Eugene B Kern

Mayo Foundation for Medical Education and Research | MMS · Department of Otolaryngology-Head and Neck Surgery

The domestic pig exhibits characteristic fluctuations in nasal mucous membrane congestion and decongestion which meet the stipulated criterion for the existence of a nasal cycle. This phenomenon was documented in 6 of the 11 pigs studied. Also, unilateral sympathectomy acutely affects ipsilateral nasal resistance, but this elevated nasal resistance...

The purpose of this study was to determine the effect of acute nasal obstruction on sleep and breathing in eight normal persons. The subjects were randomized into two groups. One night the subject was studied with the nose open and a second night with the nose obstructed. The electroencephalogram, electrocardiogram, inspiratory effort, nasal and or...

Approximately 600 resistance values were obtained for 50 subjects. Of the 50 subjects, 14 did not have evidence of a normal nasal cycle. These 14 subjects were selected for the study of the noncycle nose. The other 36 subjects with normal nasal cycles served as controls. By use of a mask flowmeter technique of rhinomanometry, three separate categor...

We determined the effect of preseasonal intranasal short ragweed (SRW) immunotherapy in a double-blind, nonpaired, 20-wk study involving 33 SRW-sensitive patients. Patients were selected on the basis of an elevated IGE serum antibody level, a positive intradermal skin test, and a positive intranasal challenge to SRW antigen. SRW-treated patients sp...

This is the first grand rounds in otorhinolaryngology from the Mayo Clinic for the Archives of Otolaryngology. Today's grand rounds will be devoted to various aspects of transseptal, transsphenoidal pituitary surgery. A clinical case of a patient who died during the immediate postoperative period will be presented. A number of colleagues from vario...

A systematic method for the perioperative management of routine cases of pituitary microadenoma treated by transsphenoidal microsurgery is presented. These methods have evolved over a 7-year period and have been utilized in the management of more than 750 patients with pituitary tumors and related problems treated by trans-sphenoidal surgery. The g...

This present model is a modification of the Hubbard speculum. The oxidizing of the metal blades prevents the reflection of light back into the operator's eyes. With our experience in more than 500 cases, we view this speculum to be the most suitable adaptation to date.

• Nasal glioma is a developmental abnormality of neurogenic origin with no malignant potential. An intranasal mass requires careful rhinologic and occasionally ophthalmologic, neurologic, and roentgenologic examinations. With a bony defect, pneumoencephalography, angiography, or computerized tomography may be helpful. In such cases, a neurosurgeon...

The response of laryngeal airway resistance to pulmonary receptor stimulation was studied in 20 mongrel dogs anesthetized with alpha-chloralose (80 mg/kg). Stimulation of pulmonary stretch receptors by lung inflation inhibited the phasic variation of laryngeal resistance during respiration and produced a sustained reduction of laryngeal resistance,...

Fresh allografts (homografts) of cartilage and bone, crushed and uncrushed, were transplanted in 53 rabbits. Each material was implanted into the auricle and concomitantly into the subdermis of the face. Postoperative assessment was every 1 to 3 days; sacrifice was at 6 weeks, 6 months, and 1 year for microscopic evaluation. Uncrushed cartilage all...

Although nasal injury is common-place in childhood, nasal septal trauma often is neglected and frequently goes undiagnosed until complications ensue. Only a complete intranasal examination in all cases of nasal trauma will detect intranasal fractures, dislocations, lacerations, hematomas, and abscess formation. Untreated, these septal and associate...

A six-year-old child with obstruction of the upper airway and a pectus excavatum defect (“funnel chest”) is presented. Correction of the funnel-chest deformity was observed four years after the performance of a tonsillectomy and adenoidectomy to relieve the obstruction of the upper airway. The relationship between chronic upper-airway obstruction a...

The resistance of the larynx to airflow was measured during hypercapnia, hypoxemia, and stimulation of peripheral chemoreceptors by sodium cyanide and phenyl diguanide in 15 dogs anesthetized with alpha-chloralose (80 mg/kg). Laryngeal airway resistance (R1x) was obtained by measuring the pressure difference between the subglottic region and the mo...

