bluuebunny/crossref_metadata_2025 huggingface dataset:
Atypical Forms of Paroxysmal Positional Nystagmus
Authors: Smouha Eric E. , Roussos Claudia
Published: May 2019

Benign paroxysmal positional vertigo (BPPV) is a common cause of vertigo, and has a typical constellation of physical findings. Atypical forms of paroxysmal positional nystagmus (APPN) also exist, and are thought to represent conditions which are in fact not “benign”. We studied 100 consecutive patients with positional vertigo in order to learn whether APPN differed from classic BPPV in etiology or clinical fate, and to learn the incidence of central nervous system (CNS) disorders in these patients.

APPN was present in 38% of these patients with diverse causes. One-fourth had CNS disorders or vascular insufficiency, the remainder, otogenic or idiopathic. APPN was more likely than BPPV to have a prolonged (persistent or recurring) clinical course. Although most cases eventually resolved, duration of symptoms tended to be longer, regardless of etiology. We conclude that APPN has a less favorable prognosis than typical BPPV, and that a CNS etiology should be suspected in prolonged cases.
Experience with Percutaneous Endoscopic Gastrostomy on an Otolaryngology Service
Authors: Wilson William R. , Hariri Suhail M.
Published: May 2019

Seventy-one patients have undergone percutaneous endoscopic gastrostomy (PEG) on our otolaryngology service. Most commonly, these were neurologically-impaired (63%) or head and neck cancer (31 %) patients. The PEG procedures were done, in almost all instances, in the operating room in conjunction with other indicated ORL—HNS procedures such as tracheotomy (71%) or with endoscopy or resection for head and neck cancer. The success rate in placement of the gastrostomy was 98%. There was one major complication, namely, seeding of the gastrostomy site with squamous cell carcinoma from a hypopharyngeal tumor. We conclude that PEG is a useful addition to the armamentarium of the head and neck surgeon.
Hemangiopericytoma of the Skull Base and Collet-Sicard Syndrome: A Case Report
Authors: Comacchio F. , D'Eredità R. , Poletto E. , Poletti A. , Marchiori C.
Published: May 2019

Hemangiopericytoma (HP) is a mesenchymal tumor that originates from the pericytes of the capillary walls. This is a rare neoplasm, particularly in the head and neck; the skull base is involved exceptionally.

We report a case of a large HP located in the jugular foramen. The last four cranial nerves were involved, causing a Collet-Sicard syndrome associated with facial palsy. Only one case of HP and Collet-Sicard syndrome is reported in the literature. The clinical course of the disease is described, emphasizing the long period of elapsed time between onset of the complaints and the final diagnosis.

Diagnostic procedures and immunohistochemical evaluation are analyzed, along with the possible differential diagnosis with other pathological processes that more frequently involve the jugular foramen.
Endoscopic Partial Inferior Turbinectomy Using a Power Microcutting Instrument
Authors: Davis William E. , Nishioka Gary J.
Published: May 2019

A technique for removing part of the inferior turbinate with a powered instrument is presented. This new technique is safe, quick, easy to teach, predictable and enables removal of the same amount of tissue and bone as is removed with other techniques of partial inferior turbinectomy.
Chondroid Syringoma of the Head and Neck: Clinical Management and Literature Review
Authors: Chen Achih H. , Moreano Edwin H. , Houston Barry , Funk Gerry F.
Published: May 2019

This report describes the case of a chondroid syringoma occurring in the nasofacial groove of a 60-year-old woman. This benign, mixed epithelial tumor is infrequently seen by the otolaryngologist—head and neck surgeon, and therefore may not be included in the differential diagnosis of a nodular lesion on the skin of the head and neck. However, the most frequent site of occurrence for these relatively rare cutaneous lesions is the head and neck region. Histologically, these tumors are quite similar to pleomorphic adenomas of salivary gland origin, and optimal surgical management similarly requires removal of a cuff of normal tissue, rather than a simple shelling out of the lesion. The clinical presentation, pathology and recommended management of this rare tumor are discussed.
Very High-Dose Streptomycin Labyrinthectomy
Authors: Sataloff Robert Thayer , McCarter Anne , Spiegel Joseph R.
Published: May 2019

Medical labyrinthectomy by systemic administration of streptomycin has proven safe and effective for treatment of selected patients with intractable vertigo. In most patients, 40 grams or less of streptomycin sulfate are required. However, otolaryngologists should be aware that much higher doses can be used safely in selected patients; and a small number of patients may be resistant to streptomycin toxicity even in doses over 100 grams.
The Anterior Hitch Method of Tympanic Membrane Repair
Authors: Scally Catherine M. , Allen Lyndsey , Kerr Alan G.
Published: May 2019

Anterior perforations of the tympanic membrane have been previously shown to have a higher failure rate than others following tympanoplasty procedures. A technique has been previously described utilizing an anterior hitch graft stabilization with avoidance of anterior blunting of the tympanic membrane. Follow-up cases in which this technique has been utilized show greatly improved results in terms of perforation closure.
Complications of Chronic Otitis Media
Authors: Nissen Alan J. , Bui Hana
Published: May 2019

