bluuebunny/crossref_metadata_2025 huggingface dataset:
Endoscopic 532-nm KTP Laser Excision of Inverted Papilloma of the Nose and Paranasal Sinuses: A Series of 9 Patients
Authors: Kaluskar S.K. , Mehta Rahul , Farnan Turlough B. , Basha S.I.
Published: May 2019

Over the past 2 decades, the surgical management of inverted papillomas has evolved from extensive radical excision to more conservative surgery. We conducted a study to evaluate the results of our endoscopic approach to tumor excision with the 532-nm potassium titanyl phosphate (KTP-532) laser. Our series included 9 patients with inverted papilloma of the nose and paranasal sinuses who were treated from January 1998 through December 2003 (72 mo). Only 1 patient (11.1%) experienced a recurrence. The recurrence was detected 12 months after initial treatment, and it was successfully managed via the same endoscopic approach; afterward, the patient was still tumor-free at 2.5 years of follow-up. The good results of this endoscopic approach for lesions limited to the nose and paranasal sinuses can be attributed to excellent visualization with the endoscope and to the bloodless dissection achieved with the KTP-532 laser. We emphasize the need for frequent and long-term follow-up of these patients; a thorough endoscopic examination at every visit is extremely important.
Transport of a Patient with Massive Traumatic Epistaxis Using a Cricket Helmet and Posterior Nasal Packing
Authors: Alexander Philip V. , Walters Alka
Published: May 2019

In developing countries, when patients with traumatic epistaxis cannot he adequately treated at their local medical facility and require further treatment at a distant tertiary care center, it is important that bleeding he controlled before their transport. We describe a patient with a traumatic anterior ethmoidal artery bleed who needed to be taken to a tertiary care center 8 hours away for endoscopic ablation, which was not available at our hospital. The inflated balloon of an 18-Fr Foley catheter attached to the face guard of a cricket helmet was used as a posterior nasal pack. The patient arrived safely and was successfully treated. This case report illustrates that, in an emergency, readily available materials can be used to effect adequate tamponade of nasal bleeding so that a patient can he transferred safely. We believe this is the only such report in the literature.
Laryngeal Oncocytic Cyst Presenting with an Acute Onset of Stridor
Authors: Puttasiddaiah Paramesh M. , Berry Sandeep , Whittet Heikki B. , Kumar Manoj
Published: May 2019

Oncocytic lesions of the larynx are rare. When they have occurred, their presentation has been varied; these tumors may he completely asymptomatic and discovered incidentally, hut more commonly they present with voice alteration. We report a case of an oncocytic cyst in a patient who presented with an acute onset of stridor. We also discuss the clinical manifestations and management of laryngeal oncocytic cyst and its relevant pathologic features.
Complete round Window Niche Occlusion for Superior Semicircular Canal Dehiscence Syndrome: A Minimally Invasive Approach
Authors: Silverstein Herbert , Van Ess Mark J.
Published: May 2019

Superior semicircular canal dehiscence (SCD) syndrome is a recognized condition associated with varying degrees of vestibular and auditory dysfunction. The authors present a case study of disabling SCD syndrome in a 37-year-old man who was successfully treated with a complete round window niche occlusion via a transcanal approach. This case represents the first report of a transcanal complete round window niche occlusion for the treatment of SCD syndrome. A brief literature review and discussion of surgical techniques follow.
Jugular Fossa Meningioma: Presentation and Treatment Options
Authors: Rutt Amy L. , Chen Xiaoli , Sataloff Robert T.
Published: May 2019

Primary jugular fossa meningiomas are among the rarest subtypes of meningioma. They are intimately related to the lower cranial nerves, the jugular bulb and vein, and the temporal bone, and they have a tendency to extend both intra- and extracranially. The most common morbidity associated with jugular fossa lesions is lower cranial nerve deficits. In these cases, the differential diagnosis and preoperative radiographic diagnosis are very important because preoperative management and operative planning for the jugular fossa subtype differ considerably from those of other types of meningioma. Because of the rarity of this condition, our understanding of its treatment, long-term follow-up, and recurrence is limited. As experience with radiosurgical treatment of all meningiomas is accumulating, we may find that radiosurgery of jugular fossa meningiomas is appropriate. In the meantime, cure is still possible with complete surgical resection, and surgical morbidity can be minimized through meticulous planning and surgical technique. We describe a case of primary jugular fossa meningioma in a 45-year-old man who presented with complaints of chronic left aural fullness, hearing loss, and difficulty understanding voices. Imaging revealed the presence of a destructive jugular fossa mass. The patient underwent surgical resection without complication, and he was free of recurrence at 1 year of follow-up.
Mylohyoid Cysticercosis: A Rare Submandibular Mass
Authors: Virk Ramandeep Singh , Panda Naresh , Ghosh Shakuntala
Published: May 2019

Cysticercosis is endemic in developing countries such as India. This infection is acquired via ingestion of cysticerci, the larvae of the Taenia solium (tapeworm, or cestode), in uncooked/undercooked pork or fecally contaminated food or water. Although skeletal muscle commonly harbors the cysticerci, we report a case in which they had infested the mylohyoid muscle in the floor of mouth, a site that has not been mentioned previously in the literature.
Necrotizing Otitis Externa: A New Trend? Report of 6 Atypical Cases
Authors: Glynn Fergal , Walsh Rory McConn
Published: May 2019

