Showing papers in "Ear, nose, & throat journal in 1994"

Long-term follow-up with the bone-anchored hearing aid: a review of the first 100 patients between 1977 and 1985

Abstract: Skin-penetrating implants have been used since 1977 for retention of Bone Anchored Hearing Aids, or BAHA. This paper analyzes the stability of the implants and the frequency of skin reactions in the first one hundred consecutive patients operated upon at Sahlgrens Hospital, Goteborg. The follow-up time varied between 8 and 16 years. Ninety percent of the implants were found to be stable. Five percent were explanted due to direct trauma. Another five percent lost integration but often after many years in use. Adverse skin reactions were seen, but 79% of the patients had no or one single episode of soft tissue reaction. A percutaneous coupling in the mastoid process will give rise to only minor clinical problems and could be considered as a simple, predictable and safe device.

Ear lobe keloids, surgical excision followed by radiation therapy: A 10- year experience

Abstract: 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 ...

Swallowing disorders in muscular diseases: functional assessment and indications of cricopharyngeal myotomy.

Abstract: Thirty-four patients with an identified muscular disease were referred to our department for assessment and treatment of swallowing difficulties Their ages ranged from 16 to 91 years (mean 59) The diagnoses were oculopharyngeal dystrophy in 17 patients, Steinert myotonic dystrophy in 6, mitochondrial myopathies 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, pharyngoesophageal manometry, videofibroscopy of the pharynx during swallowing Major pathological features found in the pharynx were decreased pharynx peristaltis and impaired UES relaxation Cricopharyngeal myotomy was performed in 11 myopathic patients (median follow-up 249 months), 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 perstaltis 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

A new method for intraoperative recurrent laryngeal nerve monitoring.

Abstract: The recurrent laryngeal nerve is at risk of iatrogenic injury during surgical procedures in which its anatomical location is exposed. Borrowing from biotechnology currently available for facial nerve monitoring, we have developed a method of electrophysiologically assessing the function of the recurrent laryngeal nerve during technically difficult neck surgeries. Electromyographic as well as nerve action potential recordings are monitored using the Xomed-Treace Nerve Integrity Monitor-2 (NIM-2). This method differs from those previously published in that it is much less cumbersome and time-consuming. The technique as well as an illustrative case are reported.

Review of Published Results for Endoscopic Sinus Surgery

Abstract: Chronic sinusitis is one of the more common chronic diseases in the United States. Over the past decade endoscopic sinus surgery (ESS) has become more common than ethmoidectomy and inferior meatal nasoantral windows. A review of the recent ESS literature, including 10 large series with a total of 1,713 patients, shows a 91% improvement rate. Subjectively, 63% of patients reported a very good result, 28% a good result, and 9% an unsatisfactory result. Twelve percent of patients required revision surgery. Major complications occurred in 1.6% of patients. Objective evaluation of the effectiveness of ESS, through the use of sinus CT, endoscopy, rhinometry, and olfactory testing, has shown mixed results.

Complications of endoscopic surgery.

Abstract: Since its introduction in the United States, endoscopic sinus surgery (ESS) has revolutionized our surgical approach to sinus disease . With the use of glass rod endoscopic visualization and specially-designed instrumentation, detailed dissections and removal of chronic disease while sparing uninvolved portions of the sinuses is now possible. With the advent of its popularity, so has risen the number and variety of complications associated with these procedures. These complications can be characterized as intranasal, periorbital/orbital, intracranial, vascular, and systemic. A clear understanding of the intricate sinus anatomy, adequate preparation and the experience learning curve will be emphasized as means of preventing complications. Two case reports from our experience serve to illustrate the potential problems encountered with ESS. Case 1: A 48-year-old woman complained of recurrent sinus infection and right frontal headaches for three years despite aggressive medical intervention. Computerized tomography (CT) revealed right anterior and posterior ethmoid and frontal recess disease . Intra-operatively thickened mucosa was removed from these areas. A 5mm perforation was made in the right lateral lamella of the lamina cribosa in the posterior ethmoid air cells, which produced a cerebrospinal fluid (CSF) leak. Intra-operative repair was performed using temporalis fascia tucked between bone and dura and middle turbinate mucosal flap to close the nasal side of the defect. Endoscopy at one month revealed the turbinate flap had retracted, but a well-mucosalized area over the fascial repair was present. There was no further CSF leak or sequelae. Case 2: . A 29-year-old man with cystic fibrosis was admitted to the hospital with pseudomonas aeruginosa pneumonia . Past medical history included multiple intranasal polypectomies and sinus procedures. Sinus CT revealed soft tissue filling the anterior and posteriorethmoid and maxillary sinuses. The middle turbinates were absent. Following ten days of intravenous antibiotics and aggressive pulmonary

