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• The assessment of worth of the neoglottic procedure has been, for the most part, subjective in nature. Evaluation by means of sequential objective measures has been developed. The following procedures are employed in our assessment: transcription intelligibility by judges unfamiliar with the passage; rate of speech; relative intensity range; intratracheal air pressure; continuous speech per breath; functional communication profile; weight status; contrast swallow study; swallowaspiration diary; and tumor status. Data from a patient with a Staffieri neoglottis procedure illustrate the method.(Arch Otolaryngol 106:715-718, 1980)

• We performed a brainstem evoked response (BSER) study to evaluate the extent to which electrical stimulation of the cochlea was conducted centrally by facial, vestibular, and cochlear nerves. Short-term experiments were performed in three monkeys: via a postauricular approach to the round window, a molded Silastic multielectrode prosthesis was placed in the scala tympani. The BSER was recorded to threshold and suprathreshold biphasic electrical pulses delivered to the implant electrodes. A middle cranial fossa dissection was then carried out, exposing the nerves of the internal auditory canal from above. Facial and vestibular neurotomy had no significant effect on BSER, while cochlear nerve section abolished the response. In one animal, blunt pressure on the cochlear nerve caused a reversible loss of electrically evoked BSER. Electrically evoked BSER probably depends on propagated impulses in the cochlear nerve.(Arch Otolaryngol 106:573-577, 1980)

Clinical features of 44 culture-confirmed cases of diphtheria involving the respiratory tract treated at the University of Washington and affiliated hospitals in Seattle over a five-year period were studied. Of 42 patients treated primarily in Seattle, five (11.9% died; nonfatal, toxin-induced complications occurred in seven (16.7%). Airway obstruction was the most common cause of death in this series. Diphtheritic membrane (especially in the larynx), dyspnea, and leukocytosis were dire prognostic signs. We urge indirect laryngoscopy in all cases showing membrane formation; tracheotomy should be considered when laryngeal membrane is present. Diphtheria should be suspected in any patient with pharyngitis who has been in contact with endemic areas, especially when pharyngeal membrane is present.(JAMA 242:2197-2201, 1979)

Patients disabled by tinnitus show a high prevalence of major depression. Furthermore, tinnitus produces patterns of disability similar to those produced by major depression. To explore further this link between tinnitus and depression, and to investigate the efficacy of treating depression in the treatment of tinnitus, a single-blind, placebo-washout, nonrandomized pilot study of the tricyclic antidepressant nortriptyline (hydrochloride) was undertaken in disabled tinnitus patients who also met diagnostic criteria for major depression. Nineteen patients began the study, two responded to placebo, and two dropped out prior to completion. Fourteen considered their tinnitus improved, and 12 chose to continue taking nortriptyline after the study. Depression severity decreased, on the average, by 65% (p<.0001). Tinnitus loudness measured by audiometric matching decreased by a mean of 10 dB or 50% (p<.02). Self-reports of tinnitus loudness and severity, somatic and psychologic symptoms, and psychosocial dysfunction all showed significant improvement with treatment. These results suggest that what initially appears to be an irreversible otologic disability in these patients may be in large part a reversible psychiatric disability.

• Symptomatic relief for hyperkinetic movements of facial musculature can be obtained by selective neurectomy of the peripheral divisions of the facial nerve with preservation of the frontal branch. Hemifacial spasm and blepharospasm represent the most common forms of facial hyperkinesia. Satisfactory results using the described technique on 191 patients were achieved in 74% of the patients with hemifacial spasm and blepharospasm in the follow-up period of one to 12 years. In hemifacial spasm, 80% were relieved after a single operation, and 95% were relieved after revision surgery. There were no major postoperative complications. Minor complications included insufficient lid closures in 1.5% of the patients and delayed wound healing with minor salivary fistulas that closed spontaneously in 7% of the patients. Resection of all fibers innervating the orbicularis oculi muscle is essential in preventing recurrence.(Arch Otolaryngol Head Neck Surg 1986;112:154-163)

• Binaural interaction (BI) in brainstem-auditory—evoked responses (BSERs) was defined as any deviation from the predictions of a model that assumes two independent monaural BSER generators whose outputs are additive. Brainstem-auditory—evoked responses were recorded in response to right (R) monaural, left (L) monaural, and binaural click stimuli. The monaural BSERs were added to give the model's prediction (P) of binaurally evoked BSER (P = L + R), and this trace was then subtracted from the actual binaurally evoked response (B). The resultant difference trace (D = B − P) represents the derived Bl. In each of ten guinea pigs, a strong BI was present in the peak IV region (latency = 3.5 to 4.0 ms). This interaction is probably present with interaural intensity differences of up to 40 dB and interaural time differences of up to 3 ms. Preliminary studies suggest the presence of a similar phenomenon in human BSERs.(Arch Otolaryngol 105:391-398, 1979)

A nutritional assessment battery consisting of anthropometric measurements, skin tests, laboratory assessment of visceral and somatic proteins, and a questionnaire was used to characterize the nutritional status of 50 consecutive new head and neck tumor patients. Forty percent of our patients had good nutrition, 20% fair, and 40% poor, with elements of both protein-calorie and protein malnutrition. There was, as expected, a positive relationship between tumor stage and nutritional impairment, but this fell short of statistical significance. There was a just significant tendency for patients with pharyngeal tumors to exhibit poorer scores than did those with oral or laryngeal tumors. Age, sex, smoking history, admitted alcohol consumption, and type of hospital (university, private multispecialty, or Veterans Administration) were not correlated with nutritional status. The best predictor of impaired nutritional status was the patient's description of his recent diet: a normal diet predicted a good score (0–2), and a soft or liquid diet predicted a fair or poor score (3–5), with an overall accuracy of 72%.

