Otolaryngology - Head and Neck Surgery RSS feed: Current Issue. Otolaryngology-Head and Neck Surgery is the official peer-reviewed publication of the American Academy of Otolaryngology-Head and Neck Surgery Foundation. The mission of Otolaryngology-Head and Neck Surgery is to publish contemporary, ethical, clinically relevant information in otolaryngology, head and neck surgery (ear, nose, throat, head, and neck disorders) that can be used by otolaryngologists, clinicians, scientists, and specialists to improve patient care and public health.http://www.otojournal.org/?rss=yesElsevier Inc.en © 2010 American Academy of Otolaryngology–Head and Neck Surgery Foundation. Published by Elsevier Inc. All rights reserved. Otolaryngology - Head and Neck Surgery0194-59981422February 2010 © 2010 American Academy of Otolaryngology–Head and Neck Surgery Foundation. Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.otojournal.org/article/PIIS0194599809015083/abstract?rss=yesAbstract: Objective: Treatment of benign paroxysmal positional vertigo (BPPV) with the Epley and Semont maneuvers has been used with and without postmaneuver postural restrictions. Studies examining these restrictions have yielded differing results. This study sought to examine the studies for a more uniform conclusion.Data Sources: Controlled studies with objective identification of unilateral posterior semicircular canal BPPV and symptom resolution were analyzed. A PubMed search identified six studies totaling 523 patients meeting all inclusion criteria.Review Methods: Cohorts treated with and without restrictions were compared. Individual patient pooled analyses in a one-stage comparison were used for the meta-analysis.Results: Pooled results of all restriction types showed no advantage over no restriction. Studies including each individual restriction were examined against the pooled population to look for technique differences. No restriction was found to be statistically significant.Conclusions: The restrictions examined in controlled trials did not differ significantly in clinical outcomes, which suggests that restrictions do not appear to significantly affect the efficacy of BPPV maneuvers.Postmaneuver restrictions in benign paroxysmal positional vertigo: An individual patient data meta-analysisAnand K. Devaiah, Steven Andreoli10.1016/j.otohns.2009.09.013Otolaryngology - Head and Neck Surgery 142, 2 (2010)2009-11-25Otolaryngology - Head and Neck Surgery2009-11-251422S0194-5998(09)X0016-1Literature Review155159http://www.otojournal.org/article/PIIS0194599809016131/abstract?rss=yesAbstract: The environment in which otolaryngologists coexist with device and drug development has become increasingly complex. There are broad implications for both the academic and the private practitioner, with neither group being more or less insulated than the other. From the medical, ethical, and resource-oriented standpoints, otolaryngologists must consider this evolving area very carefully. A survey of the American Association of Otolaryngology–Head and Neck Surgery membership identified areas of education to improve the awareness and knowledge base of these complex considerations. In particular, knowledge of legal proceedings, Food and Drug Administration processes, relevant hospital resources, and conflict of interest considerations were areas in which the membership would benefit from further instruction.Practitioners need corporate compliance education: AAO–HNS survey resultsAnand Devaiah, Ofer Jacobowitz, Gordy Siegel, Udayan K. Shah10.1016/j.otohns.2009.10.018Otolaryngology - Head and Neck Surgery 142, 2 (2010)2010-02-01Otolaryngology - Head and Neck Surgery2010-02-011422S0194-5998(09)X0016-1Commentary160163http://www.otojournal.org/article/PIIS0194599809016611/abstract?rss=yesAbstract: Objective: The chin is an important determinant of the lower third of the face, carrying much significance in an esthetically balanced facial appearance. It is, however, often neglected in patients undergoing rhinoplasty procedures in the UK National Health Service (NHS). The aim of this study was to establish the percentage of a cohort of rhinoplasty patients who may also have benefited from chin augmentation.Study Design: A cross-sectional study.Subjects and Methods: The digital preoperative pictures of the last 100 patients who underwent rhinoplasty at