[Auditory achievements of cochlear implantation].

The cochlear implant, which stimulates the auditory nerve electrically, is a rehabilitative solution for the severely deaf who cannot benefit from a hearing aid. The implant enables them to rejoin the world of sound from which they were disconnected. We present the process of auditory diagnosis which determines the patient's suitability for cochlear implantation, the implant's tuning program and the rehabilitation process it entails. Each of the 22 implanted electrodes is checked through a computer program, and the specifications of the electrical stimulation are established to provide the most comfortable hearing level for the implanted device. These stimulation specifications determine the number of active electrodes and the ideal stimulation model. During the 8-week hearing-training program which follows implantation, the patients acquaint themselves with the new world of sound through which they will communicate with their environment. Of the 16 implanted patients 7 heard only via the implant, without the aid of lipreading, a result which is considered excellent. These patients are able to talk on the telephone with the aid of the implant. 1 patient refused to use the implant, while the others have had good to moderate results. Noteworthy is the fact that even those with only moderate results greatly benefit from the implant, and are not willing to function without it for even a single day.

[Cochlear implantation].

Since the Israeli cochlear implant program was started in June 1989, 74 candidates have been evaluated for implantation. The main causes for hearing loss were meningitis (16 patients), aminoglycoside toxicity (9), congenital (6), viral (e.g. mumps) (6), and middle ear infection. Candidates were rejected mainly due to psychosocial factors (40%) and audiological parameters (30%). 16 postlingual deaf were implanted. In 7 of them (43.7%) the results were excellent, in 4 (25.0%) good, in 3 (18.7%) fair; 1 case is currently in a training program and 1 is a failure. There were 2 major complications: facial nerve palsy which necessitated surgical decompression, and insertion of the electrodes into the hypotympanic air cells, corrected by reoperation.

[Tonsillar lymphoma].

3 patients with tonsillar lymphoma are described (a man of 68 and women of 62 and 57 years, respectively). The first had intermediate grade lymphoma localized in the tonsil and was treated by tonsillectomy and combined systemic chemotherapy. The second had low-grade lymphoma of the tonsil and widespread involvement of lymphoid tissue in the liver, spleen, mediastinum and retroperitoneum for which chemotherapy was given. The last had intermediate grade lymphoma, but had been misdiagnosed 4 years before as an undifferentiated carcinoma of the tonsil and was irradiated. After the malignant process had extended to the stomach, the correct diagnosis of diffuse large-cell lymphoma was made. Subtotal gastrectomy was followed by combined systemic chemotherapy. All patients responded well to treatment.

Circadian variation of nystagmus in healthy and sick subjects.

Rhythmic activity of various biological systems and functions have been investigated extensively. However, information about diurnal variations of the vestibular system is scarce. In the present preliminary report, diurnal variations of the spontaneous and induced nystagmus in healthy subjects and in patients with peripheral vestibular disorders have been assessed. Circadian rhythms of the vestibular responses were demonstrated. In some variables significant differences have been found between health and sick examinees. These differences may have practical clinical implications on diagnosis and treatment.

Conservative management of adult epiglottitis.

A 10-year retrospective study of 30 adults suffering from acute epiglottitis is reported. Two clinical forms of onset were noted: gradual and accelerated. Abscess formation was present in 27% of cases. None of the patients required intubation or tracheotomy. In contrast to the accepted interventionist approach in children, conservative management in adults is recommended.

Sialadenoma papilliferum of the parotid gland.

Sialadenoma papilliferum is a rare, benign exophytic tumour of salivary glands. The preferred site of this tumour is usually the hard palate. A case of sialadenoma papilliferum occurring in the parotid gland of a 49-year-old man is presented; only one such case has been previously described.

[Blast injury of the ear].

147 soldiers, in whom 210 ears were blast-injured, were studied retrospectively during 1967-1986. The nature of eardrum perforations, hearing impairment, complications, changes over the course of time and different modes of treatment were reviewed. In 92.8 of the ears the perforation was up to half of the eardrum surface, most significantly of the lower part of the drum. In 75% the perforation closed spontaneously: in 40% within a month, in 59% within 2 months and in 73% within a year. Most had impaired hearing, of whom 74% had sensorineural or mixed hearing loss; 60% complained of tinnitus and/or vertigo. In 13% purulent discharge had accompanied the perforation and in 8% a cholesteatoma had developed 1-4 years after injury. The recommended treatment of blast injury is early patching of the perforation and surgical exploration a year later in cases with residual conductive hearing loss or cholesteatoma.

Tuberculosis of the middle ear in an infant.

Tuberculosis of the middle ear is currently a rare disease. As most physicians are unfamiliar with the typical presenting features, the diagnosis is made too late, with resulting complications, such as irreversible hearing loss and facial nerve paralysis. A case report and review of the literature are presented, emphasizing that tuberculosis should be considered in the differential diagnosis of chronic ear infection.

