bluuebunny/crossref_metadata_2025 huggingface dataset:
Monostotic Fibrous Dysplasia of the Temporal Bone with Associated Lymphadenopathy
Authors: Donnelly Martin J. , McShane Donald P. , Burns Hugh
Published: May 2019

Fibrous dysplasia of bone is a benign idiopathic disorder where abnormal fibro-osseous tissue replaces normal bone. The bony abnormalities may be associated with endocrine disorders and abnormal pigmentation of the skin and mucous membranes. Involvement of the temporal bone is a very rare occurrence. We report a case of monostotic fibrous dysplasia of the temporal bone with associated lymphadenopathy. To our knowledge this association has not been previously described in the literature. We also emphasise the need for long term follow up of patients with this condition as cholesteatoma may develop insidiously.
Olfaction and Endoscopic Sinus Surgery
Authors: Jafek Bruce W. , Murrow Bruce , Johnson Edward W.
Published: May 2019

Recent advances in endoscopic evaluation of the nose and paranasal sinuses and endoscopic sinus surgery, coupled with the development of standardized testing of olfactory acuity, have permitted improved correction of olfactory dysfunction. Conversely, increase in the number of operations performed has increased the number of injuries to the olfactory pathways. The mechanisms of loss and potential preventive and corrective measures are reviewed with a goal to minimize the numbers of these complications.
The Role of Total Laryngectomy in the Management of Intraluminal Upper Airway Invasion by Well-Differentiated Thyroid Carcinoma
Authors: Donnelly Martin J. , Timon Conrad I. , McShane Donald P.
Published: May 2019

Intraluminal invasion of the upper airway by well differentiated thyroid carcinoma is very uncommon, and the management can be problematic. Many conservative, reconstructive-type surgical procedures have been advocated to maintain normal laryngeal function. Although voice preservation is desirable, it may not always be in the patient's best interest and radical surgery, including total laryngectomy, may be necessary. We describe three cases in which total laryngectomy was performed, and review the indicators for this procedure in the treatment of this difficult to manage condition.
Facial Nerve Neuroma
Authors: Pulec Jack L.
Published: May 2019

Facial nerve neuromas are uncommon, slow-growing neoplasms that may occur anywhere along the course of the facial nerve from the brainstem to the facial muscles. The signs and symptoms are characteristic and vary with the anatomic site of origin. Surgery should not be attempted until a complete and thorough diagnostic examination has been completed. The surgeon should be prepared to perform a middle-cranial fossa or translabyrinthine approach in all cases, and must expect to do a nerve graft. The results of 37 patients treated by the author reveal that, under optimal conditions, patients who have had a facial nerve graft, can be expected to regain an average of 80 % facial nerve strength in almost every case. All patients who have had a facial nerve graft will have some degree of synkinesis. No graft was required in 3 patients, and a hypoglossal facial anastomosis was used for one. Facial function was completely normal in 2 patients, 16 had 80 – 90 % return, 5 patients had 50 – 80 % return, 4 had 20 – 50% return, one had no recovery at all and 9 recent patients have not reached the time for their expected recovery. Early diagnosis, prompt surgical removal and VII - VII Nerve graft for facial paralysis of ten or fewer years duration offers patients the best opportunity to avoid a permanent facial palsy.
Cephalosporin Antibiotics
Authors: Otto Randal A. , Noorily Allen D.
Published: May 2019

The last three decades have seen the emergence of a cornucopia of antimicrobials in the cephalosporin class. This becomes even more apparent when one realizes that over 60 pages of the 1993 AHFS drug information text is dedicated to the cephalosporin class.1 Due to similarities in nomenclature and the proliferation of available agents, the clinician is constantly challenged by this confusing array of antimicrobials. The intent of this manuscript will be to distill the volumes of information available on cephalosporins into a more manageable format and close with a summary of the most clinically important cephalosporin antimicrobials.
Retropharyngeal Abscess after Adenoidectomy
Authors: Prado Valeria Maria , Giardini Lucia Delia L. , Garcia Mauricio , DeSousa Rosa Maria A. , Formigoni Gilberto G. S.
Published: May 2019

In this paper, we describe a case of retropharyneal abscess with atlantoaxial joint subluxation after an adenoidectomy. This is a rare complication of which the otolaryngologist must be aware because of its potential consequences.
Sudden Hearing Loss and Unstable Angina Pectoris
Authors: Judkins Richard F. , Rubin Allan M.
Published: May 2019

Acute sudden sensorineural hearing loss has been extensively described in the literature and is a well recognized clinical entity.’ The exact etiology for this entity has been difficult to ascertain. Multiple etiologies have been promoted including infectious agents, vascular abnormalities, acoustic trauma, metabolic disorders, and autoimmune syndromes. In some cases, neoplasms such as acoustic neurinoma can be identified. On occasion, ototoxic medications are present in the history. Moulonguet and Gougelot2 have associated mitral valve prolapse, microemboli, transient hemiparesis and sudden hearing loss. This report describes a patient who had sudden sensorineural hearing loss in conjunction with unstable angina pectoris, in whom coronary bypass surgery appeared to have resulted in acute and significant hearing improvement and stabilization.
How a Labyrinthine Fistula May Sometimes be useful for Surgery
Authors: Pirodda Antonio
Published: May 2019

