Showing papers in "Journal of Otolaryngology in 1990"

Tinnitus. I: Auditory mechanisms: a model for tinnitus and hearing impairment.

Abstract: A model is proposed for tinnitus and sensorineural hearing loss involving cochlear pathology. As tinnitus is defined as a cortical perception of sound in the absence of an appropriate external stimulus it must result from a generator in the auditory system which undergoes extensive auditory processing before it is perceived. The concept of spatial nonlinearity in the cochlea is presented as a cause of tinnitus generation controlled by the efferents. Various clinical presentations of tinnitus and the way in which they respond to changes in the environment are discussed with respect to this control mechanism. The concept of auditory retraining as part of the habituation process, and interaction with the prefrontal cortex and limbic system is presented as a central model which emphasizes the importance of the emotional significance and meaning of tinnitus.

The ideal tissue adhesive in facial plastic and reconstructive surgery.

Abstract: In this paper we have reviewed cutaneous wound closure in facial plastic and reconstructive surgery using two different tissue adhesives: (1) Fibrin glue (Tisseel), and (2) N-butyl-2-Cyanoacrylate (Histoacryl Blue). Fibrin glue was used on 23 patients: eight lower blepharoplasties, eight hemi-facelifts, five mid browlifts and seven facial reconstructive procedures. Histoacryl glue was used in 108 blepharoplasty incisions, 30 facelift incisions, 21 submental incisions for liposuction, and 19 local flaps for facial reconstructive procedures. Comparison was made of the adequacy of bonding, cosmetic result of the incision, ease of use and cost. The results of our experience with tissue adhesives indicate the use of fibrin glue mainly on the undersurface of flaps. We think histoacryl glue is the ideal tissue adhesive for surface cutaneous wound closure in regards to safety, reliability, tensile strength and cost effectiveness.

An epidemiological perspective of the causes of hearing loss among industrial workers.

Abstract: An etiologic paradigm of hearing loss for industrial workers is introduced as having two major components, one being occupational and the other extra-occupational. The extra-occupational factors include age, noise exposure outside the work place, trauma, ear disease and ototoxic drugs. The work-related factors include occupational noise, whole body vibration, work-related diseases and toxic exposures. Within this framework, a review of the epidemiology of hearing loss examines the possible relationships between hearing loss and these factors.

MRI and neck metastases: a clinical, radiological, pathological correlative study.

Abstract: In a previous report CT was shown to have no advantage over physical examination in the detection of metastatic neck disease. Therefore, a study was undertaken to evaluate whether MRI would show superiority to the CT in the diagnosis of neck nodes. A series of 35 patients with various head and neck tumors were evaluated clinically, radiographically and pathologically. Eight patients were excluded from the study because of various problems involving the MRI. Therefore, 27 patients with 30 neck dissections were analyzed. There was little advantage of MRI over clinical examination in the detection of metastatic neck disease. The present size criterion for the diagnosis of occult malignant nodes is not reliable. The soft tissue contrast resolution reported by MRI is inadequate to detect minimal morphological changes in lymph nodes involved by metastases, and MRI is difficult in patients who have airway or foodway obstruction.

Wound infection in head and neck surgery: prophylaxis, etiology and management.

Abstract: Antibiotic prophylaxis in clean-contaminated major head and neck surgery is mandatory Many prospective, randomized and double blind studies have established the efficacy of antibiotics against a large spectrum of bacteria Prophylaxis should be initiated prior to surgery, and prolonged administration of antibiotics beyond the first 24 hours following surgery is unnecessary The experience of the Eye and Ear Hospital of Pittsburgh is presented along with other studies concerning the effect of different regimens on wound outcome The pathophysiology, bacteriology, evaluation and treatment of a postoperative infection are discussed, emphasizing the importance of gentle tissue handling and meticulous surgical technique

Audiovestibular functions in rheumatoid arthritis.

