Manual strangulation injuries of the larynx

Laryngeal injuries secondary to manual strangulation are seen more often by the forensic pathologist than by the otolaryngologist. Forces sufficient to cause thyroid and cricoid cartilage fractures are usually sufficient to cause acute asphyxia and death. However, due to the static nature of the compressive forces applied in strangulation, fractures of the cartilaginous framework may occur without obvious mucosal disruption or submucosal hematoma formation. If the victim survives the initial assault and the injuries go unrecognized and untreated, delayed life-threatening airway obstruction of long-term vocal dysfunction may result. Computed tomography seems to be an excellent noninvasive technique to evaluate and verify cartilaginous laryngeal fractures and soft-tissue injury. Recognition of the potential for such injuries is the key to management and treatment.

Vocal fold paresis in Shy-Drager syndrome

Twelve patients with Shy-Drager syndrome (SDS) presenting symptoms of multiple nervous system atrophy and orthostatic hypotension were examined for laryngeal movement disorders and vocal impairment in speech. Vocal fold abductor paresis was found in 11 patients and was bilateral in 10. Speech task performance was recorded in SDS patients, Parkinson patients and age- and sex-matched controls. Trained listeners with inter-rated reliability greater than or equal to .85 judged each recording on 20 attributes while blind to speaker identity. SDS patients had a breathy and strained voice quality, reduced loudness, monopitch and monoloudness, imprecise consonants, variations in rate and rate-slowing, suggesting a flaccid type of dysarthria. In comparison with Parkinson patients, SDS patients had excess vocal hoarseness, intermittent glottal fry and a slow and deliberate speaking rate. Orthostatic hypotension, laryngeal stridor, hoarseness, intermittent glottal fry and slow speech rate were found to be discriminating symptoms of SDS.

Pseudomass lesions due to occult trauma of the larynx

Fracture of the laryngeal skeleton is best diagnosed by computed tomography. Deformity of the laryngeal cartilage may cause signs and symptoms that suggest neoplastic submucosal mass. Symptoms may not develop until years after the original injury. A series is described in which the patients demonstrate the characteristic signs, symptoms, and computed tomographic appearance of old, often forgotten, fractures of the thyroid cartilage. The diagnosis is best made by computed axial tomography of the neck.

Inhibition of specific immune responses by feeding protein antigens. V. Induction of the tolerant state in the absence of specific suppressor T cells

The effect of CY pretreatment on the ability of OVA feeding to induce both tolerance and active suppression was examined in mice. CY-pretreated, OVA fed mice were fully unresponsive in both OVA-specific DTH and antibody responses, but, in contrast to untreated OVA-fed mice, did not transfer suppression to normal recipients via splenic lymphocytes. Restoration of Ts activity in CY-pretreated mice was accomplished by reconstitution with normal T cells before antigen feeding, indicating that the CY effect was at the Ts precursor level. In addition, it was found that certain OVA-specific immune parameters (DTH and splenic PFC responses) in recipient mice were susceptible to suppression by transfer of spleen cells from OVA-fed donors, whereas other measures (antigen-induced T cell proliferation and serum antibody titers) were not. The data suggest that CY-sensitive Ts are not necessary for either induction or maintenance of specific tolerance after OVA feeding.

Inhibition of specific immune responses by feeding protein antigens. V. Induction of the tolerant state in the absence of specific suppressor T cells

The effect of CY pretreatment on the ability of OVA feeding to induce both tolerance and active suppression was examined in mice. CY-pretreated, OVA fed mice were fully unresponsive in both OVA-specific DTH and antibody responses, but, in contrast to untreated OVA-fed mice, did not transfer suppression to normal recipients via splenic lymphocytes. Restoration of Ts activity in CY-pretreated mice was accomplished by reconstitution with normal T cells before antigen feeding, indicating that the CY effect was at the Ts precursor level. In addition, it was found that certain OVA-specific immune parameters (DTH and splenic PFC responses) in recipient mice were susceptible to suppression by transfer of spleen cells from OVA-fed donors, whereas other measures (antigen-induced T cell proliferation and serum antibody titers) were not. The data suggest that CY-sensitive Ts are not necessary for either induction or maintenance of specific tolerance after OVA feeding.