In summary, recent literature indicates that the complications of chronic otitis media have been decreasing. However, even with the advent of modern and more powerful antimicrobials and aggressive surgical eradication of disease, the morbidity and mortality are still high. Some complications may initially be quite obvious and some complications may be quite subtle. Therefore, the most important tools in making early diagnosis are careful history and physical examination, and a high index of suspicion for impending complications.
Cross-Face Facial Nerve Anastomosis: Historical Notes
Authors: Scaramella L. F.
Published: May 2019

The anastomosis between the two facial nerves for the treatment of facial paralysis, in which the proximal stump of the severed facial nerve is not accessible, was utilized in eleven patients. The palsy was secondary to resection of an acoustic tumor in nine patients, sarcoma of the petrous bone was the cause in one and an automobile accident in the other. The original concept of anastomosing a branch of the normal pes anserinus to the trunk of the paralyzed facial nerve, as first presented by the author at the Second International Symposium on Facial Nerve Surgery held in Japan in September, 1970, has been modified. The technique of anastomosing the cervicofacial division of the normal facial nerve, and directing it to the temporo-facial division of the paralyzed facial nerve via a sural autograft 20–22 cm long, was combined with the utilization of the ipsilateral descendens cervicalis (hypoglossi).17 This nerve was anastomosed to the cervicofacial division of the paralyzed facial nerve and utilized in four patients. The technique is illustrated in detail.
Expandacell®, a New Sponge for Endoscopic Sinus Surgery
Authors: Shikani Alain H.
Published: May 2019

Hydroxylated polyvinyl acetal (PVAc) sponges are routinely used for control of bleeding following endoscopic sinus surgery. The physical characteristics of the Merocel® sponges and the new Expandacell® sponges were evaluated, including pore diameter, sponge size and rate of expansion. The Expandacell® sponges were found to have a smaller pore diameter and to expand more slowly, giving the surgeon a bit more time for placement of the pack in the middle meatal cavity. Changing the physical characteristics of the PVAc sponges, such as making the pore size smaller, decreasing the thickness, coating with a laminated polyethylene surface or placing a fenestration in the center of the sponge, resulted in a significant decrease in the degree of pain associated with removal of the sponge.
Use of Antibiotics for Expansion of the Merocel® Packing following Endoscopic Sinus Surgery
Authors: Shikani Alain H.
Published: May 2019

Sinus packs that are used for hemostasis and the prevention of synechiae following endoscopic sinus surgery frequently get colonized with bacteria from the infected sinus, which increases the risk for infection. This study was conducted in an attempt to characterize the bacterial flora of the chronically infected sinus, and to evaluate whether direct installation of antibiotics into the sponge inhibits bacterial growth.

Bacteria were cultured from 89% of the sinuses at surgery, and in 67% of the cases, the same bacteria were recovered from the sinus dressings one week later. When the Merocel® sinus dressing was expanded with a combination of polymyxin, neomycin and hydrocortisone at the time of surgery, a 36% decrease in bacterial growth was observed, along with a decrease in the severity of pain associated with removal of the pack. This supports the concept of using an antibiotic for the expansion of the sponge following endoscopic sinus surgery.
Laryngeal Chondroma: A Benign Process with Long-Term Clinical Implications
Authors: Chiu L. D. , Rasgon Barry M.
Published: May 2019

Chondroma of the laryngeal cartilage is a rare, benign neoplasm which can manifest as a neck mass or, if situated within the airway, as slowly progressive obstruction, hoarseness or dyspnea. The most common location for chondroma is the posterior lamina of the cricoid cartilage; the next most common locations are the thyroid, arytenoid and epiglottic cartilages. Chondroma and low-grade chondrosarcoma are difficult to distinguish from one another histologically. Although chondrosarcoma reportedly recurs, local surgical excision without radical margins and with long-term clinical follow-up is recommended. We report one case of thyroid cartilage chondroma and include a review of radiologic studies and histopathologic analysis results. We also report a second case with severe airway obstruction caused by a large cricoid chondroma. A review of the English language biomedical literature on laryngeal chondroma is included.
Powered Nasal Polypectomy in the Office Setting
Authors: Krouse John H. , Christmas Dewey A.
Published: May 2019

The use of powered instrumentation has revolutionized the practice of functional endoscopic sinus surgery. We have expanded the role of the instrument to the treatment of polypoid disease of the nose within the office setting. We have found the technique to be both safe and effective, and to allow thorough exenteration of nasal polyps with minimal bleeding and discomfort. We recommend the use of the powered device as the primary tool in the surgical treatment of nasal polyps in the office.
The Management of Post-Thyroidectomy Hypocalcemia
Authors: Szubin Lisa , Kacker Ashutosh , Kakani Rajesh , Komisar Arnold , Blaugrund Stanley
Published: May 2019

Postoperative hypocalcemia was studied in 40 patients undergoing total thyroidectomy for a malignancy or massive goiter. Parameters evaluated included serum calcium, phosphate and magnesium levels. All patients exhibited a postoperative decline in serum calcium, however, the lowest serum calcium level was not seen until 48 hours after surgery. Serum calcium levels returned to normal in five to six days after surgery in 37 patients. Five patients required calcium supplementation for either symptomatic hypocalcemia or serum calcium levels lower than 7.0 mg/dl. Only three of these five patients were discharged home on oral calcium supplements.