Background and evolution of endoscopic sinus surgery

Abstract: Introduction According to Spiess,I anterior rhinoscopy was routinely used since 1868. From then on, there were numerous attempts to achieve and improve the view into the different meatis, clefts and cavities of the paranasal sinus system. Wertheim' builthis conchoscope,andZaufal,' ValentinI and others explored the Eustachian tube orifice with the help of a modified cystoscope. HirschmannandReichert' inspected the maxillary sinusendoscopically viaanalveolus. Inthatsame year, Hirschmann was able to endoscopically inspect fiveethmoidal sinuses after part of the middle turbinate had been resected. Inonecasewithchronic ethmoidalempyema, hewas able toidentifytheunderlying focusandclearitendoscopically. There was continuous technical improvement. Some authors managed to insert an endoscope through a trocar which was inserted into the maxillary sinus via the inferior nasal meatus. Despite numerous attempts, however, technical problems prevailed, prohibiting a widespread use of the technique. Zamiko in 1925 gives his impression on nasal endoscopy: \"It impresses me more as an interesting toy than as a necessary diagnostic tool. I knowof no results achieved by its use that couldnot have been achievedbyother, simpler methods.\" Zollnerstated in 1942 that: \"Althoughendoscopy wasinvented inGermany..., the nasalendoscopehasnotbeen accepted by a widecircleof our specialty.\" After the Second WorldWar, maxillarysinusendoscopygained the supportof individuals in a number of countries, although it still did not achievewide-spreadacceptance. Aslateas1956,Liischerwrote: \"A cystoscope-like antroscope can be introduced through the inferior nasal meatus that permits direct visualization of the maxillary sinus. Insomecases thismaymakea contribution.\" During this time period (1951-56) Hopkins made fundamental improvements in the optics of endoscopy. Although initially the maxillarysinus and the orificeof the Eustachian tube were the focus of diagnostic interest, endoscopy was soon extended to the other paranasal sinuses. At the beginning of my academic career my teacher, Prof. G. Hofer, advised me to study the normal as well as the pathological function of the upper airways. I conducted several experiments on: the influence of various hormones,

A contactless electromagnetic implantable middle ear device for sensorineural hearing loss.

Abstract: Following basic science experiments, improvement of precision micromechanics and electronics design, and development of different prototypes, a contactless electromagnetic hearing device has been s...

The evolution of functional endoscopic sinus surgery.