Necrotizing otitis externa (OE) is traditionally seen in elderly diabetics and immunocompromised patients. During a 7-year period at our institution, we treated 6 patients with necrotizing OE who were not diabetic, who were not immunocompromised, and who were relatively young (age range: 27 to 65 yr; mean: 42.8). The necrotizing OE in these patients was less aggressive but just as severe as its usual presentation in older diabetic or immunocompromised patients. All 6 patients had evidence of bony erosion on computed tomography of the temporal bones, although 4 had negative findings on technetium-99m scintigraphy. Four of the 6 patients required mastoid exploration and fascia lata grafting, and the other 2 chose to undergo extensive daily microdebridements and intravenous antibiotics followed by 6 weeks of oral antibiotics. We recommend that a diagnosis of necrotizing OE be kept in mind when evaluating any patient who presents with severe otalgia, particularly in the presence of Pseudomonas aeruginosa infection of the external auditory canal, edema, granulation tissue, and bony erosion.
Acute Ototoxicity from a Single Infusion of Oxaliplatin
Authors: Malhotra Narinder K. , Aslam Rizwan , Lipman Sydney P. , Bilski Vicki J.
Published: May 2019

Ototoxicity secondary to the administration of the chemotherapeutic agent oxaliplatin is uncommon. We report a case of unilateral hearing loss that occurred immediately after the infusion of a single dose of oxaliplatin in a 70-year-old woman who was undergoing postoperative chemotherapy for rectal adenocarcinoma. To the best of our knowledge, no such case has been previously reported in the literature. The hearing loss in our patient was severe enough to limit her daily activities, and she experienced only minimal improvement during the next 2 years of follow-up.
Rhinoentomophthoromycosis: Rarity Revisited
Authors: Bhatia Naresh , Singh Charu , Kawatra Rahul , Alam Seraj , Dhawan Ruchir
Published: May 2019

We describe a case of rhinoentomophthoromycosis, also known as rhinophycomycosis, in an Indian man hailing from the tropical northern region of the country. The patient presented with subcutaneous swelling in the midline of the forehead, dorsum of the nose, adjoining cheek area (more on the right side), philtrum, and upper lip. Biopsy taken from the right nostril area revealed nasofacial phycomycosis. The patient was treated successfully with itraconazole, 200 mg twice daily, and potasssium iodide, 5 drops in fruit juice three times daily.
Platysma myocutaneous flap for oral cavity reconstruction
Authors: Wang Kevin H. , Hsu Ekai Kyle , Shemen Larry J.
Published: May 2019

A retrospective study was conducted to assess outcomes of reconstruction of the oral cavity with the platysma myocutaneous flap, in terms of flap survival, complications, and quality of life. Included were 10 patients with squamous cell carcinoma (stage T1 to T4; nodal status NO to N2) of the oral cavity who were treated between 2002 and 2006. Each patient underwent tumor resection, modified radical neck dissection, and primary reconstruction with a platysma myocutaneous flap. Operating time, length of stay, time to swallow, and complications were assessed, and the University of Washington Quality of Life questionnaire was administered. Mean operating time was <4 hours, mean length of stay was 11 days, and mean time to swallow was 9 days. One patient had distal flap necrosis and one had wound dehiscence. No total flap failures or fistulas occurred. The authors conclude that the platysma myocutaneous flap provides thin, pliable, reliable tissue for use in the oral cavity. The additional operating room time is negligible, the surgical complications minimal, and the overall quality of life very good. This flap should be used more frequently in the reconstruction of oral cavity defects.
Subglottic and Tracheal Malignancies
Authors: Kennedy Kevin S. , Parker Gregg S.
Published: May 2019

Subglottic and tracheal malignancies are the least frequently encountered laryngeal cancers. When these tumors are encountered, they have often reached advanced size prior to producing symptoms. Once symptoms are brought to the attention of the otolaryngologist, rapid and accurate diagnosis is essential to effect the earliest possible treatment and to minimize morbidity and mortality associated with this problem. Illustrative cases are presented including a highly unusual case that presented with cardiac-like chest pain. A review of the literature including the pertinent anatomy, pathophysiology, and methods of diagnosis and treatment is presented. Increased familiarity with this disease process and a high index of suspicion on the part of the otolaryngologist may lead to improved survival patterns in patients with these malignancies.
Postcricoid Surface Laryngeal Electrode
Authors: Rea J. Lee
Published: May 2019

Progress in identification of the recurrent laryngeal nerve in thyroid and parathyroid surgery has lagged behind the identification of other head and neck nerves. Attempts to use electronic pulsed nerve stimulators with evoked response electromyography have failed due to the absence of a convenient and effective method of monitoring the larynx. A Postcricoid Laryngeal Surface Electrode as herein described shows excellent initial results as an electrode for electromyographic monitoring of the larynx for recurrent laryngeal nerve identification.
Auditory Brainstem Evoked Response in Patients Undergoing Carotid Endarterectomy
Authors: Antebi E. , Rubel Yehudit , Talmi Yoav P. , Finkelstein Yehuda , Nobel Michael , Zohar Yuval
Published: May 2019

Auditory brainstem evoked response-(ABR) may be affected by changes in cerebral blood flow. Apart from its primary indications for prevention of stroke and transient ischemic attacks - (TIA's), internal carotid endarterectomy - (ICE) has been shown to improve cognitive function and cause diminution of tinnitus and vertigo. A one-week postoperative ABR previous study of patients undergoing ICE demonstrated no change in ABR recordings. In order to evaluate possible late changes, we have conducted a prospective study of the delayed effects of ICE on ABR in 13 patients. No initial pathology was noted and no significant change found in any of the absolute and interpeak latencies of ABR waves.
Extrusion Rate of Shah and Shepard Ventilation Tubes in Children
Authors: Hussain S. S. M.
Published: May 2019

Shah and Shepard ventilation tubes are the two most commonly used ventilation tube in current practice. In some centres these two tubes are used interchangeably, in others the Shepard is often used as the first ‘grommet’ of insertion and the Shah for subsequent insertions.