In this series, we discovered that the critical period for monitoring of serum calcium was 24 to 96 hours after surgery. If serum calcium replacement was not needed in the first 72 hours after surgery, it would not be needed during the remainder of the patient's hospital course. In addition, we found that serum magnesium levels should also be monitored in the postoperative period and corrected if low.
Cyclic Alternating Pattern Sequences in Non-Apneic Snorers with and without Nasal Dilation
Authors: Scharf Martin B. , McDannold Michael D. , Zaretsky Nadia T. , Hux Geoffry T. , Brannen Donald E. , Berkowitz David V.
Published: May 2019

A study was conducted to polysomnographically evaluate the effects of external nasal dilation on sleep quality in mild snorers by examining the amount of sleep fragmentation and cyclic alternating pattern sequences (CAPS) rates. A two-night, open-label, one-way crossover Polysomnographic evaluation, with and without use of an external nasal dilator, was done at the Tri-State Sleep Disorders Center in Cincinnati, Ohio. Nine snorers, polysomnographically determined to be free of clinically significant levels of obstructive sleep apnea, were studied. CAPS rates with nasal dilation were 28.4% as compared to 37.9% without nasal dilation (p<0.05). We conclude that external nasal dilation reduces arousal instability in snorers without obstructive sleep apnea.
Renal Clear Cell Carcinoma Appearing as a Left Neck Mass
Authors: Boggess Michael A. , Hester T. Oma , Archer Sanford M.
Published: May 2019

Malignant clear cell tumors of the head and neck are uncommon. Primary tumors may arise from the salivary glands, thyroid gland, or parathyroid glands, while metastatic tumors most commonly arise from the lungs, kidneys, and female genital tract.

Renal cell carcinoma is the third most common metastatic tumor to the bone and soft tissues of the head and neck. Despite this, there have been few reported cases of renal clear cell carcinoma metastases to the neck. Here we report a unique case of an otherwise asymptomatic young woman with a left neck mass as the first clinical sign of advanced renal clear cell carcinoma.
Cervical Thymic Cysts
Authors: Jones Jacqueline E. , Hession Brian
Published: May 2019

Cervical thymic cysts are a rare cause of neck masses in children. This case report describes a three-year-old child with a several-month history of an enlarging neck mass, who was emergently admitted due to airway obstruction. Computed tomography revealed a large cystic mass extending from the oropharynx to the level of the mediastinum. Excision of the mass with pathologic examination revealed a thymic cyst. The clinical picture, the theories regarding development of these cysts, as well as surgical options for treatment, are discussed.
Iatrogenic Facial Paralysis Prevention
Authors: Harner Stephen G. , Leonetti John P.
Published: May 2019

Iatrogenic facial paralysis occurs in less than 4% of major otologic procedures. The prevention of iatrogenic injuries involves study, training and experience. These concepts are carefully woven into residency training, fellowship and, ultimately, into peer review. The reasons for injury may be errors of omission, such as inadequate preparation for the procedure, or errors of commission, such as inadequate surgical exposure. Currently, there appear to be enough surgical cases for training programs and the core training of otolaryngology residents prepares them to handle most facial nerve problems.

Included in this article is a more detailed description of the anatomy in and around the facial nerve, particularly in the mastoid, with suggestions on how to avoid problems and reduce injuries.
A Multifactorial Analysis of Facial Nerve Results in Surgery for Cerebellopontine Angle Tumors
Authors: Nissen Alan J. , Sikand Ashley , Welsh Joseph E. , Curto Frank S. , Gardi John
Published: May 2019

Preserving the function of the facial nerve remains a paramount objective in acoustic neuroma surgery. This study was undertaken to determine the influence of four independent variables on facial nerve outcome by means of a retrospective review of 111 surgical cases: 1) tumor size; 2) use of intraoperative facial nerve monitoring (IFNM); 3) completeness of tumor resection; and 4) surgical approach used. Partial tumor resection appeared to result in improved facial nerve outcome for patients with large tumors. Results indicated that tumor size did not correlate with facial nerve functional outcome, with no statistically significant differences observed among the three size categories. Facial nerve function was not found to depend on selection of either a translabyrinthine (n=47) or a suboccipital (n—55) surgical approach in that results were similar for both groups. Outcome data showed a trend in support of the use of IFNM, especially for large tumors, even though the differences between monitored and unmonitored groups were not statistically significant. This study describes the independent impact of the four factors generally thought to affect facial nerve outcome and, in addition, recommends the use of data stratification in reporting facial nerve function results.
Acute Human Trial of the Floating Mass Transducer
Authors: Tjellström Anders , Luetje Charles M. , Hough Jack V. D. , Arthur Bruce , Hertzmann Peter , Katz Bob , Wallace Dan
Published: May 2019

Five patients underwent acute implantation of the Floating Mass Transducer™ (FMT™) to evaluate the ability of the FMT to produce measurable auditory thresholds when temporarily placed in the middle ears of patients undergoing routine stapedotomy procedures. The FMT was placed on the long process of the incus in an inferior position, as is planned for clinical application, and in two additional positions. The ability of the FMT to produce measurable auditory thresholds was demonstrated in all patients. Results were affected by the lack of a healing period, the presence of a fixed stapes and an open middle ear space, and patient sedation.
Effects of lonomer Cement on Guinea Pig Cochleas
Authors: Kobayashi Taisuke , Hinohira Yasuyuki , Hyodo Masamitsu , Bredberg Goran , Alsterborg Edel
Published: May 2019