The author reports a case of chronic otitis with cholesteatoma complicated by a fistula of the lateral semi-circular canal and a stapedo-ovalar ankylosis, probably of otosclerotic origin, in which the decision to take advantage of the fistula to create conditions similar to those generally produced by labyrinthine fenestration allowed virtual functional recovery of the patient's hearing. The case illustrates how, with a ploy of this kind, certain intrinsically negative features may actually turn out to be a blessing in disguise.
The Management of Sinusitis in Patients Infected with the Human Immunodeficiency Virus (HIV)
Authors: Tami Thomas A.
Published: May 2019

As the Human Immunodeficiency Virus (HIV) has extended its influence across the United States, otolaryngologists have been increasingly called upon to manage its various head and neck manifestations. Sinusitis is a very prevalent, yet difficult, management problem in this patient population. The pathophysiology of sinusitis in this setting relates to altered helper T-lymphocyte function, an abnormal inflammatory response as well as increased IgE-mediated inflammation. Chronic HIV-related sinusitis is often due to Pseudomonas aeruginosa, Staphylococcus aureus, or anaerobic bacteria, and empiric antibiotic therapy must include these potential pathogens. Early cultures can facilitate organism-specific antibiotic therapy. Aggressive treatment with decongestants, topical nasal steroids, mucoevacuants and occasionally antihistamines should be included at maximal tolerated doses. When medical therapy fails, surgical drainage can be a safe and effective management option.

Appropriately directed medical, and occasionally surgical, therapy can lead to a dramatic clinical response and provide an improved quality of life in this patient population.
A Review of Absorbable Suture Materials in Head & Neck Surgery and Introduction of Monocryl: A New Absorbable Suture
Authors: LaBagnara James
Published: May 2019

Absorbable sutures are used frequently in the practice of surgery yet there have been no studies in the literature that review the currently available sutures. A newly released suture was used in a series of 80 head and neck patients and the results compared to the surgeon's experience with other absorbable suture materials. The literature regarding absorbable sutures is reviewed and background information on currently available sutures is provided. The tensile strength and absorption of various materials are compared. Degree of tissue reactivity in animals is presented. Results of the evaluation of Monocryl in 80 cases suggest that it has many preferable qualities including ease of handling, low tissue reactivity, superior tensile strength, and lower cost.
Embolization as the Definitive Treatment of Epistaxis in the Pediatric Patient
Authors: Goldman Julie L. , Winstead Welby , Ganzel Toni M.
Published: May 2019

Epistaxis occurs often in children, but these patients are seldom hospitalized. Two cases of intractable epistaxis, which were definitively treated with interned maxillary artery embolization, are presented with an algorithm for management of similar cases.
Audiological Profiles and Meniere's Disease
Authors: Lee Cheng-Shun , Paparella Michael M. , Margolis Robert H. , Le Chap
Published: May 2019

Pure-tone audiograms of 501 patients with preoperative Meniere's disease were analyzed. Age of onset and incidence of bilaterality were studied. The most common audiogram was the peak-type (50.26%), next the falling-type (26.26%), and then the dip-type (9.24%). Although few papers mention this peak audiogram, we suggest it is a diagnostic feature of Meniere's disease. Average age of onset was 42.59 years; this did not differ from males to females. Prevalence in females exceeded that in males by about 4:3. The disease was bilateral in 31.13%. Generally, those with better hearing thresholds at the first examination had less tendency to develop bilaterality. Age of onset was not significantly correlated with bilaterality.
Voice Abnormalities in Short Stature Syndromes
Authors: Heuer Reinhardt J. , Sataloff Robert Thayer , Spiegel Joseph R. , Jackson Laird G. , Carroll Linda M.
Published: May 2019

Patients with short stature have a high incidence of voice and laryngeal abnormalities. In sixteen patients with short stature of various etiologies, these abnormalities appeared to be unrelated to hearing loss or other otolaryngologic problems. However, in many patients they were associated with typical symptoms and signs of voice abuse. Physicians and speech-language pathologists caring for patients with short stature should be alert for voice problems, and should consider instituting early voice education, diagnosis and treatment.
Anterior Ethmoidal Glycerol Rhizotomy for Vasomotor Rhinitis
Authors: Yue Wen L.
Published: May 2019

The treatment of vasomotor rhinitis by anterior ethmoidal glycerol rhizotomy (AEGR) was assessed in 78 patients with a follow-up period ranging from 12 to 15 months. The reduction of nasal hypersecretion obtained with AEGR was maintained over six months. At the final assessment, sixty patients (76.9%) reported complete relief of symptoms and are taking no medications; seven (8.9%) were improved with minimal drug therapy required for symptom relief; and 11.9% had poor results with unsatisfactory control even with medication. Nineteen patients required a second treatment because of an initial suboptimal injection or recurrence. Apparently, this method offers those patients with vasomotor rhinitis a valid option for treatment of clinical symptoms, with the additional benefit of experiencing no serious complications when compared with vidian neurectomy.
Mandibular Osteosynthesis with Intraoral Miniplates and Cortical Bone Screws
Authors: Busch Richard F.
Published: May 2019

