction. This flap has produced a good voice with low phonation pressures and minimal aspiration in 7 patients. A new configuration for this flap is described and 3 patients reported. Our flaps advantages include a simplified pedicle path, ease of construction, remote microanastomosis, and safer revision. Both patients with surviving flaps rapidly developed a good voice after reconstruction. Mild aspiration in 1 delayed oral intake and forced a successful revision. Our reconfigured flap may have some technical advantages, survives to length, and restores a good voice without significant aspiration. This and its simple care make it popular with patients. Development of this flap holds promise of more complete reconstruction after total laryngectomy.

The origins of the cochlear efferent bundle of Rasmussen in primates

The spatial distribution of neurons emitting fibers of the olivocochlear bundle was determined by injecting horseradish peroxidase into the round window in a series of new and old world monkeys. Animals were perfused 24–28 h later. Sections through the pons and medulla were reacted with tetramethyl benzidine and counterstained with thionin and/or neutral red. Perikarya containing reaction product numbered over 800 in one case. The greatest concentration of labeled cells was located in the dorsal periolivary area intermediate between the dorsal margins of the lateral and medial superior olivary nuclei. Approximately 400 cells were ipsilateral to the injection, opposed to 100 contralaterally. The dorsolateral periolivary area contained over 100 labeled cells ipsilaterally, and only about one‐third as many contralaterally. While 95 labeled cells occupied the region of the contralateral medial preolivary nucleus, about two‐thirds as many labeled cells were found in the comparable ipsilateral nucleus. Although...