The Laryngoscope
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The pathophysiologic events that lead to the loss of airway compensation in obstructive sleep apnea (OSA) are poorly understood. The development of airway instability may be secondary to changes in neurologic control, airway morphology, or both. To identify potential histopathologic features of pharyngeal tissues that may contribute to OSA, transverse sections of the distal soft palate and uvula were qualitatively compared using light and electron microscopy from 4 severe apneics (greater than 50 apnea/hour), 4 severe snorers (less than 20 apnea/hour), and 4 nonsnorers. ⋯ Electron microscopy of severe apneics identified frequent focal degeneration of myelinated nerve fibers and axons. The finding of similar histopathologic changes in apneics and severe snorers supports previous speculation of a common etiology not directly related to apnea, such as vibratory trauma to pharyngeal tissues. Degenerative changes in peripheral nerves, identified on electron microscopy, however, may contribute to airway instability and the development of obstructive apnea by impairing pharyngeal reflexes.
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From a total of 1408 human temporal bones, 229 with otitis media or mastoiditis were selected; other contributing diseases were excluded. Of this group, 19.2% had an obstruction of the aditus ad antrum with pathologic tissue, usually granulation tissue. ⋯ An interesting observation was that columnar epithelial cells, goblet cells, and mucoid effusion were not observed in the mastoid, suggesting a restriction of secretory cells to the middle ear proper. It appears that obstruction of the aditus ad antrum contributes to the pathogenesis and accentuates pathologic conditions in otitis media.
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This study determines the flammability of polyvinylchloride (PVC), red rubber (RR), and silicone (Si) endotracheal tubes in oxygen- and nitrous-oxide-enriched atmospheres. Flammability is measured by using the oxygen and nitrous oxide indices of flammability with laser ignition. ⋯ These results are similar to the previously reported O2 and N2O indices of flammability with propane-torch ignition. This study validates the concept that the indices of flammability are useful measures of endotracheal tube flammability and are independent of the ignition source.
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Comparative Study
Surgical treatment of chronic otitis media and Menière's syndrome.
Menière's symptom-complex in conjunction with chronic otitis media (COM) has occasionally been encountered in otologic practice. This study compares the effects of various surgical techniques on patients with COM and Menière's syndrome, primarily on incapacitating vertigo. One group of patients with incapacitating vertigo received endolymphatic system drainage procedures, either endolymphatic sac surgery (83 patients) or cochleosacculotomy (12 patients) simultaneously with surgery for COM. ⋯ A comparison of the results for vertigo control between the two approaches indicates a significant difference in success rate in favor of endolymphatic system drainage procedures (80% versus 20%). COM is regarded as one of the causes of endolymphatic hydrops (EH). The results of this study seem to indicate both 1. the likelihood of the cause-and-effect relationship between COM and EH, and 2. the effectiveness of endolymphatic shunting procedures on control of incapacitating vertigo, thus supporting the contentions of other authors with regard to pathogenesis and sac enhancement in patients with COM and Menière's syndrome.
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A retrospective review of 400 Chinese children who had inhaled foreign bodies was undertaken. There has been a yearly increase in the total number of cases of airway foreign bodies removed in our hospital. Fifty-eight percent of the children presenting were from the countryside; 42% were townspeople. ⋯ A total of 348 (87%) bronchial foreign bodies were removed by rigid bronchoscopy (81%), rod-lens bronchoscopy (5%), and spontaneous expulsion (1%); 52 (13%) laryngeal and tracheal foreign bodies were removed by direct laryngoscopy (12%) and tracheotomy (1%). A single endoscopic procedure successfully removed 92.5% of 400 foreign bodies detected in the airways. One child died during bronchoscopy, for a mortality rate of 0.25%.