Showing papers in "Current Opinion in Otolaryngology & Head and Neck Surgery in 1994"
TL;DR: Sinonasal neoplasia offers one of the greatest challenges to the head and neck surgeon because it combines considerable potential histologic diversity with late presentation and capricious behavior, compromising management.
Abstract: Sinonasal neoplasia offers one of the greatest challenges to the head and neck surgeon. It combines considerable potential histologic diversity with late presentation and capricious behavior, compromising management. The epidemiology and etiologic aspects continue to excite interest, although few clinicians accrue large numbers of any histologic type. Patients may legitimately be offered palliation when cure is impossible, and long-term follow-up is mandatory in all cases.
28 citations
TL;DR: Methods of treatment are diverticulectomy combined with extra-mucosal myotomy of the sphincter and endoscopic treatment, the latter is gaining in popularity as the operation of choice.
Abstract: Many theories on the pathogenesis of Zenker's diverticulum have been advanced, but not one of them is generally accepted. Recent reports describe structural histologic abnormalities in the cricopharyngeal muscle fibers, but the pathogenesis seems only a result of the individual anatomic structure in the pharyngoesophageal segment. Methods of treatment are diverticulectomy combined with extra-mucosal myotomy of the sphincter and endoscopic treatment. The latter is gaining in popularity as the operation of choice.
19 citations
TL;DR: In this new phase of laryngeal endoscopic development, it is possible to perform in vivo and in situ studies of the cells, nucleus, cytoplasm, and microvascular networks.
Abstract: Rigid videoendoscopy performed during microlaryngoscopy allows exploration of regions that are difficult to observe. Higher magnifications improve the definition of lesion characteristics. Epithelial cells, which have been previously stained with methylene blue, can be identified with contact endoscopy during microlaryngoscopy. In this new phase of laryngeal endoscopic development, it is possible to perform in vivo and in situ studies of the cells, nucleus, cytoplasm, and microvascular networks.
18 citations
TL;DR: Techniques of in vivo diagnostic allergy testing rely on the reactivity and sensitivity of mast cells, which have been sensitized with specific IgE to reflect allergen sensitivity, which has a direct bearing on the methodology of immunotherapy.
Abstract: Techniques of in vivo diagnostic allergy testing rely on the reactivity and sensitivity of mast cells, which have been sensitized with specific IgE to reflect allergen sensitivity. The antigens may be applied as a challenge test in a controlled manner directly onto nasal, oral, conjunctival, bronchial, or gastrointestinal mucosa. In the clinical setting, antigen is more commonly applied directly onto or into the skin in the form of scratch, prick, or intradermal tests. Skin tests have represented the primary diagnostic tool in IgE-mediated allergy. They provide useful, confirmatory evidence for specific allergy, the diagnosis of which has been made on clinical grounds. Skin testing techniques share the characteristics of simplicity, rapidity of performance, high sensitivity and specificity when properly performed, and low cost. Recent refinements in skin testing strategies have resulted from the quest for validity and reproducibility and for quality control and assurance. Quantitation of skin test reactivity, whether by prick or intradermal testing that uses serial dilution titration technique, provides the most accurate assessment of the individual patient's hypersensitivity. Only those skin tests that can quantitate the sensitivity of each allergen to which the patient is sensitive will provide the information necessary to formulate a treatment program that gives optimum therapeutic results. For an antigen to elicit a beneficial immunologic response, it must be given in high enough does to stimulate a therapeutic immunologic response. Thus, skin test methodology has a direct bearing on the methodology of immunotherapy. Properly controlled clinical studies have demonstrated the efficacy of immunotherapy in allergic patients. These studies have yielded objective data, which have been made possible by rapid advancement in technology and the knowledge of immunobiology. These data demonstrate that in order to be effective, allergen immunotherapy is dependent on an adequate dose of the respective allergen administered for an appropriate length of time, is specific for the allergen administered, and results in prolonged relief and prevention of allergic disease.
9 citations
TL;DR: Significant improvements in the speed and accessibility of high-resolution three-dimensional reconstructions have increased their use at all implant evaluation stages, and they provide insights into tissue-electrode relationships that are important for optimizing encoding strategies.
Abstract: Temporal bone imaging is an important component of pre- and postoperative care of cochlear implant patients. It is an essential aspect of patient selection and can be a powerful tool for enhancing implant performance. Preoperative examinations with high-resolution computed tomography reliably detect osteogenic, obi iterative, and neurodegenerative processes that may compromise implant surgery or device use. Magnetic resonance imaging is less routinely used preoperatively, but it can provide valuable first-order estimates of auditory nerve preservation. Intraoperative plain films are used to verify the intracochlear position of the implant. Device failures and surgical complications are generally investigated with computed tomography and magnetic resonance imaging. Significant improvements in the speed and accessibility of high-resolution three-dimensional reconstructions have increased their use at all implant evaluation stages. Preoperatively, reconstructions provide realistic surgical views of middle and inner ear anatomy; postoperatively, they provide insights into tissue-electrode relationships that are important for optimizing encoding strategies.