The completeness of the Emergency Room evaluation of the injured nose was determined by reviewing 250 cases of acute nasal injury. A recorded examination of intranasal structures was found for only 42 (21 percent) of 200 patients with blunt nasal trauma. In another group of 50 patients with roentgenographically documented nasal fractures, only 21 (...

Photoplethysmography was used to evaluate 14 skin flaps in the pig. Eight skin flaps were 4x12 cm and were based dorsally. Six skin flaps were 4x18 cm and were based ventrally. All flaps were designed to undergo necrosis of the distal end. After elevation of the flap, blood flow to the skin flaps was estimated immediately by means of intravenously...

The site of cerebrospinal fluid leaks from the nose can be localized by means of radioactive substances. The technical aspects are important for success.

Apparently, the incidence of postoperative maxillary sinus mucoceles is greater in Japan than in the Western world. Between 1967 and 1976 at the Tokyo Medical and Dental University Hospital, Department of Otorhinolaryngology, 132 patients had the diagnosis of mucoceles of the maxillary sinus. Of these patients, 131 (99%) had histories of previous m...

Approximately one quarter of the brain’s surface is supported by the frontal, ethmoid, and sphenoid bones. Each of these bones is pneumatized by sinus cavities that in turn derive from the nasal cavity. Not surprisingly, the subject of rhinological anatomy continues to engage the attention of surgeons called on to approach the base of the skull. Tr...

Four types of synthetic materials were implanted in 54 rabbits: Supramid, Proplast, Plasti-Pore, and Silastic. Each material was implanted into the auricle and concomitantly into the subdermis of the face. Postoperative assessment was every one to three days, while killing was done at six weeks, six months, and one year postoperatively for microsco...

• Nasal airway resistance was evaluated in 1,000 patients who were seen at the Mayo Clinic between 1971 and 1977 for rhinologic complaints. Nasal obstruction was reported as the major symptom in 863 patients. Nasal airway resistance correlated well with the side and the severity of the obstructive symptoms. Symptoms of nasal obstruction typically o...

If the septal component of a nasal injury is adequately managed, usually the entire nasal injury will be well managed. Major or minor nasal trauma can cause cartilage fracture, deviation, dislocation, hematoma, or abscess formation, and the various associated sequelae, some of them life-threatening. A negative x-ray report should never be used as a...

Between June 1972 and November 1977, 108 patients had medical-grade Silastic buttons inserted transnasally into a perforation of the nasal septum. This nonsurgical technique was done as an office procedure with use of 5% cocaine applied topically in 97 of the 108 patients. The Silastic button has remained in place in 70.4% of the patients, with fol...

There are many different surgical approaches to the pituitary gland. The earliest approach was intracranial. Extracranial methods (transsphenoidal) then became briefly popular but were subsequently dropped in favor of a return to intracranial methods. Now extracranial approaches have definitely returned to favor, and the reasons for this interestin...

If the septal component of a nasal injury is adequately managed, usually the entire nasal injury will be well managed. Major or minor nasal trauma can cause cartilage fracture, deviation, dislocation, hematoma, or abscess formation, and the various associated sequelae, some of them life-threatening. A negative x-ray report should never be used as a...

In a series of 505 consecutive procedures, the transseptal-transsphenoidal pituitary operation has proved safe and effective. The overall mortality in this series is 1.39%. A wide variety of sphenoid and sellar lesions and nearly every pituitary adenoma have been found suitable for the exposure provided through the sublabial-transseptal approach. T...

Nasal airway resistance was calculated in 9 anesthetized mongrel dogs by measuring the pressure difference across the nasal airway while a continuous flow of humidified air was passed through the upper airway. Hypercapnia produced a significant decrease in nasal airway resistance (P less than 0.05, Wilcoxon signed-rank test), which was proportional...