Abstract: Audiologic, middle ear impedance and vestibular function tests were administered to 25 patients with classical or definite rheumatoid arthritis and 25 normal control subjects of 30 to 50 years age group. Any possible influence of other common causes of hearing loss was avoided by carefully selecting the patients. Six patients had mild sensorineural hearing loss and another had bilateral mixed hearing loss. Results of tone decay test, speech reception threshold, speech discrimination score and short increment sensitivity index tests suggested cochlear pathology being responsible for the sensorineural hearing loss. There was no statistical correlation between hearing loss or otoadmittance abnormality and duration or activity of rheumatoid arthritis or positivity of rheumatoid factor. Electronystagmographic recording of saccades and bithermal caloric induced nystagmus revealed no significant abnormality.

Psychosocial adjustment after laryngectomy: a review of the literature.

Abstract: This paper reviews the literature on the psychosocial outcomes of a laryngectomy. The largest group of studies focuses on factors which contribute to esophageal speech acquisition, one important measure of rehabilitation outcome. Recently, the technique of tracheoesophageal puncture (TEP) has implicated new directions for studying post-surgical speech recovery. Other studies have defined post-surgical adjustment in terms of quality of life or psychological state. Taken together, the research suggests that long-term adjustment for the laryngectomee is shaped by multiple variables, which include: (a) extent of surgery; (b) preoperative visits by a fellow laryngectomee; (c) illness variables; (d) changes in lifestyle following surgery; (e) patient satisfaction with social support; (f) chronic pain, and (g) ability to communicate. We conclude that psychosocial variables contribute substantially to successful post-surgical adjustment.

The extra-auditory effects of noise and annoyance: an overview of research.

Abstract: This paper is an overview of research on the extra-auditory effects of exposure to noise. The aim is to demonstrate the pervasiveness of the effects in support of noise reduction at the source for reasons that go well beyond hearing conservation. The areas discussed are performance effects, including vigilance, selective attention, sensory-motor behavior and memory; physical effects, including cardiovascular disease and sleep-related disorders, and annoyance, with special reference to psychological outcomes. The results show that high levels of noise are particularly disruptive for dual-task paradigms, requiring attention sharing, and sequential responding, involving speed and accuracy. Both the level and the type of noise background affect memory, severely limiting the number of stimulus dimensions that may be simultaneously encoded and retained. Community noise with a preponderance of heavy traffic and aircraft flyovers affects sleep, resulting in changes in the normal pattern of EEG fluctuations, and increases in movement and heart rate. Lastly, noise causes annoyance, with its own set of by-products: job dissatisfaction, irritability and anxiety over potential risk.

Vascular complication of neck space infection: case report and literature review.

Abstract: Antibiotic therapy has changed the face of medicine radically, and physicians no longer have the empirical knowledge of bacterial infections that they once had. Consequently, the diagnosis and management of complicated infections presents a significant challenge to today's otolaryngologists. We present a rare complication, even before the advent of antibiotics, of a head and neck infection: a carotid artery pseudoaneurysm resulting from peritonsillar abscess. The diagnosis and management of this problem is discussed and the pertinent literature reviewed.

Plasmacytomas of the larynx.

Abstract: Laryngeal plasmacytomas are rare neoplasms that present difficulties in diagnosis, both clinically and pathologically. Lymph node metastases are found in up to 25% of patients but do not alter the prognosis. Systemic dissemination occurs in 17-35% of cases and significantly shortens survival. Radiotherapy plays a major role in the primary treatment of these lesions, but the optimum dose is not yet known. Chemotherapy is reserved for locally advanced or disseminated disease. Survival at five years is approximately 50%, but the known risk of late recurrences or disseminated disease makes life-long follow-up mandatory.

A double-blind controlled study of the efficacy of cimetidine in the treatment of the cervical symptoms of gastroesophageal reflux

Abstract: Globus pharyngeus and post-nasal drip are common patient complaints encountered in general otolaryngologic practice. Although these complaints have been traditionally ascribed to stress and sinusitis respectively, recently it has been suggested that they are secondary to gastroesophageal reflux, either by a direct effect on the pharynx and posterior larynx or by referred sensation along vagal pathways from the lower esophagus. This reflux could alter the motor tone of the laryngoesophagus and contribute to the pathogenesis of dysphonias. If globus and post-nasal drip are secondary to gastroesophageal reflux, then reduction of stomach pH should reduce the frequency and severity of these complaints. To test these hypotheses in a clinical setting, a large population of patients with vocal disorders was analyzed for the incidence of these complaints. Twenty healthy patients with globus and/or postnasal drip were then entered in a double-blind random placebo-controlled study to assay the efficacy of cimetidine in treating these complaints. No significant difference was found between cimetidine and placebo.