our institution were retrieved. Four popular methods of assessment were used to assess the chin, that is, those advocated by Silver, Legan, Merrifield, and Gonzales-Ulloa. All analyses were performed on Adobe Photoshop CS4 by two ENT registrars. Values were regarded as positive when there was interobserver agreement. Relevant angles were averaged.Results: A total of 94 photographs were suitable for analysis. There were 58 males. Depending on the method of assessment, the percentage of males who fulfilled criteria for augmentation ranged from 17 to 62 percent and for females the range was 42 to 81 percent. Additionally, 21 percent of males were positive on three or more of the methods utilized. The respective figure was 58 percent for females.Conclusion: Surgeons who practice rhinoplasty should consider making an objective assessment of the need for possible chin augmentation. Our study shows that as many as 81 percent of patients may benefit, although this figure varies with the method of assessment. In this study, the necessity for further analysis with a view to chin augmentation was more likely in women.Assessment of the chin in patients undergoing rhinoplasty: What proportion may benefit from chin augmentation?Jahangir Ahmed, Sachin Patil, Samuel Jayaraj10.1016/j.otohns.2009.10.041Otolaryngology - Head and Neck Surgery 142, 2 (2010)2010-02-01Otolaryngology - Head and Neck Surgery2010-02-011422S0194-5998(09)X0016-1Facial Plastic and Reconstructive Surgery164168http://www.otojournal.org/article/PIIS0194599809017148/abstract?rss=yesAbstract: Objective: To document the frequency of vasopressor use in free tissue transfer surgery and to compare the incidence of flap complications and flap survival in patients receiving or not receiving intraoperative vasopressors.Study Design and Setting: Case series with chart review of free tissue transfers performed between 2004 and 2006 at a large-volume tertiary academic hospital.Results: Of 241 free flaps, 169 had data available for analysis. Flap survival was 96.5 percent. The rate of other flap complications was 29 percent. A total of 139 (82%) patients received vasopressors intraoperatively. Of these, four (2.9%) flap failures and 40 (29%) complications occurred. In the 30 (18%) patients who did not receive vasopressors, two (6.7%) flap failures and nine (30%) complications occurred. The most common reasons for flap failure were arterial thrombus (n = 3) and thrombosis of the venous pedicle (n = 3).Conclusion: Intraoperative vasopressors are used more frequently than previously realized but do not appear to increase overall flap failure and the incidence of complications. Intraoperative vasopressor use in free flap surgery may not be as harmful as previously feared.Vasopressor use in free tissue transfer surgeryMarcus M. Monroe, Julie McClelland, Chris Swide, Mark K. Wax10.1016/j.otohns.2009.11.001Otolaryngology - Head and Neck Surgery 142, 2 (2010)2010-02-01Otolaryngology - Head and Neck Surgery2010-02-011422S0194-5998(09)X0016-1Facial Plastic and Reconstructive Surgery169173http://www.otojournal.org/article/PIIS0194599809017161/abstract?rss=yesAbstract: Objective: 1) Compare skin graft healing of the radial forearm free flap (RFFF) donor site when using a negative pressure dressing (NPD) versus a static pressure dressing (SPD). 2) Examine the association of graft size and medical comorbidities with healing of RFFF donor site.Study Design: Randomized, controlled trial.Setting: Tertiary care hospital.Subjects and Methods: After the study was approved, consenting adults undergoing RFFF for head and neck reconstructions were randomized into two arms: SPD and NPD groups. Fifty-four patients were enrolled from March 2007 to August 2009. Pre- and postoperative data were collected, including medical comorbidities, graft size, and area of graft failure/tendon exposure. Data were collected at two postoperative time points.Results: The overall wound complication rate was 38 percent (19/50). Wound complications at the first postoperative visit (44.4% [12/27] SPD and 30.4% [7/23] NPD) were not significantly different between groups (P = 0.816). Similarly, wound complications at the second visit (68.8% [11/16] SPD and 80% [12/15] NPD) were not significantly different (P = 0.55). Percentage of area of graft failure between the groups also showed no difference (4.5% SPD vs 7.2% NPD, P = 0.361). The association of graft size with wound complications was analyzed by dividing the data set into three groups (<50 cm2, 51-100 cm2, and >100 cm2). This difference was not found to be significant (P = 0.428). Finally, when evaluating comorbidities, 50 percent (8/16) of subjects with comorbidities experienced complications compared with 32.4 percent (11/34) without comorbidities, also not reaching significance (P = 0.203).Conclusions: Although an attractive option for wound care, the NPD does not appear to offer a significant improvement over an SPD in healing of the RFFF donor site.A randomized, prospective, controlled study of forearm donor site healing when using a vacuum dressingEugene G. Chio, Amit Agrawal10.1016/j.otohns.2009.11.003Otolaryngology - Head and Neck Surgery 142, 2 (2010)2010-02-01Otolaryngology - Head and Neck Surgery2010-02-011422S0194-5998(09)X0016-1Facial Plastic and Reconstructive Surgery174178http://www.otojournal.org/article/PIIS0194599809015897/abstract?rss=yesAbstract: Objective: The objective of this study was to analyze the expression of proliferative markers and p53 in keratocystic odontogenic tumor (KCOT) sporadic type and KCOT associated with nevoid basal cell carcinoma syndrome (NBCCS).Study Design and Setting: We performed a cross-sectional study. A total of 19 patients with KCOT were selected from the Oral Pathology Laboratory archives, Central University of Venezuela, from 1995 to 2005.Subjects and Methods: Twelve cases corresponded to sporadic KCOT, and seven cases were associated with NBCCS. Immunohistochemical analysis for p53, proliferating cell nuclear antigen (PCNA), and Ki-67 was performed in all 19 cases.Results: Of the seven cases associated with NBCCS, six (86%) were positive for PCNA. From the 12 sporadic cases, nine (75%) were positive for PCNA. Only one case of sporadic KCOT showed Ki-67 positivity. Five of 12 (42%) cases of sporadic KCOT were positive for p53, and only one (14%) case associated with NBCCS was positive for p53.Conclusion: On the basis of the analysis of the expression of PCNA, Ki-67, and p53, there appears to be no evidence to indicate higher aggressiveness in growth and infiltrative behavior in syndromic KCOT compared with the sporadic type. Therefore, surgical treatment may be approached in the same manner in KCOT sporadic and syndromic with the goal of minimizing recurrence.Keratocystic odontogenic tumor associated with nevoid basal cell carcinoma syndrome: Similar behavior to sporadic type?Adriana Figueroa, Maria Correnti, Maira Avila, Aleodor Andea, Patricia DeVilliers, Helen Rivera10.1016/j.otohns.2009.10.008Otolaryngology - Head and Neck Surgery 142, 2 (2010)2010-02-01Otolaryngology - Head and Neck Surgery2010-02-011422S0194-5998(09)X0016-1Head and Neck Surgery179183http://www.otojournal.org/article/PIIS019459980901643X/abstract?rss=yesAbstract: Objective: To demonstrate, in a case series, the relentless growth of arteriovenous malformations (AVMs) of the head and neck and the importance of their vigilant management within the context of a modified staging system.Study Design: Retrospective review.Setting: Tertiary care institution, Vascular Anomalies Center.Subjects and Methods: Subjects were patients with advanced AVMs presenting to our Vascular Anomalies Center. Medical records were examined for age at first diagnosis, disease course, prior treatments, age at presentation, management, therapeutic outcomes, stage of disease, and impact on quality of life. Early patient photographs were evaluated.Results: Ten patients (ages 13-46 yrs) with extensive cervicofacial AVMs were examined. Progressive growth, worsening symptoms, and graduated disease stage were universally experienced by each patient, as evident by serial photographs, over a course of many years. Each patient presented to our institution with massive lesions, bleeding, pain, and facial destruction. Prior embolization and/or surgery had been performed in all but one patient. Every patient had been previously told that their AVMs were incurable or that treatment options were exhausted. The patients were subsequently treated at our institution with surgical resection with or without preoperative embolization. Disease control, symptom improvement, and enhanced daily functioning were attained in each patient.Conclusion: The natural