The inner ear toxicity of ionomeric cement (lonocem®) when used as a reconstructive material in ear surgery was evaluated in 47 guinea pigs used in a morphological study. The cement was implanted on either the promontory, the round window membrane or the stapes. There was no significant hair cell loss compared with the control ear at three weeks, two months or three months after implantation. Using electrocochleography, the hearing thresholds before, and three weeks, two and three months after the implantation were compared in an additional seven animals. No evident hearing loss was observed in any animal during the study period. No morphological or functional evidence for an ototoxic effect of the ionomeric cement was found in this study.
Anatomical Results with Titanium Implants in the Mastoid Region
Authors: Portmann D. , Boudard P. , Herman D.
Published: May 2019

We report our experience with titanium implants for extra-aural rehabilitation in the mastoid region with a bone-anchored hearing aid (BAHA) and auricular prosthesis. The purpose of this study was to evaluate the clnical status of the soft tissue adjacent to 63 skin-penetrating devices in 43 patients and to compare our findings with those of other reports. Forty-four fixtures have been implanted in 36 patients for the BAHA and 19 in seven patients for the auricular prostheses. The evaluation concerns osseointegration, pain in the mastoid area, skin reaction around the abutment and removal of the abutment. Three implants extruded; one due to trauma and two with no explanation. Follow-up ranged from 3 to 60 months after surgical implantation. The first outpatient check-up was performed at three months after implantation and then every six months. The soft tissue reaction around the percutaneous unit was classified at each control according to the classification proposed by Holgers et al.1 There was no irritation (type 0) in 87.5% of the controls for the BAHA group and in 87.2% for the group of auricular prostheses. No adverse skin reactions were noted in 61.36% of the BAHA group and in 66.66% of the auricular prosthesis group.

Results of this study confirm the skin's ability to tolerate a skin-penetrating unit made of pure titanium. The importance of reducing the thickness of the skin around the implant and of local hygienic conditions is emphasized.
Stapedius Tendon Reconstruction during Stapedotomy: Technique and Results
Authors: Causse Jean-Bernard , Vincent Robert , Michat Martine , Gherini Stuart
Published: May 2019

During surgery for otosclerosis, it is common for the surgeon to cut the stapedius tendon. Even without reconstruction of the tendon, the results of this kind of surgery are particularly satisfactory. The stapedial reflex is more important for improving intelligibility of speech in the presence of background noise than for protection against hazardous levels of noise. An intact stapedial reflex improves ones ability to follow speech in the presence of background noise.

This report will present a technique to reconstruct the stapedius tendon, along with the results obtained when adding this procedure to stapedotomy surgery.
Masking the Protrusion of the Receiver-Stimulator of Electronic Implants in Otology
Authors: Gyo Kiyofumi , Sato Hidemitsu , Yumoto Eiji , Murakami Shingo , Yanagihara Naoaki
Published: May 2019

Protrusion of the receiver-stimulator of a cochlear implant or a piezoelectric implantable hearing aid (IHA) was masked using bone dust applied in the gap between the receiver and the surrounding bone, making a smooth transitional border. The bone dust was then fixed with fibrin glue. Bone pâté (a mixture of bone dust and fibrin glue) was also used to fix the lead wire of a cochlear implant at the region of the posterior tympanotomy and to fasten an IHA vibrator holder to the temporal bone. Over the past two years, the use of these techniques in six patients with cochlear implants and two patients with IHAs has resulted in gratifying results; the edge of the receiver remained flush in all cases. They have been free from problems such as infection of the wound, necrosis of the overlying skin, and protrusion or migration of the receiver.
Papillary Carcinoma of the Thyroid Metastatic to the Parapharyngeal Space
Authors: Sirotnak John J. , Loree Thorn R. , Penetrante Remedios
Published: May 2019

The parapharyngeal space is a complex anatomic area which can give rise to a variety of both primary and metastatic neoplasms. Squamous cell carcinoma can also present as a parapharyngeal space mass, either by direct extension or by metastases. Occult thyroid carcinoma presenting as a parapharyngeal space mass is a rare clinical occurrence which has been only sporadically reported in the medical literature. We present a case of occult papillary thyroid cancer with parapharyngeal space metastasis in the form of an isolated tumor, as well as a review of the literature on similiar presentations. This rare situation has been previously described only once in the medical literature. Metastatic thyroid cancel-should be considered in the differential diagnosis of a parapharyngeal space mass.
Vocal Process Granuloma
Authors: Al-Dousary Surayie
Published: May 2019

Vocal process granuloma or contact ulcer is an uncommon disease in which there is chronic irritation and granulation tissue formation at the posterior third of the vocal folds. Thirteen patients (11 men and two women) with vocal process granuloma were enrolled in this study; cases of intubation granuloma were excluded. The most frequent complaints were throat irritation, frequent throat clearing and voice change. Forty-four percent of patients had a recurrence two to four months after surgery. Computed tomography (CT) of the larynx in four patients showed arytenoid sclerosis on the involved side and disclosed moderate enhancement of the vocal fold granuloma after contrast injection in one. Three patients had hyperacidity and four had hyperfunctioning granulomas: two used their voices excessively and the other two had bilateral sulcus vocalis. To our knowledge this is the first report of sulcus vocalis with vocal process granuloma, and of enhanced vocal process granuloma.
Swallowing and Pharyngeal Function in Postoperative Pharyngeal Cancer Patients
Authors: Martini David V. , Har-El Gady , Lucente Frank E. , Slavit David H.
Published: May 2019

