Of 103 people with the clinical diagnosis of laryngeal cancer studied by the authors, 53 eventually were treated by total laryngectomy and, in some cases, radical neck dissection (43), preoperative radiation therapy (15), postoperative radiation therapy (29), and post-operative chemotherapy (7). All were entered into a comprehensive rehabilitation program. Six months following completion of their cancer therapy 47 were re-evaluated. Of these, 12 (26 per cent) used esophageal speech as the dominant mode of communication, 16 (34 per cent) the electrolarynx, and the remainder either wrote (16 [34 per cent]) or signed (3 [6 per cent]). Twenty-six (55 per cen) were considered to be successfully) rehabilitated overall and 21 (45 per cent) were not. These data indicate that the rehabilitative needs of today's laryngectomee are not being met successfully with traditional methods.

Adult↗

PubMedDate not supplied

Current status of laryngectomee rehabilitation: II. Causes of failure.

The study records of 47 laryngectomees were analyzed to determine the factors related to acquisition of failure to acquire esophageal speech and to successful or unsuccessful rehabilitation. The successful speakers wee able to phonate longer preoperatively, had less postoperative radiotherapy and dysphagia, took more speech instruction, and were more vigorous and tender-minded. Factors that correlated with successful rehabilitation were less postoperative radiotherapy, more vigor, greater imaginativeness, independence, and self-assuredness, and absence of denial.

Attitude to Health↗

PubMedDate not supplied

Current status of laryngectomee rehabilitation: III. understanding of esophageal speech.

To assess those aspects of esophageal speech that contribute to effective communication, a series of measures were applied to the esophageal speech of a prospectively studied group of recent laryngectomees (n = 20) six months following completion of their cancer therapy and to that of a second group (n = 27) studied retrospectively 6.6 years postoperatively. Ages of the two groups did not differ, but there were more whites and more males in the group studied retrospectively. The technical proficiency of the subjects studied prospectively was slightly but significantly less than that of those studied retrospectively. Measures of technical proficiency correlated well with other measures of quality of esophageal speech and were much easier to perform. The understandability of the esophageal speech of the group studied retrospectively was significantly superior. For both groups, understandability was enhanced significantly during audiovisual compared with audio-only presentations. Naive judges had great variability in understanding esophageal speech.

Esophagus↗

PubMedDate not supplied

Current status of laryngectomee rehabilitation: IV. attitudes about laryngectomee rehabilitation should change.

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Attitude of Health Personnel↗

PubMedDate not supplied

Deep neck infection.

Explore the source record for details and available documents.

Abscess↗

PubMedDate not supplied

Treatment of chronic otitis media with effusion: results of tympanostomy tubes.

Insertion of tympanostomy tubes to provide prolonged aeration and drainage of the tympanum in cases of chronic secretory otitis media has become the most commonly performed operation in children. To investigate the therapeutic efficacy of current treatments of chronic secretory otitis media, the authors undertook a randomized clinical trial with four treatment arms: myringotomy alone, tympanostomy tubes, adenoidectomy and myringotomy, and the combination of adenoidectomy and tympanostomy tubes. This report describes the preliminary (one-year) outcome in the group of children who were treated with tympanostomy tubes. The observed average differences between the myringotomy and tympanostomy tube groups were small, with the exception of one variable (time to first recurrence). Although the clinical importance of these differences remains to be established, the authors believe they are substantial enough to justify continued use of tympanostomy tubes in the primary surgical therapy of chronic secretory otitis media, when medical therapy and observation indicate the need for drainage to improve hearing or correct anatomic deformities of the tympanum.

Audiometry, Pure-Tone↗

PubMedDate not supplied

Differential otomanometry.

Management of otitis media, both acute and chronic, is one of the most common problems in clinical medicine. Among the many unresolved issues in otitis media research is accurate diagnosis which, in turn, depends heavily on valid otoscopic observation. Yet even today clinical otoscopy remains more of an art than a science. Because precise therapy is predicated on precise diagnosis, efforts to improve the validity and reliability of otoscopic techniques are warranted. Of great importance to the otoscopist is the visual estimate of tympanic membrane mobility secondary to hand-generated pneumatic pressure (pneumotoscopy). The degree of motion is usually graded in relative terms. In addition to pneumotoscopy, tympanometry is also used to assess the status of the middle ear. This is done indirectly through the plot of induced pressure versus acoustic immitance (tympanogram). Thus, both procedures depend on the differential application of induced pneumatic pressure on the tympanic membrane. If the middle ear is air-containing and the tympanic membrane is normal, even a slight pressure rise in the ear canal will displace the membrane. If the middle ear is fluid-filled, even large amounts of pressure produce no motion of the tympanic membrane. The pressure gradients, normal threshold, and optimal frequency of application for pneumotoscopy have not been studied previously in humans. Data are presented to compare the sensitivity, specificity, and predictive value of pneumotoscopy and tympanometry in the detection of effusion due to chronic secretory otitis media. In addition, preliminary data obtained by a new procedure, quantitative pneumotoscopy, are discussed.

