The present book contains the original papers and essential points of the general discussion of a meeting organized in a series of tri-annual conferences, initiated by Dr. R. Plomp with the meeting in Driebergen, The Netherlands, 1969. These symposia have tried to bring to\ether people from extreme fields in auditory research and to amalgamate their recent findings. This series of conferences has proven to be most successful and has attracted much attention by scientists in auditory research. The organizers have tried to maintain the character of the meeting with em phasis on discussion by precirculation of the full text of the papers and by re stricting the number of active contributions. Unfortunately, this forced us to reject a great number of submitted papers - in selection we attempted to compose a fair survey of certain fields of auditory research but leave others untreated. Because of the same reason the number of invited review papers had to be limited to three. The reader may decide whether or not this selection was adequate. We thank all those participants who attended the meeting inspite of the rejection of their paper. The authors have been responsible for text and typing of their manuscripts. The editors have not attempted to standardize the spelling."

This book contains a series of articles and summaries regarding surgical voice restoration after or during a total laryngectomy. Most readers will recall the pleasure patients feel when they are able to speak again after years of mute existence. A few simple questions are relevant to the articles contained herein. Firstly, how important is a person's voice? Is it for example as important to man as the dances bees use to convey essential information? Even the most superficial consideration must tell us that the function of the human voice is still more important as we already have a detailed body language of our own, e.g., when we feel pain, joy, love, fear, etc. Without doubt, speech is the basis of knowledge and surely it is the capacity to learn which characterizes the human intellect. Secondly, one may ask whether man was always intended to have a voice? A few every-day observations can provide us with an answer. When little children play together, for instance, they all speak at once and seldom listen to what their neighbors are saying. Obviously, this is b cause it is not so important what they are actually saying as that something is being said at all.

The region of the skull base was long considered a surgical barrier because of its complex anatomy. With few exceptions, the region immediately beyond the dura or bony skull base constituted a "no man's land" for the surgeon working from the other direction. A major reason for this was the high morbidity associated with operative procedures in that area using traditional dissection techniques. This situation changed with the advent of the operating microscope. Used initially by ear, nose and throat specialists for resective and reconstructive surgery of the petrous bone and parana sal sinuses, the operating microscope was later introduced in other areas, and neurosurgeons began using it in the mid-1960s. With technical equality thus established, the groundwork was laid for taking a new, systematic, and interdisciplinary approach to surgical problems of the skull base. Intensive and systematic cooperation between ear, nose and throat surgeons and neurologic surgeons had its origins in the departments of the University of Mainz bindly supported by our chairmen Prof. Dr. Dr. hc Kurt Schiirmann (Department of Neurosurgery) and Prof. Dr. W. Kley (Depart ment of Ear, Nose and Throat Diseases, Head and Neck Surgery). The experience gained from this cooperation was taught in workshops held in Hannover from 1979 to 1986, acquiring a broader interdisciplinary base through the participation of specialists from the fields of anatomy, patholo gy, neuroradiology, ophthalmology, and maxillofacial surgery.

Contemporary laryngology had its beginnings near the close of the 19th century and is probably best exemplified in the work of Morel McKenzie and of Czermak. Subsequent to their pioneering efforts, another surge of interest could be said to have centered about the efforts of the Chevalier Jacksons in the 1920's. After those bold steps, and for almost 40 years, research in laryngology and interest in laryngology continued, but at considerably and increasingly less intense levels, certainly so far as the otolaryngologist population was concerned. In the 1940's Julius Lempert sparked a renaissance in otologic research, deVelopment, and surgery, and exciting new frontiers opened in otology. In our own time, otology remains a large basic and fundamental segment of the otolaryngologic purview, but the flood of new discoveries which followed Lempert, like those which had followed the Jacksons in the 1920's in laryngology, appears to have diminished. When the authors of this publication made acquaintance in the late 1960's, there were approximately 10 centers in the United States for laryngologic research which could be truly designated as voice research facilities. The senior author was at that time instrumental in formulating the major criteria for laboratories to be so designated. In the early 1980's interest in laryngology has revived. At a recent meeting it was possible to list over 40 such laboratories which now were known to the authors over a broad geographic sweep, covering the entire United States.

