bluuebunny/crossref_metadata_2025 huggingface dataset:
Head and Neck Manifestations of Lymphogranuloma Venereum
Authors: Albay Diana T. , Mathisen Glenn E.
Published: May 2019

Lymphogranuloma venereum (LGV)—caused by Chlamydia trachomatis serovars L1, L2, or L3—rarely occurs in the United States. The disease clinically manifests in three stages: primary, secondary, and tertiary. The primary manifestation, a self-limited genital ulcer at the site of inoculation, often is absent by the time the patient seeks medical attention. The most common clinical manifestation of LGV is evident in its secondary stage: unilateral tender inguinal and/or femoral lymphadenopathy. However, proctocolitis or inflammatory involvement of perirectal or perianal lymphatic tissues resulting in fistulas and strictures may also occur. The diagnosis of LGV is usually made serologically and by exclusion of other causes of inguinal lymphadenopathy or genital ulcers. Doxycycline is the preferred treatment; it cures the infection and prevents ongoing tissue damage. This case highlights an unusual manifestation of LGV infection—cervical lymphadenopathy following suspected oropharyngeal infection with C trachomatis. Head and neck manifestations of LGV may become an increasing problem in the future if sexual practices such as orogenital contact become more widespread.
Oropharyngeal and Laryngeal Burn Resulting from Exposure to Endoscope Disinfectant: A Case Report
Authors: Senchak Andrew J. , Bager Jennifer , Cable Benjamin
Published: May 2019

Iatrogenic injury from medical disinfectants is an uncommon but potentially devastating complication. We report an unusual, but severe, upper aerodigestive complication from the use of ortho- Phthalaldehyde solution, a commonly used endoscope disinfectant.
Nasal Packing after Septoplasty: A Randomized Comparison of Packing versus no Packing in 88 Patients
Authors: Awan Mohammad Sohail , Iqbal Moghira
Published: May 2019

The once-common practice of packing the nose after septoplasty was based on a desire to prevent postoperative complications such as bleeding, septal hematoma, and adhesion formation. However, it was since found that not only is nasal packing ineffective in this regard, it can actually cause these complications. Although the consensus in the world literature is that packing should be avoided, to the best of our knowledge, no truly randomized study has been undertaken in Southwest Asia upon which to justify this recommendation here. Therefore, we conducted a prospective randomized comparison of the incidence of a variety of postoperative signs and symptoms in 88 patients, 15 years of age and older, who did (n = 44) and did not (n = 44) undergo nasal packing following septoplasty. We found that the patients who underwent packing experienced significantly more postoperative pain, headache, epiphora, dysphagia, and sleep disturbance on the night of surgery. Oral and nasal examinations 7 days postoperatively revealed no significant difference between the two groups in the incidence of bleeding, septal hematoma, adhesion formation, and local infection. Finally, the packing group reported a moderate to high level of pain during removal of the packing. Our findings confirm that nasal packing after septoplasty is not only unnecessary, it is actually a source of patient discomfort and other signs and symptoms.
Eagle Syndrome: Case Report and Review of the Literature
Authors: Kim Esther , Hansen Karla , Frizzi James
Published: May 2019

Eagle syndrome, which is an uncommon sequela of elongation of the styloid process, can manifest as pain in the anterolateral neck, often with referred pain to the ear. In most cases, the elongation is an acquired condition, often occurring as a result of a traumatic incident, including tonsillectomy. We describe the case of a 57-year-old man who experienced unremitting right neck pain for several years following an accidental fall. A multidisciplinary investigation identified an elongated styloid process. Surgical shortening of the structure provided definitive relief of the patient's symptoms. We review the anatomy of the peristyloid structures and discuss the etiology, diagnosis, and treatment of Eagle syndrome.
Practice Patterns in Academic Otolaryngology 2006: A Tool for the Future
Authors: Raynor Eileen M.
Published: May 2019

Although the American Academy of Otolaryngology–Head and Neck Surgery conducts a workforce survey annually, no study has been conducted to examine practice patterns as they pertain specifically to academic otolaryngology. Therefore, I developed the Academic Otolaryngologist Survey for this purpose. This survey, conducted in 2006, was mailed to 856 practicing otolaryngologists in the United States; 230 responded, for a return rate of 26.9%. Of the 230 respondents, 94% practiced full-time, 97% worked with otolaryngology residents and were hoard certified, and 67% had fellowship trainingin one or more subspecialties. The most commonly reported fellowships were in pediatric otolaryngology, facial plastic surgery, head and neck, and otology/neurotology. Respondents answered that they felt practice patterns had changed. Unlike the private-practice sector, academic otolaryngology is seeing a shift from generalists to subspecialists. The subspecialization becoming prevalent in academic otolaryngology may ultimately alter resident training. Therefore, academic programs need a balance of general and subspecialized otolaryngologists in order to train residents for practice.
Asymmetric Agenesis of the Mastoid Antrum in a Neonate
Authors: Shah Rahul K. , Vasanth Adarsh , Karmody Collin S.
Published: May 2019

The authors report a case of asymmetric development of the mastoid antrum in a neonate. The lack of mastoid development most likely represents a congenital maldevelopment. Agenesis of the mastoid antrum has surgical implications, as failure to recognize its absence can result in disorientation during surgery, with potential to injure adjacent structures.
Chondrosarcoma of the Nasal Septum
Authors: Rahal Akram , Durio Joseph R. , Hinni Michael L.
Published: May 2019