A study was undertaken of extrusion rate of these ventilation tubes in 180 children who had surgery for Serous otitis media in 1987.

Extrusion time was found to be very significantly different between these tubes. The Shah ventilation tube remains in situ 3 months longer than the Shepard.

A case is made for the use of Shah ventilation tubes as the first “grommet” of insertion.

Otorrhoea following insertion of ventilation tube did not affect the extrusion rate of ventilation tubes in this study. Nor has otorrhoea a predilection for any particular ventilation tube.
Complications of Interstitial Radioactive Iodine Implants for Recurrent Pituitary Adenomas
Authors: Moore Gary F. , Massey John , Yonkers Anthony J. , Leibrock Lyal G.
Published: May 2019

Three cases of recurrent pituitary adenoma elected to be treated with I125 implants are presented. The I125 implants caused significant delayed changes in the tissues surrounding the sella tursica which lead to the development of refractory cerebrospinal fluid (CSF) rhinorrhea. All three cases developed meningitis and two had pneumocephalus. This complication lead to the death of two patients and required intensive therapy in the third to achieve recovery.
Orbital Impalement by a Gearshift Knob: Case Report
Authors: Kulber David A. , Aframian David , Hopp Martin L. , Hiatt Jonathan R.
Published: May 2019

Penetrating trauma to the orbit may cause complex injuries involving the bone, globe, and brain. Successful treatment requires a strategic scheme for preoperative assessment and management and a multidisciplinary surgical approach. These principles are demonstrated by report of a motor vehicle accident in which the driver sustained orbital impalement by a gearshift knob.
Allergic Rhinosinusitis: The Total Rhinologic Disease
Authors: Trevino Richard J. , Gordon Bruce R.
Published: May 2019

Allergic rhinosinusitis has three forms of therapy: pharmacotherapy, immunotherapy, and surgical therapy. Pharmacotherapeutically, there are six classes of drugs that give symptomatic relief: mucolytics, decongestants, anticholinergic agents, antihistamines, mast cell stabilizers, and corticosteroids. All six classes are discussed individually and in detail.

For immunotherapeutic therapy of allergic rhinosinusitis, there are four types of skin testing in current use: scratch testing, prick testing, single intradermal testing, and skin end point titration testing. Only the latter is able to quantitate the antigenicity of each antigen, and thus the treatment vial made from only this type of skin testing can adequately treat all antigens to which the patient is sensitive. These differences in testing and vial mixing are explained.

The last form of therapy is surgical therapy, which corrects the obstructive phenomenon caused by allergic rhinosinusitis. The procedures described are reduction inferior turbinectomies and endoscopic sinus surgery.

It is felt by the authors that the specialist who is uniquely positioned to offer a patient suffering from allergic rhinosinusitis all three forms of therapy is the rhinologist.
Warthin's Tumor-Associated Neoplasms: Report of Two Cases and Review of the Literature
Authors: Shikhani Alain H. , Shikhani Lama T. , Kuhajda Francis P. , Allam Charles K.
Published: May 2019

The association of Warthin's tumor with another neoplasm of a different histological type in the same salivary gland is extremely rare. The literature includes 42 such cases to date. A case of malignant lymphoma developing within Warthin's tumor and another case of oncocytoma synchronous with Warthin's tumor in the same parotid gland are reported. The relation of Warthin's tumor to other neoplasms is discussed.
Head and Neck Malignant Fibrous Histiocytomas
Authors: Sawyer Robert , Webb David L. , Wittich Donald J.
Published: May 2019

Malignant fibrous histiocytoma of the head and neck is a rare tumor with less than 50 total cases reported in the literature. Its rarity and complex histopathology combine to make it a difficult diagnosis. Two cases are described. Pathology characteristics are discussed. The traditional treatment of choice is wide surgical excision. Radiation therapy is usually reserved for recurrent, unresectable, or extremely aggressive tumors.
Health Care Crisis: The Head and Neck Cancer Patient and Affordable Health Insurance
Authors: Hagen Patrick C. , Nuss Daniel W. , Ellis Michael , Lyons George D.
Published: May 2019

In an evaluation of 30 patients with head and neck cancer, we found that 14 (46%) were uninsured at the time of diagnosis and 15 (50%) had yearly incomes below the poverty level. Tobacco and alcohol were identified as risk factors in 25 (83%) of the patients. These patients spent an average of $2,781 on carcinogenic agents yearly, increasing the risk of cancer 55 times that of the unexposed population, whereas the cost of a health insurance policy was $2,321 per year. To remedy the disparities and incongruities of this situation, we advocate patient education to influence behavioral change in these high-risk groups, a lowering of insurance rates, legal reform, and continued physician activism toward managing the current health care crisis.
Antrochoanal Polyposis: A Review of 33 Cases
Authors: Cook Paul R. , Davis William E. , McDonald Robert , McKinsey Joel P.
Published: May 2019