This study examines the pharyngeal phase of swallowing after the resection of pharyngeal cancer, and focuses on the pharynx as a functional organ. The purpose of the study was to obtain information on both reconstruction and rehabilitation in cases of surgically treated pharyngeal cancer. The records of 21 consecutive patients who underwent surgical treatment of oropharyngeal and hypopharyngeal squamous cell carcinoma between 1990 and 1993 were reviewed. Functional results following surgery were graded on a numerical scale in three categories: pharyngeal swallow, laryngeal and lower airway protection, and oral alimentation. Three treatment groups were observed: group 1=transoral excision with primary closure (six patients); group 2=composite resection with primary closure (nine patients); and group 3=composite resection with deltopectoral or pectoralis major flap closure (six patients). Comparison of pharyngeal swallow and laryngeal protection functions showed no significant difference between the three groups. However, oral alimentation performance in group 1 was significantly better than in group 3, and groups 1 and 2 achieved a similar level. In patients with T3 and T4 tumors postoperative function was poor and no difference in postoperative function was demonstrated between patients undergoing reconstruction with primary closure and patients undergoing reconstruction with deltopectoral or pectoralis major flaps. Patients with T3 and T4 tumors experienced impaired postoperative function regardless of the method of reconstruction used. This is not a condemnation of the surgical treatment of advanced pharyngeal tumors, but rather a suggestion that other reconstruction techniques be considered.
Central Auditory Evaluation of Patients with Spasmodic Dysphonia
Authors: Middleton Michele L. , Wilson Keith M. , Keith Robert W.
Published: May 2019

Spasmodic dysphonia is a focal laryngeal dystonia characterized by inappropriate contractions of the intrinsic laryngeal musculature. The prevalence of associated neurological findings has led to detailed investigation of the central nervous system. Previous research revealed latency abnormalities in patients’ auditory brainstem responses. The present study further investigated central auditory findings in patients with spasmodic dysphonia, including brainstem and cortical function.

Fourteen normal-hearing patients with spasmodic dysphonia were tested using the auditory brainstem response (ABR) and SCAN-A test of central auditory processing. The ABR estimated brainstem transmission time and evaluated auditory pathway integrity at a high stimulus rate. SCAN-A assessed the auditory cerebral cortex. Implications of these findings are discussed.

We found no ABR abnormalities in subjects with spasmodic dysphonia. Positive SCAN-A findings were negligible. The ABR findings contradict previous reports.
Rhinophyma: Treatment with CO2 Laser
Authors: Lomeo Paul , McDonald John , Finneman Judith
Published: May 2019

Rhinophyma is an acne rosacea which primarily affects the midface of elderly men, and causes disfigurement as well as obstruction. There are numerous ways of treating this condition and, in our institution, a CO2 laser is the treatment of choice.
p53 Immunostaining of Surgical Margins as a Predictor of Local Recurrence in Squamous Cell Carcinoma of the Oral Cavity and Oropharynx
Authors: Ball Valerie A. , Righi Paul D. , Tejada Eduardo , Radpour Shokri , Pavelic Zlatko P. , Gluckman Jack L.
Published: May 2019

Local and regional recurrence is the principal reason for treatment failure in squamous cell carcinoma (SCC) of the head and neck. The conventional method of evaluating surgical margins for cellular atypia does not always predict risk of local recurrence accurately. Immunostaining of surgical margins for tumor markers may provide a more precise evaluation of risk of local recurrence. Paraffin-embedded tissue blocks of surgical margins from 24 patients with oral cavity and oropharyngeal squamous cell carcinoma were immunostained for p53 protein. Fifty-eight percent of the patients had at least one margin stain positive for p53, including eight often patients whose SCC recurred locally. The sample odds ratio test predicted a 5.333 times higher chance of local recurrence with at least one p53 positive surgical margin. The implications of these results for patient management and further investigations will be discussed.
Retained Wooden Foreign Body in a Child's Parotid Gland: A Case Report
Authors: Woolley Audie L. , Wimberly Lee T. , Royal Stuart A.
Published: May 2019

Foreign bodies can present a diagnostic challenge to even the experienced surgeon. In one review of 200 surgical cases involving retained foreign bodies, one-third of the cases had been initially missed.1 Wooden foreign bodies in particular pose a challenge to the physician. In the review cited above, only 15% of wooden foreign bodies were well visualized on plain radiographs.1 Acutely, on computed tomography (CT) scans, wooden foreign bodies will usually mimic air.2 However, with time, the attenuation value of a wooden foreign body may increase as moisture is absorbed from the surrounding tissues.3 Once this occurs, the wooden foreign body may mimic fat, water or muscle.2 We present an interesting case of a wooden foreign body in the parotid gland in order to illustrate a common presentation of such a foreign body, to review current guidelines for their clinical and radiologic diagnosis, and to suggest strategies for the management of their unique complications.
Inferior Turbinate Reduction Surgery in Children
Authors: Weider Dudley J. , Sulzner Sarah E.
Published: May 2019