Abstract: When I started my ENT training in 1975 with Professor Messerklinger in Graz , as the junior member of the staff, I was assigned some ofthe more unpleasant tasks and some which were considered burdensome by more senior colleagues. Among other things, these included assisting Professor Messerklinger during his experimental work and taking motion pictures with a 16-mmcamera during endoscopic procedures in the nose . This \"honorable task\" was not regarded highly by the staff, since it usually extended substantially beyond official working hours. It did not take long, however, until I became fascinated by this experimental and surgical technique and the proceeding diagnostic approaches. Until this time the only methods ofwhich I was aware formanaging polypoid or chronic sinusitis were limited to a radical procedure, a \"simple\" polypectomy with snares, fenestration of the maxillary sinus in the inferior meatus, symptomatic drug therapy, or therapeutic nihilism. The endoscope now opened an entirely new world for me.' ? In several hundred of cases in which I was \"forced\" to operate the camera and the articulated arm connecting it to the endoscope, I was able to share in the experience of seeing massive changes in the maxillary and frontal sinuses resolved within a short period of time following mostly minor manipulations of the key sites in the lateral nasal wall. These were changes in the mucous membranes, from conditions that were described in the authoritative textbooks of the time as \" irreversible.\" At that time , while worldwide many still were trying to modify and improve radical surgical procedures with endon asal or external approaches, a technique was developed in Graz that rendered largely obsolete major radical procedures directed towards the larger paranasal sinuses. By 1972 Messerklinger had completed a manuscript for a work on endoscopic diagnosis of the nose, in which the surgical potential of the technique was mentioned only briefly. It was not before 1975, however, that it was placed with a publisher. Large and well-known publishing houses in Germany and Austria showed no interest in a manusc ript

Acute mastoiditis--revisited.

Abstract: The clinical course and causative organisms were studied in 18 patients with acute mastoiditis, 13 of whom (72%) had no previous history of middle ear disease. Their age ranged from 5 months to 21 years, and duration of middle ear symptoms immediately prior to admission ranged from 1 to 45 days (average 9.7 days). None had undergone a myringotomy prior to admission, while 13 (72%) had been receiving antibiotic treatment for acute otitis media. Three were admitted with intracranial complications. Bacteria were isolated in 10 of the 16 patients in whom samples were available for bacterial culture, and included Streptococcus pneumonia (2), Streptococcus pyogenes (2), Staphylococcus aureus (2), Staphlococcus coagulase negative (2), Klebsiella pneumonia (1), and Pseudomonas aeruginosa (1). Of the 17 patients treated by us, 11 received surgery. Acute otitis media, secretory otitis media, acute mastoiditis, subacute mastoiditis and masked mastoiditis create a continuum. Antibiotic treatment for acute otitis media cannot be considered as an absolute safeguard against acute mastoiditis. When antibiotics are prescribed for acute mastoiditis before culture result is available, an anti-staphylococcal agent should be included. At least some patients with acute mastoiditis develop a primary infection of the bony framework of the middle ear cleft. The prevalence of the intracranial complications in acute mastoiditis is still high and may appear soon after or concomitant with the first sign of acute mastioditis.

Effectiveness of azelastine nasal solution in seasonal allergic rhinitis.

Abstract: Azelastine is a novel antiallergy medication currently under investigation for the treatment of allergic rhinitis and asthma. Pharmacologic studies in laboratory animals and in vitro model systems ...

The bone-anchored hearing aid: principal design and audiometric results.

Abstract: The principle of the bone-anchored hearing aid (BAHA) is simple: sound vibrations are directly transmitted to the skull bone via a skin-penetrating titanium implant, and then are further transmitted to the cochlea, bypassing the middle ear The present paper summarized the audiometric results from 122 patients with an average follow-up time of 56 years When herein-suggested indications for treatment with the bone-anchored sound processor HC 300 are followed, the success rate is very high The improved quality of life reported by the patients is a combination of improved quality of sound (warble tone threshold, speech reception threshold, and discrimination in noise), improved comfort, and relief from middle ear and ear canal disease occasioned by conventional hearing aids

Carcinoma of the larynx: selective approach to the management of cervical lymphatics.

Abstract: Our experience with the surgical management of 472 patients with squamous cell carcinoma of the larynx suggests that more aggressive management of the N0 neck is effective in managing patients with laryngeal carcinoma. Only 3% of patients developed recurrence at the primary site. Patients with T3 and T4 carcinoma of the glottic larynx and all patients treated surgically for carcinoma of the supraglottic larynx should undergo routine elective neck dissection of the N0 neck. This is undertaken on the ipsilateral side for T3 and T4 glottic lesions. Selective neck dissection is undertaken bilaterally for patients with carcinoma of the supraglottic larynx irrespective of the side of the primary tumor. Distant metastasis develops as a sole site of recurrent disease in 9% of patients overall. Additionally, 14% of patients developed a second primary carcinoma sometime during the postoperative period. Strategies to prevent and manage these problems are the challenge for the future.