Chondrosarcoma of the nasal septum is a rarely encountered malignancy. When it does occur, early diagnosis is difficult because patients generally present with common, nonspecific sinonasal complaints. We describe a case of chondrosarcoma of the nasal septum in a 38-year-old Hispanic man. The lesion was discovered on computed tomography during a workup for symptoms of chronic sinus disease. The tumor was removed in its entirety and identified as a low-grade lesion that required no further treatment. The patient remained disease-free 4 years postoperatively. We review the diagnosis of this neoplasm and its treatment and follow-up.
Training in the Primary Prevention and Early Detection of Oral Cancer: Pilot Study of its Impact on Clinicians’ Perceptions and Intentions
Authors: LeHew Charles W. , Epstein Joel B. , Koerber Anne , Kaste Linda M.
Published: May 2019

In this pilot study, we tested a new program for training medical care providers in the primary prevention and early detection of oral cancer. The training program consisted of two modules: (1) oral cancer epidemiology and head and neck examinations for the early detection of oral cancer and (2) assessment and counseling of patients in tobacco cessation. On a pretraining questionnaire, the 8 participating clinicians (3 primary care physicians, 4ENT nurses, and 1 physician assistant) indicated that they had only a limited awareness of oral cancer, that they generally did not routinely examine asymptomatic patients for oral cancer, and that they engaged in only a limited amount of risk assessment/counseling with their patients. On a post-training questionnaire, they indicated that their training had been well received and would prompt them to increase their efforts to examine their patients for early signs of oral cancer and to counsel them about its risks.
Isolated Extramedullary Plasmacytoma of the Middle Turbinate
Authors: Shahrizal Tengku A. , Prepageran Narayanan , Rahmat Omar , Mun Kein-Seong , Looi Lai-Meng
Published: May 2019

Extramedullary plasmacytoma is a rare plasma cell proliferative disorder with a predilection for the head and neck region. Occasionally, it presents as a solitary lesion in the nasal cavity. We report a case of an isolated lesion in the middle turbinate of the right nasal cavity. The lesion was completely excised via an endoscopic approach. We also review the pathology and management of plasmacytomas in general.
Patient History and Ct Findings in Predicting Surgical Outcomes for Patients with Rhinogenic Headache
Authors: Mariotti Louis J. , Setliff Reuben C. , Ghaderi Mahmoud , Voth Spencer
Published: May 2019

The concept of rhinogenic headaches remains a subject of much debate. While many authors have reported good results in treating these headaches with endoscopic sinus surgery, few have attempted to establish objective criteria for identifying the best surgical candidates. We conducted a study of 33 adults with rhinogenic headaches to determine if three elements of the history and/or five aspects of computed tomography (CT) would predict which patients might benefit from the minimally invasive sinus technique (MIST) as the primary treatment modality for their headaches. Postoperative follow-up interviews revealed that endoscopic surgery was widely successful, as 28 patients (84.8%) reported improvement. However, we were unable to find any statistically significant history or CT parameters that predicted surgical outcomes.
Dacryocystitis Secondary to An Iatrogenic Foreign Body in the Lacrimal Apparatus
Authors: Gupta Deepak , Whittet Heikki B. , Sood Salil , Maitra Suchir
Published: May 2019

Dacryocystitis is an infection of the lacrimal sac that is usually caused by obstruction of the nasolacrimal duct. We describe a case of iatrogenic dacryocystitis that occurred secondary to the presence of an impacted piece of a metallic dilator in the lacrimal apparatus. The foreign body was detected on dacryocystography and removed during dacryocystorhinostomy. The patient recovered uneventfully.
Three Spontaneous Occurrences of Nasal Septal Abscess in Patients with Chronic Asymptomatic HIV–the Need for Early Intervention and Reconstruction
Authors: Sandel Henry D. , Davison Steven P.
Published: May 2019

We identified 3 patients with chronic, asymptomatic HIV who presented between 2001 and 2005 with spontaneous nasal septal abscesses in the absence of previous trauma, nasal surgery, sinusitis, infection, or immunodeficiency. A MEDLINE search revealed no other cases of spontaneous isolated nasal septal abscesses. Each of our patients presented to the emergency department with complaints of fever and headaches; 2 of them also had nasal obstruction, nasal and lip swelling, and pain. Clinical examinations and imaging studies revealed isolated anterior nasal septal abscesses. In each case, incision and drainage was performed immediately, and antibiotics started. One patient had an early loss of septal cartilage and nasal support, which developed into a crooked and saddle-nose deformity requiring reconstruction 7 months later. Staphylococcus aureus was identified in all 3 cases. To the best of our knowledge, these are the only 3 cases of spontaneous isolated nasal septal abscess reported in the literature. We discuss the importance of early diagnosis and intervention, as well as reconstructive techniques.
Accomplishment and Opportunity in Geriatric Otolaryngology
Authors: Chalian Ara A.
Published: May 2019

Geriatric otolaryngology is an emerging medical subspecialty developed in response to a pressing societal need. In this article, the author explains the rationale for this new subspecialty, reviews the landmark events that led to the creation of an organizational structure, celebrates the accomplishments that have been achieved thus far, and discusses the challenges that remain and the opportunities for future growth.
Geriatric Otolaryngology Toolbox: What you and your Nurse can do to Improve Outcomes for Older Adults
Authors: Van Vuuren P.A.C. , Kagan Sarah H. , Chalian Ara A.
Published: May 2019