9 citations
TL;DR: Outcomes research focuses on the results of medical care and differs from traditional clinical research in two ways: 1) outcomes research uses nonrandomized research methodologies, and 2) it uses an expanded description of patient outcomes.
Abstract: Quality of care refers to the degree to which health services increase the likelihood of desired health outcomes. The evaluation of quality depends on the assessment of process, structure, and outcomes of medical care. Outcomes research focuses on the results of medical care and differs from traditional clinical research in two ways: 1) outcomes research uses nonrandomized research methodologies, and 2) it uses an expanded description of patient outcomes. The results of outcomes studies will be used to measure treatment effectiveness, assess quality of care, and measure provider performance.
8 citations
TL;DR: The Immunodeficient child presents a unique challenge to the otolaryngologist, who must be able to recognize the early stages of immunodeficiency as well as be a consultant in later stages of the disease.
Abstract: The immunodeficient child presents a unique challenge to the otolaryngologist, who must be able to recognize the early stages of immunodeficiency as well as be a consultant in later stages of the disease. Infection by HIV has brought about a new era both in the magnitude of immunodeficiency seen and in our understanding of the mechanisms of immune function. The current literature concerning HIV-infected children with manifestations in the head and neck is reviewed. Many similarities between HIV-infected children and other immunosuppressed patients have emerged, and salient features of immunodeficiency diseases of childhood are examined.
6 citations
TL;DR: Current in vitro test methods are safe, cost-effective, expeditious, and accurate for use in the diagnosis and treatment of IgE-mediated allergic disease.
Abstract: This article reviews in vitro testing in the 1990s. Several tests remain standards. In the United States, modified radioallergosorbent test (RAST) scoring is performed by either a RAST or enzyme-linked immunosorbent assay method; in Europe, Phadebas RAST (Kabi Pharmacia Diagnostics, Piscataway, NJ) scoring is more popular. Newer quantitative tests reviewed include the Ala STAT, MAST, and CAP testing systems (Pharmacia Diagnostics, Piscataway, NJ). Qualitative test screens include the Phadiatop microscreen (Kabi Pharmacia Diagnostics, Piscataway, NJ) and Quidel dipstick multiscreen (Quidel Corp., San Diego, CA). The newer tests produce results in 1 day or less. Test correlation with in vivo methods, including skin endpoint titration and skin prick testing is good. Current in vitro test methods are safe, cost-effective, expeditious, and accurate for use in the diagnosis and treatment of IgE-mediated allergic disease.
6 citations
5 citations
TL;DR: The flow characteristics of nasal respiratory air and the essential role of the nose in processing large inspiratory and expiratory volumes are discussed, and patent sinus ostia are essential to health.
Abstract: The flow characteristics of nasal respiratory air and the essential role of the nose in processing large inspiratory and expiratory volumes are discussed. These features contrast with sinus airflow, which is small, and whose contribution to the respiratory process is inconsequential. Nevertheless, patent sinus ostia are essential to health. Because there have been few relevant publications in the immediate review period, this presentation extends beyond it. Olfaction and speech are not discussed.
5 citations
TL;DR: Ossicular reconstruction remains a significant surgical problem that continues to demand the search for new and better materials, prosthetic design, and surgical techniques.
Abstract: Ossicular reconstruction remains a significant surgical problem that continues to demand the search for new and better materials, prosthetic design, and surgical techniques. Several factors, including the various deficits that are possible within the ossicular chain and the array of materials and implant designs from which the surgeon may choose, account for the complex nature of ossicular reconstruction. Allograft, homograft, and autograft materials each have different physical and biologic properties. When the different materials for ossicular reconstruction are coupled with different prosthetic designs for specific ossicular chain deficits, the assessment of surgical results is difficult. With these factors in mind, the recent literature of techniques and materials for ossicular reconstruction is reviewed.
TL;DR: The indications and the relative contraindications to FESS are outlined, the importance of preoperative nasal endoscopy and radiographic imaging is emphasized, and specific operative techniques are discussed.
Abstract: Functional endoscopic sinus surgery (FESS) has emerged as the technique of choice in the treatment of benign diseases of the nose and paranasal sinuses. With emphasis on the functional aspect of this modality, patients have been treated with much less radical procedures when compared with traditional intranasal nonendoscopic and external techniques. This review outlines the indications and the relative contraindications to FESS, emphasizes the importance of preoperative nasal endoscopy and radiographic imaging, and discusses specific operative techniques. Postoperative care, surgical results, complications, and additional applications of endoscopic sinus surgery are also enumerated.
