Laryngeal and tracheal problems in patients with central nervous system and spinal disorders.
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Adolescent↗
Biomedical subjects
E L Applebaum
Publications and source records attributed to E L Applebaum.
Otospongiosis (otosclerosis): polytomographic and histologic correlation.
The Temporal Bone Laboratory of Northwestern University Medical School has three sets of temporal bones from patients who had antemortem polytomographic examinations resulting in a diagnosis of otospongiotic involvement of the cochlea. One of these cases was thought to have been an example of pure cochlear otospongiosis. The other two cases were patients with clinical (stapedial) otospongiosis, and their polytomograms were interpreted as unilateral otospongiosis with involvement of the basal turn of the cochlea. In the first set of temporal bones, no otospongiosis was present. In the other two sets, the otospongiotic lesion did not involve the cochlea, and a contralateral otospongiotic lesion was present that had not been seen on the polytomograms. Caution must be exercised in the interpretation of subtle polytomographic changes noted in the cochlear capsule and restraint used in the X-ray diagnosis of pure cochlear otospongiosis until there is evidence of correlation with pathological material.
Aged↗
The submandibular triangle in radical neck dissection.
Various modifications of the standard radical neck dissection operation have been advocated since its original description. An ideal operation would offer maximum cure rates with minimal cosmetic and functional disturbance. The validity of removing the submandibular triangle contents as part of radical neck dissection was studied by analyzing the involvement of this region by metastatic squamous cell carcinomas of the head and neck. Only three of the 51 neck-dissection specimens that were examined contained metastases to submandibular triangle lymph nodes. The primary sites were nose, floor of mouth, and retromolar trigone. None of the 26 laryngeal tumors in this series had spread to the submandibular triangle. In the absence of palpable submandibular or upper, deep cervical lymph nodes, the contents of the submandibular triangle can probably be left undisturbed in radical neck dissections for laryngeal cancer.
Carcinoma, Squamous Cell↗
Pharyngeal reconstruction after laryngectomy.
A method of pharyngeal reconstruction following laryngectomy is described. In 44 successive laryngectomies using this technique, no postoperative pharyngocutaneous fistulas occurred. Ten of the patients had received full courses of radiation therapy prior to the surgical procedure and had recurrent carcinomas. Other reports have noted that laryngectomy following full courses of "unplanned preoperative" radiation therapy is usually associated with a high incidence of postoperative pharyngeal fistula. The pharyngeal fistula problem, and the pharyngeal repair that was used in our series, are discussed. The pharynx was closed carefully in three layers with fine, absorbable sutures, and a submucosal inverting technique was used for the important mucous membrane closure. Tube feedings were used for two weeks after surgery. A high incidence of pharyngocutaneous fistula after laryngectomy in the irradiated patient can be prevented.
Carcinoma, Squamous Cell↗
Cranial nerve injuring during carotid endarterectomy.
Injury to the greater auricular, hypoglossal and superior laryngeal nerves during carotid endarterectomy is preventable. A knowledge of regional anatomy and the mechanisms of such injury allows prevention of this complication. Unilateral individual nerve injury is generally well tolerated, but bilateral or combined nerve injuries can pose a serious threat to life. Minor modifications in technique aid greatly in avoiding nerve injury.
Aged↗
Squamous cell carcinoma of the soft palate.
Thirty-eight patients with squamous cell carcinoma of the soft palate treated between 1960 and 1975 were reviewed. Males in the seventh decade predominated. All symptomatic patients complained of sore throat and/or odynophagia. Seventy-eight percent were symptomatic less than three months. Approximately equal numbers of patients presented with T1, T2, and T3 tumors. Twenty-seven percent had cervical metastases when initially seen. The majority (89%) of patients were treated with radiation initially and the remainder (11%) received radiation therapy at the time of postsurgical recurrence with an absolute five year survival of 33%. Patients less than 60 years of age and those with small primary tumors and no neck metastases demonstrated better survival. Radiation therapy to the primary tumor and neck appears to be the preferred modality of initial treatment.