Interest in addressing the health needs of older adults and improving their outcomes is burgeoning in otolaryngology, but the availability of practical strategies to achieve these aims is limited. In this article, we describe how otolaryngologists can capitalize on collaboration with nurses to create a toolbox of quick and effective strategies that can be incorporated into outpatient otolaryngology practice. The toolbox was compiled by a collaborative team of three: an otolaryngologist—head and neck surgeon who specializes in microvascular reconstruction, a geriatrician completing a second residency in otolaryngology, and a gerontologic clinical nurse. We selected and developed these strategies to fit within the framework of standard otolaryngology practice based on evidence we gathered from the geriatric literature and our own collective academic and clinical experience. We review our criteria for selecting each of the 10 items in our toolbox, and we discuss the potential benefits of each.
An Asymptomatic Schwannoma of the Nasal Septum: Report of a Unique Case
Authors: Pagella Fabio , Giourgos Georgios , Matti Elina , Colombo Andrea
Published: May 2019

Schwannomas of the nasal septum are extremely rare, and therefore their diagnosis and treatment can pose certain challenges. We describe the case of an incidentally discovered schwannoma of the nasal septum that was unique in that the lesion was completely asymptomatic. In view of our finding, we believe that routine examinations of both nasal fossae should be considered during routine diagnostic laryngeal flexible endoscopy.
Primary Sinonasal Malignant Melanoma: A Clinicopathologic and Prognostic Study
Authors: Kumar Sudesh , Gupta Ashok K. , Yadav Budhi S. , Ghoshal Sushmita
Published: May 2019

We conducted a retrospective study to evaluate the clinicopathologic features and prognostic factors associated with primary sinonasal malignant melanoma. We reviewed the records of 10 patients—7 men and 3 women, aged 35 to 70 years (mean: 51.4)— who had been treated at our referral center over a 9-year period. The tumors were located in the nasal cavity in 7 patients and in a paranasal sinus in the other 3. Medial maxillectomy was performed in 4 patients, wide local excision in 3, and endoscopic excision in 2; the remaining patient, who had presented with a liver metastasis, received chemotherapy and palliative local radiotherapy. Two patients who presented with a neck node metastasis also underwent concurrent radical neck dissection. Follow-up ranged from 8 to 70 months (median: 25). Only 4 patients remained alive through the duration of follow-up. The 2- and 5-year survival rates were 60 and 40%, respectively. Based on the findings of our small study, we conclude that primary sinonasal malignant melanoma carries a generally poor prognosis despite aggressive treatment. The primary cause of death in our series was a distant metastasis (n = 5) despite adequate locoregional control in most cases. This finding confirms the aggressive nature of this disease. Other factors that appeared to he associated with a poor prognosis were (1) older age, (2) a primary tumor location in a paranasal sinus, (3) an advanced tumor stage, (4) an external approach to surgery, and (5) the absence of adjuvant radiotherapy.
Synovial Sarcoma of the Head and Neck: A Review of its Diagnosis and Management and a Report of a Rare Case of Orbital Involvement
Authors: Kusuma Shashidhar , Skarupa David J. , Ely Kim A. , Cmelak Anthony J. , Burkey Brian B.
Published: May 2019

Synovial sarcoma is typically an aggressive malignant tumor of the soft tissues, usually in the extremities, that affects young adults. Tumors of the head and neck are rare. Reported head and neck sites have included the hypopharynx (the most common site), the oropharynx, the larynx, and the soft tissues of the neck; only 4 cases of orbital involvement have been previously reported. We describe a case of synovial sarcoma of the medial canthus, which we discovered during a review of a tumor registry. The patient, an 18-year-old woman, underwent conservative excision and postoperative radiation therapy. Long-term follow-up detected no evidence of recurrence. Because there is no established, consistent approach to the treatment of synovial sarcoma of the head and neck, we also present a consensus management plan based on our review of the literature.
Composite Tumor of the Larynx
Authors: Gianoli Gerard J. , Butcher R. Brent , Martin Edward J.
Published: May 2019

Composite tumor of the larynx has been described as a mixed squamous cell and oat cell carcinoma originating in the larynx. Only eight cases of composite tumor of the larynx have been described in the world medical literature. We present the ninth case ever reported. Therapy for this very aggressive malignancy is with a combined approach - surgery, radiation, and chemotherapy. A common etiology for both squamous cell and oat cell carcinoma has been proposed. Recommendations for diagnostic evaluation as well as therapeutic intervention will be discussed.
Extracranial Approaches to the Repair of Cerebrospinal Fluid Rhinorrhea
Authors: Daly David T. , Lydiatt William M. , Ogren Frederic P. , Moore Gary F.
Published: May 2019

This paper presents a review of the extracranial evaluation and treatment of cerebrospinal fluid (CSF) rhinorrhea. Diagnosis with attention to a careful history and physical with maneuvers which exacerbate drainage and thorough physical exam along with imaging techniques are discussed. The common etiologies of CSF rhinorrhea including trauma, spontaneous leakage, tumor, and iatrogenic injury are included. Management consists of conservative measures including the avoidance of straining maneuvers which increases intracranial pressure. Periodic drainage of CSF via lumbar puncture or continuous drainage via flow-regulated systems may also be of benefit in attempts of conservative management. Failure of conservative management, constant leakage, pneumocephalus, and recurrent meningitis are indicators for surgical repairs. Ethmoid-cribiform plate region repairs are generally approached by external ethmoidectomy and the development of mucoperiosteal flaps from various donor sites which are then rotated to the leak area to seal the defect. Frontal sinus leaks are usually repaired via an osteoplastic flap technique with direct repair of the dural defect or the use of fascial graft tucked under the bony defect, then obliterated with abdominal fat. CSF rhinorrhea presents a diagnostic and surgical challenge to the otolaryngologist. After diagnosis and localization, operative repair using extracranial approaches is accepted as the initial method of intervention in these cases.
Neurostimulation for Obstructive Sleep Apnea: Investigations
Authors: Fairbanks David W. , Fairbanks David N.F.
Published: May 2019