Observations on central neurologic etiology for laryngeal dysfunction

Observations of patterns of laryngeal dysfunction in patients with known as well as unrecognized neurological disease have provided the basis for a new classification. Representative patients are used to describe typical patterns of laryngeal dysfunction which occur with afferent and efferent (upper motor neuron, extrapyramidal, cerebellar and nuclear pathways) neurological disorders. The value of cinephotography in documenting and avoiding the pitfalls of brief indirect laryngoscopy is emphasized as a factor in achieving a correct diagnosis in patients with laryngeal diseases of central origin.

Photographic studies of the larynx in central laryngeal paresis and paralysis

Characteristic patterns of laryngeal dysfunction due to central neurologic disease are documented by 16 mm ciné photography. Representative patients are used to describe typical patterns of abnormal laryngeal function which occur in upper motor neuron, extrapyramidal, cerebellar, nuclear and mixed foci of lesions. The pitfall of brief indirect laryngoscopy without visual documentation is emphasized as a factor in misdiagnosis of patients with laryngeal disease of central origin. The value of more careful evaluation of similar patients is emphasized in relation to better understanding of laryngeal function and improved patient care.

Cross-suppression of specific immune responses after oral tolerance

Adult normal inbred mice rendered tolerant to OVA by previous oral exposure do not respond to intraperitonela immunization with DNP-OVA in adjuvant. These tolerant mice also form less DNP-specific antibodies to DNP-KLH when immunized with mixtures of DNP-KLH and DNP-OVA, or less HGG-specific antibodies when immunized with cross-linked conjugates of OVA and HGG. These same procedures increased DNP-specific or HGG-specific responses in non-tolerant control mice. The cross-supperssion was ineffective, however, to inhibit already ongoing antibody responses.

Improving grant applications for research in communicative disorders

In making research funding appropriations, Congress considers, in part, the percentage of applications which are approved, but cannot be funded with the existing budget. The Communicative Disorders Program will have difficulty justifying increased Congressional appropriation without an increase in the number of approved grant applications. Investigators in otolaryngology and other fields of communicative disorders are urged to submit innovative proposals of high scientific quality to be considered for funding. The National Institutes of Health (NIH) review process is explained and suggestions for improving a potential grantee's application are made.

Binding of ovalbumin to mouse spleen cells with and without carbodiimide

We studied the binding of ovalbumin (OVA) to mouse spleen cells. In the presence or absence of carbodiimide (ECDI), uptake increased with greater cell numbers, increasing OVA concentration and increasing time up to 60 min. Between 60 and 210 microgram OVA could be coupled with ECDI to 2 X 10(8) cells. In the absence of ECDI, however, OVA uptake was still appreciable, but appeared to be of low avidity as it did not occur in the presence of competing fetal calf serum. These experiments provide a basis for the use of protein coupled to autologous cells in the induction of immunologic tolerance.

Enterically induced immunologic tolerance. I. Induction of suppressor T lymphoyctes by intragastric administration of soluble proteins

Specific immune unresponsiveness was induced in inbred mice (BDF1) by the administration of soluble ovalbumin (OVA) by gastric intubation. Anti-hapten (DNP) responses likewise were specifically diminished when animals were fed autologous carrier (OVA or keyhole limpet hemocyanin). Adoptive transfer of spleen cells demonstrated that the tolerant state could be maintained in irradiated recipient mice, and specific anergy could be transferred to normal recipient animals. Adoptive suppression was mediated by T lymphocytes, as demonstrated by nylon wool fractionation and susceptibility of the cells to anti-Thy 1.2 and complement. Transferred B cells had neither suppressive nor augmentative effects. Enteric administration of OVA also specifically diminished antigen-induced DNA synthesis of primed lymph node T cells, although suppressor cells were not identified in the lymph nodes per se.