We assessed the effectiveness and safety of surgical reduction of the inferior turbinate in 64 children, ages three to 15 years, who were operated on between January 1985 and November 1995. All patients/parents were interviewed and assessed by means of a questionnaire one to 10 years postoperatively. All patients had follow-up and were evaluated clinically at one and two weeks postoperatively. Long-term follow-up visits occurred at six, 12 and 24 months. Eighty-nine percent of the children/parents reported a sustained improvement in their nasal airways. No cases of serious postoperative hemorrhage, excessive dryness nor long-term crusting of the nose were observed or reported. We conclude that in the treatment of children with severe nasal obstruction, surgical reduction of the inferior turbinate is a safe and effective operation, alone or in combination with other airway procedures, and may increase the effectiveness of subsequent medical management.
Surgical Management of Tracheocutaneous Fistula
Authors: Drezner Dean A. , Cantrell Harry
Published: May 2019

Tracheocutaneous fistula (TCF) is a complication of tracheotomy that adds a difficult and bothersome aspect to the patient's care and may exacerbate respiratory disease. Closure of the fistula is recommended, but complications associated with fistula closure include pneumothorax and respiratory compromise. Several surgical approaches have been advocated in the literature.

We reviewed the operative techniques and outcomes of TCF closures performed at Cooper Hospital/University Medical Center between February 1990 and April 1995. Direct, or flap, closure of large tracheocutaneous fistulas was associated with significant complications and morbidity. Therefore, the closure technique was modified so that we now recommend, in patients with large tracheocutaneous fistulas (a defect of the anterior tracheal wall of ≥4 mm diameter), excision of the fistula, replacement of the tracheotomy tube and healing by second intention after a short recannulation period. No complications have occurred since this closure technique was adopted.
Ethanol Injection to Parathyroid Tissue: Indications and Limitations
Authors: Khafif Avi , Halperin Doron , Marshak Gavriel
Published: May 2019

Hyperparathyroidism is a potentially life-threatening disease, caused primarily by parathyroid adenoma. Surgical excision of the tumor, with consequent return of calcium levels to the normal range, is considered the treatment of choice.”3 Within the last few years, several reports have described the destruction of parathyroid tissue using ultrasonically guided injection of 96% ethanol into pathologic parathyroid glands, resulting in successful regulation of both primary and secondary hyperparathyroidism.4–9 The procedure was reported as an alternative to operative treatment for patients at high surgical risk, such as the elderly and the critically ill. We report the occurrence of transient Horner's syndrome and vocal fold paralysis after successful injections of ethanol into a parathyroid adenoma, and discuss the implications and restrictions of the procedure in view of the medical literature.
Thyroglossal Duct Cyst: The New York Eye and Ear Infirmary Experience and a Literature Review
Authors: Josephson Gary D. , Spencer William R. , Josephson Jordan S.
Published: May 2019

Thyroglossal duct cysts often present in childhood but can also afflict the adult population. In 1920, Sistrunk described surgical management and advocated the removal of the central portion of the hyoid bone, following the cyst tract to the base of the tongue. This surgical technique has not changed since its description 60 years ago. In this paper, a retrospective review of 70 thyroglossal duct cyst excisions performed at the New York Eye and Ear Infirmary from 1988 through 1996 is presented. The patient population consisted of 43 females (61 %) and 27 males (39%). The average age at presentation was 21.5 years, with a range of 18 months to 64 years. The most frequent presenting symptom was a painless midline neck mass. Computed tomography (CT) was the most frequent imaging study performed. Sixty-four patients underwent a Sistrunk procedure while five patients had excision alone. One patient was diagnosed but lost to follow-up. All five patients who underwent simple cystectomy required a second procedure. One patient who underwent the Sistrunk operation required revision. Nine patients had postoperative complications, with recurrence being the most common. We present our experience over an eight-year period.
Traumatic Neuromas of the Head and Neck
Authors: Lee Edwin J. , Calcaterra Thomas C. , Zuckerbraun Lionel
Published: May 2019

An interesting case of a traumatic neuroma of the greater auricular nerve provides the impetus for a discussion of head and neck neuromas. Traumatic neuromas of the head and neck are relatively rare. Division of the greater auricular nerve during parotidectomy occasionally results in a traumatic neuroma. We report a case of a 73-year-old woman who presented with a traumatic neuroma nine years after undergoing superficial parotidectomy with dissection of the facial nerve for a mixed tumor. The patient had a 1.5 cm x 1.0 cm mass located below the old surgical site over the anteromedial border of the sternocleidomastoid muscle. The patient's past history was significant for Frey's syndrome, which is the result of abnormal neurologic growth. On first impression, the tumor was thought to be a recurrence of neoplastic disease; however, because of the evaluation, traumatic neuroma was suspected. An attempt at fine-needle aspiration of the mass was too painful to be carried out. At surgery, a whitish tumor was excised which, on final pathologic examination, revealed traumatic neuroma.