Neurostimulation of the upper airway muscles (accessory muscles of respiration) was accomplished in anesthetized dogs and sleeping humans by electrical stimulation of the hypoglossal nerves. Such stimulations relieved partial airway obstructions in dogs. They also aborted (shortened) obstructive sleep apnea events in humans who suffer with obstructive sleep apnea syndrome. In one subject, stimulations delivered in advance of apneic events (by automatic cycling) prevented apneas. Neurostimulation for obstructive sleep apnea may be an important concept for future research and development.
Uvulopalatopharyngoplasty for Obstructive Sleep Apnea in Adults: Clinical Correlation with Polysomnographic Results
Authors: Davis Jeffrey A. , Fine Edward D. , Maniglia Anthony J.
Published: May 2019

The success of Uvulopalatopharyngoplasty (UPPP) for Obstructive Sleep Apnea (OSA) can be assessed by a variety of parameters including clinical evaluation and polysomnography (PSG). Patients are often reluctant to undergo post-operative testing and insurance companies are often unwilling to reimburse for expensive overnight sleep studies. Due to the reality of these medical and economical problems, can a clinician be confident of the success of UPPP based solely on clinical evaluation?

Sixty patients underwent UPPP for the treatment of OSA from July 1987 through June 1992. Patients treated with tracheostomy or other methods were not included in this study. Fifty-three patients (88%) reported an improvement in their symptoms of snoring, daytime somnolence, morning headache and apnea. Twenty-one patients (35%) had post-operative PSG. Eighteen of 21 patients (85%) reported improvement in their symptoms. Eleven of 21 patients (57%) showed objective improvement in their sleep apnea. The objective findings of PSG do not correlate, in a significant number of patients, with subjective clinical improvement of patients treated with UPPP.
Eagle's Syndrome: A Reappraisal
Authors: Baugh Reginald F. , Stocks Rose Mary
Published: May 2019

W. W. Eagle in 1937 described two patients with elongated styloid processes, cervico-facial pain and a history of pharyngeal trauma. Selected case reports are used to illustrate the spectrum of Eagle's Syndrome. An analysis of the prevailing theories of etiology and causation is undertaken correlating anatomy, embryology, and physiology to derive a clearer understanding of Eagle's Syndrome.
Tonsil and Adenoid Surgery for Airway Obstruction: Perioperative Respiratory Morbidity
Authors: Price Scott D. , Hawkins Donald B. , Kahlstrom Emily J.
Published: May 2019

A series of 160 consecutive patients undergoing tonsil and adenoid surgery for upper airway obstruction is reported. The ages ranged from 8 months to 13 years. Sixty-seven percent were 2, 3, or 4 years of age. All were routinely admitted overnight postoperatively. Forty-five (28%) remained in the hospital longer than one night (2 to 20 days). Postoperative respiratory problems were the reason for prolonged hospital stay in 30 of these 45 patients. Preoperative “danger-signals” of potential postoperative respiratory problems were: a history of severe obstructive symptoms with apnea and moderate or strongly positive sleep study, daytime somnolence, need for urgent T&A, and cardiomegaly. Risk factors present in a smaller number of patients were obesity, congenital stenosis of airways, and bronchopulmonary dysplasia. We suggest that children with these danger signals not be considered as candidates for outpatient T&A surgery.
Protrusion of Postoperative Maxillary Sinus Mucocele into the Orbit: Case Reports
Authors: Hasegawa Makoto , Kuroishikawa Yasushi
Published: May 2019

Maxillary sinus mucocele, which appears more than 10 years after Caldwell-Luc surgery, is very rare in the United States or Europe. However, it is very common in Japan. It is called “postoperative maxillary sinus mucocele” or “postoperative maxillary cyst.” In this paper, postoperative maxillary sinus mucoceles, which protruded into the orbits, are reported. One patient, a 50-year-old man, underwent Caldwell-Luc surgery 31 years ago, and the other patient, a 61-year-old woman, underwent Caldwell-Luc surgery at the age of 18. The incidence of this disease, symptoms, diagnosis and treatment are discussed in this paper.
Efficacy of Clarithromycin vs. Amoxicillin/Clavulanate in the Treatment of Acute Maxillary Sinusitis
Authors: Dubois Jacques , Saint-Pierre Claude , Tremblay Chantal
Published: May 2019

A new macrolide drug, clarithromycin (Biaxin®) was compared with amoxicillin/clavulanate (Augmentin®) in a single-blind (investigator-blind), randomized, multicenter study of 497 outpatients with acute maxillary sinusitis; treatment was 500 mg clarithromycin bid (n = 246) or 500 mg amoxicillin/clavulanate tid (n = 251). Pathogens included Streptococcus pneumoniae in 22% of patients, Staphylococcus aureus in 16%, Haemophilus influenzae in 10%, and Moraxella catarrhalis in 7%.