Previously, this author and others described a technique of maxillomandibular fixation utilizing intraoral cortical bone screws and intermaxillary wires. This procedure has been very successful in achieving superior fixation of relatively undisplaced fractures in a fraction of the time previously required for arch bar application. A method was sought to extend the procedure to include displaced mandibular fractures as well. Miniplates have been utilized through the same intraoral approach to provide reduction of displaced fragments. Excellent fixation has been achieved with anatomical reduction while utilizing less than half the previous operating time. It appears that the majority of mandibular fractures can be treated with this combination of techniques.
Outcome-Oriented Managed Care Comparing Efficacies of Cefaclor and Amoxicillin in Acute and Recurrent Acute Otitis Media
Authors: Perry Brian P. , Zieno Salvatore A. , Yonkers Anthony J. , Moore Gary F.
Published: May 2019

A study utilizing outcome-oriented care is employed to show the effectiveness of a given medical treatment. A specific patient population is studied in order to determine the most effective treatment for a common clinical disorder. A total of 201 children were retrospectively studied to evaluate the efficacy and side effects of amoxicillin and cefaclor in the treatment of acute otitis media and recurrent acute otitis media. There were 456 episodes of acute otitis media; 245 episodes were treated with amoxicillin with an efficacy of 91%, while 211 episodes were treated with cefaclor with an efficacy of 97%. The dosage of 40mg/kg/day, divided in three equal doses, was employed for both antibiotics in the treatment of acute otitis media, while half of this amount was given once daily for the chemoprophylaxis of recurrent acute otitis media. In the 87 courses of chemoprophylaxis with cefaclor for recurrent otitis media, the efficacy was found to be 53%; while amoxicillin was found to be effective in 30% of the 33 patients studied. There were fewer side effects noted in the cefaclor group than in the amoxicillin group (4% vs. 12%). Both drugs caused diarrhea, while cefaclor also caused a mild maculopapular rash in two patients (1.67%).

While amoxicillin remains the drug of choice for acute otitis media (AOM), this study suggests that cefaclor may be a better selection in the chemoprophylaxis of recurrent acute otitis media.
Asthma: An Important Disease to Otolaryngologists — Part I: Suspecting and Diagnosing Asthma
Authors: Gordon Bruce R.
Published: May 2019

Asthma is a chronic inflammatory disease of the lower respiratory tract which is triggered by exposure to allergens or other airway irritants. This inflammation results in airway hyperresponsiveness, bronchial muscle spasm, mucous gland hypersecretion and mucosal edema, which combine to create symptoms such as cough, wheezing and respiratory distress. Because the inflammatory process is highly variable, asthma is a disorder with many possible presentations. It may therefore proceed for years without clinical recognition, and may challenge the most astute diagnostician.

It is important for otolaryngologists to be able to suspect, diagnose and treat asthma. This is so because asthma is a common disease in the otolaryngologic patient population, both as one of the options in the differential diagnosis of respiratory complaints, and as a comorbid condition which may complicate the treatment of other medical or surgical problems. Furthermore, both the understanding of asthma's pathophysiology, and its optimum treatment methods have undergone radical changes during the past decade.

This three-part discussion reviews our modern understanding of asthma, and proposes diagnosis and treatment guidelines which can assist otolaryngologists in effectively managing their asthmatic patients. Part one summarizes current information on the pathophysiology and increasing prevalence of asthma, its clinical variability, the assessment of asthma sensitivity, and methods for diagnosis of asthma. Parts two and three cover the strategy for asthma management, and the use of both adjunctive and anti-inflammatory therapies for asthma control.
Asthma: An Important Disease to Otolaryngologists — Part II: Asthma Management Strategy
Authors: Gordon Bruce R.
Published: May 2019

Asthma is a chronic inflammatory disease of the lower respiratory tract which is triggered by exposure to allergens or other airway irritants, and is commonly encountered in otolaryngologic practice. This three-part review is designed to assist otolaryngologists in effectively managing their asthmatic patients. In Part I, current information on the pathophysiology and increasing prevalence of asthma, its clinical variability, the assessment of asthma severity and methods for diagnosis of asthma were summarized. Part 11 discusses a tripartite strategy for asthma management, based on environmental controls, the use of anti-inflammatory therapies and patient education. In addition, pharmacologic treatments which are not primarily anti-inflammatory are reviewed in detail. The uses, effectiveness, side effects and suitability for drug combination therapy for mucolytic, anticholinergic, antihistamine, theophylline and beta agonist drugs are compared, and the disadvantages of beta antagonists are summarized. Part III concludes with an overview of antiinflammatory therapies for asthma control.
Labyrinthine Fistula from Cholesteatoma: Surgical Management
Authors: Pulec Jack L.
Published: May 2019

Labyrinthine fistula is a complication of chronic otitis media with cholesteatoma which can result in progressive sensory hearing loss or permanent loss of inner ear function. Total surgical removal of cholesteatoma and use of the intact canal wall tympanoplasty and mastoidectomy can result in preservation or improvement of hearing and elimination of vertigo. Long-term results in a series of 63 cases are reported. The important features of surgical technique involve use of high magnification with the operating microscope, a high-speed drill, suction irrigation and thorough knowledge of temporal bone anatomy. In addition, the surgeon must avoid tearing or perforation of the squamous epithelium basement membrane during dissection. In some cases, sensory hearing returns to normal following surgery, making a successful second-stage reconstruction for hearing possible.
Orbital Floor Fracture following Nose Blowing
Authors: Oluwole Matthew , White Paul
Published: May 2019