The title of this book may at first appear to be somewhat restrictive in its use of terminology. However, this is far from the intention of the writer; on the contrary, the following chapters seek to reflect a departure from the traditional segmentally orientated approach to this type of disability. Indeed one reason why the book has been written is the sense of frustration arising out of the largely ineffectual static and structural methodology of remedial work. Alternative titles could have been Disorders of Speech Production, or Neurogenic Speech Disorders, but neither would have encapsulated the essence of the book. Much of the recent research in the neurophysiology of motor control and also in the field of neurolinguistics has been concerned with ways in which intention and planning of movement is effected. Such models are still in their infancy, but it seems the potential value of their application to speech is considerable. In the case of verbal dysp'taxia, for example, we have long since in rather vague terms described it as a disorder of organization and programming without ever stating exactly what may be disorganized or not properly planned. This book does not provide the answer for as yet there is insufficient data on which to work so that formulated theories may be tested and further defined. But as we move from speculative guess-work towards established fact so the likelihood grows of providing more positive help for those who suffer these drastic limitations in communication.

The work on clinical aspects of inner ear deafness started out in 1983/1984 as a general review conceived by the Deutsche Gesellschaft fUr Hals-Nasen-Ohren-Heilkunde, Kopf-und Hals-Chirurgie (German Society for Oto-Rhino-Laryngology and Head and Neck Surgery) under the presidency of Professor Harald Feldmann, Munster. My task was to sift through the literature available at that time, to record the current status of knowledge, and if appropriate to describe existing new tendencies and potential developments. It was a conscious decision that the subject matter should extend to the entire field of inner ear deafness, though without reproducing too much of the detail given in the reviews already available, such as those by Vosteen (1961) on the biology of the inner ear, Beckmann (1962) on deafness in children, and Lehnhardt (1965) on industrial otopathies. The text contains only brief references to these, followed by more detailed expositions of what has come to light in the interim. In keeping with the broadness of the topic the list of references is extremely long, though we are aware that it is still not absolutely comprehensive. It is intended to give readers interested in specific topics an idea of the literature available and to provide a point of departure for further work. Scientific research is progressing and news insights appearing so fast, however, that the topicality of the material will be limited.

Often being vastly underrated the human sense of smell plays an essential role in our life, e.g. in food acceptance, fragrance appreciation, and as a warning device for spoiled food, toxic gases and the presence of fire. The book provides a multidisciplinary up-to-date review of the structure and function of the sense of smell and of how it is influenced by the environment and diseases. It is divided into the following 5 sections: - Anatomy, Physiology and Chemistry - Measurement of OlfactoryResponses - Development and Senescense - Basic Characteristics of Human Olfaction - Clinical and Health Aspects of Olfaction.

The exponential explosion of diagnostic techniques that is the hallmark of Twentieth Century medicine often makes us forget that the human perceptual senses are still the simplest, most reliable, and most readily available means of recognizing disease and detecting abnormalities in the human body. Improvements in optical telescopes and in glass rod light transmission have enables us to look directly into the human body, and they are indispensable to modern endoscopy. The present monograph is a product of many years of diligent search and tireless work by Professor WOLFGANG DRAF in the field of endoscopy of the parana sal sinuses. Scholastic curiosity, pursuit of academic excellence, and a fervent desire to give patients prompt and lasting relief of symptoms caused by paranasal sinus disease were the author's initial motivations. As time went on and the methodology became more refined, he ventured from the field of endoscopic diagnostic and photographic documentation into the area of endoscopic therapy for selective diseases of maxillary, frontal, and sphenoid sinuses. Many of the instruments and most of the optical and photo graphic equipment and accessories have been developed and improved in parallel with the author's professional career; indeed, many of these technical innovations were a product of Professor DRAF'S keen and methodical research.