Aggressive osteoblastoma of the temporal bone: a case report.

Abstract: Osteoblastoma is a rare tumor of bone which is usually present in the long bones and vertebrae. Occasionally, they present in the head and neck, and only very rarely will they have a locally aggressive clinical course. We report a case of the aggressive subtype of benign osteoblastoma and its histologic and radiologic presentation.

Radioprotective effect of free radical scavenging enzymes.

Abstract: Ionizing radiation is an important treatment modality in the management of head and neck squamous cell carcinoma. The superoxide (O2-) and hydroxyl (OH.) radicals produced from oxygen and the radio-hydrolysis of water are responsible for most of the DNA and lipid membrane injury caused by radiotherapy. Superoxide dismutase (SOD) and catalase (CAT) are intracellular enzymes that scavenge the superoxide and hydroxyl radicals respectively. The effect of intravenous SOD and CAT on acute and delayed radiation injury was investigated in a rat model. Catalase was shown to reduce the severity of radiation-induced changes in both the vascular endothelium and squamous epithelium. SOD, alone or with CAT, showed no radioprotective effect. As intravenous catalase does not penetrate intracellularly it should have no effect on the tumoricidal effect of radiation. Further investigation of catalase as an agent to reduce the acute side-effects of radiotherapy is warranted.

Vocal function following vertical hemilaryngectomy: a preliminary investigation.

Abstract: Seven consecutive male patients who received a vertical hemilaryngectomy were examined for vocal function employing video-stroboscopic, aerodynamic and acoustic measurement techniques. The results of this preliminary investigation suggest that with the group of patients studied, vocal quality was rated as "rough", "breathy" and "constricted". While large variability was noted between individuals, the general tendencies for the group included: (a) incomplete glottic closure; (b) supraglottic structures (ventricular folds, arytenoids) fulfilled or aided vibratory action of the remaining fold; (c) high average transglottal airflow; (d) reduced maximum phonation time; (e) high and more variable vocal frequency positioned near the top of the frequency range; (f) a lower, more variable, and restricted vocal intensity range, and (g) a reduced vocal fold diadochokinetic (vocal fold opening and closing action) rate. We are currently attempting to determine factors related to individual patient strategies for using either glottic or supraglottic valving during phonation.

Tinnitus. II: Surgical management of conditions associated with tinnitus and somatosounds.

Abstract: The literature relating to the effects of otological surgery on tinnitus is reviewed. The results of such surgery are often unpredictable with respect to postoperative tinnitus, and ablative surgery may well make the tinnitus worse. The concept of somatosounds (tinnitus arising from outside the auditory pathway) is presented, and the management of some conditions, including patulous Eustachian tube and palatal myoclonus, is discussed.

Neurologic aspects of spasmodic dysphonia.

Abstract: We discuss the etiology of 100 spasmodic dysphonia patients. Seventy-one patients had underlying essential tremor, 25 had Meige's syndrome, 12 were hypothyroid, and 27 had either a functional disturbance or focal dystonia. Six patients had intermittent breathy dysphonia. A large corpus of spasmodic dysphonia patients have organic neurolaryngeal disease.

Pediatric human immunodeficiency virus infection: an otolaryngologist's perspective.

Abstract: Children with human immunodeficiency virus (HIV) frequently have recurrent otitis media, chronic rhinorrhea, parotitis, cough and other common pediatric otolaryngologic problems. As these complaints often occur before more unusual opportunistic infections or pulmonary conditions prompt a diagnosis of acquired immunodeficiency syndrome (AIDS), members of our specialty are liable to see HIV-positive children before infection with the virus has been recognized. Children with HIV infection are also likely to be referred to us after diagnosis, as is any immunosuppressed child with otolaryngologic infections. These children may require procedures such as bronchoscopy, sinus irrigations or tympanocentesis. The subject of this review is the natural history of pediatric HIV infection with special emphasis on otolaryngologic manifestations and recommendations for safe techniques of examination and treatment.

Peritonsillar abscess: the treatment options.

