Showing papers in "Current Opinion in Otolaryngology & Head and Neck Surgery in 2002"
TL;DR: The role of voice therapy in male-to-female transsexuals encompasses perceptual and acoustic analysis of voice characteristics and gathering of case history, which demonstrates that these characteristics correlate—albeit in varying degrees—with perceptions of femininity.
Abstract: The role of voice therapy in male-to-female transsexuals encompasses perceptual and acoustic analysis of voice characteristics and gathering of case history. The overall aim of therapy is to assist the male-to-female transsexual to achieve congruency between their gender identity and their presentation in the female role. Therapy goals have traditionally relied on varying empirical reports of gender differences in voice. Fundamental frequency (the acoustic correlate of pitch) is universally accepted as the voice feature that distinguishes males from females. However, increase in mean fundamental frequency to within the female range does not necessarily result in listener's perceptions of the speaker as female. Current research examines the voice characteristics that contribute to perceptions of gender, such as mean speaking fundamental frequency, the upper limit and lower limits of speaking fundamental frequency, intonation, resonance, and voice quality. This research demonstrates that these characteristics correlate—albeit in varying degrees—with perceptions of femininity.
45 citations
TL;DR: The use of radiotherapy for the treatment of patients with benign head and neck neoplasms should be recommended with caution, and complications of such treatments should be documented in the literature when they arise.
Abstract: Ionizing radiation is an established curative therapeutic modality in the management of neoplasms. However, it is well recognized that radiation is also carcinogenic to bone and soft tissues. In the head and neck, radiation-induced tumors are uncommon despite the large numbers of patients treated by primary or adjunctive radiotherapy. However, with patients living longer, the risk of radiation inducing a tumor in previously irradiated areas is increasingly possible. Because of the case reports and the increasing numbers of patients who are surviving many years, clinicians must be conscious of changes in patients treated with radiation, and may suggest a thorough work-up to exclude a new tumor. The possibility of a second squamous cell carcinoma tumor arising after several years in a previously irradiated squamous cell carcinoma site, such as the larynx, must be considered a metachronous carcinoma not related to previous irradiation. The use of radiotherapy for the treatment of patients with benign head and neck neoplasms should be recommended with caution, and complications of such treatments should be documented in the literature when they arise.
22 citations
TL;DR: This review integrates current research on assessment, management options and respective outcomes, and prognostic considerations into the existing knowledge on parotid carcinoma into a properly validated prognostic index summarizing the weighted contributions of each prognostic factor in one patient, improving prognostic accuracy.
Abstract: This review integrates current research on assessment, management options and respective outcomes, and prognostic considerations into the existing knowledge on parotid carcinoma. Standard management remains a complete resection, with sacrifice of facial nerve branches only for obvious neural invasio
20 citations
TL;DR: The literature published over the past year addresses development of new tests, procedures to improve efficiency, sensitivity, and ecologic validity of speech perception tests, and research on the effects of lexical factors in speech recognition.
Abstract: Tests of speech perception abilities are used to evaluate and monitor the effects of hearing loss on communicative abilities, to evaluate the effectiveness of hearing aids and implantable aids, and to assess auditory processing. The literature published over the past year addresses (1) development o
16 citations
TL;DR: Development during the early postnatal period likely results from maturation of relatively low-level neural processing, and the final stages of auditory development depend on the m maturity of higher-level processes such as selective attention.
Abstract: Infants come into the world prepared to process and respond to sound. However, at birth their hearing is immature in several ways. Some aspects of hearing such as frequency and temporal resolution mature by 6 months postnatal age. Other aspects of hearing such as absolute sensitivity, intensity resolution, and complex sound processing continue to develop throughout infancy and well into childhood. Development during the early postnatal period likely results from maturation of relatively low-level neural processing. The final stages of auditory development depend on the maturation of higher-level processes such as selective attention.
15 citations
TL;DR: P piercing in the head and neck region has gained increasing popularity as an expression of body art and there has been an increasing number of published reports on the complications related to piercing.