The surgical literature is reviewed and the subject of head and neck neuromas, including their evaluation and management, is thoroughly discussed. Knowledge of this possible diagnosis may spare the patient and the surgeon needless worry, as well as unnecessary procedures, once tumor recurrence has been ruled out.
New Aspects of Secretory Otitis Media, Eustachian Tube Function and Middle Ear Gas
Authors: Ovesen Therese , Børglum Jens D.
Published: May 2019

The insertion of ventilation tubes to equalize pressure in the middle ear is the most common procedure used to treat otitis media. This article evaluates the advantages and drawbacks of ventilation and explores the various roles of the components of middle ear pressure, with special emphasis on oxygen-derived free radicals.
Viagra: What Every Physician Should Know
Authors: Kloner Robert A.
Published: May 2019

Viagra, an oral drug taken one hour prior to sexual activity, improves erectile function in the majority of men with erectile dysfunction who receive it. It is not an aphrodisiac and therefore will not work without sexual stimulation. The drug is absolutely contraindicated in patients on organic nitrates, as this combination can lead to severe drops in blood pressure. Patients with heart disease, suspected heart disease and risk factors for heart disease should discuss with their physicians the safety of resuming sexual activity. A cardiac work-up, including exercise treadmill testing, should be considered in appropriate patients.
The Efficacy of Topical Ciprofloxacin in the Treatment of Chronic Suppurative Otitis Media
Authors: Kiris Muzaffer , Berktas Mustafa , Egeli Erol , Kutluhan Ahmet
Published: May 2019

We conducted a test of the efficacy of ciprofloxacin eardrops in 80 patients (95 ears) with otorrhea due to chronic suppurative otitis media in two treatment settings. One group (n=40; 47 ears) received daily ciprofloxacin therapy plus aspiration in the clinic. The other group (n=40; 48 ears) self-administered ciprofloxacin at home. Overall, otorrhea resolved in 88% of all ears within 12 days of the initiation of treatment. The clinic-treated patients tended to respond more rapidly than did the self-treated patients, but there was no statistically significant difference in success rates between the two groups. Side effects were negligible. We conclude that empiric topical ciprofloxacin therapy is an effective, safe and relatively inexpensive treatment for otorrhea in patients with chronic otitis media.
Evaluation and Treatment of Head and Neck Venous Vascular Malformations
Authors: Pappas Dennis C. , Persky Mark S. , Berenstein Alejandro
Published: May 2019

Congenital venous vascular malformations of the head and neck are low-flow, nonproliferative lesions that should be distinguished from hemangiomas. The characteristic history and clinical findings can establish the diagnosis. Direct percutaneous puncture and contrast injection at the time of treatment delineate the lesion and its drainage pattern. Treatment must be individualized according to lesion extent, patient tolerance and physician experience. Sclerotherapy with ethanol has proved to be a successful treatment modality for these lesions, as demonstrated in this study of 57 patients. Surgery is used for treatment of clinically significant residual disease. A multidisciplinary approach to evaluation and treatment is key to successful management.
Diagnosis of Vertebrobasilar Insufficiency: Time to Rethink Established Dogma?
Authors: Kumar Arvind , Mafee Mahmood , Dobben Glen , Whipple Mark , Pieri Albert
Published: May 2019

As isolated symptoms, vertigo, dizziness and imbalance are not regarded by neurologists as reflections of transient ischemia in the vertebrobasilar circulation. The purpose of this retrospective study was to demonstrate that these symptoms can and do occur in isolation. To this end, we analyzed the symptoms, stroke risk factors and diagnostic algorithms in 27 patients with a diagnosis of transient vertebrobasilar ischemia. None of the 27 patients included in the review complained of any associated neurologic symptoms. Against the reference standard of brain imaging, the site of the pathologic lesion was defined in the brainstem/cerebellum with the Torok monothermal caloric test, with a sensitivity greater than 86%. Vestibular decruitment and hyperactive caloric responses were of particular diagnostic value. Thus, we recommend that the neurologic dogma with regard to brainstem cerebellar ischemia be rethought.
Endolymphatic Sac Enhancement Surgery in Elderly Patients with Ménière's Disease
Authors: Sajjadi Hamed , Paparella Michael M. , Williams Thomas
Published: May 2019

Ménière's disease is a pathologic condition of the inner ear that is characterized by vertigo, tinnitus and a progressive loss of hearing. When Ménière's disease is unresponsive to medical treatment and when destructive surgery is not advisable, patients, particularly the elderly, often benefit from endolymphatic sac enhancement, a conservative, nondestructive surgical procedure. We evaluated the outcomes of 62 such patients, aged 65 years and older, who underwent a total of 78 endolymphatic sac enhancements. We assessed their response to surgery by means of a questionnaire, which classified pre- and post-surgical data according to criteria established by the American Academy of Otolaryngology–Head and Neck Surgery. Of the 27 patients who returned questionnaires, 23 reported significant alleviation of vertigo symptoms and 19 said their hearing ability had either improved or was maintained at presurgical levels. Endolymphatic sac enhancement resulted in no mortality, and morbidity was documented in only one patient. We conclude that endolymphatic sac enhancement is a safe and viable treatment for elderly patients with Ménière's disease that is refractory to medical therapy.
Radiology of Unilateral Sinonasal Opacification
Authors: Berry Julie A. , Davidson Terence M.
Published: May 2019