A 70-year-old woman with an upper respiratory infection sustained an orbital floor fracture after vigorous nose blowing. The injury was complicated by orbital emphysema and cellulitis. CT scanning confirmed orbital floor fracture and associated orbital soft tissue herniation into the maxillary antrum. A follow-up sinus endoscopy three months later showed a healed periosteum and mucosa, but continued orbital herniation. As the patient's symptoms had largely resolved, repair was averted. Follow-up after nine months showed no recurrence of orbital swelling. The case presented illustrates a rare complication of vigorous nose blowing, coupled with thinning of the sinus walls seen in aging.
Pseudotumor of Infancy — the Role of Ultrasonography
Authors: Maddalozzo John , Goldenberg John D.
Published: May 2019

Pseudotumor of infancy (POI) occurs within the first month of life as a benign neck mass and affects 0.4% of all newborns. Differentiating these lesions from a malignancy or a congenital anomaly requiring surgical intervention can represent a diagnostic challenge for the clinician. While 80-90% of these masses resolve spontaneously within the first six months of life, there is still considerable time expended and cost incurred in the evaluation of POI. We have established and implemented a protocol for the evaluation of these patients consisting of a complete history and physical exam, ultrasonography and routine follow-up every four to six weeks.

Seventeen patients were identified who had been evaluated and followed in the aforementioned manner. Two patients underwent diagnostic imaging studies prior to referral, consisting of magnetic resonance imaging (MRI) and computed tomography (CT). Ultrasonography appeared identical in 80% of the cases of POI with a heterogeneous pattern of internal echogenicity and a hypoechoic surrounding rim. The remaining ultrasound studies differed only subtly with regard to the internal echo pattern. There were no patients with pseudotumor of infancy in whom the ultrasound was normal.

We concluded that a work-up including a history and physical exam and ultrasound is an accurate and cost-effective method for evaluating newborns with a neck mass, when suspicious for POI. Ultrasonography has a 100% sensitivity for the diagnosis of POI in this clinical scenario.
Nutritional Management of the Patient with a Neurologic Disorder
Authors: Kelly James H. , Buchholz David W.
Published: May 2019

Maintaining nutrition in patients with neurologic disorders can be a difficult task. The best results can be expected with individual treatment plans based on a thorough knowledge of the disease process and carried out by a multidisciplinary team working in concert.
Isolated Subglottic Scleroma
Authors: Postma Gregory N. , Wawrose Steven , Tami Thomas A.
Published: May 2019

Scleroma, more commonly known as rhinoscleroma, is a progressive, chronic, granulomatous disease of the respiratory tract and adjacent tissues. Early diagnosis and prolonged therapy are critical in avoiding its late sequelae. We describe an unusual case of scleroma presenting as worsening chronic lung disease. The variety of clinical presentations and treatment modalities is reviewed.
Angiocentric T-Cell Lymphoma of the Tonsil: A Case Report
Authors: Helfend Lisa K. , Finkle Howard I. , Freedman Harvey M.
Published: May 2019

We present a case of an angiocentric T-cell lymphoma (ACTL) occurring in a 31-year-old woman with the Acquired Immunodeficiency Syndrome (AIDS). This patient had oropharyngeal pain, a non-healing superficially ulcerated right tonsil, and no obvious tumor mass. Initial tonsillar biopsy revealed a subtle, non-specific, perivascular lymphocytic infiltrate subjacent to an ulcerated and inflamed mucosal lining. A benign, although atypical, inflammatory process was suspected. The distinctive features in this case include the relationship of ACTL to the Epstein-Barr Virus (EBV), which is usually related to B-cell lymphoproliferative disorders, the unique non-midline location of the lesion, and the relationship of ACTL to AIDS. ACTL appears to represent a unifying pathologic entity encompassing formerly described angioinvasive lymphoid lesions including polymorphic reticulosis, midline lethal granuloma, and lymphomatoid granulomatosis. We present these subtle histopathologic features to alert otolaryngologists who may encounter these cases, especially in AIDS patients who present extensive diagnostic possibilities. To the best of our knowledge, this is the first case report of ACTL involving the tonsil.
A Survey of Facial Paralysis: Etiology and Incidence
Authors: Bleicher Joel N. , Hamiel Steve , Gengler Jon S. , Antimarino Jeff
Published: May 2019

Facial paralysis has numerous etiologies ranging from the most common, Bell's palsy and trauma, to rare tumors and congenital anomalies. This paper divides the etiologies of facial paralysis into five major classifications: idiopathic, traumatic, infectious, neoplastic and neurologic. The incidence of each of these classifications has been estimated from incidence rate information published in the United States and abroad. Using this information, an estimate of the incidence rate has been determined. This information was previously untabulated, thus making statistical analysis nearly impossible regarding this disorder.
Total Facial Nerve Decompression: Technique to Avoid Complications
Authors: Pulec Jack L.
Published: May 2019

Exposure of the facial nerve from the brainstem to the parotid can be accomplished without injury to the nerve, tympanic membrane, external auditory canal, ossicular chain, inner ear or structures within the cerebello-pontine angle. The procedure has reliably provided good results for patients who have had the proper indications with facial paralysis from Bell's palsy, herpes zoster oticus, infection, hemifacial spasm, temporal bone fracture and tumors. The current technique for exposure through the mastoid, middle cranial fossa and retrolabyrinthine combined approaches are described. This technique, properly performed, is a valuable treatment for facial nerve lesions.
Cholesterol Granuloma Cyst of the Petrous Apex
Authors: Isaacson Jon E. , Sismanis Aristides
Published: May 2019