Abstract: Peritonsillar abscess is the second most common ENT emergency admission at our hospital. The optimal management has been a subject of discussion for years. This paper reviews 51 patients and the literature to question the traditional medical/surgical managements.

Adult supraglottitis due to herpes simplex virus.

Abstract: Changes in the concepts regarding epiglottis have occurred over the last two decades. Supraglottis, once thought to occur exclusively in the pediatric population, is now recognized in adults. Supraglottis is a well-defined syndrome usually caused by a bacterial infection by Haemophilus influenzae type B. Recently, other organisms have been implicated as etiologic agents in cases of supraglottitis. Documented viral supraglottitis is very rare, and adult supraglottitis due to herpes simplex virus-I has not been reported to our knowledge.

Outer ear canal shape and its relation to the effectiveness of sound attenuating earplugs

Abstract: This investigation was undertaken to explore the relationship between the level of sound attenuation achieved by the wearing of hearing protectors, and the shape of the external ear canal. Bilateral molds of the outer portion of the external ear canal were made in 93 males and females with normal hearing, who had participated in a previous study on the effect of gender on sound attenuation, measured for a variety of insert type devices. The ear canal molds were analyzed in terms of tortuosity, caliber, and degree of funneling. The results showed that individuals with straight canals achieved significantly higher attenuation scores than those with twisted canals. With regard to caliber, the more important of the two parameters reviewed was the cross-sectional area of the canal measured at the cartilaginous-bony junction (IA). The relationship between IA and attenuation depended on both gender and the type of earplug tested. Funneling, measured by the ratio of concheomeatal and cartilaginous-bony cross-sectional areas, had the opposite effect of that for IA. These findings underscore the need for more controlled prescription and fitting procedures for the insert type of hearing protectors commonly used in the industrial setting.

Desmoplastic fibroma of the temporal bone.

Abstract: A desmoplastic fibroma is a rare entity in the temporal bone. An 86-year-old woman was seen for evaluation of ear discharge and stenosis of the ear canal with a mass involving the post-auricular region. The tumor was found to be a desmoplastic fibroma. The clinical picture, pathology, diagnosis and prognosis of the tumor are discussed.

Impacted cerumen: a disorder of keratinocyte separation in the superficial external ear canal?

Abstract: In the majority of individuals, impaction of cerumen in the external auditory canal does not occur, and it is only a fraction of the population who regularly need to consult their physician for aural toilet. In this study we looked at the clinical features associated with recurrent cerumen impaction in 20 individuals. This was complemented by an examination of the cerumen plugs taken from their ears and hydrated to analyze the morphology of the keratin sheets, which had been observed in a previous study to constitute over one-half of the volume of impacted cerumen. In a further eight patients with cerumen, impaction plugs of cerumen were removed and subjected to histological examination. We observed that excessively long sheets of undivided keratin could be isolated from the hydrated cerumen plugs and that these sheets of keratin morphologically resembled the superficial layers of the stratum corneum of normal human deep external auditory canal skin. Based on these observations, we propose that cerumen impaction is the result of a failure in the normal keratinocyte separation which occurs in the superficial external auditory canal.

The efficacy of pulse-dosed antibiotic therapy in the management of persistent otitis media with effusion.

Abstract: Consensus has been achieved supporting the efficacy of antimicrobials in the management of acute otitis media with effusion (OME). No such agreement has been reached into medical management of the patient in whom middle ear effusion (MEE) persists beyond the conventional 10- to 14-day treatment cycle. This study is designed to demonstrate the efficacy of antibiotics administered in a single daily dose in the management of persistent otitis media with effusion (POME). Seventy-nine subjects who had MEE in 116 ears after conventional therapy were randomized into medication and placebo groups and followed by the authors on a blinded basis. The results demonstrate the efficacy of pulse-dosed antibiotics in the management of POME. Prevention of relapses during therapy was responsible for the superior outcome for children in the treatment group.

Parotid gland enlargement in HIV infection: clinical/imaging findings.