A series of 1,000 consecutive intranasal ethmoidectomies performed on 565 patients was reviewed. There were 28 complications (2.8%) in 26 patients. No patient died, and none became blind. This experience suggests that, in experienced hands, intranasal ethmoidectomy for polypoid disease and chronic ethmoid sinusitis can be a safe operation.

The response of nasal airway resistance (Rn) to various degrees of hypoxia and hypercapnia was measured in six subjects using active posterior mask rhinomanometry. All resistances were computed during expiration at the flow rate of 0.5 liter/sec. Hypercapnia, induced by breathing gas mixtures of various contents of carbon dioxide, significantly dec...

This study evaluated autografts of bone and cartilage, uncrushed and crushed, in the perichondrial space of the ear and subcutaneously in the paraspinal region in rabbits six weeks and six months after transplantation. The results support the belief that in a clinical setting it is important to preserve perichondrium because it facilitates growth o...

Seventy-three patients had medical-grade Silastic buttons inserted transnasally (between June 1972 and June 1976) into a perforation of the nasal septum. This nonsurgical technique was done as an office procedure on 67 of the patients with the use of topically applied 5% cocaine solution. The Silastic button has remained in place in 72.6% of the en...

A group of 51 patients was studied by a technique of active posterior rhinomanometry that assessed the influence of breath holding, hyperventilation, and exercise on nasal resistance. Breath hodling of 30 seconds or longer produced a decrease in nasal resistance in most of the subjects tested. Hyperventilation had variable effects on nasal resistan...

Fifty human subjects were studied and evaluated utilizing posterior rhinomanometry techniques. The main purpose of the investigation was to study the physiologic dynamic range of nasal resistance so that the data might serve as a baseline, not only for evaluation and diagnosis of pathologic states but also for the assessment of nasal responses to v...

A systematic surgical approach to nasal valve abnormalities depends on adequate and precise exposure of the abnormality to be corrected and is facilitated by the use of magnification. Small anatomic disturbances in the region of the nasal valve can produce significant airway obstruction by narrowing the nasal valve angle. Normally, this angle betwe...

Transseptal transsphenoidal pituitary surgery has proved to be safe and effective in the management of various problems associated with the region of the sella turcica. A new group of pathologic problems, namely microadenomas (tumors less than 1 cm in diameter in which baseline normal pituitary function is preserved following surgery), has now beco...

Transseptal, transsphenoidal pituitary surgery is safe and effective in the management of various problems associated with the region of the sella turcica. This series include 285 operations on 272 patients treated from Sept. 1, 1972, to Sept. 1, 1976. The operative mortality was 1.75%. In every patient, the anatomy should be assessed preoperativel...

SYNOPSIS Facial pain and headache are common and difficult problems encountered by physicians. A rather common cause, frequently overlooked, is rhinologic. Structural or nasal mucosal (or both) disorders are capable of producing facial pain or headache. In addition, either benign or malignant lesions of the nose and or paranasal sinuses can cause f...

The alternating congestion and decongestion of the nasal mucosa, termed the "nasal cycle", was investigated with current mask (posterior) active rhinomanometric techniques. This communication reports variations in nasal resistance in 50 human subjects, each studied for about 7 hours. Approximately 600 resistance values (cm H2O/liter per second) wer...

Seroma formation was most apparent in the A-treated groups and was probably related to the continued leakage of methyl alcohol from the graft. Warping in the pinna, fibrosis around grafts, graft resorption, and cellular infiltration were least evident in the FZ and R groups. Both produced better results than storage in BSS or A, but because radiati...

Changes in the pulmonary mechanics of various animal species have been observed after nasal stimulation. In reviewing the methods of these studies, we found that often the respiratory patterns were not controlled well enough to permit conclusions about changes in resistance and compliance. To further investigate the possibility of a nasopulmonary r...

• Intranasal dermoplasty and estrogen therapy have been shown to be the most effective means of managing epistaxis in patients with hereditary hemorrhagic telangiectasia. In a series of 80 patients studied, the most effective treatment was by intranasal dermoplasty; of 22 patients so treated, 14 had improvement for more than six months after surger...

