William H. Saunders

Acquired Cholesteatoma: Light and Electron Microscopic Observations

the hypotheses, concepts dealing with metaplasia?.8 b as a 1 c e 11 hyperpla~ia,6-~**~’-’ and immigration**8*2s have received popular support. Also disputed is whether or not a tympanic membrane perforation is a prerequisite for the development of cholesteatoma. There is experimental evidence that proliferation of the basal cells in the absence of a perforation can lead to the development of cholesteat~ma,~~ particularly if initiated by an inflammatory p r o c e ~ s . ’ ’ * ~ ~ * ~ ~ In any case, certain characteristics such as its pearl formation and invasiveness, have not been wholly explained.

Cervical Osteophytes and Dysphagia

How often and to what extent do osteophytes protruding anteriorly from the cervical spine cause dysphagia or other esophageal or tracheal symptoms? When read closely many of the reports dealing with the subject leave doubt as to the relationship between osteophytes and esophageal symptoms. For example, one patient with dysphagia was reported as having both cervical osteophytes and advanced pseudobulbar palsy. Whether the osteophytes caused her dysphagia seemed questionable. Another report described a patient with dysphagia who had an osteophyte removed but who later was found to have carcinoma of the esophagus.

Morphologic and immunohistochemical observation of otosclerotic stapes: A preliminary study

Stapes with otosclerotic lesions obtained during stapedectomies were examined with light microscopy, histochemistry, immunochemistry, and electron microscopy to elucidate the cellular mechanism(s) involved in this disease process. Three types of lesions were identified: cellular (spongiotic), fibrotic, and sclerotic. The cellular type is characterized by monocyte, macrophage, osteoblast, and osteoclast recruitment and their activation. Macrophage recruitment is an early event of otosclerosis. The fibrotic type is characterized by extensive fibrosis of the bone, and the sclerotic type is characterized by a paucity of bone cells. Cytochemical results showed a large accumulation of granular substances positive for periodic acid-Schiff stain along the edge of the marrow spaces coinciding with ultrastructural calcospherite deposits, suggesting that glycosaminoglycans are involved in the mineralization process. Acid phosphatase is largely localized in the osteoclasts, but a sporadic diffusion of this enzyme was observed in the demineralizing front of the preotosclerotic lesion. Immunoglobulin G and complement C3 were colocalized in pericapillary tissue, suggesting deposit of immune complex in the spongiotic lesion. This finding indicates a possibility that immune mechanisms are involved in otosclerosis.

Otosclerotic stapes: morphological and microchemical correlates. An electron microscopic and x-ray analytical investigation.

A total of 32 otosclerotic stapes is thin-sectioned without decalcification and examined using transmission and scanning electron microscopes, with a nondispersive x-ray analyzer attached to the latter. These otosclerotic stapes are classified as spongiotic, sclerotic, or preotosclerotic, according to their pathologic characteristics and state of mineralization. Either diffuse or patchy demineralization in the ground substance appears to be the initial stage of otosclerosis, and this area coincides with preotosclerotic lesions (also known as blue mantle) in light microscopy. Therefore, it is interpreted that demineralization precedes the destruction of ground substance in the preotosclerotic lesion. Bone mineral deposits in new otosclerotic bone appear to be related to the collagen fibrils that are embedded in the ground substance. No mineral deposit could be seen without the ground substance deposition; therefore, it is suggested that this ground substance is the single most important factor in the poor mineralization of the otosclerosis. The sclerotic lesions are well mineralized and show a typical pattern of hydroxyapatite by x-ray diffraction study. We could not confirm the notion that the sclerotic lesion is hypermineralized as compared to the normal stapes. The spongiotic lesions are poorly mineralized, with low calcium salt. Using the Ca/P ratio and x-ray diffraction pattern as criteria, it was determined that spongiotic lesions belong to unstable, immature bone.

Surgery of the inferior nasal turbinates.

The inferior turbinates are responsible for nasal obstruction more often than commonly thought. When there is no other obvious cause for nasal obstruction, and when allergic disorder or other medical condition is not responsible, attention should be given to treatment of the inferior turbinates in many instances of nasal obstruction. Such treatment is usually surgical and may consist of submucous resection of the turbinate bone or excision of redundant hyperplastic turbinate tissue, or a combination of the two. Other treatments consist of electrocautery or cryotherapy. Injection of corticosteroids have produced blindness through embolism and, in general, this treatment is discouraged. The paper discusses in some detail which patients are best suited for submucous resection and which for excision of soft tissue. Techniques, which are simple, are also described.

Bilateral Hypoglossal Nerve Paralysis after Irradiation Therapy

Cancericidal doses of irradiation therapy to the head and neck may be followed by paralysis of cranial nerves due to fibrosis of tissue about the nerves and infiltration of the nerves with fibrous tissue. The hypoglossal nerve is particularly prone to this delayed effect of irradiation therapy and a case is presented here in which there was bilateral hypoglossal paresis appearing three years after therapy.

LIV Dysphonia Plica Ventricularis: An Overlooked Condition Causing Chronic Hoarseness

Dysphonia plica ventricularis was first described by Jackson and Jackson in 1935. Previous authors had described vocal states probably resulting from this condition, but they failed to correlate voice changes with laryngeal appearances. Since 1935 no additional articles written by physicians describing this condition have appeared in the literature. I find that some otolaryngologists are unaware of this relatively common cause of hoarseness.

LXXVIII Reduced Blood Volume Occurring in Otolaryngologic Patients

Many surgeons believe that ordinary determination of the blood hemoglobin, blood erythryocyte count, hematocrit, and plasma protein concentration is an adequate measure of a patients blood volume and total hematologic constituents. To put it another way, they think that if these values in any specimen of blood are normal, there is no deficiency in the total amount of circulating plasma volume and protein and erythryocyte mass.