Cholesterol granuloma cyst of the petrous apex is an uncommon lesion and often presents a diagnostic and management dilemma to the otolaryngologist. Patients usually demonstrate signs and symptoms referable to a mass lesion of the cerebellopontine angle or brainstem. We present two cases of cholesterol granuloma cyst that were treated at our institution and discuss our diagnostic and management algorithms. Also included is a thorough review of the literature.
Intratympanic Steroid Treatment of Inner Ear Disease and Tinnitus (Preliminary Report)
Authors: Silverstein Herbert , Choo Daniel , Rosenberg Seth I. , Kuhn Jeffery , Seidman Michael , Stein Ira
Published: May 2019

Intratympanic instillation of Depo-Medrol® (80 mg/cc), dexamethasone ophthalmic solution (1 mg/cc), or dexamethasone intravenous (4 mg/cc) solution produces improvement of cochlear function in certain patients with Meniere's disease, autoimmune inner ear disease and sudden sensorineural deafness. Tinnitus improved in 47%, most often in patients with Meniere's disease (9 of 15; 60%). The SRT improvement of greater than 10 dB or SD greater than 15% was documented in 41% (average improvement in SRT: 15 dB; SD: 24%). Patients with tinnitus and bilateral sensorineural hearing loss (i.e., presbycusis) did not benefit from the treatment.

Prior to treatment with intratympanic medication, laser-assisted tympanostomy with middle ear exploration, using otoendoscopy to determine the status of the round window niche and remove mucosal folds, helps in making the round window membrane accessible to local application of drops. Placing Gelfoam into the round window niche under direct vision, and using a Venturi Bobbin tube in the tympanic membrane, appears to be a satisfactory method for delivering medication to the inner ear fluids. The medication can be injected by the physician through the tube into the middle ear, or the patient can perform self-treatment at home, placing medication in the external auditory canal. A double-blind, cross-over study in patients with Meniere's disease is now in progress with Institutional Review Board (IRB) approval, which will be reported at a later date.

This preliminary study has shown that intratympanic steroids may affect the symptoms of hearing loss and tinnitus in patients with various inner ear problems. Patients with Meniere's disease appear to respond in the highest percentage of cases. Hopefully, additional research will suggest the appropriate drugs which can be used to treat inner ear disease. Direct application of the drug to the round window membrane may increase the concentration in the inner ear fluids, thus avoiding the systemic effects.
Thyroglossal Duct Cyst Causing Airway Obstruction in an Adult
Authors: Brown Eugene G. , Albernaz Marcus S. , Emery Mark T.
Published: May 2019

Thyroglossal duct cysts, though not uncommon, rarely present with evidence of laryngeal compromise. The case presented is one of the very few cases with documented laryngeal invasion reported in the English language. Of clinical significance is the patient's presentation with laryngeal symptoms of choking and dysphonia in the presence of a small anterior cervical mass. While the thyroglossal duct cyst usually presents as an asymptomatic anterior neck mass, this case illustrates the importance of considering a thyroglossal duct cyst in any patient with airway compromise in the absence of a neck mass.
Hearing and Sjögren's Syndrome
Authors: Trott Martin S. , Hughes Gordon B. , Calabrese Leonard H. , Barna Barbara P. , Nodar Richard H.
Published: May 2019

Immune sensorineural hearing loss is manifested in several systemic immune diseases.1,2 Although hearing loss has been previously documented in patients with Sjögren's syndrome (SS),3 the effect of SS on hearing is unclear. This prospective study was designed to assess the presence of hearing loss in 14 patients with SS and, if sensorineural hearing loss was present, to determine if the hearing loss was immune-mediated. Patients were evaluated with basic audiologic tests as well as for cellular immune inner ear reactivity as measured by the lymphocyte transformation test (LTT).4 Three patients had evidence of sensorineural hearing loss. Two patients had a positive LTT without evidence of sensorineural hearing loss. This preliminary study suggests that SS may not directly cause sensorineural hearing loss, immune-mediated or otherwise.
Errors in Otology
Authors: Kartush Jack M.
Published: May 2019

Practicing medicine successfully requires that errors in diagnosis and treatment be minimized. Malpractice laws encourage litigators to ascribe all medical errors to incompetence and negligence. There are, however, many other causes of unintended outcomes.

This article describes common causes of errors and suggests ways to minimize mistakes in otologic practice. Widespread dissemination of knowledge about common errors and their precursors can reduce the incidence of their occurrence. Consequently, laws should be passed to allow for a system of non-punitive, confidential reporting of errors and “near misses “ that can be shared by physicians nationwide.
Persistent Trigeminal Artery as a Cause of Dizziness
Authors: Battista Robert A. , Kwartler Jed A. , Martinez Daniel M.
Published: May 2019

Complaints of vertigo and dizziness are common problems referred to otolaryngologists for evaluation. Awareness of uncommon causes of dizziness increases the physician's ability to diagnose and treat these patients. We present the case of a middle-aged woman who presented with episodes of vertigo and symptoms suggestive of vertebrobasilar insufficiency. These symptoms were the result of a persistent trigeminal artery (PTA) and occlusive carotid artery disease.