For evaluable patients, clinical success (cure or improvement) was noted for 97% (128/132) of clarithromycin recipients and 93% (119/128) amoxicillin/clavulanate recipients. Clinically significant improvement in signs and symptoms was comparable between groups. Bacteriologic cure rates were 87% (115/132) and 90% (115/128), respectively. Respective pathogen eradication rates were 87% (125/143) and 90% (125/139). Adverse events not due to concurrent conditions occurred in 41% of the former and 46% of the latter group; most were mild to moderate gastrointestinal upsets (21% and 38%, respectively; P ≤ 0.001).

We conclude that clarithromycin appears to be as effective as amoxicillin/clavulanate in acute maxillary sinusitis and may cause fewer gastrointestinal upsets.
The Mayo Clinic Experience with the Cochlear Implant
Authors: Facer George W. , Peterson AnnaMary , Brey Robert H. , Marion Mitchell , Cevette Michael , Balko Karla , Green J. Douglas , Rose Darrell , Pool Angela
Published: May 2019

The implantati on of a cochlear electronic prosthetic device is an accept able means of improving the communication ability of pre- and postlinguaIIy deafened children and adults. A significant number of patients in this series are in the senior citizen age group. It has been beneficial in improving communication ability in selected profoundly deafened individuals. There has been a significant improvement in the cochlear electronic prosthetic device since the initial report of Djourno1 in 1957.
Malignant Otitis Externa in AIDS Patients: Case Report and Review of the Literature
Authors: Weinroth Stephen E. , Schessel David , Tuazon Carmelita U.
Published: May 2019

Malignant otitis externa is a necrotizing infection of the external ear canal and surrounding soft tissue and bone, usually caused by Pseudomonas aeruginosa. The infection classically occurs in diabetic patients, however recently, several patients with the acquired immunodeficiency syndrome (AIDS) have been reported to have malignant otitis externa. A patient with AIDS who had malignant otitis externa with skull base osteomyelitis is presented and reported cases in patients with AIDS are reviewed. Predisposing factors include immunologic abnormalities (notably neutropenia), dermatitis, medications, neoplasm, and iatrogenic procedures, e.g., ear lavage. Treatment of malignant otitis externa has traditionally included anti-pseudomonal cephalosporins/penicillins and aminoglycosides for prolonged durations. Recently, ciprofloxacin has been shown to be effective as an oral regimen.

With the increasing number of patients with AIDS being seen in the outpatient clinics, the diagnosis of malignant otitis externa should be considered in any patient with persistent ear pain or otorrhea who does not respond to conventional treatment for external otitis.
Functional-Anatomic Correlation of Eustachian Tube Obstruction Related to the Adenoid in a Patient with Otitis Media with Effusion: A Case Report
Authors: Buchman Craig A. , Stool Sylvan E.
Published: May 2019

Prospective randomized clinical trials have shown modest but significant reductions in morbidity from otitis media with effusion following adenoidectomy. However, the precise role of the adenoid in the pathogenesis of otitis media with effusion remains unknown. Some authors have hypothesized that the adenoid may compress or obstruct the Eustachian tube lumen, thereby causing middle ear underpressures and subsequent effusion formation. Functional-anatomic correlation for this theory is lacking. Herein, we present a single case of a pediatric patient with otitis media with effusion and manometrically proven active and passive Eustachian tube obstruction which was relieved by adenoidectomy. Photographic anatomic correlation is presented.
Stuttering Induced by Theophylline
Authors: Rosenfield David B. , McCarthy Michael , McKinney Kevin , Viswanath Nagalapura S. , Nudelman Harvey B.
Published: May 2019

We retrospectively evaluated three fluent asthmatic children who developed speech dysfluency following administration of theophylline. The dysfluency ceased in all three, following discontinuation of the medication. The medication was re-instituted in two patients, prompting return of dysfluency. It is unknown whether the patients had characteristics of “acquired stuttering” or “developmental stuttering.” We urge appropriate testing should this complication again occur. This might then provide pharmacologic information regarding stuttering.
Cochlear Nerve Section for Intractable Tinnitus
Authors: Pulec Jack L.
Published: May 2019

Tinnitus is a common and often very disturbing symptom. The majority of patients can now be successfully treated either by conservative medical treatment or by specific surgery. Intractable subjective tinnitus originating within the cochlea or cochlear nerve can frequently be successfully treated by cochlear nerve section. The cochlear nerve must be severed medial to the spiral ganglion to obtain optimum results. One hundred fifty-one cases are reported. Complete relief of tinnitus was achieved in 101 patients, worthwhile improvement was obtained in 43 patients and 7 patients obtained no improvement. The indications for this surgery will be given. Careful examination, accurate diagnosis, and proper selection of patients with intractable tinnitus for cochlear nerve section offer a good chance for success.
Meniere's Syndrome: An Approach to Therapy
Authors: Brookler Kenneth H. , Glenn Morton B.
Published: May 2019

There are patients with symptoms similar to those of Meniere's disease who do not have Meniere's disease and therefore do not respond to conventional medical or conservative surgical management. Some have subtle disorders of carbohydrate and lipid metabolism and inner ear otosclerosis, which are responsible for the production of their symptoms. The response to dietary therapy confirms that glucose tolerance levels which are not diabetic nor hypoglycemic may be sufficiently significant in relation to inner ear function to produce the symptoms like those of Meniere's Disease. Management of inner ear otosclerosis with supplemental sodium fluoride, calcium carbonate, and Vitamin D was also effective in controlling the symptoms in some patients.
A Pathway for Information Transmission to the Ear
Authors: Bento Ricardo Ferreira , Miniti Aroldo , Sanchez Tanit Ganz , Leiner Adolfo , Nunes Carlos Augusto
Published: May 2019

