bluuebunny/crossref_metadata_2025_split huggingface dataset:
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.
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.
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.
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.
Atypical Forms of Paroxysmal Positional Nystagmus
Authors: Smouha Eric E. , Roussos Claudia 
Published: May 2019

Benign paroxysmal positional vertigo (BPPV) is a common cause of vertigo, and has a typical constellation of physical findings. Atypical forms of paroxysmal positional nystagmus (APPN) also exist, and are thought to represent conditions which are in fact not “benign”. We studied 100 consecutive patients with positional vertigo in order to learn whether APPN differed from classic BPPV in etiology or clinical fate, and to learn the incidence of central nervous system (CNS) disorders in these patients. APPN was present in 38% of these patients with diverse causes. One-fourth had CNS disorders or vascular insufficiency, the remainder, otogenic or idiopathic. APPN was more likely than BPPV to have a prolonged (persistent or recurring) clinical course. Although most cases eventually resolved, duration of symptoms tended to be longer, regardless of etiology. We conclude that APPN has a less favorable prognosis than typical BPPV, and that a CNS etiology should be suspected in prolonged cases.
Hemangiopericytoma of the Skull Base and Collet-Sicard Syndrome: A Case Report
Authors: Comacchio F. , D'Eredità R. , Poletto E. , Poletti A. , Marchiori C. 
Published: May 2019

Hemangiopericytoma (HP) is a mesenchymal tumor that originates from the pericytes of the capillary walls. This is a rare neoplasm, particularly in the head and neck; the skull base is involved exceptionally. We report a case of a large HP located in the jugular foramen. The last four cranial nerves were involved, causing a Collet-Sicard syndrome associated with facial palsy. Only one case of HP and Collet-Sicard syndrome is reported in the literature. The clinical course of the disease is described, emphasizing the long period of elapsed time between onset of the complaints and the final diagnosis. Diagnostic procedures and immunohistochemical evaluation are analyzed, along with the possible differential diagnosis with other pathological processes that more frequently involve the jugular foramen.
Use of Antibiotics for Expansion of the Merocel® Packing following Endoscopic Sinus Surgery
Authors: Shikani Alain H. 
Published: May 2019

Sinus packs that are used for hemostasis and the prevention of synechiae following endoscopic sinus surgery frequently get colonized with bacteria from the infected sinus, which increases the risk for infection. This study was conducted in an attempt to characterize the bacterial flora of the chronically infected sinus, and to evaluate whether direct installation of antibiotics into the sponge inhibits bacterial growth. Bacteria were cultured from 89% of the sinuses at surgery, and in 67% of the cases, the same bacteria were recovered from the sinus dressings one week later. When the Merocel® sinus dressing was expanded with a combination of polymyxin, neomycin and hydrocortisone at the time of surgery, a 36% decrease in bacterial growth was observed, along with a decrease in the severity of pain associated with removal of the pack. This supports the concept of using an antibiotic for the expansion of the sponge following endoscopic sinus surgery.
The Management of Post-Thyroidectomy Hypocalcemia
Authors: Szubin Lisa , Kacker Ashutosh , Kakani Rajesh , Komisar Arnold , Blaugrund Stanley 
Published: May 2019

Postoperative hypocalcemia was studied in 40 patients undergoing total thyroidectomy for a malignancy or massive goiter. Parameters evaluated included serum calcium, phosphate and magnesium levels. All patients exhibited a postoperative decline in serum calcium, however, the lowest serum calcium level was not seen until 48 hours after surgery. Serum calcium levels returned to normal in five to six days after surgery in 37 patients. Five patients required calcium supplementation for either symptomatic hypocalcemia or serum calcium levels lower than 7.0 mg/dl. Only three of these five patients were discharged home on oral calcium supplements. In this series, we discovered that the critical period for monitoring of serum calcium was 24 to 96 hours after surgery. If serum calcium replacement was not needed in the first 72 hours after surgery, it would not be needed during the remainder of the patient's hospital course. In addition, we found that serum magnesium levels should also be monitored in the postoperative period and corrected if low.
Renal Clear Cell Carcinoma Appearing as a Left Neck Mass
Authors: Boggess Michael A. , Hester T. Oma , Archer Sanford M. 
Published: May 2019

Malignant clear cell tumors of the head and neck are uncommon. Primary tumors may arise from the salivary glands, thyroid gland, or parathyroid glands, while metastatic tumors most commonly arise from the lungs, kidneys, and female genital tract. Renal cell carcinoma is the third most common metastatic tumor to the bone and soft tissues of the head and neck. Despite this, there have been few reported cases of renal clear cell carcinoma metastases to the neck. Here we report a unique case of an otherwise asymptomatic young woman with a left neck mass as the first clinical sign of advanced renal clear cell carcinoma.
Iatrogenic Facial Paralysis Prevention
Authors: Harner Stephen G. , Leonetti John P. 
Published: May 2019