Abstract: Parotid gland enlargement with or without facial paralysis may be the presenting clinical manifestation of AIDS. Submandibular involvement may occur as well. Failure to recognize this association may lead to inappropriate or unnecessary intervention in the investigation and treatment of the salivary gland enlargement. In this paper, we discuss the role of imaging techniques in the investigation of salivary gland enlargement, and identify the specific radiologic signs found in HIV infection. Demonstration of intraparotid or submandibular gland cysts with focal intraparotid mass lesion(s) on imaging may help to differentiate parotid gland enlargement due to HIV infection from the many other causes of parotid enlargement.

Septorhinoplasty in children: benefits of the external approach.

Abstract: Following a series of septorhinoplasties performed on 28 children over a period of eight years as well as a review of the literature, the authors consider that the taboo on this sort of surgery would seem to have passed. Given that the septum plays a fundamental role in the projection of the nasomaxilliary complex, it is clear that certain surgical rules must be applied: the perichondrium must be left intact, no wide cartilaginous resections must be made, the areas of contact between the septum, the vomer, and the perpendicular lamina of the ethmoid must be reconstituted, and finally, the remodeled cartilage must be repositioned. For all of the above reasons, the external approach, performed on 20 children, is the best suited for this sort of operation. No serious long-term complications were observed.

The hanging columella

Abstract: A hanging columella significantly detracts from otherwise pleasing nasal esthetics. Preoperative assessment of the nasal base is crucial to determine the etiology of a pre-existing hanging columella, and to assess the potential for creating such a deformity with rhinoplasty. Prevention or correction of a hanging columella requires surgical techniques that take into consideration the anatomic tip dynamic factors involved. We discuss the anatomy of the nasal base, define the hanging columella, and distinguish this entity from others with which it can be confused. We propose a methodical approach to the evaluation of the hanging columella, and recommend corrective techniques which we have found successful in achieving good cosmetic results.

Tuberculosis of a periglandular lymphnode presenting as a parotid tumor.

Abstract: The presentation of tuberculosis as isolated cervical adenopathy is not a common entity. The presentation of this disease as a parotid mass has rarely been reported. In most instances, direct parenchymal involvement exists, although involvement of intraglandular lymphnodes has also been reported. In most cases, an initial misdiagnosis of a parotid tumor, usually a pleomorphic adenoma, was made. We report a case of a 57-year-old patient with a left parotid mass of two years' duration. The patient was referred because of the development of firm, nontender, ipsilateral cervical adenopathy, suggesting possible malignancy. The course of the disease, diagnosis, and treatment are reported. The relevant literature is reviewed.

Cervicofacial liposuction: results and controversies.

Abstract: Obtaining ideal results with cervicofacial rhytidectomy has long frustrated facial plastic surgeons due to the difficulty of removing local excesses of adipose tissue in the parotid, melolabial, submental and submandibular areas. Open and closed liposuction techniques are being developed in conjunction with the facelift to improve definition of the facial, mandibular and cervical contours. A review of the senior author's (PAA) cases of cervicofacial liposuction and rhytidectomy is presented with emphasis placed on surgical techniques and results. Current literature is reviewed. Recommendations are made regarding analysis, surgical techniques and postoperative management of patients presenting for rejuvenation of the lower face.

Recurrent meningitis secondary to perilymph fistula in young children.

Abstract: All young children treated for meningitis should have post-treatment evoked potential audiometry. If neurosensory hearing loss is identified, the clinician should be alerted to the possibility of a perilymph fistula as the cause of the meningitis. Radiology of the inner ear and possibly exploratory tympanotomy may be necessary to rule out a perilymph fistula. Two young children with meningitis secondary to perilymph fistula are presented to illustrate the problems of diagnosis and management.

Tinnitus. III: The practical management of sensorineural tinnitus.

Abstract: A weekly tinnitus clinic at University College Hospital, London, has been in existence since 1976. By developing a holistic and multidisciplinary approach to the management of tinnitus, we have been able to help the majority of patients referred with severe and disabling tinnitus. We have developed a protocol for the clinical assessment of tinnitus as a disability, and a strategy of investigation and reassurance based on the patient's understanding of the underlying mechanisms involved in tinnitus generation. Most treatment is aimed at bringing about a process of habituation (which occurs naturally in the majority of people experiencing tinnitus over a period of time). Symptom control is required in about half the patients referred, and various techniques are discussed including prosthetic masking devices, psychological approaches, drug therapy and electrical tinnitus suppression.