We report on a series of 33 consecutive cases of antrochoanal polyp (ACP) treated by endoscopic sinus surgery over a five-year period. All but one patient was treated by endoscopic sinus surgery alone. This method of treatment was quite effective for ACPs. These 33 patients represent 22.3% of all nasal polyp patients on whom we operated during the same period. This incidence of ACP is greater than that generally reported in the literature. Some authors have attempted to distinguish ACPs from common nasal polyps primarily on the basis of morphology, histology, and the clinical behavior of the ACPs. In our series, a multivariate analysis, including histopathologic correlation, did not support the notion that ACPs are clearly distinct from common nasal polyps. Some interesting differences between the polyp groups did, however, become evident in our data analysis. Generally, ACPs are not thought to be associated with allergic disease; however, in our series we found the association of allergic disease with ACPs to be statistically significant (Chi-square=4.575, p<.05).
Symptom Relief after Endoscopic Sinus Surgery: An Outcomes-Based Study
Authors: Hoffman Sanford R. , Mahoney Martin C. , Chmiel James F. , Stinziano Gerald D. , Hoffman Kevin N.
Published: May 2019

Previous studies of patient outcomes after sinus surgery have generally described only a summary measure of overall change in symptoms or health status. This paper describes an outcomes-based longitudinal study of sinus symptom prevalence among thirty-one patients treated with endoscopic surgery for chronic sinusitis. Patients completed structured data collection forms to quantify the prevalence of commonly experienced sinus-related symptoms during an eight-week period both before surgery and six months after undergoing sinus surgery. Significant decreases in nasal symptom prevalence (post-surgery versus pre-surgery) were noted for headaches, nasal drainage, nasal congestion, sinus infection, and breathing difficulties. In addition, the proportion of subjects who rated their current health as “better” compared to one year previously increased from 27% pre-surgery to 58% six months after sinus surgery. These findings aid in quantifying the magnitude of improvement experienced by sinus surgery patients and provide further evidence that endoscopic sinus surgery represents an effective treatment for chronic sinusitis.
Aneurysms of the Temporal Bone
Authors: Papazian Martin , Paparella Michael , Hames Edward , Frisk James
Published: May 2019

Aneurysms of the internal carotid artery in the temporal bone are rare lesions which can present clinically as a growth in the middle ear cleft. Hemorrhage, occurring spontaneously or iatrogenically, is a primary concern. This study describes morphological and embryological characteristics of the internal carotid artery in relationship to the protympanum and temporal bone. Concepts of pathogenesis and pathology are discussed, with reference to the neurosurgical and otolaryngologic literature. Clinical characteristics, including methods of surgical repair, are presented using three illustrative case reports. Methods of surgical repair include: 1) reinforcement; 2) ligation; and 3) primary excision and reanastomosis.
Radical Removal of a Large Glossopharyngeal Neurinoma with Preservation of Cranial Nerve Functions
Authors: Quester Ralf , Menzel Jürgen , Thumfart Walter
Published: May 2019

A 51-year-old man is reported who was suffering from an extensive right-sided glossopharyngeal neurinoma (4.6×3.4 cm). The patient was admitted with a history of headache for six to seven years and vomiting for two years accompanied by a progressive hearing loss, tinnitus and dizziness during the last year. Audiometry indicated a perceptive deafness in the whole frequency range up to 70 dB HL, while electronystagmography (ENG) showed a loss of vestibular function of the right side, but there were no signs of a jugular foramen syndrome. Magnetic resonance imaging (MRI) revealed a large tumor portion in the right cerebello-pontine angle with only a small part in the jugular foramen. The neurinoma was completely removed by microsurgery through a suboccipital approach with preservation of nerves VII–XII. The postoperative course was uneventful and normal function of facial and caudal cranial nerves (Nn IX–XII) were proven by electromyography and magnetic stimulation, with exception of a transitory hypesthesia in the palatine region which completely normalized within a few months. The right-sided hearing loss was unchanged, but vertigo improved. In comparison with literature review the lack of temporary or permanent postoperative dysfunctions of caudal cranial nerves as well as of the facial nerve was extraordinary in the reported case.
Anastomosis of the Intratemporal Facial Nerve Using Fibrin Tissue Adhesive
Authors: Bento Ricardo F. , Miniti Aroldo
Published: May 2019

This work aimed at studying the results obtained by the repair of complete lesions of the facial nerve in its intratemporal portions. Clinical, electrophysiological and surgical techniques were studied. Twenty-three patients with traumatic facial nerve lesions were operated. Nerve grafts were made in 10, and end-to-end anastomosis in thirteen. The surgical technique performed was the coaptation of the stumps and stabilization with fibrin tissue adhesive. Sixteen months after surgery, a clinical and electrophysiological evaluation was made. The use of fibrin tissue adhesive to stabilize intratemporal anastomosis of facial nerve showed clinical and electrophysiological evidence of axonal growth and reinnervation of mimical muscles of the face. These results were similar to that obtained by other authors that used other methods of microanastomosis. The use of fibrin tissue adhesive is an effective technique to utilize in intratemporal anastomosis of the facial nerve.
Surgical Management of the Paralyzed Eyelid
Authors: Keen Monte S. , Burgoyne John D. , Kay Scott L.
Published: May 2019