Abstract: Body piercing in the head and neck region is an emerging practice that has gained increasing popularity as an expression of body art. The primary motivation of piercing in the head and neck is based predominantly on aesthetics. Piercing is generally an unregulated practice occurring in a multitude of diverse settings and is usually performed by unlicensed individuals. Available data on the extent and prevalence are limited, but there has been an increasing number of published reports on the complications related to piercing that range from damage to teeth and gingival tissues to disease transmission, potentially life-threatening infections, hemorrhage, and infective endocarditis.
14 citations
TL;DR: The pathogenesis of chronic rhinosinusitis remains poorly understood and it is still unclear whether bone around the sinuses acts as an innocent bystander becoming secondarily involved in the inflammatory process or whether bone plays a more active role in propagating inflammation.
Abstract: The pathogenesis of chronic rhinosinusitis remains poorly understood. The mucosal changes associated with this inflammatory disease have been well studied and described but the underlying bony involvement remains poorly defined. Osteitis and osteomyelitis are terms describing the clinical, pathologic, and radiographic appearance of bone involvement, but no consensus exists regarding the most appropriate terminology. It is still unclear whether bone around the sinuses acts as an innocent bystander becoming secondarily involved in the inflammatory process or whether bone plays a more active role in propagating inflammation.
13 citations
TL;DR: The principles of modern treatment of benign lesions of the vocal folds are summarized and the major advances over the last 2 years are highlighted.
Abstract: The treatment of benign lesions of the vocal folds has undergone significant advances over the last 20 years. The widespread use of laryngovideostroboscopy has refined our diagnosis of these lesions. Concurrent awareness of vocal fold physiology has led to surgical techniques that attempt to minimiz
12 citations
TL;DR: Gene therapy has a potential for localized and long-term expression of growth factors and modulators are agents that influence the wound healing mechanism by creating a growth factor environment that allows optimal wound healing.
Abstract: Wound healing is a complex coordinated physiologic process involving various cytokines and growth factors that exert their influence through autocrine and paracrine pathways within the site of injury and repair. Cytokines and growth factors are polypeptide regulatory molecules that are secreted by different cell lines and are essential for normal wound healing for host defense. Conversely, they are also responsible for pathologic wound healing (abnormal scar formation and nonhealing). Modulators (eg, B-chain dimer platelet derived growth factor) are agents that influence the wound healing mechanism by creating a growth factor environment that allows optimal wound healing. The recent advances in genetic research have opened a new front in the management of chronic, nonhealing wounds. Gene therapy has a potential for localized and long-term expression of growth factors.
11 citations
TL;DR: New applications of tissue expansion in head and neck reconstruction include development of self-expanding implants, use of growth factors and cytokines to improve the outcome of tissue Expansion, and application of bone distraction to defects of the midface and mandible.
Abstract: Reconstruction of defects following significant facial trauma or ablative surgery for head and neck cancers continues to be a significant challenge to the reconstructive surgeon. A variety of local, regional, and free tissue transfer techniques can be used to affect an outcome that is cosmetically and functionally acceptable. Unfortunately, the quality and quantity of tissue available for extensive facial reconstruction is often limited. The techniques of tissue expansion have been used for many years to expand normal skin adjacent to the site of the defect for use in scalp and facial reconstruction. New applications of tissue expansion in head and neck reconstruction include development of self-expanding implants, use of growth factors and cytokines to improve the outcome of tissue expansion, and application of bone distraction to defects of the midface and mandible.
10 citations
TL;DR: Research is being done to investigate the potential use of magnetic resonance imaging to evaluate velopharyngeal function and the use of continuous positive airway pressure is currently being studied as a potential method to strengthen the velum through resistance training.