Iatrogenic facial paralysis occurs in less than 4% of major otologic procedures. The prevention of iatrogenic injuries involves study, training and experience. These concepts are carefully woven into residency training, fellowship and, ultimately, into peer review. The reasons for injury may be errors of omission, such as inadequate preparation for the procedure, or errors of commission, such as inadequate surgical exposure. Currently, there appear to be enough surgical cases for training programs and the core training of otolaryngology residents prepares them to handle most facial nerve problems. Included in this article is a more detailed description of the anatomy in and around the facial nerve, particularly in the mastoid, with suggestions on how to avoid problems and reduce injuries.
Anatomical Results with Titanium Implants in the Mastoid Region
Authors: Portmann D. , Boudard P. , Herman D. 
Published: May 2019

We report our experience with titanium implants for extra-aural rehabilitation in the mastoid region with a bone-anchored hearing aid (BAHA) and auricular prosthesis. The purpose of this study was to evaluate the clnical status of the soft tissue adjacent to 63 skin-penetrating devices in 43 patients and to compare our findings with those of other reports. Forty-four fixtures have been implanted in 36 patients for the BAHA and 19 in seven patients for the auricular prostheses. The evaluation concerns osseointegration, pain in the mastoid area, skin reaction around the abutment and removal of the abutment. Three implants extruded; one due to trauma and two with no explanation. Follow-up ranged from 3 to 60 months after surgical implantation. The first outpatient check-up was performed at three months after implantation and then every six months. The soft tissue reaction around the percutaneous unit was classified at each control according to the classification proposed by Holgers et al.1 There was no irritation (type 0) in 87.5% of the controls for the BAHA group and in 87.2% for the group of auricular prostheses. No adverse skin reactions were noted in 61.36% of the BAHA group and in 66.66% of the auricular prosthesis group. Results of this study confirm the skin's ability to tolerate a skin-penetrating unit made of pure titanium. The importance of reducing the thickness of the skin around the implant and of local hygienic conditions is emphasized.
Stapedius Tendon Reconstruction during Stapedotomy: Technique and Results
Authors: Causse Jean-Bernard , Vincent Robert , Michat Martine , Gherini Stuart 
Published: May 2019

During surgery for otosclerosis, it is common for the surgeon to cut the stapedius tendon. Even without reconstruction of the tendon, the results of this kind of surgery are particularly satisfactory. The stapedial reflex is more important for improving intelligibility of speech in the presence of background noise than for protection against hazardous levels of noise. An intact stapedial reflex improves ones ability to follow speech in the presence of background noise. This report will present a technique to reconstruct the stapedius tendon, along with the results obtained when adding this procedure to stapedotomy surgery.
Central Auditory Evaluation of Patients with Spasmodic Dysphonia
Authors: Middleton Michele L. , Wilson Keith M. , Keith Robert W. 
Published: May 2019

Spasmodic dysphonia is a focal laryngeal dystonia characterized by inappropriate contractions of the intrinsic laryngeal musculature. The prevalence of associated neurological findings has led to detailed investigation of the central nervous system. Previous research revealed latency abnormalities in patients’ auditory brainstem responses. The present study further investigated central auditory findings in patients with spasmodic dysphonia, including brainstem and cortical function. Fourteen normal-hearing patients with spasmodic dysphonia were tested using the auditory brainstem response (ABR) and SCAN-A test of central auditory processing. The ABR estimated brainstem transmission time and evaluated auditory pathway integrity at a high stimulus rate. SCAN-A assessed the auditory cerebral cortex. Implications of these findings are discussed. We found no ABR abnormalities in subjects with spasmodic dysphonia. Positive SCAN-A findings were negligible. The ABR findings contradict previous reports.
Surgical Management of Tracheocutaneous Fistula
Authors: Drezner Dean A. , Cantrell Harry 
Published: May 2019

Tracheocutaneous fistula (TCF) is a complication of tracheotomy that adds a difficult and bothersome aspect to the patient's care and may exacerbate respiratory disease. Closure of the fistula is recommended, but complications associated with fistula closure include pneumothorax and respiratory compromise. Several surgical approaches have been advocated in the literature. We reviewed the operative techniques and outcomes of TCF closures performed at Cooper Hospital/University Medical Center between February 1990 and April 1995. Direct, or flap, closure of large tracheocutaneous fistulas was associated with significant complications and morbidity. Therefore, the closure technique was modified so that we now recommend, in patients with large tracheocutaneous fistulas (a defect of the anterior tracheal wall of ≥4 mm diameter), excision of the fistula, replacement of the tracheotomy tube and healing by second intention after a short recannulation period. No complications have occurred since this closure technique was adopted.
Traumatic Neuromas of the Head and Neck
Authors: Lee Edwin J. , Calcaterra Thomas C. , Zuckerbraun Lionel 
Published: May 2019