The most devastating sequelae of the facial nerve paralysis is the loss of eye lid function. The inability to blink, lubricate and protect the globe can lead to exposure keratitis, corneal abrasion and even the loss of vision. Eyelid closure is approximately 85% upper eyelid and 15% lower eyelid. In order to ensure adequate protection of the globe, deficiencies of both eyelids must be addressed. We report our experience with 20 patients with eyelid paralysis. Upper lid reanimation was performed by the placement of gold lid weights on the tarsal plate. Lower lid reanimation procedures included lateral canthopexy and horizontal lid shortening. A discussion of the above-mentioned procedures, the timing of the procedures and a critical analysis of results will be included. A comprehensive approach to the management of the paralyzed eye will be presented.
Neuroma of the Chorda Tympani Nerve
Authors: Filho Otacilio Lopes , Filho Ivo Bussoloti , Betti Estelita T. , Burlamachi Jose Carlos , Eckley Claudia Alessandra
Published: May 2019

The authors present a case of Neuroma of the Chorda Tympani Nerve, which is extremely rare. Apparently, only two (2) cases have been reported to date. The initial manifestation was a hard tumor that occupied the posterior wall of the external auditory canal. There were no other symptoms.
Septal Pleomorphic Adenoma Masquerading as Squamous Cell Carcinoma
Authors: Liao Been S. , Hilsinger Raymond L. , Chong Edmund
Published: May 2019

A 43-year-old woman had left midfacial pain and a left intranasal mass. Pathologists from three different institutions agreed that the biopsy specimens from the mass represented squamous cell carcinoma. The final pathologic diagnosis made from the resected specimen was pleomorphic adenoma of the septum. This report describes a case which was initially misdiagnosed on the basis of misleading tissue biopsy results, but the excised tumor was finally diagnosed as pleomorphic adenoma. Otolaryngologists treating an intranasal mass must be aware of the difficulty of correctly diagnosing the initial tissue biopsy specimen in order to guard against unnecessary radical surgery.
Cystic Schwannoma of the Sphenoid Sinus and Skull Base
Authors: DiNardo Laurence J. , Mellis Michael G.
Published: May 2019

Skull base and intracranial cystic schwannomas are rare tumors. To our knowledge, a cystic schwannoma involving the sphenoid sinus has not been previously reported. The location and fluid-filled nature of the lesion resulted in an erroneous preliminary diagnosis of a destructive sphenoid sinus mucocele. Endoscopic biopsy and decompression established the correct diagnosis and reversed a progressive visual loss until definitive surgical removal of the lesion was accomplished. Diagnostic evaluation, histologic findings and management strategies are discussed.
External Laryngocele: An Unusual Cause of Respiratory Distress in a Newborn
Authors: Zelman Warren H. , Burke Luke I.
Published: May 2019

Congenital larygoceles are rare causes of respiratory distress in the newborn. We report a case of airway compromise in a two day old newborn boy secondary to a solitary giant external laryngocele. No internal component or other laryngeal pathology was found. The patient had a progressively enlarging neck mass and increasing stridor culminating in respiratory arrest. Tracheotomy was avoided and the lesion was excised in its entirety. Airway management, the role of CT scanning, and surgical excision of laryngoceles are discussed.
Swallowing Disorders in Muscular Diseases: Functional Assessment and Indications of Cricopharyngeal Myotomy
Authors: Guily Jean Lacau St. , Périé Sophie , Willig Thiébaut-Noël , Chaussade Stanislas , Eymard Bruno , Angelard Bruno
Published: May 2019

Thirty-four patient s with an identified muscular disease were referred to our department for assessment and treatment of swallowing difficulties. Their ages ranged from 16to 91 years (mea n 59). The diagnoses were oculopharyngeal dystrophy in 17 patients, Steinert myotonic dystrophy in 6, mitochondri almyopathies in 4, polymyositis in 3, and other types in 4 patients. The main consequences of the dysphagia were weight loss (12 patients), pulmonary infections (15 patients), modified food consistency (18 patients) and non-oral feeding (3 patients). Several techniques were used to assess the different stages of deglutition: physical examination during swallowing, videofluoroscopy, pharyngoesophagealmanometry, videofibroscopy ofthe pharynx during swallowing. Major pathological features found in the pharynx were decreased pharynx peristaltis and impaired UES relaxation.

Cricopharyngeal myotomy was performed in II myopathic patients (median follow-up 24.9months), while it was unnecessary, refused or contraindicated in the other patients. The procedure was successful in 8 patients whose dysphagia was dramatically improved, and failed in 3 patients. Pharyngeal perstalti s was severely impaired only in the 3 failures and was partly preserved in the improved cases.