Since the establishment of magnetic resonance imaging the clinical diagnostic of the head and neck has improved substantially and, therefore, in many cases this technique is used in the first place of radiological diagnosis. The feasibility of non-invasive MR angiography and 3-dimensional reconstruction has enlarged the indication field of MRI. This book presents the meaning of this imaging technique for the diagnosis of diseases in head and neck. Excellent figures show the technicaland diagnostical possibilities of this method, the advantages and limitations of which are explained as well. A comprehensive diagnostic strategy for each diagnostic region is presented. This book is disigned for the use of especially radiologists, ENT specialists and surgeins.

A different kind of book! The clivus of skull base is an area difficult to reach in neurosurgery, otorhinolaryngolo- gy, maxillo-facial surgery, plastic surgery, reconstructive surgery, and orthopedic surgery. It is for this reason that the various specialities gave found different approaches for different operations.

The cerebello-pontine angle has always posed a challenge to the neurosurgeon, the otoneurosurgeon, and the neuroradiologist. Angle masses which are very small and difficult to detect frequently produce symptoms, but may remain silent while growing to exceptional size. The neuroradiologist must have firm knowl edge of the clinical manifestations of the diverse angle lesions in order to tailor his studies to the patients' needs. The majority of angle lesions are benign; thus successful surgery has the potential for complete cure. Angle lesions typically arise in conjunction with vital neurovascular structures, and often displace these away from their expected positions. Large lesions may attenuate the vestibulocochlear and facial nerves and thin them over their dome. Since the nerves often remain functional, the surgeon then faces the need to separate the tumor from the contiguous nerve, with preservation of neurological function. Depending on the exact location and extension of the lesion, resection may best be attempted via otologic or neurosurgical approaches. The neuroradiologist must determine - precisely -the presence, site, size, and extension( s) of the lesion and the displacement of vital neurovascular structures as a guide to selecting the line of surgical attack. Since the arteries, veins, and nerves that traverse the angle are fine structures, the neuroradiologist must perform studies of the highest quality to do his job effectively."

"Linguistic Analyses of Aphasic Language" represents results from linguistic and neurolinguistic research on aphasic language performance. The contributions encompass all linguistic levels, ranging from phonetics to discourse, and present results on languages other than English. The findings and applied methods are both relevant to the study of aphasia in general and to cross-linguistic analyses. Furthermore, they have clear implications for language and speech therapy and thus show the importance of linguistic concepts for language testing and therapeutic intervention.

There is no question that the topic of this meeting in Seeheim, Germany, on intracranial and intralabyrinthine fluids is pertinent. This was the first international meeting at which these two closely-related topics were addressed together. Combining the clinical and research aspects of fluid and pressure regulation in the intracranial and the intralabyrint hine compartments as well as discussions on the clinical implications of abnormal fluid pressure was an excellent idea. The presentations and discussions of both the clinicians and basic scientists who participated proved that the concept of having such a combined focused gathering was both original and relevant. The two topics of the meeting in Seeheim have much in common. Maintaining both the intracranial pressure (lCP) and the intralabyrinthine pressure within normal limits is important for the normal functions of both the central nervous system and the ear. The intracranial space and the intralabyrinthine space are closed compartments that communicate with each other in an intricate manner. Deviations from normal intracranial pressure result in specific symptoms and signs. Medical problems related to elevated intracranial pressure vary from subtle to severe. Accumulated knowledge indicates that there are adverse effects from even relatively small elevations in ICP. Elevations in ICP may cause injuries to the brain and the ear. Abnormal pressure in the ear may cause abnormal function and injury. Maintaining the intracranial pressure within normal limits depends on a normally functioning pressure regulation."