Abstract: Velopharyngeal dysfunction can occur due to anatomic defects, physiologic causes, and even mislearning of speech. Regardless of the cause, velopharyngeal dysfunction can affect the quality and intelligibility of speech by causing hypernasality, nasal air emission, weak or omitted consonants, short utterance length, and compensatory or obligatory speech errors. Traditionally, the evaluation of velopharyngeal function has included a perceptual evaluation, nasometry, pressure/flow measures, videofluoroscopy, and nasopharyngoscopy. Currently, research is being done to investigate the potential use of magnetic resonance imaging to evaluate velopharyngeal function. The findings from the evaluation of velopharyngeal dysfunction are considered in determining the appropriate course of treatment. Surgical treatment historically has included augmentation procedures, the superiorly based pharyngeal flap, or the sphincteroplasty procedure. There is current interest in the use of a palatoplasty, such as the Furlow technique, as a secondary procedure. Speech therapy is an appropriate method of treatment for patients with poor velopharyngeal function in selected cases. The use of continuous positive airway pressure is currently being studied as a potential method to strengthen the velum through resistance training. Curr Opin Otolaryngol Head Neck Surg 2002,
TL;DR: The surgical treatment of EER is evolving and may be considered in selected patients and recent evidence supports the use of proton pump inhibitor therapy for a period of 3 to 6 months.
Abstract: Extraesophageal reflux (EER) has assumed a prominent role in the differential diagnosis of many laryngeal and other extraesophageal disorders. A knowledge of the scope of the problem and the particular complexities involved the diagnosis of EER facilitates sound clinical judgment. A presumptive diagnosis of EER is based on a combination of historical information and laryngeal findings. The presumptive diagnosis can be confirmed with ambulatory pH monitoring using a hypopharyngeal probe or an empiric trial of proton pump inhibitors. Recent evidence supports the use of proton pump inhibitor therapy for a period of 3 to 6 months. The surgical treatment of EER is evolving and may be considered in selected patients.
TL;DR: The underlying surgical theme is to interrupt the circumferential scar by inserting new tissue in a manner similar to the techniques described for construction of the primary stoma to treat established tracheostomal stenosis.
Abstract: Tracheostomal stenosis is reported to be present in 4 to 44% of patients who have had total laryngectomy. Numerous contributory factors to this stenosis have been cited. This paper reviews the evidence surrounding these factors. Surgical techniques that use a skin flap inserted into the circumferenc
TL;DR: Surgical techniques used to treat unilateral vocal fold paralysis are capable of restoring a more normal glottic configuration and often restore normal laryngeal physiology.
Abstract: The evaluation and management of unilateral and bilateral vocal fold paralysis has long been a subject of controversy as new techniques for diagnosis as well as surgical management have evolved. Although most agree upon the phylogenesis of the laryngeal apparatus as a protective sphincter for the lower airways, there still lies a thirst for knowledge regarding laryngeal physiology and pathology. As the effort is continued to try and unravel the mysteries of laryngeal innervation, neurophysiology, and glottic configuration in unilateral and bilateral vocal fold paralysis, the techniques for surgical management are evolving. This article will focus on some of the current theories affecting glottic configuration and how they relate to surgical management. Surgical techniques used to treat unilateral vocal fold paralysis are capable of restoring a more normal glottic configuration and often restore normal laryngeal physiology. Bilateral vocal fold paralysis remains a difficult entity to treat without affecting glottic closure and phonation. Improving upon existing techniques such as laryngeal reinnervation and pacing is the future for treatment of vocal fold paralysis.
TL;DR: Operations on the nose and sinuses result in the largest number of malpractice lawsuits and the highest indemnity payouts for otolaryngologic procedures.
Abstract: Operations on the nose and sinuses result in the largest number of malpractice lawsuits and the highest indemnity payouts for otolaryngologic procedures. The advent of CT scanning and endoscopic technology has increased the number of such operations performed. Directly related to this has been an in
TL;DR: Improvements in technology with digital imaging have brought it closer to clinical application, as it may have advantages over videostroboscopic in evaluating aperiodic vibratory patterns, visualization of onset and decay of vocalization, and in cases of diplo-or triplophonia.