We conclude that pharyngeal function is the major prognostic factor. Cricopharyngeal myotomy is an effective treatment in those cases where cricopharyngeal dysfunction is a predominant problem or where pharyngeal peristaltis is partly impaired, since the procedure removes one obstacle. It is contraindicated when pharynx propulsion is severely impaired.
Listening Strategies and Benefits when using a Programmable Hearing Instrument with Eight Programs
Authors: Ringdahl A.
Published: May 2019

The main argument for purchasing a programmable hearing instrument with multiple programs is the assumption that different program settings can be used in acoustically different listening environments. The presumed advantages of the 3M Model 8200 programmable hearing instrument have been investigated in three clinical trials. This paper is a summary of the results. The evaluations were based on protocols and diary booklets where the patients indicated the selected listening situation versus program number. The Datalogging feature of the instrument, measuring the total on-time and the on-time per program, provided a unique support of the evaluation. The results indicated that most patients use 2–5 different programs, and have 2–4 programs fitted for their specific listening environments (“spotlight-listening”). It will, however, be difficult to develop general prescriptive formulas, as the listening pattern and environments differ across subjects.
Neurogenic Vascular Headaches, Food and Chemical Triggers
Authors: Trotsky Martin B.
Published: May 2019

Recent evidence has demonstrated that neurogenic vascular headaches are a combinationof neurological primary events and secondary vasomotor changes. The neurological events involve the hypothalmus and sensory cortex with sympathetic hypofuncti on and noradrenergic abnormalities. A platelet theory has been proposed but has not really been confirmed as a legitim ate cause of the neurogenic vascular head aches. Food and chemicals in foods can act as a precipitating factor in the food-sen sitive neurogenic vascular headache patient. In these patients evidence is now being demonstrated to confirm this, but larger patient studies are needed. The food-sensitive migraine patient and cluster headache patient must give a good history and food diary to go along with active challenges and provocative testing in order to determine the causative foods. Any concomitant allergies of inhalants or environmentals must also be treated. The treatment modalities of elimination and rotation diets or provocation neutralizationmay successfully control the headaches without the need for continuous medications.
Intranasal Steroids in Rhinology: The Changing Role of Intraturbinal Injection
Authors: Mabry Richard L.
Published: May 2019

Intraturbinal injection of repository corticosteroid has been widely used by otolaryngologists for over four decades. The potential for visual loss when retinal embolization or vasospasm complicate this procedure and the introduction of topical nasal steroid preparations have gradually reduced its usage and reshaped the role of intraturbinal steroid injection in the management of a variety of rhinologic disorders. A review by the author of twenty-five years’ experience, including over thirteen thousand intraturbinal corticosteroid injections, shows no visual complications in this large series. However, a decline in the use of this procedure was noted, possibly influenced by several factors. Appropriate roles for intraturbinal steroid injection and topical corticosteroid nasal sprays are suggested.
Laryngocele Associated with Squamous Carcinoma in a 20-Year-Old Nonsmoker
Authors: Murray Sean P. , Burgess Lawrence P.A. , Burton Deborah Mitchell , Gonzalez Carlos , Wood Gordon S. , Zajtchuk Joan T.
Published: May 2019

A laryngocele associated with squamo us cell carcinoma of the larynx is reported in a 20-yea r-old man without a history of smoking. This is the youngest reported case of carcinoma associated with laryngocele in the literature. This association is supported by the patient's young age and his nonsmoking status. However, this case does not appear to support the conclusion that laryngoceles predispose to the development of squamous cell carcinoma. The clinical history supports the tumor obstruction theory, whereby a laryngocele developed from an obstructing carcinoma of the ventricle.
Endoscopic Management of a Large Ethmoid Mucocele
Authors: Terris Mark H. , Davidson Terence M.
Published: May 2019

We present a patient complaining of severe proptosis and diplopia, who had a large ethmoid mucocele. The patient was treated with endoscopic surgical drainage. He had complete resolution of all symptoms. There is no evidence of recurrence at six months follow-up.
Cochlear Implantation and Variation of Facial Nerve Anatomy: A Case Report
Authors: Liening Douglas A. , Haupert Michael , Kartush Jack
Published: May 2019

Cochlear implantation becomes more common with every passing year. Since adequate exposure of the round window requires a facial recess approach, facial nerve variation and anomalies could potentially alter the surgical approach significantly. We report the case of a patient with a variation of facial nerve anatomy. The nerve was found to be lateral to the annulus in its mastoid segment and required retrofacial dissection to approach the round window. A good result was achieved in this patient, demonstrating that facial nerve anomalies need not be a barrier to successful implantation. The reported congenital anomalies of the facial nerve are discussed, along with their influence on cochlear implantation. A knowledge of these variations is mandatory for those engaged in implant surgery.
Surgical Treatment of Meniere's Disease
Authors: Rivas Jose Antonio
Published: May 2019

Surgical treatment is used only for patients with Meniere's disease in cases that do not respond to medical therapy. At the present time, the endolymphatic sac shunt operation is performed in cases where the auditory threshold is fluctuant around 30 dB. When the auditory threshold is between 40 and 70 dB we use the vestibular neurectomy by the retrosigmoid approach. In patients with Meniere's disease with profound hearing loss the translabyrinthine neurectomy is used. The advantages of the vestibular neurectomy by the retrosigmoid approach compared to the retrolabyrinthine and middle fossa approaches will be described.
Ear Lobe Keloids, Surgical Excision Followed by Radiation Therapy: A 10-Year Experience
Authors: Chaudhry M. Rashid , Akhtar Sajjad , Duvalsaint Fregens , Garner Leroy , Lucente Frank E.
Published: May 2019

This retrospective study was conducted to analyze the recurrence of ear lobe keloids in 36 patients after surgical excision followed by radiation therapy. In all the cases keloids were excised and the surgical wound closed primarily. Following surgery, patients underwent 1800 cGy of radiation therapy in three equally divided doses over five to seven days. Most of our patients were young black females who developed keloids secondary to ear lobe piercing. Of the 36 patients followed for a mean period of 5.6 years, we noted only one (2.8%) recurrence. All the patients were followed for a minimum of two years. No serious complications were observed in our series. However, one patient developed radiation dermatitis followed by patchy hypopigmentation. We conclude that surgical excision followed by radiation therapy is a safe and effective method to control keloid recurrence in the ear lobe region.
Double Maxillary Antrum as a Cause of Maxillary Sinus Mucocele
Authors: Yue V. , Bleach N. R. , van Hasselt C. A.
Published: May 2019