Vestibular physiology has acquired new interest in the past few years. The development of fast aircraft, beginning during the Second World War and continuing through modern supersonic jets and space travel, has increased dramatically the acceleration range to which man is subjected, from prolonged weightlessness to several gs. The labyrinth measures all kinds of acceleration, including gravity. and therefore has taken on particular impor tance in the study of human health in the Space Age. It is understandable. then, that NASA sponsored the Symposium on Vestibular Function and Morphology. a satellite of the Eighth Annual Meeting of the Society of Neuroscience. held October 30-November 1. 1978, at the University of Pittsburgh, which also supported the symposium. The present volume was developed from papers originally presented there. My strategy in editing this book has been to focus upon the vestibular end organ and its direct connections. both peripheral and central, in order to as sure a coherent discussion of the basics of vestibular function, structure, and ultrastructure. Fortunately, it was possible to secure the contributions of a number of outstanding investigators from both the United States and abroad, including functionally oriented morphologists. ultrastructuralists, biophysicists, and vestibular physiologists. The result is a comprehensive discussion of the main mechanisms of the labyrinth: the transduction pro cess at the receptor level, in the semicircular canals, and in the utricular and saccular maculae; the information transfer through neuronal pathways to the nuclei and the cerebellum; and the general organization of the system."

In Videofluorscopic Studies of Speech in Patients with Cleft Palate, Drs. M.L. Skolnick and E.R. Cohn present multiview videofluoroscopy as a technique for the radiological evaluation of speech defects in patients with cleft palate. Dr. Skolnick's invaluable contributions as both the originator and leading authority on the subject are discussed in a concise, clinical fashion. Topics examined include the anatomy and imaging of the velopharyngeal portal; the equipment and techniques of multiview videofluoroscopy; the interpretation of results and various patterns of velopharyngeal closure; Passavant's Ridge and patterns of velopharyngeal closure; normal and abnormal speech production; and the evaluation of test results. This book is the only source which concisely and completely describes the technique and its interpretations for those who need a description of the clinical procedure.

This book is based largely upon a series of articles which originally appeared in Update. The purpose of the series was to give medical practitioners an insight into dental and oral disease. The diagnosis of oral disease is not a subject which receives particular emphasis in most medical curricula and it is almost com pletely absent from many. Postgraduate courses in this field are not generally available to medical practitioners. The prevention and early detection of dental and oral disease can be a very positive contribution to the health of our patients. The dental profession sees only about half the population on a regular basis, though it has been shown that over 99 per cent of the population will suffer from oral disease at some time. This places the burden of responsibility on the shoulders of the medical practitioner. There are many diseases which originate in and are peculiar to the oral cavity. Many systemic diseases have their early visible manifestations in this area. The early detection and identification of disease and deformity of the oral cavity is an important part of diagnosis in the field of general medicine. The book is designed to present basic knowledge about the diseases found in the mouth, which will aid in their early recognition, prompt referral and treatment."

Many books from symposia describe the current status in well established fields of research, where much is known and where the loose ends are only details in the picture. The topic dealt with here does not fall into this pattern. The study of time as a parameter in its own right is difficult, and the loose ends tend to do minate the present picture. Although the book does provide the reader with an overview of the field, its main value is probably to act as a source of "food for thought" for those interested in the function of sense organs and nervous systems as substrates for behaviour. The Introduction is intended to provide the readers of the book with a short guide to the topiCS discussed in the different chapters. The rather detailed Index may help those looking for information on specific topiCS. The Index also explains most of the abbreviations used in the book. The basic idea of the Danavox symposia is to invite a small group of experts to discuss a rather narrow theme in sound communication. The small number of active par tiCipants has the advantage of encouraging intense dis cussions and of avoiding overloading the program. On the other hand, selecting the partiCipants is difficult."