course of AVMs is progressive, invasive, and destructive. Vigilant observation, early treatment, and radical therapy are necessary for AVMs of the head and neck.Clinical course of arteriovenous malformations of the head and neck: A case seriesGresham T. Richter, James Y. Suen10.1016/j.otohns.2009.10.023Otolaryngology - Head and Neck Surgery 142, 2 (2010)2010-02-01Otolaryngology - Head and Neck Surgery2010-02-011422S0194-5998(09)X0016-1Head and Neck Surgery184190http://www.otojournal.org/article/PIIS0194599809016593/abstract?rss=yesAbstract: Objective: Development of an artificial salivary gland will benefit patients with xerostomia after radiation therapy for upper respiratory cancer. The goal is to devise a three-dimensional (3D) culture system in which salivary cells differentiate into polarized acini that express essential biomarkers and directionally secrete α-amylase. Differentiated acini-like structures in a 3D biomaterial-based scaffold will mimic salivary gland functions.Study Design: Cells were seeded onto HA-based hydrogels containing PlnDIV peptide and allowed to differentiate into acini-like structures. Cell viability and phenotype were examined.Setting: Laboratory-based tissue procurement study.Subjects and Methods: Salivary gland tissue was obtained from patients undergoing surgery. Marker expression established the phenotype of salivary gland cells. Perlecan/HSPG2, an important component of the basement membrane, was highly expressed in salivary gland tissue. A culture system consisting of hyaluronic acid (HA) hydrogel and a coupled bioactive peptide derived from domain IV of perlecan (PlnDIV) was used. Prior studies demonstrated differentiation of acinar cells into lobular structures that mimicked intact glands when cultured on PlnDIV peptide–coated surfaces.Results: Lobular acini-like structures formed on hydrogels and expressed tight junction components such as zona occludens 1. Acini-like structures were stained for the presence of α-amylase. Live/dead staining revealed the presence of apoptotic cells in the center of the acini-like structures, indicative of lumen formation.Conclusion: A novel system supporting acini-like assembly in a 3D culture system was established. Presence of biomarkers and secretion of salivary enzymes confirms functionality in vitro. Future experiments will test the 3D system in an animal model.Lumen formation in three-dimensional cultures of salivary acinar cellsSwati Pradhan, Chao Liu, Chu Zhang, Xinqiao Jia, Mary C. Farach-Carson, Robert L. Witt10.1016/j.otohns.2009.10.039Otolaryngology - Head and Neck Surgery 142, 2 (2010)2010-02-01Otolaryngology - Head and Neck Surgery2010-02-011422S0194-5998(09)X0016-1Head and Neck Surgery191195http://www.otojournal.org/article/PIIS0194599809016581/abstract?rss=yesAbstract: Objective: To assess the prognostic factors of recurrence after endoscopic sinus surgery for maxillary chronic rhinosinusitis without nasal polyps.Study Design: Prospective.Setting: Tertiary referral center.Methods: A total of 411 patients were operated on for maxillary chronic rhinosinusitis without nasal polyps (307 rhinogenic rhinosinusitis, 74 odontogenic rhinosinusitis, and 30 oroantral fistula cases) in a single institution between 2002 and 2007. Ten parameters were analyzed to study their relationship with recurrence: etiology of rhinosinusitis, partial resection of middle turbinate, smoking history, allergy, asthma, gastroesophageal reflux, preoperative endoscopic score, CT stage, maxillary sinus mucosa score, and bleeding score. Preoperative characteristics and recurrence rates were compared with the analysis of variance test. Failure was analyzed as a time-dependent variable by the Kaplan-Meier method. Variables identified on univariate analysis were entered into a multivariate Cox proportional hazards model.Results: Recurrent rhinosinusitis developed in 28 (6.8%) cases. In the univariate analysis, preoperative endoscopic score, CT stage, and bleeding score were associated with recidivism. However, the multivariate analysis suggested that only bleeding is an independent predictive factor of recurrence (P = 0.034, 95% confidence interval for odds ratio 0.92-7.21).Conclusion: Intraoperative bleeding may be a risk factor for failure in endoscopic surgery of maxillary rhinosinusitis, but there is substantial uncertainty and future research