Abstract: Proper use of laryngeal videostroboscopy aids the otolaryngologist in appreciating vocal fold vibratory patterns and phonatory characteristics. A laryngology practice is incomplete without the application of the stroboscope in diagnosing and tracking treatment progression in patients with vocal comp
TL;DR: The past decade has witnessed a revolution in the understanding and treatment of vascular lesions, marked by more advanced laser therapy, earlier intervention, and an increased sensitivity to the psychosocial dynamics of the disease.
Abstract: Congenital vascular anomalies have been the subject of much controversy and confusion over the years. Since 1982, hemangiomas and vascular malformations have been recognized as distinct diseases exhibiting unique properties and behavior that demand an appropriately tailored treatment plan. This article will briefly review the characteristics of these vascular anomalies, including epidemiology, classification, and clinical presentation, and will then focus on the current therapeutic options available. The past decade has witnessed a revolution in the understanding and treatment of vascular lesions, marked by more advanced laser therapy, earlier intervention, and an increased sensitivity to the psychosocial dynamics of the disease.
TL;DR: Survey of the literature from a recent 12-month period found that patients with chronic sinusitis have typical and predictable patterns of headache and facial pain, and there is evidence that ostial obstruction of the frontal sinus can cause frontal headache.
Abstract: Associations between facial pain, headache, sinusitis, and nasal anatomical abnormalities have long been of clinical interest, but there are very few clinical studies on those subjects. According to survey of the literature from a recent 12-month period, studies have found that patients with chronic sinusitis have typical and predictable patterns of headache and facial pain. After surgical treatment of chronic sinusitis, facial pain and headache tended to improve after 2 months, but at 1 year after surgery many patients had developed recurrent pain. There is evidence that ostial obstruction of the frontal sinus can cause frontal headache. Theoretically, the pathophysiologic mechanism of pain from ostial obstruction could also explain the pain associated with some anatomical abnormalities and mucosal contact points. In a large series, 10% of patients seen in a nasal clinic had neurologic origins of facial pain with no evidence of sinusitis. There have been isolated reports of endoscopic sinus surgery being successful for patients with limited sinus disease and facial pain, but many senior surgeons advise significant caution when considering surgery in those patients because of high long-term failure rates and the eventual identification of other causes of the pain in many cases.
TL;DR: Five flaps recently advocated in the literature for head and neck reconstruction after cancer ablation are reviewed: the buccal flap, the nasolabial/melolabIAL flap,The submental and platysma flaps, and the latissimus dorsi myocutaneous flap.
Abstract: Although the current trend in head and neck reconstruction is the use of free tissue transfer, local and regional flaps can still provide effective donor tissue. The recent literature has focused on the use of locoregional and regional flaps used for oral cavity and oropharynx reconstruction. Additi
TL;DR: It is conclusive that standard auditory brain stem response measures are inadequate for small tumor detection, but it is premature to conclude that other new auditory brainstem response measures cannot be used to screen effectively and play an important role in acoustic tumor diagnosis.
Abstract: In the past year, there was a lack of published papers on using auditory brainstem responses for acoustic tumor diagnosis. This lack is probably caused by the large number of published studies demonstrating that standard auditory brainstem response measures frequently fail to detect small (≤ 1 cm) a
TL;DR: The role of the in vitro assay is reviewed and a desensitization protocol that can be maintained as a long-term treatment without adverse side effects is presented.
Abstract: The full clinical picture of aspirin intolerance, the Sampter triad, is associated with nasal polyposis, clinical sensitivity to most nonsteroidal anti-inflammatory drugs, and intrinsic bronchial asthma. The triad can be incomplete, however, and nasal polyposis can be the first clinical symptom of aspirin sensitivity. The recurrence rate of nasal polyps after surgical therapy is high in these patients but can be reduced by a long-term desensitization therapy with oral aspirin. Although the exact mechanisms of aspirin intolerance as well as those of desensitization remain obscure, an in vitro assay on eicosanoid metabolism has been proven to be helpful in diagnosis and treatment as it correlates well to the individual severity of clinical symptoms. It can be used to unveil aspirin sensitivity in cases of an incomplete clinical triad and to monitor the effectiveness of desensitization over time. This paper reviews the role of the in vitro assay and presents a desensitization protocol that can be maintained as a long-term treatment without adverse side effects. The risk of recurrence if the treatment is discontinued is also discussed.