The need for better implant materials was a stimulus for the increa sing knowledge of Biomaterial Scientists. Different surgical disciplines were very successful in the use of prostheses, especially because they based their surgery on a good cooperation with fundamental scientists. The use of alloplastic implant materials in the reconstruction of the middle ear has not always been successful. We all know the initial suc cess in the sixties and the disappointments after short term follow-up periods. Because of these failures, Otology missed contact with the new developments in Biomaterial Science. However, we must realize that in the reconstruction of a sound conducting system our most successful results are achieved with alloplastic implants. John Shea introduced the use of Teflonprostheses in the restoration of hearing in otosclerosis and ever since this has been the most rewarding reconstructive middle ear opera tion. With the development of the intact canal wall techniques and the use of homologous implant materials the problems of middle ear surgery see med to be solved. However, we now know that closed techniques have dis advantages after longer post-operative periods and the use of homologous implant materials give problems. Collection of these implants is not al ways easy and the preservation is still in discussion. Furthermore, pro blems of resorption, rejection or fixation give uncertain post-operative results. Middle ear prostheses of different new implant materials are promoted by industry and good results are published, but also disappointments after shorter or longer periods."

Our common interest in surgery of the vertebral artery was born in 1976, when as residents in the same hospital, we attended an attempt by two senior surgeons to treat an aneurysm of the vertebral artery at the C 3 level. Long discussions had preceded this unsuccessful trial, to decide if surgery was indicated and to choose the surgical route. Finally a direct lateral approach was performed, but access was difficult and correct treatment was impossible, resulting in only partial reduction of the aneurysmal pouch. Following this experience, we decided to seek a regular and well defined approach for exposition of the vertebral artery. Review of the literature indicated some surgical attempts, but the descriptions did not give the impression of safety and reproducibility. No landmark on the described surgical route appeared sufficiently reliable. Henry's anatomical work (1917) gave the only accurate description on vertebral artery anatomy, and it became the basis for our work. When the same patient was referred again one year later, after a new stroke in the vertebro-basilar system, we had behind us repetitive experience on cadavers of an original approach to the distal vertebral artery.

Close cooperation between those involved in clinical treatment and pathology is imperative in head and neck surgery, as in all surgical fields. The degree of cooperation depends, on the one hand, on the knowledge that the head and neck surgeon has about the possibilities and limits that confront the pathologist, and on the other hand, on the knowledge that the pathologist has about the special problems of head and neck pathology and their management by the surgeon. Within the last 15 years, the knowledge of larynx growths and their treatment has changed rapidly. Parallel to this increase in knowledge, the technical possibilities in histopathology have also increased. For this reason, the authors of this volume present an up-to-date view of the whole scope of the pathology and clinical treatment of larynx tumours.

Dear colleagues, Promotion of the development of ENT is one of the most important tasks of IFOS (International Federation of Otorhinolaryngology). Apart from organizing the World Congresses it supports different international and regional meetings, organizes symposiums on well determined subjects, etc. Since the last World Congress in 1981, in addition to the Danube Symposium in 1982 and the Congress of ENT Societies in Asia Oceania in 1983, an international symposium was organized in Antwerp by the Belgian ENT Society on evaluation problems of middle ear surgery. This is a very controversial question on which there is no concensus. During a four-day meeting many anatomical and pathological aspects, operative methods, possibilities of the evaluation of the results with computers, were widely discussed. You will find all the lectures presented in this book. I am convinced that these papers will prove to be a good basis for further discussion and hope that finally we shall achieve an international agreement on the evaluation of our results in middle ear surgery. My thanks go to Professor Marquet for organizing the meeting and for publishing the papers. Professor Dr. L. Surjan President of IFOS 10 WELCOME Dear colleagues and especially dear Professor Marquet, In my function as pro-rector of the University of Antwerp I am very proud of welcoming you to the opening of the International Conference on "The Postoperative Evaluation in Middle Ear Surgery." It gives me the opportunity to stress the importance of this congress and to honour Prof. Marquet."

