Acquired aural cholesteatoma poses a unique procedural dilemma with regard to pathogenetic research and theory building. Because cholesteatoma spontane ously occurs only in the poorly pneumatized human ear, its pathogenesis is specific to humans. Nonetheless, because of the ethical questions surrounding human experimentation, pathogenetic study has almost exclusively involved nonhuman subjects. Indeed, attempts have failed in almost all animal expe riments except with the gerbil, and even here experimental designs have been improbable compared with human cholesteatoma. Cholesteatoma in the gerbil is useful, therefore, only for the study of pathology and not for human pathogenesis. I hold that the pathogenesis of cholesteatoma will be understood by studying the cholesteatomatous ear, that is, the malpneumatized ear of the human. The anatomical difference between the normal and malpneumatized ear is a probable cause of cholesteatoma. This difference may be found clinically in facial nerve decompression and cholesteatoma surgery, as, for example, facial nerve palsy occurs usually in the normal, well-pneumatized ear. Of course, conventional animal experimentation will not confirm this clinical difference since there is no ideal animal model for the poorly pneumatized human ear. Present surgical techniques for cholesteatoma vary greatly according to indi vidual otosurgeon's opinion. The most extreme difference of opinion is focused on whether to remove the external ear canal wall. Normally, the best option would be not to remove the canal wall if cholesteatoma recurrence can be prevented. Simply put, recurrence of cholesteatoma comes about when its cause has not been removed during primary surgery."

Both the major and minor salivary glands can be the site of a wide variety of diseases and functional disturbances. This monograph covers both the common lesions and conditions of the salivary glands as well as the rare ones. Much attention is given to the problematic complaint of dry mouth and the even more cumbersome diagnostic aspects of Sjogren's syndrome. Emphasis is on the clinical aspects and the management of the various disorders. The vast experience of the authors is reflected in their clear and concise style. The illustrations are well chosen and updated references are provided, where appropriate."

This Atlas of Oral PathologV is intended primarily as a ances where appropriate and reproduce relevant radio graphs. Every pathologist who deals with bone specimens bench companion for the general diagnostic pathologist. especially the trainee. It has not been designed to cover will know the value of radiographs, and some indeed are the subject fully and in detail, nor does it enter into the reluctantto make a diagnosis in their absence. In addition, radiographs may give a good idea of the extent aFld other more theoretical aspects. Since the book is essentially an atlas the text has been features of a lesion that may be represented in the first kept to a minimum, but in it we have tried to adopt'a instance only by a small biopsy specimen. practical approach, with special regard to differential diag While many of the illustrations have been made from nosis. We have made some remarks about the clinical sections freshly cut and stained for the purpose, others features of the various conditions dealt with, since this have been prepared from stained sections already in our may help the pathologist to appreciate what is in the refer files and since, in addition, the material comes principally ring clinician's mind in an area with which the pathologist from two departments, as well as from outside sources, may not be particularly familiar."

For more than three decades the methods for assessing cell pro liferation have been largely the preserve of experimental biologists, and in their hands such techniques have contributed greatly to our understanding of the dynamic organisation of normal and patho logical tissues. In recent years, with the advent of novel method ologies, there has been increased interest among both pathologists and clinicians, particularly oncologists and others interested in neoplasia, in assessing cell proliferation. This interest has been stimulated by the possibility that indices of cell proliferation may have direct clinical relevance, for example in being useful predictors of outcome in patients with certain forms of malignancy. In addi tion, interest in assessing cell proliferation has been fuelled by the tremendous advances in our understanding of the mechanisms of cell proliferation and their deregulation in pathological processes. Consequently, the time is ripe for a monograph critically reviewing the available methods for assessing cell proliferation, their potential and their problems. We have been particularly concerned to present a balanced view of the advantages and disadvantages of different methods currently available for assessing cell proliferation. The assessment of cell proliferation often requires some familiarity with mathematical methods, but in this book we have attempted to keep detailed mathematical analyses to a minimum. We have asked exponents of each of the well-recognised methods to critically review the tech niques and the ways in which they may be applied to clinical mate rial."

The syllabus for the FRCS (ORL-HNS) is vast, and sound preparation for the exams has traditionally involved assimilating knowledge from a wide range of sources. This book provides a focused guide for exam candidates. More than a question and answer book, this book is a coaching manual. Each section features a combination of model answers, pearls of wisdom, checklists and pointers for further reading. Detailed advice is provided for both Part 1 and Part 2 of the examination. Viva topics that have featured in the exam in recent years have been included. and are supplemented by invaluable editorial contributions from leaders in each of the subspecialties. Trainees frequently comment that exam preparation is an enlightening process and the knowledge gained would have served them well during their time as an ENT registrar or Otorhinolaryngology resident.This book will also serve as a valuable learning tool for trainees as early as ST3 and will facilitate the development of effective and safe clinical practice.

The purpose of this work is to review the current knowledge of laryngeal pathology in the light of my experience at the Institute of Laryngology and Otology, London. The role of histopathological investigations in the care of patients with diseases of the larynx is given special consideration. Radiologi cal study of the larynx has become more refined in recent years with the introduction of computerised tomography. Microlaryngoscopy with biopsy of the interior of the larynx is now a frequent procedure in the diagnosis of laryngeal disease. In the effort to interpret the findings resulting from these methods, the need for a monograph outlining the pathological basis of laryngeal disorders has arisen. To the best of my knowledge, such a work, devoted to the pathology of the larynx only, has never been written; a modern study in this field is certainly not available. I have aimed the text towards the practising pathologist in order to give it the broadest scope. It was necessary, therefore, to include an account of the basic anatomy of the larynx. For this purpose (and in subsequent descriptions throughout the book) I have not used the formal anatomical terminology for the two folds on either side of the ventricle of the larynx. There is some variation in the use of these terms, and they are not yet completely in general use."

A disease of unknown origin - this is the challenge presented by Meniere's disease and taken up by top clinicians and scientists, members and coworkers of The Vestibular Disorder Research Committee organized by The Ministry of Health and Welfare, Japan. They explore the pathophysiology, diagnosis and treatment of Meniere's disease to help physicians faced with treating this intractable ailment. Specialists investigating the etiology of the disease will welcome these reports which clear the picture for future research."

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."

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.

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.

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.

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.

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.

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.

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."

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."

"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.

The Oxford Handbook of Head and Neck Anatomy offers a succinct yet comprehensive quick reference guide with over 400 schematic colour and grey-scale illustrations. It tackles the notoriously difficult three-dimensional anatomy of the head and neck and provides essential clinico-anatomical correlates, etymology and background insight to help the reader easily remember complex features. Written and illustrated throughout with an awareness of the difficulties faced in linking the anatomy on the page with real cases seen in day-to-day clinical practice, this handbook is an essential resource for trainees and students at all levels.

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.

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."

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."

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."