The use of implantable hearing aids and cochlear implants as an aid to neurosensory deafness is becoming an established procedure. The transmission of a processed speech signal is accomplished either transcutaneously via radiofrequency or percutaneously by connector coupling. Whereas the former is sensitive to electromagnetic interference, the latter increases the risk of infection. To overcome these disadvantages, an infrared (IR) system for transmission through the tympanic membrane was devised and tested. The transmitter/receiver consisted of an IR light emitting diode (LED;920nm) and a photovoltaic cell. The LED was placed inside the auditory canal of four dogs and the photovoltaic cell in the tympanic cavity over the cochlear promontory. A sinusoidal signal modulation was applied to the LED. The emitted signal was detected undistorted after crossing the tympanic membrane, with an average absorbance of 20%. High-frequency cut-off was adequate for cochlear implant purposes and audio prosthetic devices in general. The authors conclude that the tympanic membrane may be used as a translucent sealed interface to transmit data in the audio range to the middle and inner ears, with small power loss, good frequency response, and immunity to interface.
Middle Ear Effusion—Allergy Relationships
Authors: Mattucci Kenneth F. , Greenfield Barak J.
Published: May 2019

Middle ear effusion (MEE), in its various forms, is one of the most common disorders of childhood. There are several possible etiologies, depending on the makeup of the effusion. However, the common factor in many middle ear effusions is eustachian tube dysfunction, and the role of allergy, although only one of many possible causes, is significant. A relatively large number of children with MEE are found to have atopic disorders. Nonetheless, allergy treatment alone must not preclude the use of conventional medical and surgical therapy. Optimal results will be obtained if recurrent or persistent MEE is managed in a coordinated manner by the otologist, pediatrician and allergist.
Rosai-Dorfman Disease Involving the Nasal Septum
Authors: Özünlü Adnan , Dündar Ahmet , Yildirim Altan , Yildiz F. Rüstü
Published: May 2019

Rosai-Dorfman disease, or sinus histiocytosis with massive lymphadenopathy (SHML), is a benign, self-limited pseudolymphomatous entity with characteristic histologic features. The disease may be atypically present in the absence of detectable nodal involvement. This is a case of nasal septum involvement of Rosai-Dorfman disease without clinically apparent lymphadenopathy.
Powered Instrumentation in Functional Endoscopic Sinus Surgery I: Surgical Technique
Authors: Christmas Dewey A. , Krouse John H.
Published: May 2019

The use of the microdebrider provides an excellent, safe and thorough technique in functional endoscopic sinus surgery. It provides atraumatic dissection with minimal bleeding which enables decreased surgical time and faster postoperative healing. It is easily learned and requires minimal supplemental instrumentation. We feel that it is a superior technique in the practice of functional endoscopic sinus surgery.
Sinus Tympani: Retrofacial Approach for the Removal of Cholesteatomas
Authors: Pulec Jack L.
Published: May 2019

The epithelium basement membrane of cholesteatomas in cases of chronic otitis media often extends into the sinus tympani. In the majority of cases it can be safely and completely removed by dissection through the ear canal and tympanum. In 2% of cases, not all squamous epithelium basement membrane can be removed because the sinus tympani extends more than 3 or 4 mm posterior to the anterior edge of the facial nerve and because the membrane is adherent to the irregular bony surface. Surgical exposure of the sinus tympani through the mastoid posterior and medial to the facial nerve allows complete removal of all basement membrane with a direct view. The technique using a retrofacial approach to expose this obscure sinus is described and a series of 48 cases treated successfully by this method are reported.
Facial Nerve Palsy as an Early Manifestation of Relapse in T-Cell Acute Lymphoblastic Leukemia
Authors: Juhn Young J. , Inoue Susumu
Published: May 2019

We describe a 14-year-old girl with T-cell acute lymphoblastic leukemia (ALL) who developed peripheral type facial palsy alternately on each side during remission. The cerebrospinal fluid examination and imaging studies of the brain including the temporal area failed to identify the etiology. Fully 10 weeks after the onset of the facial nerve palsy, she showed cytological findings of meningeal and bone marrow relapse. Review of the literature revealed that an isolated facial nerve palsy due to leukemic cell infiltration is a rare occurrence. Nonetheless one needs to keep in mind that it may represent the initial sign of a relapse in a patient with leukemia, particularly with T-cell ALL.
Neurogenic Stuttering: Further Corroboration of Site of Lesion
Authors: Heuer Reinhardt J. , Sataloff Robert Thayer , Mandel Steven , Travers Nancy
Published: May 2019

Cases of neurogenic stuttering have been reported in the literature throughout the past century. Site(s) of lesion(s) have been documented usually by association of symptoms, EEG studies and occasionally by computed tomography (CT). The authors present three cases in which the site(s) of lesion(s) are documented by CT, magnetic resonance imaging (MRI) and SPECT. This study supports previous findings of neurogenic stuttering following either bilateral diffuse lesions or a unilateral lesion. In at least one case, the actual site of the lesion would have been missed without the use of SPECT testing. EEG studies were not helpful in identifying the site of the lesion.
Extramedullary Nasal Plasmacytoma — An Unusual Clinical Entity
Authors: Soo Gordon , Chan Anthony , Lam Dennis , Abdullah Victor , van Hasselt C. Andrew
Published: May 2019