Current methods of rhinomanometry used by various workers from around the world were investigated. The data for this communication were based on the studies of 11 scientists who have an accumulation of approximately 81 years of experience with more than 20,000 rhinometric examinations. The results of this survey provide a consensus of methods, proc...

Intranasal administration of a 4% solution of cromolyn sodium for the treatment of ragweed hay fever was tested in an 8-week double-blind matched-pair study involving 66 patients. Patients on active drug received 5.2 mg into each nostril 6 times daily; control patients received a placebo spray. The treated group showed a significant reduction in mo...

The physiologic phenomenon of alternating congestion and decongestion of the nasal airways was studied by rhinomanometric techniques. This study included the largest reported normal population, 50 persons (32 females, ages 14 to 72 years, mean 25, and 18 males, ages 14 to 50 years, mean 23). The "mask-flowmeter" technique of active posterior rhinom...

• Some patients with a fixed uninasal obstruction in whom the normal or patent side becomes temporarily obstructed because of the nasal cycle, and in whom the total nasal resistance is elevated, complain of nasal obstruction. It is when the normal side responds to the congestive phase of the nasal cycle that the patient becomes symptomatic; hence,...

Artificial nasal obstruction produces objective and subjective changes. A statistically significant increase in pulmonary airway resistance is found along with a disturbance in the person's sense of well being.

The structural relationships of the upper lateral cartilage and the septum form an important anatomic area called the liminal valve, one of three known paired valves of the nose. A small deformity in the region of the liminal valve may cause significant airway obstruction that usually can be relieved by surgery. Eighty percent of the population has...

The structural relationships of the upper lateral cartilage and the septum form an important anatomic area called the liminal valve, one of 3 known paired valves of the nose. A small deformity in the region of the liminal valve may cause significant airway obstruction that can usually be relieved by surgery. Eighty percent of the population has alt...

A 6-year-old child manifested symptoms and signs of alveolar hypoventilation and signs of cor pulmonale caused by obstruction of the upper airway. These symptoms and signs disappeared after tonsillectomy and adenoidectomy. The relationship of upper airway obstruction to hypoventilation and cor pulmonale is discussed in the hope of renewing interest...

A review of 52 recent cases of Wegener's granulomatosis has clarified the clinical manifestations and has emphasized the otolaryngologist's role in its early diagnosis. All the cases satisfied the currently accepted criteria for the condition: the presence of primary necrotizing vasculitis in a patient with a typical clinical course. Among the 52 p...

A brief historical review with some of the hydrodynamic principles of air flow and methods of rhinomanometry is presented. The complexity of factors that affect nasal resistance, such as changes in flow rates, turbulence, and variations of the normal respiratory cycle, has been suggested. Absolute figures denoting respiratory alterations during qui...

Eight dogs underwent denervation of the nasal mucosa by bilateral surgical interruption of the caudal nasal nerve, major palatine nerves, nerve branches traversing the pterygopalatine ganglion, and ethmoid nerve. Determinations of pulmonary resistance and compliance immediately before denervation and 1 hour, 24 hours, and 7 days after denervation d...

Forty-five patients with isolated sphenoid sinus lesions were seen at the Mayo Clinic between 1935 and 1972. The types of lesions that these patients had included inflammatory lesions (chronic sphenoid sinusitis and mucopyoceles), tumors, fibrous dysplasia, rhinoliths, and sphenoid polyp. A review of the anatomy and important structures contiguous...

Clinical and experimental observations suggest that vasomotor rhinitis results primarily from a relative overactivity of the parasympathetic nervous system; however, some questions remain unanswered. Does the autonomic imbalance produce vasomotor rhinitis through local neural effects on the mucosal and submucosal structures or is there activated a...

Changes in pulmonary resistance and compliance, secondary to excitation of a nasopulmonary reflex, were studied in awake and anesthetized dogs. Resistance increased in all dogs after stimulation of the nasal mucosa. Because the direction and magnitude of compliance changes varied widely in both awake and anesthetized dogs, no predictable pattern co...

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