Lactate dehydrogenase as a measure of inflammation in experimental otitis media

A reliable animal model for acute otitis media due to Streptococcus pneumoniae was used to study the accumulation of lactate dehydrogenase (LDH) in middle ear effusion during acute pneumococcal otitis media and after penicillin treatment. The findings indicate that LDH levels rise in the middle ear effusion during the early phase of acute infection and decrease as the infection resolves over time. Penicillin treatment affects the natural course of infection by resolving most visible signs of inflammation and by sterilizing the middle ear. However, once middle ear infection was established, penicillin treatment did not reduce the elevated levels of effusion LDH, suggesting that inflammation persists after sterilization of infected middle ears.

Inhibition of homocytotropic antibody responses in adult inbred mice by previous feeding of the specific antigen

Profound and prolonged states of specific immunologic tolerance were induced in adult mice of high-responder genetic background by a single exposure to moderate doses of the specific antigen by digestive route.

Effects of Bordetella pertussis on the sensitivity of inbred mice to vasoactive amines

Pretreatment with Bordetella pertussis was determined to increase significantly the hypovolemia induced by intravenous injections of histamine either alone or in mixture with serotonin in a total of 26 different strains of mice. Two factors affecting the mortality rates observed by challenge after B. pertussis treatment were: the sensitivity of the strains to vasoactive amines before B. pertussis treatment, and their resistance to acute hypovolemic shock. Appropriate crosses and backcrosses between resistant and susceptible strains failed to demonstrate a clear pattern of inheritance of the susceptibility to B. pertussis effects.

Inhibition of specific immune responses by feeding protein antigens

A profound and long-lasting state of specific immune unresponsiveness may be induced in adult inbred mice given a single dose of protein immunogens--such as ovalbumin or hemocyanin--by the digestive route. The degree of unresponsiveness induced by intragastric exposure to ovalbumin could not be achieved by intravenous injection of deaggregated ovalbumin solutions across a wide range of doses. Unresponsiveness induced by intragastric exposure to hapten-protein conjugates is specific to the carrier protein.

Sensitivity to intravenous injections of histamine and serotonin in inbred mouse strains

A large panel of inbred strains of mice and some of their Fl hybrids were tested on their sensitivity to the hemoconcentrating effects of intravenous injections of histamine alone, serotonin alone, or histamine-serotonin mixtures. Major differences in susceptibility were observed. Crosses and backcrosses were made between susceptible (SJL/J) and less susceptible (RF/J, C57BL/6J) strains; it was found that the sensitivity to vasoactive amines is, at least partially, inheritable.

Endolymphatic sac drainage for intractable vertigo (method and experiences)

This paper describes a method of endolymphatic sac decompression and drainage. The method emphasizes widely exposing dura, avoiding skeletonization of the posterior semicircular canal and draining the sac via a T tube. The results of this procedure in 75 patients, including statistics in 46 ears are discussed. In patients with unilateral disease good results were obtained in control of vertigo in 94 percent of patients and significant improvement in cochlear function in over 30 percent.

Genetic sensorineural deafness in adults

Progressive genetic sensorineural hearing loss is a common problem in adults which is frequently incorrectly diagnosed or escapes diagnosis as to etiology altogether. If the hearing problem becomes manifest in the twilight of the patient's life it is often identified with the nondescriptive term "presbycusis." In all patients with sensorineural hearing loss, extrinsic (environmental) causes should be ruled out after which intrinsic or genetic etiology should strongly be considered, recognizing that extrinsic factors can be superimposed. A group of young adults was studied and diagnosed as having genetic progressive hearing loss. Polytomography ruled out the theoretical possibility of chochlear otosclerosis. The diagnosis of this disorder tests most heavily on the history and audiometric configuration which is characteristically flat or basin shaped with fairly good discrimination. Of further diagnostic significance was the fact that some patients, early in the course of their difficulty, presented with a predominantly low- or high-frequency loss which, over time, assumed a flat audiometric shape. The most important pathological finding from human temporal bone studies was atrophy of the stria vascularis.