An interesting case of a traumatic neuroma of the greater auricular nerve provides the impetus for a discussion of head and neck neuromas. Traumatic neuromas of the head and neck are relatively rare. Division of the greater auricular nerve during parotidectomy occasionally results in a traumatic neuroma. We report a case of a 73-year-old woman who presented with a traumatic neuroma nine years after undergoing superficial parotidectomy with dissection of the facial nerve for a mixed tumor. The patient had a 1.5 cm x 1.0 cm mass located below the old surgical site over the anteromedial border of the sternocleidomastoid muscle. The patient's past history was significant for Frey's syndrome, which is the result of abnormal neurologic growth. On first impression, the tumor was thought to be a recurrence of neoplastic disease; however, because of the evaluation, traumatic neuroma was suspected. An attempt at fine-needle aspiration of the mass was too painful to be carried out. At surgery, a whitish tumor was excised which, on final pathologic examination, revealed traumatic neuroma. The surgical literature is reviewed and the subject of head and neck neuromas, including their evaluation and management, is thoroughly discussed. Knowledge of this possible diagnosis may spare the patient and the surgeon needless worry, as well as unnecessary procedures, once tumor recurrence has been ruled out.
Noise Levels in the Health Club Setting
Authors: Yaremchuk Kathleen L. , Kaczor Janet C. 
Published: May 2019

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

Cervical hematomas are generally associated with trauma, surgery, and tumors. Although they are rare, they can be life-threatening because they put the patient at risk for great-vessel compression and upper airway obstruction. We describe two cases of spontaneous cervical hematoma— one in an 81-year-old man and the other in a 30-year-old woman. The man reported dysphonia, dysphagia, and neck swelling of 5 hours’ duration. He had been taking 100 mg/day of aspirin for a cardiovascular condition. Examination revealed that the man had polycythemia vera. The woman was found to have neck ache, odynophagia, and cervical ecchymosis; portal hypertension, schistosomiasis, and blood dyscrasia were also found. Both patients denied trauma. A suspected diagnosis of cervical hematoma was confirmed by computed tomography, and treatment was instituted. The hematomas resolved in about 2 weeks. The treatment of cervical hematoma is controversial, although it is agreed that the evaluation of upper airway obstruction and its permeability is mandatory. Surgical treatment is generally reserved for complicated cases because of the risk of infection or bleeding.
Intensity-Modulated Radiotherapy: First Results with this New Technology on Neoplasms of the Head and Neck
Authors: Kuppersmith Ronald B. , Greco Stephen C. , Teh Bin S. , Donovan Donald T. , Grant Walter , Chiu Joseph K.C. , Cain Robyn B. , Butler E. Brian 
Published: May 2019

Intensity-modulated beam radiotherapy (IMRT) delivers a highly conformal, three-dimensional (3-D) distribution of radiation doses that is not possible with conventional methods. When administered to patients with head and neck tumors, IMRT allows for the treatment of multiple targets with different doses, while simultaneously minimizing radiation to uninvolved critical structures such as the parotid glands, optic chiasm, and mandible. With 3-D computerized dose optimization, IMRT is a vast improvement over the customary trial-and-error method of treatment planning. We retrospectively reviewed the charts of the first 28 head and neck patients at our institution who were treated with IMRT. All had head and neck neoplasms, including squamous cell carcinoma, adenoid cystic carcinoma, paraganglioma, and angiofibroma. Total radiation doses ranged from 1,400 to 7,100 cGy, and daily doses ranged from 150 to 400 cGy/day. A quality assurance system ensured that computer-generated dosimetry matched film dosimetry in all cases. For midline tumors, this system allowed us to decrease the dose to the parotid glands to less than 3,000 cGy. The incidence of acute toxicity was drastically lower than that seen with conventional radiotherapy delivery to similar sites. This is the first report of the application of IMRT strictly to head and neck neoplasms. We discuss the indications, technique, and initial results of this promising new technology. We also introduce the concept of the Simultaneous Modulated Accelerated Radiation Therapy boost technique, which has several advantages over other altered fractionation schemes.
Combined infratemporal fossa and transfacial approach to excising massive tumors
Authors: Shahinian Hrayr K. , Suh Richard H. , Jarrahy Reza 
Published: May 2019

Massive tumors of the infratemporal and pterygopalatine fossa are usually resected via the Fisch type C infratemporal fossa approach. This approach provides the surgeon with wide enough access to safely remove massive tumors, and it allows excellent control of the internal carotid artery without leaving facial scars. The disadvantages of this approach include a total loss of hearing on the affected side and the risk of damage to the facial nerve. The Fisch type D infratemporal preauricular approach provides a limited access to tumors, but it does preserve hearing. We studied the practice of combining the Fisch type D approach with a transfacial, transmaxillary approach. This allows the removal of massive tumors of the area without the necessity of resorting to the type C approach and the resultant loss of hearing and the possibility of facial paralysis. The flexibility of the type D infratemporal fossa approach allows the surgeon to combine it with transmaxillary, transmandibular, and periorbital approaches to remove tumors of all sizes from the infratemporal fossa, pterygopalatine fossa, parapharyngeal space, and orbit.