A PTA is a carotid-basilar anastomosis that has been reported to be demonstrated on 0.1% to 0.6% of all cerebral angiograms. Persistence of this vessel usually leads to hypoplasia or agenesis of the ipsilateral posterior communicating artery, and leaves the internal carotid artery as the main source of blood supply to the region of the upper brainstem. The appearance and clinical significance of this unusual condition will be discussed.
Vasopressin Levels in Major Head and Neck Surgery
Authors: Jensen Niels F. , Block Robert I.
Published: May 2019

In an effort to further understand the perioperative intravascular volume status of major head and neck surgery patients, serum antidiuretic hormone (ADH) and osmolality levels were assessed at four perioperative junctures. Thirty-five major head and neck surgical patients were randomly selected for examination with placement of a central venous pressure monitor. Serum osmolality and serum vasopressin levels were obtained at four junctures perioperatively. ADH levels were lower both after patients were anesthetized and five hours into the procedure than at either baseline or 24 hours after the end of the procedure. ADH levels after patients were anesthetized did not differ from those at five hours into the procedure, nor did ADH levels at baseline differ from those 24 hours after the end of the procedure. In addition, osmolality levels did not change over time. Additional analyses examining relationships between preoperative, intraoperative, and postoperative characteristics and ADH levels after patients were anesthetized and five hours into the procedure, as well as changes from baseline at these times and the baseline levels themselves, detected no significant relationships. This study provides information about the perioperative intravascular volume status of major head and neck surgery patients which may be important to intraoperative care, especially to decisions regarding invasive intraoperative fluid monitoring. Specifically, the data provide additional evidence against the need for the routine placement of central venous catheters to guide fluid administration during major head and neck surgery.
A Bone-Anchored Percutaneous Connector System for Neural Prosthetic Applications
Authors: Downing M. , Johansson U. , Carlsson L. , Walliker J. R. , Spraggs P. D. R. , Dodson H. , Hochmair-Desoyer I. J. , Albrektsson T.
Published: May 2019

A percutaneous connector system has been developed for use in neural prosthetic applications. It is based on a skin-penetrating, bone-anchored titanium pedestal, housing an 11-channel electrode array. Initial applications for the system are in audiology and, as such, the proposed fixture site is in the temporal bone.

The titanium pedestal is based on existing design features of the EPI Bioglass® implant, developed by University College London (UCL), and the Brånemark System®, employed by Nobel Biocare AB. The electrode array, consisting of platinum wires in a silicone carrier, can be custom designed to suit the application. The design features of the connector system are reviewed.

Animal studies have been used to assess soft tissue reactions and the osseointegration of the pedestal. The histological data are presented. The pedestal, electrode array and the mating external connector are currently undergoing mechanical and electrical testing.

The percutaneous connector system will undergo clinical trials, initially in the study of tinnitus (employing stimulation via an extracochlear electrode), and as part of a cochlear implant system (using a multichannel intracochlear electrode array and digital signal processing techniques).
Etidronate for the Neurotologic Symptoms of Otosclerosis: Preliminary Study
Authors: Brookler Kenneth H. , Tanyeri Hasan
Published: May 2019

The efficacy of etidronate, a Bisphosphonate, was assessed as a treatment for the inner ear symptoms of otosclerosis in a retrospective case review of 896 patients diagnosed with otosclerosis, with primary complaints of dizziness, hearing loss, tinnitus or Meniere's syndrome. The diagnosis of otosclerosis was based on small-pixel computed tomography of the temporal bones. Of the 896 patients placed on an etidronate protocol, 545 were followed for more than six months and were analyzed. The symptomatic response to etidronate, as well as audiologic and computerized rotary chair results were used in the assessment. Patients who were previously on sodium fluoride were separately analyzed. In this preliminary study etidronate appeared to be an effective treatment for the neurotologic symptoms of otosclerosis. Prospective blinded efficacy studies of the bisphosphonates in the treatment of otosclerosis should be undertaken.
Unilateral Conductive Hearing Loss Secondary to a High Jugular Bulb in a Pediatric Patient
Authors: Haupert Michael S. , Madgy David N. , Belenky Walter M. , Becker John W.
Published: May 2019

A high jugular bulb is not an uncommon otologic anomaly. It may be noted as an incidental finding on physical exam, middle ear surgery, or computed tomography of the temporal bones. Frequently the patient is asymptomatic, but a high jugular bulb can occasionally cause tinnitus or conductive hearing loss. The case of a seven-year-old black male with unilateral conductive hearing loss secondary to a high jugular bulb is presented. The diagnosis, differential diagnosis, and management of a conductive hearing loss associated with a high jugular bulb are discussed.
Endolymphatic Mastoid Shunt Surgery in Unilateral Meniere's Disease
Authors: Moffat David A.
Published: May 2019

One-hundred endolymphatic mastoid shunt operations in patients with classic unilateral Meniere's disease were analyzed. The patients were carefully preselected with a comprehensive protocol of audiovestibular and metabolic investigations. All patients had definitive electrophysiologic evidence of endolymphatic hydrops with an enhanced negative summating potential on transtympanic electrocochleography. The surgical results were analyzed both by the original American Academy of Ophthalmology and Otolaryngology Guidelines (AAOO, 1972), and the more recent modifications of the American Academy of Otolaryngology— Head and Neck Surgery (AA-HNS, 1985). Control of vertigo was achieved in 79% of the patients overall, with 42% sustaining complete control and 37% substantial control. A significant hearing improvement was obtained in 15% of cases, there was no change in 56% of patients, and hearing became worse in 29%. Tinnitus improved following surgery in 35% of patients, was the same in 56%, and worse in 9%. Postoperatively, there was no disability in 42% of the patients, some degree of disability in 50%, and severe disability and inability to sustain gainful employment in only 8%.
The Role of Vestibular Nerve Section in Meniere's Disease
Authors: Brookes Gerald B.
Published: May 2019