TL;DR: The microdebrider may not lessen complications and in some circumstances may be responsible for them, so the surgeon should be observant to prevent complications at all times.
Abstract: Despite our best efforts, complications still occur during and after endoscopic sinus surgery. The addition of the microdebrider as a surgical tool was originally felt to lessen the risks and complications because it provided real-time suction with a cutting instrument on the side, not the front. However, complications are still occurring despite the use of this instrument. Essentially, it appears the microdebrider may not lessen complications and in some circumstances may be responsible for them. Whatever instrumentation is used, the surgeon should be observant to prevent complications at all times.
TL;DR: Investigation has revealed that in the subset of patients with aspirin sensitivity, arachidonic acid metabolism is shunted into the highly inflammatory leukotriene pathway, which creates an uncontrollable inflammatory response.
Abstract: Scientific literature has been reviewed to determine whether aspirin sensitivity has a role in the generation of nasal polyps. Much of the focus of research and clinical management of respiratory disease has been on the inflammatory processes. Variations on the theme of inflammation are manifested in a variety of clinical conditions that overlap considerably. Aspirin sensitivity, nasal polyposis, and asthma are examples of these conditions. Investigation has revealed that in the subset of patients with aspirin sensitivity, arachidonic acid metabolism is shunted into the highly inflammatory leukotriene pathway, which creates an uncontrollable inflammatory response. This highly upregulated situation (a veritable gasoline-on-the-fire) may, in the presence of genetic predisposition, lead to the formation of nasal polyps.
TL;DR: Osteoradionecrosis may lead to chronic otomastoiditis, meningitis, lateral sinus thrombosis, and intracranial abscess and requires long-term therapy.
Abstract: Osteoradionecrosis of the temporal bone is a rare but potentially serious complication of radiation therapy in the head and neck. It is most commonly associated with treatment of nasopharyngeal carcinoma but is also found after radiation therapy for lesions of the oropharynx, parotid, paranasal sinuses, and jugular foramen. Typically, osteoradionecrosis is a late complication presenting many years after radiation insult. Secondary infection promotes further bone necrosis and accounts for the persistent and indolent nature of the disease. Osteoradionecrosis may lead to chronic otomastoiditis, meningitis, lateral sinus thrombosis, and intracranial abscess. Evaluation of the patient with otologic complaints and a history of locoregional radiation involves a combination of history, physical examination, and radiographic imaging. Treatment includes a combination of medical and surgical interventions and typically requires long-term therapy. The role of hyperbaric oxygen has not been adequately defined.
TL;DR: The most frequent sequelae are related to radiation therapy, but occasional problems are encountered due to the cytotoxic effects of chemotherapy, and molecular cytogenetics now plays a crucial role in the diagnosis and management of pediatric rhabdomyosarcoma.
Abstract: Rhabdomyosarcoma is the most common soft-tissue sarcoma of childhood and adolescence, and just over one third of pediatric rhabdomyosarcoma occurs in the head and neck region. Over the past 25 years, the Intergroup Rhabdomyosarcoma Study Group protocols have increased 5-year survival rate from 55 to 71%. Although the Intergroup Rhabdomyosarcoma Study Group approach advocates primary chemotherapy and adjuvant radiation therapy, surgery still plays an important role in the multidisciplinary management of pediatric rhabdomyosarcoma. As survival rates have improved, more long-term, treatment-associated complications have been identified. The most frequent sequelae are related to radiation therapy, but occasional problems are encountered due to the cytotoxic effects of chemotherapy. Finally, molecular cytogenetics now plays a crucial role in the diagnosis and management of pediatric rhabdomyosarcoma.