We report a rare case of a mucocele occuring in a naturally compartmentalized maxillary sinus in a 50-year-old woman. Sinus computerized tomography (CT) showed the antrum to be divided by a vertical bony septum, producing a mucocele within an isolated and non-draining anterolateral compartment. Accidental trauma to the thin bony shell precipitated rapid swelling of the pre-existing mass, leading to her initial consultation. A wide sublabial surgical approach allowed complete excision with a good cosmetic result.
Cephalic Zoster with Laryngeal Paralysis
Authors: Rothschild Michael A. , Drake William , Scherl Michael
Published: May 2019

Herpes zoster reactivaction in the head and neck region is often associated with multiple cranial neuropathies, the most common one being facial paralysis. Laryngeal paralysis has also been occasionally reported with zoster infection. We present two such cases, and discuss the relevant literature on the pathophysiology, evaluation and management of this disease. Recent advances in antiviral therapy have allowed for specific medical treatment, thus making it all the more imperative to suspect zoster, even in clinically atypical cases. We suggest aggressive treatment with intravenous acyclovir for cephalic zoster complicated by vocal cord paralysis.
Direct Laryngoscopy in Children: Rigid and Flexible Fiberoptic
Authors: Handler Steven D.
Published: May 2019

Examination of the child's larynx is mandatory in the management of pediatric airway problems. The techniques used to perform this examination have evolved over time and now present the airway specialist with choices that can be tailored to each specific situation. Traditionally, rigid direct laryngoscopy (RDL) has been used to evaluate the pediatric larynx. More recently, flexible fiberoptic laryngoscopy (FFL) has been used to visualize the child's airway. RDL and FFL each play a role in the evaluation of the pediatric larynx. Expertise with both techniques is mandatory for the otolaryngologist managing respiratory disorders in children. FFL has become our technique of choice to evaluate the pediatric larynx especially when airway dynamics are of concern. RDL remains the preferred technique when laryngeal/tracheal surgery is planned or establishment and protection of the airway with intubation or bronchoscopy is required.
Metastatic Small Cell Carcinoma to the Masseter Muscle Originating from the Uterine Cervix
Authors: Wong Brian J. F. , Passy Victor , DiSaia Philip
Published: May 2019

Metastatic tumors to the head from infraclavicular primaries are relatively uncommon. The vast majority of primary tumors that metastasize to the head originate from the lung and breast. Tumors metastatic to the masseter are exceedingly rare with only one other case being reported in the literature. The case of a 34-year-old woman with a history of surgically-treated small cell carcinoma of the uterine cervix is presented. This case and our review of the literature illustrates the unusual nature of metastatic patterns in the head and their diagnostic complexity.

Masses localized to the buccomasseteric region are usually considered to be of parotid origin. The differential diagnosis for masses in this area is generally limited to cogenital, inflammatory, or neoplastic lesions. Though uncommon, metastatic tumors from non-head and neck primary malignancies should be considered in the diagnosis as they may herald the onset of a new disease or the recurrence of cancer.
Cylindrical Cell Papilloma of the Nasal Septum
Authors: Bawa Rohit , Allen Gregory C. , Ramadan Hassan H.
Published: May 2019

Papillomas of the sinonasal tract are uncommon tumors. They can be subdivided into different histopathological entities including inverting papilloma, fungiform papilloma and cylindrical cell papilloma. Cylindrical cell papilloma is one of the rarest with only twenty-three cases reported. This rare histologically distinct variant of papillomas of the sinonasal tract behaves clinically like inverting papillomas. We present what we believe to be the first reported case of a cylindrical cell papilloma isolated to the nasal septum. The patient's pathology and a literature review of cylindrical cell papillomas of the sinonasal tract are presented.
Extrinsic Tracheal Compression — A Newly Described Complication of Acquired Immune Deficiency Syndrome (AIDS)
Authors: Patete Michael L. , Mellon Dorothy
Published: May 2019

An AIDS patient was seen in respiratory difficulty with a superior mediastinal mass. Examination revealed a Candida fungoma. To the best of our knowledge, this is the only case of its nature. The differential diagnosis and management of this patient are presented in detail.
Sclerosing Cervicitis: Case Report and Literature Review
Authors: Queen Timothy A. , Gibbs Paul M. , Rice Dale H.
Published: May 2019

Sclerosing cervicitis is an idiopathic fibrosis of the soft tissue compartments of the neck. Reported cases in the past have been characterized by both benign and malignant courses, but the histopathology of the lesion has been invariably benign.
Intracranial Facial Neuromas: Total Tumor Removal with Facial Nerve Preservation: A New Surgical Technique
Authors: Sataloff Robert Thayer , Frattali Mark A , Myers Donald L.
Published: May 2019

Neuromas of the facial nerve are uncommon tumors. The majority of cases involve the intratemporal and parotid areas. Since their description in 1930, there have been only 26 cases of intracranial facial neuroma reported in the world literature. Of these, 19 involved the middle cranial fossa, and only seven tumors extended into or originated in the posterior cranial fossa. In this location, the seventh nerve is surrounded by a very delicate and thin arachnoid casing. Thus, although these tumors are encapsulated, there is usually no obvious plane of separation between the tumor and perineurium. As a result, the seventh nerve has been sacrificed routinely.