The role of vestibular nerve section (VNS) surgery in the management of Meniere's disease is considered by prospective analysis of a large series of 531 patients treated by the author over a period of 11 years. Twenty-seven percent were referred by their primary care physicians, while the rest were secondary (45.6%) or tertiary (27.3%) referrals. Overall, 62 (11.7%) Meniere's patients underwent 63 VNS procedures. This surgery was undertaken more frequently in the secondary and tertiary referral patients (14.2%) than in the primary referrals (5.5%). The retrolabyrinthine technique was the preferred approach in almost 90% of ears. The results and complications of these and other surgical options are discussed in an attempt to define the present role of VNS in intractable Meniere's disease. Vertigo was abolished after VNS in 93% of cases. Compensation was significantly impaired in 12.9%. All these patients had contralateral Meniere's disease or marked labyrinthine hypofunction. Although highly effective and associated with few postoperative complications, VNS is generally reserved for sac failures, though may be appropriate as a primary procedure in severe unilateral cases.
Progressive Sensorineural Hearing Loss, Subjective Tinnitus and Vertigo Caused by Elevated Blood Lipids
Authors: Pulec Jack L. , Pulec Marlene B. , Ignacio Mendoza H.
Published: May 2019

The otologist frequently sees patients with progressive sensorineural hearing loss, subjective aural tinnitus and vertigo with no apparent cause. Elevated blood lipids may be a cause of inner ear malfunction on a biochemical basis. To establish the true incidence of this condition, all new patients (4,251) seen during an eight-year period were evaluated; of these, 2,332 patients had complaints of inner ear disease. All had a complete neurotologic examination, appropriate audiometric and vestibular studies and imaging, and blood tests including lipid phenotype studies. Hyperlipoproteinemia was found in 120 patients (5.1%). Most patients were found to be overweight and had additional coexisting conditions such as diabetes mellitus. Treatment with vasodilators and a 500-calorie, high-protein, low-carbohydrate diet yielded improvement of symptoms in 83% of patients within five months of initiation of treatment.
Pre- and Postoperative Mucociliary Clearance in Functional Endoscopic Sinus Surgery
Authors: Kaluskar Shashikant K.
Published: May 2019

The advent of functional endoscopic sinus surgery (FESS) has revolutionized the treatment of chronic sinusitis over the last decade. Although it has been well-established that FESS is more efficacious than conventional surgery, the lack of a quantifiable means of assessing results remains one of the major shortcomings of the technique, and hence a source of criticism. Since the pathophysiology of chronic sinusitis is intimately related to the mucociliary mechanism of the nose and sinuses, it seems logical to use this parameter as a yardstick of success.

We undertook a prospective, controlled study of 40 patients and measured their “saccharin times” before and after surgery. The results show a marked reduction in clearance times postoperatively, corresponding well with improvement in symptom profile. We therefore propose this technique as a simple, safe and reliable method of assessing the results of surgery. Furthermore, the method could act as a preoperative indicator of ciliary motility disorders, as the prognosis in these patients is distinctly poor.
Steroid Use in Rhinoplasty: An Objective Assessment of Postoperative Edema
Authors: Berinstein Todd H. , Bane Steven M. , Cupp Craig L. , DeMarco J. Kevin , Hunsaker Darrell H.
Published: May 2019

The objective of this study was to measure the effect of a single, preoperative 10 mg dose of dexamethasone on postoperative edema associated with rhinoplasty. This was a randomized, double-blind prospective study conducted in a military academic tertiary referral center. Twenty men, aged 18 to 45 years, were enrolled in the study over 28 months. All 20 men underwent rhinoplasty with osteotomy. Preoperative magnetic resonance imaging scans were obtained on the morning of surgery and postoperative scans were obtained within 48 hours. Postoperative edema was quantified as the difference in soft tissue thickness (mm) between the pre- and postoperative scans. Contrary to our expectations, the rhinoplasty patients who received dexamethasone had increased postoperative edema (p<0.02) when compared to patients not receiving dexamethasone. This is the first objective, double-blind study that shows an increase in postoperative edema after rhinoplasty with a single preoperative dose of dexamethasone.
Dermoid Cyst of the Lateral Neck: A Case Report and Literature Review
Authors: Rosen David , Wirtschafter Ari , Rao Vijay M. , Wilcox Thomas O.
Published: May 2019

Dermoid cysts of the lateral neck are rare, with the majority of head and neck dermoids occurring in the midline. The demonstration of a fat-fluid level on MRI or CT is diagnostic for a cervical dermoid cyst. The treatment of choice remains surgical excision.
Pre- and Postoperative Imaging Analysis for Frontal Sinus Disease following Conservative Partial Middle Turbinate Resection
Authors: Saidi Iyad S. , Biedlingmaier John F. , Rothman Michael I.
Published: May 2019