Definition of a standard threshold shift (STS) and its use as an early indicator to identify those employees with deteriorating hearing are necessary aspects of hearing conservation programs in industry. STS criteria were evaluated using techniques borrowed from decision theory and signal detection theory to separate audiometric threshold shifts into true-positive and false-positive shifts. The current Occupational Safety and Health Administration definition of a “change in hearing threshold relative to the baseline audiogram of an average of 10 dB or more at 2, 3 or 4 kHz in either ear” and the American Academy of Otolaryngology-Head and Neck Surgery recommendation of a “10 dB or greater change for the worse for either the 0.5, 1, 2 kHz pure tone average or the 3, 4, 6 kHz pure tone average, in either ear” were supported. Revision of baselines after an STS occurs is recommended.

Hypopharyngeal stenosis is a frequent complication of laryngectomy and radiotherapy in patients treated for carcinoma. In a retrospective study of patients treated in the University of Washington Affiliated Hospitals, hypopharyngeal stenosis was more frequent after laryngectomy with partial pharyngectomy than after laryngectomy alone and occurred more commonly in lesions of the pyriform fossa than in glottic tumors. Neck disease and inclusion of radical neck dissection were both significant factors in the development of hypopharyngeal stenosis. Recurrent tumor was significantly more prevalent in these patients.

In linear systems analysis, a system is often studied by determining its response to impulsive stimulation. Alternatively, the system's response to continuous noise may be measured; cross-correlation of input and output then yields a function identical to the impulse response. This approach has been extended to auditory evoked responses, using vertex potentials as the system output. Although the auditory system, viewed as a brain stem evoked response generator, is highly nonlinear, replicable cross-correlograms were obtained in a series of guinea pigs. Stimulus artifact was ruled out by comparison of these responses with autocorrelograms of the noise stimulus. Responses decreased in amplitude with decreasing stimulus intensity. Experiments involving brain stem lesions and anoxia suggested that the short-latency cross-correlogram reflects cochlear microphonic, auditory nerve, and brain stem contributions. Study of bioelectric potentials by cross-correlation with noise input allows data acquisition continuously, without the limitations in stimulus repetition rate and dynamic range imposed by impulse (eg, click) analysis. This approach may prove useful in both experimental and clinical settings.

Sixteen normal-hearing adults were tested in both awake and sedated states for several evoked responses to low-frequency stimuli. Responses obtained by cross-correlation function, middle latency responses, and the 40-Hz response proved most sensitive; all had mean thresholds of less than 20 dB normal hearing level for the awake-alert state, but 40-Hz and middle latency response mean thesholds were shifted about 10 dB under sedation. The cross-correlation method seems to offer promise for pediatric auditory assessment.

Otitis media affects nearly every child at some time; many children have mild-to-moderate hearing losses for prolonged periods. The effects of these losses on language and educational development may be significant; possible mechanisms are discussed. Especially in suboptimal listening situations, speech perception may be impaired by even a mild hearing loss. Patterns of imperception are predicted by comparison of composite audiometric data from children with middle ear effusions with speech power data, and by analysis of sound pressure waveforms of speech filtered to simulate the typical hearing loss of these patients. A new method of analysis of brain stem evoked responses, yielding response components attributable to binaural interaction, is reported. This and other evoked response techniques may be able to identify objective changes in auditory nervous system function attributable to relative sensory deprivation during development. Finally, directions for further research in this area are discussed.

Determine whether occupational noise exposure increases audiometric asymmetry.

When two speech sounds are presented simultaneously to the two ears, normal subjects were able to report accurately the input to either ear until the signal amplitude to the unattended ear exceeded that to the attended ear by 15 dB—the dichotic threshold. While the right ear and left ear thresholds were never more than 15 dB apart in 33 normal subjects, six of 10 patients with unilateral brain damage showed interaural performance differences ranging from 48 to 110 dB. Six patients had non-dominant cerebral lesions, and of these, four showed markedly superior performance by the ear opposite the intact dominant hemisphere. Two of the four aphasic patients also showed large asymmetries, favoring the ear contralateral to the lesion in one case, and the ipsilateral ear in the other. In 17 normal right-handed subjects, the mean dichotic threshold when the right ear was attended exceeded that obtained for the left ear by 4.8 dB (p &lt; 0.01). In a group of 16 left-handed subjects, there was a slight tendency to superior performance by the left ear (1.3 dB, p &lt; 0.20). These results suggest a role for the nondominant hemisphere in processing and/or storage of competing speech stimuli.

The article offers information on the chronic tinnitus, a perception of sound in the ears that are more common in adults, blue collar workers and people with common health problems including arteriosclerosis, arthritis, and hypertension. It mentions the effect of the disease including frustration, insomnia, and poor concentration. It mentions the therapies for the disease.