Modern imaging of paranasal sinuses and the role of limited sinus computerized tomography; considerations of time, cost and radiation

Abstract: The modern diagnostic radiology department is equipped with a variety of medical imaging systems that can be used for evaluation of diseases of the sinonasal cavities. Each has advantages and disadvantages. The imaging examinations of the paranasal sinuses may include conventional films, complex motion tomography, computed tomography (CT) and magnetic resonance imaging (MRI). The indications for these imaging methods are reviewed, along with a discussion on the role of imaging for endoscopic sinus surgery. A summary of CT anatomy relating to the ethmoidal sinuses and ostiomeatal complex is given, as is a review of the risk of radiation for radiologic sinus imaging.

Endoscopic resection of a sphenoethmoid osteoma: a case report

Abstract: Osteomas are slow-growing neoplasms of the paranasal sinuses. The previously used management of symptomatic osteomas has consisted of open excision utilizing one of several approaches. Endoscopic sinus surgery offers a convenient, safe and effective alternative to open procedures and can be safely performed in well-selected cases of ethmoid osteoma. The reduced morbidity, length of stay and superior cosmetic result are distinct advantages of this technique.

A Subjective Evaluation of a Nasal Dilator on Sleep & Snoring:

Abstract: A noninvasive external nasal dilator device was used by 20 subjects with a history of mild snoring in a 2 week open label study. The baseline assessments were obtained during the first week. Treatment effects were evaluated during the second week. Subjects were evaluated using: pre- and post-sleep questionnaires; Stanford Sleepiness Scales completed at breakfast, lunch and dinner; and post-sleep bed partner questionnaires. All twenty subjects completed the study. A significant number of subjects' scores improved for sleepiness. Mean scores for the subjective assessment for ease of breathing during sleep improved compared to baseline by 25.6%, snoring loudness improved by 34%, sleep quality improved by 21.8%, and the Stanford Sleepiness Scale revealed a 26% reduction in daytime sleepiness.

Long-term clinical results of the partially implantable piezoelectric middle ear implant

Abstract: The governmental 5-year project in Japan ended in 1983, and two types of Middle Ear Piezoelectric Implantable Hearing Devices (Middle Ear Implant, MEl) were developed: I) totally implantable; and 2) partially implantable. The partia lly implantable Middle Ear Implant (P-MEI) was tested since then in clinical trials. There are sixty-four P-MEI implanted cases at two institutions: Teikyo and Ehime University Hospitals .' Reports were submitted to the Ministry of Health and Welfare of Japan. The government issued approval to manufac ture the P-MEI in October, 1993. In May 1993, approva l was obtained to apply to the health insurance syste m to partially support the clinical use in the category of \"Highly Advanced Medical Technology.\" We are thus allowed now to expand the use of the P-MEI to several institutions, in addition to Teikyo and Ehime Universities. The clinical experiences acquired at other instituti ons will be used to support the application of P-MEI implantations for the total health insurance reimbursement , and even to the category of \"Medicine and Welfare.\" The P-MEI has two components, the internal and the external. The external component consists of a microphone, a battery, an amplifier and an induction coil. The internal component consis ts of an induction coil, a vibra tor (ceramic bimorph) anda vibrator-holder. Theelectromagnetic signals converted by the external component are transmi tted through the skin to the interna l coil, and then to drive the piezoelectric vibrator. The vibrator transmits the sound to the stapes head or to the stapes foot-plate . The sounds transmitted by the P-MEI appear to be of high fidelity.l\" Th is has been proved by physico-acous-

Parotidectomy: a ten year experience with fine needle aspiration and frozen section biopsy correlation.

Abstract: During the years 1980 through 1990, 247 patients underwent parotidectomy at our institution for the removal of primary parotid lesions. Charts were reviewed in an effort to document the distributio...