Two patients with posterior fossa facial neuromas underwent total tumor removal with a new surgical technique permitting preservation of the nerve fascicles via a translabyrinthine approach. Each patient has good recovery of seventh nerve function with no evidence of recurrence six and nine years later, respectively. Leaving the nerve fascicles intact appears to result in good reinnervation following total tumor removal. The potential value of this technique is best considered in the context of diagnostic and therapeutic options for facial neuromas in general. Neurotologists should find this a useful addition to their surgical armamentarium for selected cases.
An Unusual Cause of Dysphagia following Total Laryngectomy
Authors: Bergman Justin A. , Pallant Ronald , Bleier Howard
Published: May 2019

A case of dysphagia following wide-field total laryngectomy with excision of the overlying skin is presented. Initial investigation as to the cause of the dysphagia proved fruitless. Mechanical compression of an adequate-sized neopharynx by the “band-like effect” created by the skin closure was hypothesized to be the etiology of the dysphagia. Release of the scar contracture and resurfacing with a pectoralis major myocutaneous flap reestablished an adequate-sized hypopharynx and normal deglutition.
Tinnitus and Acoustic Neuromas: Analysis of the Effect of Surgical Excision on Postoperative Tinnitus
Authors: Henrich Douglas E. , McCabe Brian F. , Gantz Bruce J.
Published: May 2019

In this retrospective review of the 160 acoustic neuroma cases treated at The University of Iowa between 1980 and 1991, follow-up information was obtained for 82% by telephone interview. Postoperative tinnitus was a symptom reported by 75% of the acoustic neuroma patients. Overall, among patients with tinnitus preoperatively, the condition postoperatively was absent in 45%, lessened in 17%, unchanged in 30%, and greater in 8%. Detailed results are compared to other series and significant differences in the depth of comparison described.
Permanent Restoration of Hearing and Vestibular Function by the Endolymphatic Subarachnoid Shunt Operation
Authors: Pulec Jack L.
Published: May 2019

In cases of surgically treatable Meniere's disease, the endolymphatic subarachnoid shunt operation, when successful, can eliminate endolymphatic hydrops and restore function which has not been permanently damaged. This paper will demonstrate the restoration to normal of cochlear and vestibular function following successful endolymphatic subarachnoid shunt procedures. A series of 454 Endolymphatic Subarachnoid Shunt Operations performed on patients with Meniere's disease is reported. Twenty-six patients had surgery on their only hearing ear. Overall, the Endolymphatic Subarachnoid Shunt Operation offered success in sixty-five percent of operations performed. Cases of failure can often receive significant benefit from progressively more destructive procedures. The use of the Endolymphatic Subarachnoid Shunt procedure performed early in the course of Meniere's disease can significantly reduce the risk of permanent hearing loss and disability.
Invasive Fungal Sinusitis in the Immunocompromised Pediatric Patient
Authors: Lansford Bryan K. , Bower Charles M. , Seibert Robert W.
Published: May 2019

Invasive fungal sinusitis in the pediatric population appears to be a relatively rare entity. An increasing incidence has been noted in accordance with the widespread use of antibiotics, steroids, antineoplastic drugs and radiation therapy. Three illustrative cases are described which outline the initial presenting symptoms, findings on physical examination, computed tomography (CT), intraoperative findings, and histopathologic findings. A review of the literature is presented and a treatment protocol is proposed once a diagnosis is made. Early suspicion and diagnosis are the most important prerequisites for successful treatment which consists of control of the underlying disease, surgical debridement, and systemic antifungal therapy. Cooperation between the otolaryngologist, pediatric specialists, and pathologists are key to the survival of children with invasive fungal sinusitis. Survival in this series was dependent upon return of an immune competent state.
Osteoradionecrosis of the Hyoid Induced by Combined Modality Therapy for Laryngeal Carcinoma
Authors: Robertson J. Scott , Frauenhoffer Elizabeth E. , Stryker John , Schaitkin Barry , Velkley Donald E. , McGinn Johnathan D.
Published: May 2019

Contemporary management of laryngeal carcinoma often incorporates multiple modalities of therapy. We report a case of osteoradionecrosis of the hyoid bone in a patient treated with surgery, chemotherapy, and radiation therapy for a supraglottic squamous cell carcinoma. A discussion regarding pathophysiology, radiation dosimetry and treatment options is also presented.
Airway Obstruction in Children with Infectious Mononucleosis
Authors: Wohl Daniel L. , Isaacson Jon E.
Published: May 2019

Epstein-Barr Virus (EBV) infection generally has a benign clinical course. Upper airway obstruction is a known complication requiring the otolaryngologist's attention. EBV is usually associated with adolescence but has been increasingly documented in younger children. We review 36 pediatric admissions for infectious mononucleosis over a 12-year period at our institution, 11 of which required consultation for airway obstruction. Airway management was based on clinical severity and ranged from monitored observation, with or without nasopharyngeal stenting, to prolonged intubation or emergent tonsilloadenoidectomy. A rare case of a four-year-old with near total upper airway obstruction secondary to panpharyngeal and transglottic inflammatory edema prompted this review and is reported. The otolaryngologist must recognize the potential severity of EBV-related airway compromise and be prepared to manage it.