A case of extramedullary plasmacytoma with its unusual appearance is reported. This is the second reported case in world literature affecting the paranasal sinuses with intracranial extension. The role of surgery is to obtain tissue for diagnosis and to excise residual disease. Radiotherapy is the treatment of choice and long-term follow-up is necessary for monitoring disease recurrence. The overall 10-year survival is about 50%. The case is discussed with a general review of the management of this pathology.
Salivary Gland Choristoma of the Middle Ear: Report of a Case and Review of the Literature
Authors: Hinni Michael L. , Beatty Charles W.
Published: May 2019

Salivary gland choristoma (heterotopic salivary gland tissue) is a rare condition that occurs at various locations within the head and neck. We present a 10-year-old boy with a salivary gland choristoma of the middle ear and compare findings with the 15 similar cases published in the English and German languages. Patients typically have a long-standing conductive hearing loss and visible middle ear mass. Operative findings include a lobulated middle ear mass of histologically normal salivary gland tissue attached posteriorly in the region of the oval window, together with absent or malformed ossicles. Frequently the mass is intimately associated with the facial nerve. The constancy of these findings has led to the proposal of an abnormal developmental syndrome. This syndrome will be described and possible explanations for its cause will be discussed.
Intraoperative Vagal Nerve Monitoring
Authors: Leonetti John P. , Jellish W. Scott , Warf Patricia , Hudson Elizabeth
Published: May 2019

A variety of benign and malignant neoplasms occur in the superior cervical neck, parapharyngeal space or the infratemporal fossa. The surgical resection of these lesions may result in postoperative iatrogenic injury to the vagus nerve with associated dysfunctional swallowing and airway protection. Anatomic and functional preservation of this critical cranial nerve will contribute to a favorable surgical outcome.

Fourteen patients with tumors of the cervical neck or adjacent skull base underwent intraoperative vagal nerve monitoring in an attempt to preserve neural integrity following tumor removal. Of the 11 patients with anatomically preserved vagal nerves in this group, seven patients had normal vocal cord mobility following surgery and all 11 patients demonstrated normal vocal cord movement by six months. In an earlier series of 23 patients with tumors in the same region who underwent tumor resection without vagal nerve monitoring, 18 patients had anatomically preserved vagal nerves. Within this group, five patients had normal vocal cord movement at one month and 13 patients demonstrated normal vocal cord movement at six months.

This paper will outline a technique for intraoperative vagal nerve monitoring utilizing transcricothyroid membrane placement of bipolar hook-wire electrodes in the vocalis muscle. Our results with the surgical treatment of cervical neck and lateral skull base tumors for patients with unmonitored and monitored vagal nerves will be outlined.
Retrolabyrinthine Selective Posterior Root Section of the Trigeminal Nerve for the Treatment of Trigeminal Neuralgia
Authors: Pulec Jack L.
Published: May 2019

Patients frequently consult otolaryngologists for the treatment of trigeminal neuralgia. Retrolabyrinthine selective posterior root section of the fifth cranial nerve effectively and permanently eliminates pain from areas supplied by this nerve without the production of annoying anesthesia dolorosa. The procedure is performed by the neurotologist and causes minimum morbidity. The results of this surgery in 106 patients are reviewed and demonstrate that the procedure provides lasting relief from intractable pain from a variety of conditions whose innervation is the Vth cranial nerve as well as trigeminal neuralgia. The surgical technique and long-term results are described.
Diagnosis and Management of Complications of Self-Injection Injuries of the Neck
Authors: Kay David J. , Mirza Natasha
Published: May 2019

When IVDUs who lose peripheral access turn to their necks, they invite a spectrum of unique complications that require particular management and treatment. While many of these complications are infectious, other possibilities include vocal cord paralysis and needle fragment foreign bodies. Work-up of these patients must include a very thorough history and physical exam, particularly of the head and neck, complete with a laryngeal exam. All patients should undergo imaging studies, including plain films, CT or MRI of the neck, and other studies as appropriate. Laboratory studies should include HIV and hepatitis serologies. Because of the risks to the surgical team, neck explorations, when indicated, should be performed under general anesthesia with strict adherence to universal precautions. Further management includes early referrals to methadone clinics, although unfortunately poor patient compliance is usual. Public campaigns aimed at prevention are useful, although limited, and should be encouraged.
Solitary Fibrous Tumor of the Parapharyngeal Space: A Case Report and Review of the Literature
Authors: Gangopadhyay Kunal , Taibah Khalid , Manohar M. Babu , Kfoury Hala
Published: May 2019

Solitary fibrous tumors are uncommon spindle cell neoplasms generally associated with serosal surfaces, especially the pleura. Recently, these tumors have been documented in a number of extrapleural sites including the head and neck. So far only two cases of parapharyngeal solitary fibrous tumor have been reported in the English literature. Rare location of an uncommon lesion often gives rise to difficulty in diagnosis or to misdiagnosis. In both the previously reported cases, as well as in our case, the diagnosis of solitary fibrous tumor was not made until the excised tumor was subjected to histopathology and immunohistochemistry.
Protection against Noise Trauma by Sound Conditioning
Authors: Canlon Barbara
Published: May 2019