Several years ago Coleman (1981) reported that in 1979 one of the many in ternational cosmetics companies had an annual sales figure of $2. 38 billion, nearly 1. 25 million sales representatives, and over 700 products, the majority of these being for the face. Cash and Cash (1982) noted that in 1979 U. S. consumers spent over $4 million on cosmetic products. They stated that, "Although this practice would seem to be a fascinating aspect of human be havior on the basis of its generality and resilience, social-behavioral scientists have largely ignored the phenomenon so plainly (or pleasingly) in front of their eyes. " Why should people be so concerned with their facial appearance? Many psychologists have argued (e. g., Kleck & Rubenstein, 1975) not only that facial information is usually the first that is available to the perceiver, but also that it is continuously available during social interaction. Maruyama and Miller (1981) stated that "appearance is often the first dimension upon which a stranger can be evaluated. Since people tend to see others as integrated and consistent units, rather than as collections of situation-specific behaviors, a potent and immediately evident basis for an evaluation, such as physical appearance, should intrude into and affect any overall and subsequent evalua tion."

In planning The Handbook volumes on Audition, we, the editors, made the decision that there should be many authors, each writing about the work in the field that he knew best through his own research, rather than a few authors who would review areas of research with which they lacked first hand familiarity. For the purposes of the chapters on Audition, sensory physiology has been defined very broadly to include studies from the many disciplines that contribute to our understanding of the structures concerned with hearing and the processes that take place in these structures in man and in lower animals. A number of chapters on special topics have been included in order to present information that might not be covered by the usual chapters dealing with anatomical, physi ological and behavioral aspects of hearing. We wish to thank all authors of the volumes on Audition for the contributions that they have made. We feel confident that their efforts will also be appreciated by the many scientists and clinicians who will make use of the Handbook for many years to come. WOLF D. KEIDEL WILLIAM D. NEFF Erlangen Bloomington August 1974 Contents Introduction. By G. v. BEKESY t. With 3 Figures. . . . . . . . 1 Chapter 1 Consideration of the Acoustic Stimulus. By R. R. PFEIFFER. With Chapter 2 19 Figures. . . . . . . . . . . . . . . . . . . . . . . . . 9 Comparative Anatomy of the Middle Ear. By O. W. HENSON Jr. With Chapter 3 23 Figures. . . . . . . . . . . . . . . . . . . . . . . 39 . . . . ."

This book has been assembled from the radiographic and photo graphic records of patients presenting to craniofacial units on four continents over 7 years. It is our purpose to illustrate a wide range of craniofacial deformities with the technique of three-dimensional com puted tomography. Many topics are briefly addressed with descriptive text intended to amplify the accompanying images but not to exclude the need for more comprehensive references as recommended in the reading list of each chapter. The ability to generate three-dimensional radiographic images rep resents a successful integration of computed tomography with com puter graphics. Although this technique remains an electronic substi tute for the study of dry skull specimens, it offers a permanent pictorial record of anatomical structures with the opportunity for fu ture interactive data manipulation. It is hoped, therefore, that this work will assist others to gain a more complete understanding of disorders of the craniofacial region. We encourage other surgeons and investigators to examine and employ the techniques used to gather these images but also to ensure that standardized scanning regimens are adapted. The importance of data collection within its full anatomical context was borne out with many of our early studies, which were limited owing to computational con straints. Often an image requirement for surgical intervention is much less than an image necessary for strict scientific inquiry."

Many pathologists have little acquaintance with ear, nose concomitant biopsy have become commonplace in the and throat pathology. Some receive few specimens from management of throat disorders. It is hoped that. by ENT tissues; others are deterred from deeper study of the publication of this Atlas, pathologists receiving only material that emanates from regions the normal anatomy occasional specimens will be guided in their provision of of which is so forbidding in its complexity and holds no a report helpful to the clinician and those who are involved familiarity through autopsy investigation, for, apart from with a larger ENT service may be providec with a guide the larynx, there is usually no compelling indication for to the deeper understanding of the subject. examination of the ear, nose or throat at postmortem. Yet. The modern tendency in publication of ristopatholog equally with biopsy specimens from other parts of the ical microphotographs is to omit any statement of their body, the pathologist's report is consequential for the magnification, since it will usually be clear to the reader efficient handling of ear, nose and throat illnesses and what order of enlargement is involved. I n this Atlas, sometimes even for the patient's survival."