Adult↗
Temporal bone histopathology of Paget's disease with sensorineural hearing loss and narrowing of the internal auditory canal.
A temporal bone report is presented of a patient with progressive sensorineural hearing loss and advanced Paget's disease involving the skull. The histopathology reveals Pagetic bone invading the internal auditory canal and compressing the cochlear division of the VIIIth cranial nerve resulting in severe neural degeneration. There are no other histopathologic abnormalities present in the cochlea to explain the hearing loss. A low-frequency conductive hearing loss was also present, but no histopathologic correlate could be identified.
Aged↗
Eustachian tube function in children.
Eustachian tube function of children with bilateral serous otitis media was studied in 14 ears following myringotomy and pressure equalizing tube insertion. Cases with non-Eustachian tube pathology potentially contributing to Eustachian tube dysfunction were excluded from the study. Eustachian tube function was evaluated utilizing an impedance audiometer to document neutralization of positive and negative middle ear pressures. All cases showed persistent tubal dysfunction for up to six months. Partial incomplete neutralization of positive pressure occurred in 64 per cent, but in no case could negative pressure be partially neutralized even when "locking" was relieved with valsalva. Continuous ventilation of the middle ear for up to six months did not allow a return to normal Eustachian tube function. This is extremely effective palliation, and should be recognized as such.
Child↗
Surgery for hearing loss.
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Chronic Disease↗
Electron microscopy in the diagnosis of head and neck tumors.
Six patients with malignant head and neck tumors are shown to have required electron microscopy for accurate diagnosis. In all of these tumors, there were ultrastructural features of cytodifferentiation that were not discernible by light microscopy, such as neurosecretory granules, desmosomes, cytoplasmic processes, tonofibrils, and myofilaments. Electron microscopy is helpful in the differential diagnosis of tumors in general, but its effectiveness is particularly apparent in small-cell "undifferentiated" tumors such as neuroblastoma, rhabdomyosarcoma, Ewing's sarcoma, undifferentiated squamous-cell carcinoma of the lymphoepithelioma type, and malignant lymphoma. It has also been helpful in the identification of amelanotic melanoma and spindle-cell carcinoma.
Adult↗
Extramedullary hematopoiesis of the middle ear.
A 22-year-old man with sickle cell disease developed a conductive hearing loss as a result of extramedullary hematopoiesis in the right middle ear. This is the first reported case of conductive hearing loss from extramedullary hematopoiesis and only the second report of extramedullary hematopoiesis in the middle ear.
Adult↗
Proton nuclear magnetic resonance spectroscopy of plasma lipoproteins in head and neck cancer patients.
Proton nuclear magnetic resonance spectroscopy was used to evaluate changes in plasma lipoproteins in patients with squamous cell head and neck cancer. Plasma from 14 patients was analyzed by proton nuclear magnetic resonance spectroscopy, and line widths and fast and slow methyl and methylene transverse relaxation values were obtained. In addition, the lipid and lipoprotein concentrations in the sera of these patients were measured by standard biochemical techniques. Preliminary results suggested that squamous cell carcinomas of the head and neck with nodal metastases are associated with measureable changes in slow methylene transverse relaxation values, as compared with controls. These findings indicate the presence of a new lipoprotein complex in patients with squamous cell carcinomas of the head and neck with nodal metastases.
Adult↗
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.
Administration, Oral↗
Dynamic computerized tomography in the assessment of hemangioma.
Three hemangiomas of the face and orbit are studied with dynamic computerized tomography (CT). This noninvasive technique has the advantage of simultaneous bone and soft tissue visualization at the time of peak contrast enhancement, and it precludes the potential complications of arteriography and biopsy. The hemangiomas are precisely delineated with intense contrast; the sharp peak and rapid uninterrupted runoff of the computer-generated plot of contrast concentration (CT number) versus time is characteristic of this lesion. It is suggested that the progress of hemangioma involution may be documented by the change in contrast distribution in sequential dynamic CT studies. Dynamic CT is recommended for the evaluation of head and neck vascular tumors.