Malignant otitis externa in AIDS patients: case report and review of the literature

Abstract: Malignant otitis externa is a necrotizing infection of the external ear canal and surrounding soft tissue and bone, usually caused by Pseudomonas aeruginosa. The infection classically occurs in diabetic patients, however recently, several patients with the acquired immunodeficiency syndrome (AIDS) have been reported to have malignant otitis externa. A patient with AIDS who had malignant otitis externa with skull base osteomyelitis is presented and reported cases in patients with AIDS are reviewed. Predisposing factors include immunologic abnormalities (notably neutropenia), dermatitis, medications, neoplasm, and iatrogenic procedures, e.g., ear lavage. Treatment of malignant otitis externa has traditionally included anti-pseudomonal cephalosporins/penicillins and aminoglycosides for prolonged durations. Recently, ciprofloxacin has been shown to be effective as an oral regimen. With the increasing number of patients with AIDS being seen in the outpatient clinics, the diagnosis of malignant otitis externa should be considered in any patient with persistent ear pain or otorrhea who does not respond to conventional treatment for external otitis.

Implantation of electromagnetic ossicular replacement device.

Abstract: Semi-implantable hearing aids consisting of permanent middle ear implanted magnet, either partial ossicular replacement prostheses (PORP's) or total ossicular replacement prostheses (TORP's) driven...

Retropharyngeal Hematoma Secondary to Minor Blunt Head and Neck Trauma

Abstract: Retropharyngeal hematomas are relatively rare. They are clinically important because of the close proximity of the retropharyngeal space to the upper airway. Any swelling in the space may cause the...

The mayo clinic experience with the cochlear implant

Abstract: The implantation of a cochlear electronic prosthetic device is an acceptable means of improving the communication ability of pre- and postlingually deafened children and adults. A significant number of patients in this series are in the senior citizen age group. It has been beneficial in improving communication ability in selected profoundly deafened individuals. There has been a significant improvement in the cochlear electronic prosthetic device since the initial report of Djourno in 1957.

Intraductal tetracycline therapy for the treatment of chronic recurrent parotitis.

Abstract: Chronic recurrent parotitis (CRP) is recurrent parotid inflammation with non-obstructive sialectasis. Therapies which produce acinar atrophy or remove the acini are effective in treating CRP. Parotidectomy, tympanic neurectomy, duct ligation, and radiation therapy have either a low success rate or a high risk of morbidity. Intraductal antibiotic instillation has been proposed as a possible method of treatment. We hypothesized that the cytotoxic effects of tetracycline could produce acinar atrophy. A double-blind experiment of intraductal tetracycline instillation was performed in ten rabbits. Acinar atrophy and acute inflammation were found in 40% of the tetracycline treated glands; controls had a complete absence of these histologic changes. These results support the use of tetracycline instillation to produce acinar atrophy and therefore, intraductal tetracycline may be an effective, low-risk therapy for CRP. The clinical features of CRP will be reviewed and therapeutic implications discussed.

Post-operative care for functional endoscopic sinus surgery.

Abstract: In summary, functional endoscopic sinus surgery has become a widespread tool for the treatment of chronic sinus conditions. Within the office, under local anesthesia, aggressive post-operative care can greatly diminish the need to return to the operating room for revision endoscopic sinus surgery. Under local anesthesia, most limited procedures performed in the operating room can also be performed in the office. Effective post-operative care is critical to obtain the best possible results. Any and all means necessary must be taken to assure expert, detailed, and timely post-operative care.

Sound evaluation of partially implantable piezoelectric middle ear implant: comparative study of frequency responses.

Abstract: Two comparative studies were performed in six subjects using partially implantable middle ear implants (MEI). The sound quality was evaluated by speech discrimination tests and sound evaluation tests. In the first experiment, the performance of the output transducer of the MEI and an ear phone of a conventional hearing aid was compared. The MEI showed better results than the hearing aid in both the speech discrimination tests and sound quality rating. In the second experiment, four kinds of frequency responses for the external component of the MEI were compared. Sound quality evaluation in a wide frequency response with a peak at 4000 Hz were superior to those with the frequency response of the present MEI model. In conclusion, improvement of the external component in the frequency response can provide better performance of the MEI.