Acoustic Impedance Tests↗

PubMedDate not supplied

Biodisposition of dibromoacetic acid (DBA) and bromodichloromethane (BDCM) administered to rats and rabbits in drinking water during range-finding reproduction and developmental toxicity studies.

Dibromoacetic acid (DBA) and bromodichloromethane (BDCM), by-products of chlorine disinfection of water, were provided in drinking water in range-finding reproductive/developmental toxicity studies (rats) and a developmental toxicity study (BDCM) in rabbits. Studies included absorption and biodisposition of DBA and BDCM, including passage into placentas, amniotic fluid, fetuses (rats and rabbits), or milk (rats). The DBA and BDCM range-finding reproductive/developmental toxicity studies each included 50 Sprague-Dawley rats/sex/group. DBA (0, 125, 250, 500, or 1000 ppm) or BDCM (0, 50, 150, 450, or 1350 ppm) was provided in drinking water 14 days premating through gestation and lactation (63 to 70 days). The developmental toxicity range-finding study included 25 time-mated New Zealand white rabbits/group given 0, 50, 150, 450, or 1350 ppm BDCM in drinking water on gestation days (GDs) 6 through 29. Satellite groups (6 male, 17 female rats/group/study and 4 rabbits/group) were used for bioanalytical sampling. Rats and rabbits had exposure-related reduced water consumption caused by apparent taste aversion to DBA or BDCM, especially in the parental animals at the two highest exposure levels (500 and 1000 ppm DBA; 450 and 1350 ppm BDCM). Female rats consumed slightly higher mg/kg/day doses of DBA than male rats, especially during gestation and lactation; weanling rats consumed the highest mg/kg/day doses. DBA produced detectable and quantifiable concentrations in plasma, placentas, amniotic fluid, and milk. Plasma samples confirmed that rats drink predominately during the dark; this drinking pattern, not accumulation, produced detectable plasma concentrations for 18 to 24 hours/day. No quantifiable concentrations of BDCM occurred in plasma, placentas, amniotic fluid, or milk, suggesting that BDCM is rapidly degraded or metabolized in vivo. DBA (500 and 1000 ppm, rats) and BDCM (450 and 1350 ppm, rats and rabbits) produced secondary toxicity in the parental generation by reducing water consumption, which caused severe exposure-related apparent dehydration, reduced feed intake and weight gain. Reproductive and developmental parameters were essentially unaffected (mating possibly reduced [DBA at 1000 ppm]; exposure-related decreases in body weights of pups secondary to reduced water and feed consumption [DBA at 250, 500, and 1000 ppm; BDCM at 150, 450, and 1350 ppm]). No effects on development of rabbit fetuses occurred at BDCM concentrations as high as 1350 ppm. Results from these preliminary studies, in which DBA and BDCM were provided in the drinking water at concentrations thousands of times higher than those to which humans are exposed, suggest that neither DBA nor BDCM are reproductive/developmental risks for humans.

Acetates↗

PubMedDate not supplied

Normal tympanometric shape.

Computer-assisted curve-fitting techniques were used to describe quantitative and qualitative characteristics of normal tympanometric shape. The data base consisted of set of triplicate tympanograms, obtained at 2-week intervals, from 72 ears of children with normal middle ears enrolled in the first through the fifth grades. A nonlinear equation produced significantly better prediction of normal tympanograms (R2 = 0.70) than did linear equations (R2 less than 0.44), bringing into question the use of the latter in determining normality. The complexity of applying curve fitting in clinical practice led to the development of a qualitative technique to determine normality. An initial application of the technique as a screen in 76 ears subjected to myringotomy produced a sensitivity of 96% and a specificity of 83% with respect to identification of the presence of middle ear fluid.

Acoustic Impedance Tests↗