Adult↗
Inflammatory effects of topical antibiotic suspensions containing propylene glycol in chinchilla middle ears.
This study examines the occurrence of inflammatory changes and cholesteatoma in the middle ears of seven chinchillas after the application of topical antibiotic suspensions containing two different concentrations of propylene glycol. The preparations used were Cortisporin otic suspension, which contains neomycin, polymyxin B, hydrocortisone, and 10.5% propylene glycol, and Cortisporin ophthalmic suspension, containing the same ingredients, but only a 2% concentration of propylene glycol. Six weeks after the administration of the Cortisporin preparations, applied to the middle ear through a transbulla approach, no cholesteatomas were found in the seven ears treated with the ophthalmic suspension. Evidence of mild inflammation was present in only two of these ears. In the seven contralateral ears treated with the otic suspension, middle ear adhesions were found in six, cholesteatoma was present in four, serous effusions were found in three, and one had a large tympanic membrane perforation. The ears that showed cholesteatomas also had histologic evidence of squamous metaplasia, granulation tissue, and erosion of the underlying bone. We submit that the pathologic responses of the middle ear mucosa treated with the otic suspension, were due to an inflammatory response to the higher concentration of propylene glycol compared to that of the ophthalmic suspension.
Animals↗
Propylene glycol-induced cholesteatoma in chinchilla middle ears.
Propylene glycol is a solvent commonly used in topical otic preparations. This study examines the occurrence of inflammatory changes and cholesteatoma in chinchilla middle ears after the application of propylene glycol in varying concentrations. A total of 32 ears were studied, divided into four treatment groups. Three groups received propylene glycol in concentrations of 10%, 50%, and 90%. One group received normal saline. Six weeks after the application of propylene glycol to the middle ear through the bulla, examination revealed cholesteatoma, tympanic membrane perforations, and middle ear adhesions in most of the ears subjected to 50% and 90% propylene glycol. Only one ear treated with 10% propylene glycol showed a cholesteatoma, while the group treated with normal saline showed only mild inflammation. Histologic preparations confirmed cholesteatoma and revealed replacement of the normal columnar epithelium by keratinizing stratified squamous epithelium, inflammatory infiltration, and granulation tissue eroding underlying bone. We conclude that exposure to propylene glycol in high concentrations will consistently produce cholesteatoma in chinchilla middle ears. Although the effects of propylene glycol in the human middle ear are yet to be investigated, we recommend the avoidance of otic preparations containing high concentrations of propylene glycol in patients with tympanic membrane perforations.
Animals↗
Spontaneous subcutaneous temporal emphysema.
The presence of air in the temporal regions is an uncommon presentation of spontaneous pneumomediastinum. As terminal alveoli rupture, air dissects along bronchovascular shafts. Usually, air travels either in a superior or inferior direction. Thus, extensive spontaneous subcutaneous emphysema accompanied by both cervical and retroperitoneal emphysema is rarely encountered. We present an unusual case of spontaneous pneumomediastinum, pneumoretroperitoneum, and cervical and facial emphysema presenting as bilateral painless temporal swelling. To our knowledge, this association has not been reported. Treatment involves observation for potentially life-threatening sequelae.
Adult↗
The latero-medial inferior pontine syndrome.
A case is presented with a pontine vascular lesion involving the V, VI, VII, and VIII cranial nerves. The diagnostic evaluation included audiometry and electronystagmography as well as arteriography, pneumoencephalography, and brain scan. Total deafness developed in the involved ear and was present for seven weeks before complete recovery occurred. Electronystagmographic findings consistent with a brain stem lesion also resolved following recovery of the patient. Audiometry and electronystagmography are described and documented for the first time in a report of a patient with a latero-medial inferior pontine syndrome. A discussion of some of the unique features of the brain stem vasculature and its relationship to clinical syndromes involving the brain stem is given.
Audiometry↗