Peritonsillar abscess in children and its indication for tonsillectomy.

38 children aged 1-15 years treated for peritonsillar abscess (PTA) between 1976 and 1986 have been reviewed. The patients were divided into those with a history of recurrent tonsillitis prior to developing PTA (T+) (10 patients = 26.3%) and those without such history (T-) (28 patients = 73.4%). 19 patients were surgically drained, 2 abscesses ruptured spontaneously, 2 patients were treated by repeated needle aspirations and 15 patients were treated by medication only. Neither the pre-PTA history (T+ versus T-) nor the mode of treatment during the acute event showed any significant differences in comparing the recurrency rate of PTA or tonsillitis. Therefore, it seems that a single event of PTA among pediatric population should not be considered an indication for tonsillectomy.

Vocal cord paralysis as a presenting sign in the Shy-Drager syndrome.

A 70-year-old patient with bilateral vocal cord paralysis, accompanied by inspiratory stridor and increased snoring, is presented. Respiratory dysfunction, deteriorating over 18 months, necessitated permanent tracheostomy. Only two and a half years after the onset of symptoms the patient developed extrapyramidal signs combined with severe autonomic failure, suggesting a diagnosis of Shy-Drager syndrome. Vocal cord palsy preceding any other neurological or autonomic manifestations of that syndrome has been infrequently described. This diagnosis should be considered in cases of vocal cord palsy of undetermined etiology, especially when associated with increased snoring or episodes of sleep apnea.

Rapidly progressive hearing loss as a symptom of polyarteritis nodosa.

The hearing loss that occurs in polyarteritis nodosa is due largely to middle ear effusion but usually appears as a mixed type. Pure perceptive hearing loss is rare; only two cases have been reported previously in which sensorineural hearing loss was the initial sign of the disease. A case of profound, rapidly deteriorating perceptive hearing loss in which the etiology was not clear is described. One year after the onset of hearing loss, other manifestations of polyarteritis nodosa led to the diagnosis.

Peritonsillar abscess: recurrence rate and the indication for tonsillectomy.

Two hundred ninety patients treated for peritonsillar abscess (PTA) between 1970 and 1982 were reviewed. The patients were divided into those with a history of recurrent tonsillitis prior to developing PTA (72 patients, 25%), and those without (218 patients, 75%). The patients in the first group had four times more recurrences than those in the second group (40% versus 9.6%). Patients older than 40 years were found to have a lower incidence of throat infections than younger patients, and no PTA recurrences were observed. Neither subsequent tonsillitis nor recurrent PTA was observed among 72 patients (25%) who underwent tonsillectomy 6 to 12 weeks after PTA. The pre-PTA history was found to be a dominant factor in determining the need for tonsillectomy. In patients who suffered from recurrent tonsillitis prior to PTA, tonsillectomy is recommended. In those with a single episode of PTA and no history of tonsillitis, tonsillectomy is not indicated.

Enhanced recovery of gut-associated lymphoid tissue by infusion of buffy coat cells and gut leukocytes in the murine syngeneic bone marrow transplantation model.

Ways of accelerating recovery of the mucous membrane immune system in lethally irradiated mice following syngeneic bone marrow transplantation were studied over a 35-day period by quantification of jejunal intraepithelial lymphocytes (IELs) and lamina propria plasma cells. Recovery after a low bone marrow dose allowing 100% animal survival (LBM) was compared with a high (five times minimal) dose (HBM), or a minimal dose augmented with equal numbers of buffy coat cells (LBM + BC) or small gut mucosal lymphocytes (LBM + GL). The maximal decline and subsequent peak repopulation of IELs were: LBM, days 7 through 14, peaking suboptimally by day 28; HBM, day 14, peaking suboptimally but higher than LBM by day 35; LBM + BC, days 11 through 14, peaking at control levels by day 35; and LBM + GL, day 7, peaking at control levels by day 28. The IEL decline was most severe with LBM and HBM treatment and least with LBM + GL. All transplant groups experienced maximal plasma cell decline by day 7. LBM had the most severe depletion, and LBM + GL had the least. Recovery to control levels for the LBM, HBM, LBM + BC and LBM + GL groups occurred by days 28, 21, 21, and 14, respectively. In all instances, greater than 95% of the plasma cells were IgA positive.

Histology of the endolymphatic sac of the rat ear and its relationship to surrounding blood vessels: the "endolymphatic glomerulus".

Histologic and histochemical studies of the endolymphatic sac of full-term rat fetuses were undertaken to clarify the anatomy of the endolymphatic sac, and the mechanism of endolymph circulation and regulation. Hitherto undescribed structure enveloping the sac with blood vessels extending from the sigmoid sinus resembling the kidney glomerulus was seen. This endolymphatic "glomerulus" is believed to provide a means of active exchange of water and electrolytes between blood vessels and the endolymphatic sac.