TL;DR: The development of thin, high-resolution, transnasal esophagoscopes ushers in a new era of office-based endoscopy, and returns the field of esphagoscopy to the otolaryngologist.
Abstract: The development of thin, high-resolution, transnasal esophagoscopes ushers in a new era of office-based endoscopy. The bronchoesophagologist can now perform comprehensive in-office esophageal examinations without the need for intravenous sedation or anesthesia. Although there is a high prevalence of reflux and swallowing disorders in otolaryngologic practice, most otolaryngologists do not incorporate esophagoscopy into their diagnostic armamentarium. The introduction of these new endoscopes returns the field of esophagoscopy to the otolaryngologist. In my practice, transnasal esophagoscopy has replaced radiographic imaging of the esophagus in patients with reflux, globus, and dysphagia.
TL;DR: Recent advances in diagnosis and management of individual episodes of streptococcal pharyngitis are reviewed, the clinical approach to the strePTococcal carrier, and the role of tonsillectomy in the management of recurrent pharygotonsillitis are discussed.
Abstract: The group A Streptococcus is the most common bacterial cause of pharyngitis. Although most cases of streptococcal pharyngitis are managed by primary care providers, the otolaryngologist is often consulted to assist in the management of patients with persistent sore throat, chronic streptococcal carriage, recurrent streptococcal pharyngitis, or complications of streptococcal infection. This article reviews recent advances in diagnosis and management of individual episodes of streptococcal pharyngitis, the clinical approach to the streptococcal carrier, and the role of tonsillectomy in the management of recurrent pharyngotonsillitis. Curr Opin Otolaryngol
TL;DR: The authors conclude that although traditional complete tonsillectomy continues to be the procedure of choice for recurrent infections or chronic tonsillitis, partial supracapsular tonsilLECTomy is a viable alternative for obstructive disease, offering lower postoperative morbidity with equal efficacy.
Abstract: The surgical approaches and techniques for tonsillar disease have evolved over the years. Complete subcapsular tonsillectomy has traditionally been the procedure of choice for all tonsillar surgery indications. Although new surgical modalities such as ultrasonic-activated scalpel and ionized field ablation appear to decrease the postoperative pain of tonsillectomy, patients continue to have a significant incidence of postoperative hemorrhage. Subsequently, supracapsular partial tonsillectomy has been used for patients with obstructive tonsillar hypertrophy with efficacy equal to that of complete subcapsular tonsillectomy. Partial tonsillectomy seems to offer a less painful postoperative course and a decrease in the complications common after complete tonsillectomy. Although originally the CO2 laser was used for surgical ablation of the tonsils, ionized field ablation and radiofrequency tissue ablation also have very promising results. The authors conclude that although traditional complete tonsillectomy continues to be the procedure of choice for recurrent infections or chronic tonsillitis, partial supracapsular tonsillectomy is a viable alternative for obstructive disease, offering lower postoperative morbidity with equal efficacy.
TL;DR: If telemedicine images can safely determine the difference between a normal and abnormal tympanic membrane, patients with an abnormal image can be triaged for a live visit and reimbursement could follow for these portions of the examination in a store-and-forward format.
Abstract: The largest obstacle to telemedicine deployment is the lack of well controlled studies validating the safety and efficacy of this type of physician-patient encounter. These studies will eventually lead to clinical acceptance and the codes for reimbursement. The second largest obstacle for telemedicine is validating the change from live, three-dimensional viewing to a two-dimensional image on a monitor. In otolaryngology, video protocols need to be standardized for flexible nasopharyngolaryngoscopy and laryngostroboscopy. Because these are already commonly viewed on a two-dimensional monitor in the live setting, reimbursement could follow for these portions of the examination in a store-and-forward format. Viewing images of the tympanic membrane will be more challenging because the resolution of binocular microscopy will be difficult to duplicate. However, if telemedicine images can safely determine the difference between a normal and abnormal tympanic membrane, patients with an abnormal image can be triaged for a live visit.