Sound conditioning provides protection against a subsequent noise trauma. The sound conditioning paradigm consists of a low-level, long-term, non-damaging acoustic stimulus (1 kHz, 81 dB SPL x 24 days). Morphological and physiological alterations are not induced by the sound conditioning stimulus alone. In addition, the middle ear muscles have been shown not to be influenced by sound conditioning. It has been shown that after exposure to a traumatic stimulus, sound conditioning protects the outer hair cell morphology (fewer missing outer hair cells), as well as physiology (distortion product otoacoustic emissions) compared to an unconditioned group exposed only to the traumatic stimulus. Further studies are needed in order to establish the underlying mechanisms for the phenomenon of sound conditioning. Nevertheless, since sound-conditioning experiments have been successfully applied to human subjects our understanding of hearing impaired individuals has been enhanced.
External Unit for a Semi-Implantable Middle Ear Hearing Device
Authors: Garverick Steven L. , Kane Michael , Ko Wen H. , Maniglia Anthony J.
Published: May 2019

A miniaturized, low-power external unit has been developed for the clinical trials of a semi-implantable middle ear electromagnetic hearing device (SIMEHD) which uses radio-frequency telemetry to couple sound signals to the internal unit. The external unit is based on a commercial hearing aid which provides proven audio amplification and compression. Its receiver is replaced by an application-specific integrated circuit (ASIC) which: 1) adjusts the direct-current bias of the audio input according to its peak value; 2) converts the audio signal to a one-bit digital form using Σ—Δ modulation; 3) modulates the Σ—Δ output with a radio-frequency (RF) oscillator; and 4) drives the external RF coil and tuning capacitor using a field-effect transistor operated in class D. The external unit functions as expected and has been used to operate bench-top tests of the SIMEHD. Measured current consumption is 1.65 - 2.15 mA, which projects to a battery lifetime of about 15 days. Bandwidth is 6 kHz and harmonic distortion is about 2%.
Intranasal Meningoencephalocele and the Use of Fibrin Glue
Authors: Khan Maroof Aziz , Salahuddin Iftikhar
Published: May 2019

Meningoencephaloceles are rarely seen in adults. This case report illustrates the management of a large intranasal meningoencephalocele in an adult man. Excision of this lesion resulted in a defect in the cribriform plate which was closed using tissue and fibrin glue.
Medical Management of Meniere's Disease
Authors: Brookes Gerald B.
Published: May 2019

The management of Meniere's disease often creates a formidable clinical challenge. Drugs may be helpful in treating the acute attacks of vertigo, and in more long-term management. These remedies are largely symptomatic and there are few properly controlled studies of their efficacy. A critical overview of the scientific and clinical basis for these various pharmacological agents is discussed.
Bone Conduction Implants for Amplification: Comparison of Results
Authors: Hough David A. , Matthews Pamela , Hough Jack V. D.
Published: May 2019

We compared the results from the North American patient database on the Xomed Audiant™ Bone Conductor™ to those reported on the NobleBiocare (previously Noblepharma) HC200 bone-anchored hearing aid (BAHA) implant, using the literature and specific results provided by one of the authors. It has been proposed that the percutaneous coupling of the NobleBiocare implant transduces energy more powerfully than the Audiant transcutaneous coupling. If true, percutaneous coupling could provide greater amplification, helping patients experiencing both conductive and sensorineural hearing loss. Aided sound-field thresholds corresponding to bone-conduction thresholds were compared retrospectively through the speech frequencies. Both the BAH A and the Audiant devices amplified in the sound field to approximate preoperative bone-conduction thresholds. No statistically significant differences existed between the amplification of warble tones through the speech frequencies for either device. We conclude that amplification with the Audiant device offers as much gain as the HC200 device through the speech frequencies. While both devices can supply effective amplification for select patients suffering from conductive hearing loss, neither provides gain superior to preoperative bone-conduction thresholds to address the needs of select patients with a substantial sensorineural component.
Internal Auditory Canal
Authors: Valvassori Galdino , Palacios Enrique
Published: May 2019

This is the first in a series of clinics on ENT imaging. The purpose of this series is to review important technical, anatomic and pathologic features of interest to the ENT clinician and surgeon.
Local Recurrence of Carcinoma of the Tongue after Glossectomy: Patient Prognosis
Authors: Yuen Anthony Po Wing , Wei William Ignace , Wong Simon Hon Wai , Ng Raymond Wai Man
Published: May 2019

We conducted a retrospective review of the prognosis for patients with local recurrence after surgical treatment of carcinoma of the tongue. Glossectomy for squamous cell carcinoma of the tongue was performed in 167 patients. Local recurrence developed in 32 patients including 21 with local recurrence alone, 10 with locoregional recurrence and one with locodistant recurrence. The incidence of local recurrence increased with tumor stage (from 16% of T1 tumors to 46% of T4 carcinomas). Eleven (34%) patients underwent surgical salvage for local recurrence, with only one (9%) patient surviving free of carcinoma at 43 months post-surgical salvage. All of the remaining 21 patients with local recurrence were treated palliatively and all died within one year. Patients who underwent surgical salvage had significantly higher survival rates compared to those treated palliatively. Close follow-up after glossectomy is important for early detection of local recurrence amenable to surgical salvage. However, the overall prognosis for patients with local recurrence was poor, with a three-year actuarial survival rate of only 3%. Therefore, prevention of local recurrence with adequate initial surgical treatment is essential.