TL;DR: The effects of impaired glottic function on swallowing, current methods for evaluation, conservative management, and surgical treatment strategies are reviewed, with emphasis on early vocal fold medialization for symptoms of aspiration and dysphagia associated with laryngeal paralysis.
Abstract: Glottic closure, elevation of the larynx, anterior displacement of the arytenoids, and retroflexion of the epiglottis are normal and essential events in the swallowing mechanism. It is therefore not surprising that impaired laryngeal function resulting in incomplete glottic closure will affect not only phonatory function but also deglutition. The effects of impaired glottic function on swallowing are reviewed with respect to pathophysiology of aspiration and dysphagia. Current methods for evaluation, conservative management, and surgical treatment strategies are reviewed, with emphasis on early vocal fold medialization for symptoms of aspiration and dysphagia associated with laryngeal paralysis.
TL;DR: Current research on the physiology of swallowing and on the diagnosis and management of patients with oropharyngeal dysphagia is reviewed.
Abstract: Oropharyngeal dysphagia is a problem that is often best managed in an interdisciplinary environment; therefore, the material discussed here represents the efforts of scientists and clinicians from various fields. This article reviews current research on the physiology of swallowing and on the diagnosis and management of patients with oropharyngeal dysphagia. Reference to past research is made to provide the interested reader with a suitable bibliography from which to gain additional information on this topic.
TL;DR: Whereas an impaired antireflux barrier remains a major focus of research on gastroesophageal reflux disease, the current understanding of the nature of this barrier indicates that it is more complex than previously thought.
Abstract: Whereas an impaired antireflux barrier remains a major focus of research on gastroesophageal reflux disease, our current understanding of the nature of this barrier indicates that it is more complex than previously thought. In addition, other factors such as impaired esophageal clearance, gastric hypersecretion, and poor gastric emptying may play a role in reflux disease. Acid suppression continues to have a central role in the treatment of reflux disease. The pharynx and airway are more sensitive to acid than the esophagus and even limited regurgitation of acid into the pharynx may produce extraesophageal manifestations of reflux disease. Consequently, extraesophageal presentations are often more difficult to treat than more typical esophageal manifestations of reflux disease.
TL;DR: It is concluded that most pediatric maxillofacial trauma can be managed conservatively, ie, maxillomandibular fixation for mandibular fractures, closed reduction of nasal fractures, and observation of orbital fractures.
Abstract: The management of facial fractures has undergone a revolution, with advances such as computed tomographic-guided diagnosis, craniofacial exposure, and rigid fixation. Although these advanced techniques have been widely accepted for adult trauma victims, their use remains controversial for children because of concerns over facial growth. High energy facial fractures in children are uncommon; therefore, few surgeons have a large experience or long-term follow-up with the newer reconstructive choices. The reliability of time-tested conservative management for simple pediatric injuries is not in question; however, with severe and complex fractures, traditional interventions do not yield consistently excellent results. In this report, we review current concepts of pediatric facial fracture management and conclude that most pediatric maxillofacial trauma can be managed conservatively, ie, maxillomandibular fixation for mandibular fractures, closed reduction of nasal fractures, and observation of orbital fractures. Nevertheless, complex injuries require three-dimensional reconstruction, which is currently best accomplished with rigid fixation.
TL;DR: A review of the current literature regarding the epidemiology, etiology, clinical manifestations, and surgical and medical treatments of recurrent respiratory papillomatosis can be found in this paper.
Abstract: Recurrent respiratory papillomatosis is a frustrating and challenging disease for surgeons, patients, and patients' families. Although the voice and airway manifestations are managed surgically, a "cure" for this disease remains elusive. In this edition of the "Seminar Series," we endeavor to review the current literature regarding the epidemiology, etiology, clinical manifestations, and surgical and medical treatments of this disorder. The key to future management of recurrent respiratory papillomatosis may lie in its prevention, if current efforts to develop an effective vaccine come to fruition.
TL;DR: This review focuses on recent basic and clinical research contributions and discusses the clinical rationales for the use of new implants in facial reconstruction.
Abstract: Considerable interest has arisen with regard to the use of biologic tissue and biomaterial implants in the reconstruction of the cranio-maxillofacial skeleton. This review focuses on recent basic and clinical research contributions and discusses the clinical rationales for the use of new implants in facial reconstruction.
TL;DR: The anatomy, physiology, and pathophysiology necessary to formulate an effective management plan for gastroesophageal reflux disease are reviewed.
