Interpretation of sonotubometry. A critical view of the acoustical measurement of the opening of the eustachian tube.

The principle of sonotubometry for recording the opening of the Eustachian tube is based on the assumption that this opening increases the sound transmission from the nasopharynx to the external ear canal. However, the clinical validity of the method remains to be documented. In the present study the results in 37 normal ears were compared with those of 11 ears which showed signs of Eustachian tube dysfunction. In these glue was found in the middle ear at a subsequent myringotomy. In 13 of the subjects a comparison was made of the signals picked up from the ear canal and from the contralateral nostril. It was concluded that the interpretation of the signals from the ear canal is very complicated. They may be due to an opening of the Eustachian tube, but they may also be caused by a change of the acoustic conditions in the nasopharynx during the swallowing procedure. Despite the fact that this test principle in theory is ideal, much research seems to be required before the clinical value of the method can be confirmed.

Endolaryngeal devices for perioperative identification and functional testing of the recurrent nerve.

It has previously been shown that identification of the recurrent laryngeal nerves reduces the risk of injury to the nerves during thyroid surgery. To facilitate identification and to test the conductivity of the recurrent nerves we have used electrical stimulation of the nerves and simultaneous recording of the vocal cord movements with two different endolaryngeal devices. The experience gained with these devices indicates that it is possible to reduce the frequency of injury to the nerves, and the method accelerates the progress of the operation, especially in cancer surgery and repeat operations.

Chronic headache: the role of deformity of the nasal septum.

To ascertain a possible causal relation between chronic headache and nasal stenosis arising from deformity of the nasal septum 79 people suffering from both symptoms were observed over one year. On entry to the study they were randomly allocated to either an operative or a control group. The patients in the operative group underwent nasal reconstructive surgery, and the control patients were observed without treatment. Comparison of the two groups showed a considerable decrease in headache after operation. These findings support the suggestion of a causal relation between chronic headache and nasal stenosis and indicate that a nasal origin should be borne in mind in cases of otherwise unexplained chronic headache.

Objective venous tinnitus. A case report.

A case of objective venous tinnitus with onset just after an operation for otosclerosis is presented. The maximum intensity of the tinnitus was measured at 38 db. SPL. The tinnitus disappeared after ligation of the internal jugular vein on the affected side. It is concluded that, even if objective tinnitus is uncommon compared with subjective tinnitus, it is important to elucidate its cause, because it is sometimes possible to cure the patient.

A study of operative treatment and bacteriological examination of persistent oro-antral fistulas.

A retrospective study of 35 patients with oro-antral fistulas of more than 2 weeks duration is presented. Treatment results by using the Rehrmann plastic procedure, as well as complications and sequelae are described. The results of bacteriological examination in 15 patients with maxillary sinusitis in association with oro-antral fistulas are presented. The bacteriological findings suggest that broad spectrum antibiotics in certain conditions should be administered in cases of persisting oro-antral fistulas associated with maxillary sinusitis. The results of the present study show that the Rehrmann-operation proves satisfactory even in treatment-resistent cases.

Identification and functional recording of the recurrent nerve by electrical stimulation during neck surgery.

A method for identification and functional recording of the recurrent nerve during neck operations is described. The basic principle implicates electrical stimulation of the recurrent nerve causing adduction of the vocal cord registered by means of a balloon placed between the vocal cords. Three different recording methods have been tested in animal experiments and during 26 neck operations on patients. The most simple method employed is recommended as a routine procedure, likely to reduce surgical damage to the recurrent nerve.

Hereditary dysfunction of the brain stem auditory pathways as the major cause of speech retardation.

Grossly abnormal auditory brain stem responses (ABR) and abnormally high stapedius reflex thresholds were found in 2 pairs of siblings, not akin. Pure tone audiometry showed moderate to moderately severe hearing impairment in all 4 subjects, but neither the ABR findings nor the stapedius reflex thresholds were compatible with pure cochlear lesions. In all the cases the benefit from using hearing aids was conspicuously poor, and the development of oral language markedly retarded, one pair of siblings being essentially incapable of oral--aural communication. A cousin to one of the pairs of siblings showed similar but less pronounced symptoms and signs. Intelligence was judged to be normal in all 5 individuals and neurologic examination did not reveal CNS abnormalities besides the hearing impairment. We assume dysfunction of the brain stem auditory pathways to be the main cause of the speech retardation in the 2 pairs of siblings and the abnormality to be hereditary in nature.