The prudence of partial or complete middle turbinate resection during endoscopic sinus surgery (ESS) is controversial. The greatest concern regarding partial resection relates to the effect on the frontal recess and the development of frontal sinus disease. The purpose of this study was to radiographically evaluate the frontal sinus in patients who had undergone ESS with partial conservative middle turbinate resection. We reviewed the charts and operative records from 195 consecutive cases of ESS performed by a single surgeon (JFB) over a two-year period. Thirty-three of 117 patients who had undergone ESS with conservative partial middle turbinate resection without frontal recess exploration agreed to return for magnetic resonance imaging (MRI) of their sinuses. The preoperative computed tomography (CT) scans and postoperative MR images were reviewed and graded (1–3) by a single neuroradiologist. Significant frontal sinus disease (grades 2 and 3) was seen in 15 of 52 sides preoperatively (29%), and in 14 sides postoperatively (27%). During the postoperative MRI studies, only six frontal sinus sides demonstrated minimal mucosal thickening (grade 1) which had not been apparent on preoperative CT. This radiographic analysis suggests that conservative partial middle turbinate resection during ESS does not adversely affect the frontal sinus. We believe that the surgical technique employed when resecting the middle turbinate, and the avoidance of unnecessary dissection in the recess are both important factors in preventing the development of frontal sinus disease following ESS.
Use of Foam Bolsters for Securing Facial Skin Grafts
Authors: Caldwell Richard K. , Giles William C. , Davis Paul T.
Published: May 2019

Many methods of securing skin grafts to their recipient beds have been described. A review of the senior author's experience with facial skin cancers over a two-year period revealed that reconstruction with full-thickness skin grafts was employed in 60 of more than 500 cases. This series of 60 cases was reviewed. Use of foam as a bolster has proven to be a simple, time-conserving and reliable technique that produces consistently excellent results with a low complication rate. The technique is reviewed, along with its advantages and disadvantages.
Endolymphatic Subarachnoid Shunt Failure Caused by Silastic Allergy
Authors: Pulec Jack L.
Published: May 2019

During the period from 1964 through 1994, the endolymphatic subarachnoid shunt operation was initially successful in eliminating endolymphatic hydrops and the symptoms and findings it produces in 76% of 645 ears of patients with Meniere's disease. After initial success, lasting from five weeks to nine years, endolymphatic hydrops suddenly returned due to obstruction of the Silastic shunt tube in 11% of patients. In these cases, prompt revision can often restore an initial good result. Histologic and immunologic examinations of the material surrounding and occluding the tubes showed an allergic response to the Silastic material in most instances. Efforts to eliminate this cause of failure using a tube of new design and different plastic material are described.
Giant Pleomorphic Adenoma of the Parotid Gland: Case Report and Review of the Literature
Authors: Buenting John E. , Smith Timothy L. , Holmes Douglas K.
Published: May 2019

Pleomorphic adenomas account for the majority of parotid masses, typically arising in the tail of the gland and enlarging slowly over time. The vast majority are 2 to 6 cm in size when resected. We report resection of the largest benign mixed tumor recorded in the modern English language literature. An 85-year-old reclusive woman had a 20-year history of an enlarging right periauricular mass that had begun bleeding several days prior to admission. The patient ultimately underwent resection of the mass, which measured 26 cm in diameter, weighed 6.85 kg, and proved on pathologic examination to be a benign mixed tumor without malignant degeneration. The implications of this unusual case for the management of mixed tumors are discussed, and a review of the world literature on giant pleomorphic adenomas is presented.
Mucosal Immunity and Bacteriology of the Eustachian Tube
Authors: Sørensen Christian Hjort , Brygge Kirsten
Published: May 2019

The pathogenesis of otitis media is a multifaceted process that is not completely understood. Eustachian tube dysfunction plays a central but uncertain role, as do viral and bacterial microorganisms. Of the latter, the three most important are Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis. This article reviews the various mechanisms of infection and the immune system's response to them.
Drug-Induced Changes in Eustachian Tube Function
Authors: Malm Lars , Tjernström Örjan
Published: May 2019

Many studies have shown that antihistamines and decongestants are of little use in the treatment of acute otitis media and otitis media with effusion, or in the prophylaxis of these disorders.1 However, because some drugs can improve otitis media with effusion (glycocorticosteroids)2–4 and some can impair the opening function of the eustachian tube (atropine),5 it seems justified to continue studies of eustachian tube function and medication.
Continuous, High-frequency Objective Tinnitus Caused by Middle Ear Myoclonus
Authors: Bento Ricardo Ferreira , Sanchez Tanit Ganz , Miniti Aroldo , Tedesco-Marchesi Antônio J.
Published: May 2019

Myoclonus of the middle ear is a rare condition characterized by abnormal repetitive muscle contractions of the tympanic cavity. In this paper we describe what we believe is the first reported case of continuous high-frequency objective tinnitus caused by middle ear myoclonus. During exploratory tympanomastoidectomy it was hypothesized that a small dural arteriovenous malformation not identified on previous tests was the cause of the tinnitus. However, complete disappearance of the tinnitus during administration of curare for anesthesia led us to believe that the tinnitus might have been caused by myoclonus of the middle ear. Sectioning of the stapedius and tensor tympani tendons rendered the patient asymptomatic and confirmed the diagnosis of middle ear myoclonus. At follow-up of one year, the patient's quality of life had improved substantially; the tinnitus did not recur and she no longer had vertigo.