Abstract: Pediatric gastroesophageal reflux is a common problem during the 1st year of life and is defined as the retrograde passage of gastroduodenal contents into the esophagus. The most common presentation is a benign course of postprandial vomiting limited to the 1st year of life. However, this refluxate, which can be acidic, basic, or neutral, can cause pathologic changes within the upper aerodigestive tract. Children defined as having gastroesophageal reflux disease may present initially with airway manifestations that include stridor, apnea, apparent life-threatening events, or sudden infant death syndrome. This paper reviews the anatomy, physiology, and pathophysiology necessary to formulate an effective management plan for this complex problem.
TL;DR: This review is designed to address new developments in the understanding of the pathogenesis and medical treatment of chronic rhinosinusitis.
Abstract: Chronic inflammatory disease of the nose and paranasal sinuses is most often multifactorial. Identification of cause of this disease in a given individual is frequently impractical. Moreover, if a source of inflammation can be recognized, it may not be reversible. Thus, treatment of chronic rhinosinusitis is customarily aimed at disease manifestations. Nasal endoscopy is essential to objectively assess disease and its response to medical therapy. Patients may require multiple medications for satisfactory treatment. Thus complications due to drug interactions are possible, and it is necessary to inform patients of the potential risks of therapy. This review is designed to address new developments in our understanding of the pathogenesis and medical treatment of chronic rhinosinusitis.
TL;DR: In patients with a tracheostomy, a Passy-Muir valve is often effective in preventing aspiration and may avoid the need for further definitive surgery.
Abstract: Laryngotracheal diversion and separation are definitive procedures for the treatment of intractable aspiration. Laryngotracheal separation is the preferred technique because of its simplicity, low morbidity, effectiveness, and applicability to patients with a previous tracheostomy. As we gain additional experience with these procedures, we can better define the decision-making process in the treatment of patients with intractable aspiration. In patients with a tracheostomy, a Passy-Muir valve (Passy-Muir, Irvine, CA) is often effective in preventing aspiration and may avoid the need for further definitive surgery. Most patients undergoing laryngotracheal separation lose little speech function due to an underlying neurologic disease. Many patients are able to resume a regular diet following surgery. Successful vocal rehabilitation using a tracheoesophageal prosthesis has been demonstrated in patients undergoing laryngotracheal separation.
TL;DR: The mechanisms controlling the processes of glandular secretion and transudation have been examined in relation to allergic and nonallergic rhinitis and the possible role of bacterial products has been explored.
Abstract: Over the past year there have continued to be advances in our understanding of the functions of the nasal mucosa and mucociliary system. In the area of mucosal blood flow, the roles of several peptide neurotransmitters in the regulation of mucosal circulation have been clarified. Ciliary function has been studied leading to a better understanding of the effects of classical and peptide neurotransmitters and prostaglandins on ciliary beating. The possible role of bacterial products on ciliary function has been explored as it relates to the etiology and progression of clinical sinusitis. Finally, the mechanisms controlling the processes of glandular secretion and transudation have been examined in relation to allergic and nonallergic rhinitis.
TL;DR: The expansion of the knowledge of normal physiology has served as the driving force behind studies of diagnostic and treatment effects, ie, efficacy, in speech therapy and rehabilitation.
Abstract: Research over the past 5 years, in speech therapy and rehabilitation can be classified into two major areas: 1) studies of normal anatomy and physiology of the upper aerodigestive tract during respiration, phonation, articulation, and deglutition; and 2) investigations of the efficacy of diagnostic and treatment procedures in the management of disorders in this physiology. Our understanding of normal physiology of the upper aerodigestive tract from birth through senescence serves as the foundation for understanding pathophysiology and for the development of effective treatment strategies. Therefore, the expansion of our knowledge of normal physiology has served as the driving force behind studies of diagnostic and treatment effects, ie, efficacy.
TL;DR: The evaluation of a child with a significant feeding disorder requires the expertise of a multidisciplinary team to allow an all-inclusive examination of the swallowing process and the development of a comprehensive treatment plan.
Abstract: The swallowing reflex undergoes an orderly maturation in concert with the physical development of the child. The pattern of muscular activity involved with the oral and pharyngeal phases of swallowing is the result of an individual strategy of swallowing, influenced by the anatomic relationships of the upper aerodigestive tract. Children with medical conditions that prevent the normal acquisition of oromotor skills are at risk for developing debilitating swallowing disorders. The evaluation of a child with a significant feeding disorder requires the expertise of a multidisciplinary team to allow an all-inclusive examination of the swallowing process and the development of a comprehensive treatment plan. Early identification of situations that may lead to swallowing disorders offers the opportunity to initiate treatment proactively in order to minimize the major debilitating defects that may develop.