Two recent cases managed at the University of California San Diego (UCSD) Nasal Dysfunction Clinic are described, with a review of the sinus computed tomography (CT) findings of six common unilateral sinonasal conditions. These include the homogeneous appearance and absence of bony destruction characteristic of unilateral benign polyposis, the focal hyperintensities of fungal sinusitis, the septal bowing seen in inverting papilloma, the involvement of the pterygopalatine fossa by an angiofibroma, the cribiform plate dehiscence associated with an encephalocele/meningocele and the extensive bony destruction characteristic of malignancy, such as epidermoid carcinoma. The clinical appearance and salient sinus CT features may suggest the diagnosis, thereby decreasing the morbidity from invasive tests, such as biopsy of an angiofibroma or an encephalocele, and improving quality resource management.
Noise Levels in the Health Club Setting
Authors: Yaremchuk Kathleen L. , Kaczor Janet C.
Published: May 2019

Nonoccupational noise exposure increasingly has become an issue in society as a possible cause of noise-induced hearing loss. Leisure activities such as rock concerts, snowmobiling and auto racing have been shown to produce dangerous levels of noise exposure.

Noise-induced hearing loss also has become problematic in the health club setting. A study of the noise levels measured during 125 aerobics classes revealed that club noise levels often exceeded those recommended for occupational noise exposure. Average noise levels during aerobics classes ranged from 78 to 106 dB(A), with 79% of readings reaching 90 dB(A) or more for 60 minutes of class time. Instructors reported that, after class, they received subjective complaints of fluctuating hearing loss and tinnitus from class members 50% of the time. Education of participants and instructors should be encouraged, to increase their awareness that loud noise levels can cause permanent hearing loss and to prevent the occurrence of such loss.
Spontaneous Cervical Hematoma: A Report of Two Cases
Authors: DiFrancesco Renata C. , Escamilla Jorge S. , Sennes Luiz U. , Voegles Richard L. , Tsuji Domingos H.
Published: May 2019

Cervical hematomas are generally associated with trauma, surgery, and tumors. Although they are rare, they can be life-threatening because they put the patient at risk for great-vessel compression and upper airway obstruction.

We describe two cases of spontaneous cervical hematoma— one in an 81-year-old man and the other in a 30-year-old woman. The man reported dysphonia, dysphagia, and neck swelling of 5 hours’ duration. He had been taking 100 mg/day of aspirin for a cardiovascular condition. Examination revealed that the man had polycythemia vera. The woman was found to have neck ache, odynophagia, and cervical ecchymosis; portal hypertension, schistosomiasis, and blood dyscrasia were also found. Both patients denied trauma. A suspected diagnosis of cervical hematoma was confirmed by computed tomography, and treatment was instituted. The hematomas resolved in about 2 weeks.

The treatment of cervical hematoma is controversial, although it is agreed that the evaluation of upper airway obstruction and its permeability is mandatory. Surgical treatment is generally reserved for complicated cases because of the risk of infection or bleeding.
Intensity-Modulated Radiotherapy: First Results with this New Technology on Neoplasms of the Head and Neck
Authors: Kuppersmith Ronald B. , Greco Stephen C. , Teh Bin S. , Donovan Donald T. , Grant Walter , Chiu Joseph K.C. , Cain Robyn B. , Butler E. Brian
Published: May 2019

Intensity-modulated beam radiotherapy (IMRT) delivers a highly conformal, three-dimensional (3-D) distribution of radiation doses that is not possible with conventional methods. When administered to patients with head and neck tumors, IMRT allows for the treatment of multiple targets with different doses, while simultaneously minimizing radiation to uninvolved critical structures such as the parotid glands, optic chiasm, and mandible. With 3-D computerized dose optimization, IMRT is a vast improvement over the customary trial-and-error method of treatment planning.

We retrospectively reviewed the charts of the first 28 head and neck patients at our institution who were treated with IMRT. All had head and neck neoplasms, including squamous cell carcinoma, adenoid cystic carcinoma, paraganglioma, and angiofibroma. Total radiation doses ranged from 1,400 to 7,100 cGy, and daily doses ranged from 150 to 400 cGy/day. A quality assurance system ensured that computer-generated dosimetry matched film dosimetry in all cases. For midline tumors, this system allowed us to decrease the dose to the parotid glands to less than 3,000 cGy. The incidence of acute toxicity was drastically lower than that seen with conventional radiotherapy delivery to similar sites.

This is the first report of the application of IMRT strictly to head and neck neoplasms. We discuss the indications, technique, and initial results of this promising new technology. We also introduce the concept of the Simultaneous Modulated Accelerated Radiation Therapy boost technique, which has several advantages over other altered fractionation schemes.
Lingual thyroid gland: Clinical evaluation and comprehensive management
Authors: Kalan A. , Tariq M.
Published: May 2019

Although lingual thyroid gland is the most common benign mass found at the junction of the anterior two-thirds and the posterior one-third of the tongue, it is still a rare clinical entity. This developmental anomaly is the result of an arrested descent of the gland anlage early in the course of embryogenesis. Patients may have symptoms of dysphagia due to obstruction or even hemorrhage. These symptoms can occur at any time from infancy through adulthood. The clinical findings, laboratory tests, and radiographic imaging studies employed in confirming the diagnosis and in planning appropriate treatment have been evaluated. The primary therapeutic goal is to restore thyroid function. We describe a case of lingual thyroid gland and summarize the current management principles for this condition.