Simultaneous secure endoscopic sinus surgery and rhinoplasty.

Abstract: Surgical rhinology has undergone substantial technical advances in North America during the past several years . This is primarily the result of the intergration of splendid diagnostic and management techniques proposed by our European coIleagues during the past 25 years. The management of all aspects of functional rhinology and sinusology have evolved toward anatomicaIly specific diagnosis of obstructive pathologic conditions by the introduction of direct coron al computed tomography (CT) imaging and the concurrent ' development of precision endoscopic diagnostic and surgical techniques. 1,2.3.4.5 Thanks to integration of the methods pioneered by Drs . Messerklinger and Wigand in Austria and Germany in the 1970' s, American surgeons can now analyze nasal and sinus anatomic defects with road map clarity via the CT scans, then combine the best of endoscopic techniques with traditional rhinologic surgery to correct pathologic conditions with a specificity, precision, and security never before achievable .s-\" For decades , experienced preendoscopic rhinologic surgeons have combined management of funct ional nasal disorders with cosmetic rhinoplasty in patients with indications and motivation. Now that endoscopic technique has become firmly established as part of the functional rhinologic armamentarium, it is logical that endoscopic nasal and sinus surgery could be combined with rhinoplasty in those patients who have both functional and cosmeti c indication. In a series of 698 endoscopicaIly managed functional nasal and sinus surgical patients over the past seven years, I did perform rhinoplasty in 122 cases, or 19%, of the overaIl series. I have found no difficulty in comb ining the modalities of functional endoscopic and traditional rhinoplastic surgery in selected patients. The foIlowing is my experience with simultaneous endoscopic surgery and rhinoplasty.

The transmigration of endoscopic sinus surgery from Europe to the United States.

Abstract: Within the past decade, rhinology has witnessed a dramatic rebirth both in the United States and abroad. No other area of otolaryngology has experienced so much renewed interest. This rediscovery of the nose and paranasal sinuses has been accompanied by a dramatic increase in publications and post-graduate courses addressing the medical and surgical treatment of rhinologic disorders. Central to these developments has been the availability of nasal telescopes. The illumination and optical resolution of these telescopes have provided rhinologists with the ability to define the anatomy of the lateral nasal wall and objectively evaluate the nasal cavity and the paranasal sinuses. The now widespread use of these telescopes has further advanced our ability to care for patients with sinonasal disease. In 190I, when Hirshman performed the first endoscopic sinonasal examination with a modified cystoscope, the Caldwe ll-Luc operation was gaining popularity as the definitive approach in the surgica l management of chronic maxillary sinusitis. At this time and for some time after , surgeons felt the mucosa within the maxillary and other sinuses was irreversibly diseased and they therefore developed radical surgical approaches directed towards its removal. Soon telescopes were developed specifically for the examination ofthe nose, and the technique of sinuscopy was advocated by Maltz, a New York rhinologist. Maltz felt that, \"it was only a natural course of events that the observant rhinologist would take advantage of an electrical-optical instrument for his own specialty.\"! It was Professor Messerklinger in Graz who took advan tage of the nasal telescopes to study the anatomy of the

Allergic fungal sinusitis with intracranial extension and frontal lobe symptoms: a case report.

Abstract: This is the first report of AFS which caused frontal lobe symptomatology and which resolved with surgical therapy. The surgical approach used provided excellent exposure and the sinuses could be ex...

Localized amyloidosis of the nasopharynx

Abstract: A case of localized amyloidosis of the nasopharynx is presented. This is only the seventh case report of nasopharyngeal amyloidosis to the best of our knowledge. Though rare, this disease should be diagnosed early and properly treated with surgery. All patients of localized disease should be followed up for any evidence of systemic amyloidosis.