is needed.Failures in endoscopic surgery of the maxillary sinusSilviu Albu, Mihaela Baciut10.1016/j.otohns.2009.10.038Otolaryngology - Head and Neck Surgery 142, 2 (2010)2010-02-01Otolaryngology - Head and Neck Surgery2010-02-011422S0194-5998(09)X0016-1Sinonasal Disorders196201http://www.otojournal.org/article/PIIS0194599809017720/abstract?rss=yesAbstract: Objective: Establish the feasibility of a predictive validity study in sinus surgery simulation training and demonstrate the effectiveness of the Endoscopic Sinus Surgery Simulator (ES3) as a training device.Study Design: Prospective, multi-institutional controlled trial.Setting: Four tertiary academic centers with accredited otolaryngology-head and neck surgery residency programs.Subjects: Twelve ES3-trained novice residents were compared with 13 control novice residents.Methods: Subjects were assessed on the performance of basic sinus surgery tasks. Their first in vivo procedure was video recorded and submitted to a blinded panel of independent experts after the panel established a minimum inter-rater reliability of 80 percent. The recordings were reviewed by using a standardized computer-assisted method and customized metrics. Results were analyzed with the Mann-Whitney U test. Internal rater consistency was verified with Pearson moment correlation.Results: Completion time was significantly shorter in the experimental group (injection P = 0.003, dissection P < 0.001), which, according to the rater panel, also demonstrated higher confidence (P = 0.009), demonstrated skill during instrument manipulation (P = 0.011), and made fewer technical mistakes during the injection task (P = 0.048) compared with the control group. The raters' post hoc internal consistency was deemed adequate (r > 0.5 between serial measurements).Conclusion: The validity of the ES3 as an effective surgical trainer was verified in multiple instances, including those not depending on subjective rater evaluations. The ES3 is one of the few virtual reality simulators with a comprehensive validation record. Advanced simulation technologies need more rapid implementation in otolaryngology training, as they present noteworthy potential for high-quality surgical education while meeting the necessity of patient safety.From virtual reality to the operating room: The endoscopic sinus surgery simulator experimentMarvin P. Fried, Babak Sadoughi, Marc J. Gibber, Joseph B. Jacobs, Richard A. Lebowitz, Douglas A. Ross, John P. Bent, Sanjay R. Parikh, Clarence T. Sasaki, Steven D. Schaefer10.1016/j.otohns.2009.11.023Otolaryngology - Head and Neck Surgery 142, 2 (2010)2010-02-01Otolaryngology - Head and Neck Surgery2010-02-011422S0194-5998(09)X0016-1Sinonasal Disorders202207http://www.otojournal.org/article/PIIS019459980901732X/abstract?rss=yesAbstract: Objective: To determine the prevalence of penetration and aspiration on videofluoroscopic swallow studies (VFSS) in normal individuals without dysphagia.Study Design: Case series with planned data collection.Setting: A tertiary urban university hospital.Subjects and Methods: Normal adult volunteers without dysphagia, neurological disease, or previous surgery underwent VFSS. Studies were recorded and then reviewed for evidence of penetration or aspiration. The degree of penetration was assessed with the penetration-aspiration scale (PAS). The effect of age, bolus size, and consistency was evaluated.Results: A total of 149 VFSS (596 swallows) were reviewed. The mean age of the cohort was 57 years (±19 years); 56 percent were female. Only one (0.6%) individual aspirated on VFSS. Seventeen (11.4%) individuals demonstrated penetration. The mean PAS for the entire cohort was 1.17 (±0.66). Prevalence of penetration by swallow was 2.85 percent (17/596). Prevalence of penetration was 9.3 percent in elderly individuals aged >65 years and 14.3 percent in adults aged <65 years (P = 0.49). Prevalence of penetration on a liquid bolus was 3.4 percent (15/447) and on paste was 1.3 percent (2/149) (P > 0.05). Prevalence of penetration for a bolus <30 cc was 2.34 percent (7/298) and for a bolus >30 cc was 5.4 percent (8/149) (P > 0.05).Conclusion: Aspiration on VFSS is not a normal finding. Penetration is present in 11.4 percent of normal adults and is more common with a liquid bolus.Prevalence of penetration and aspiration on videofluoroscopy in normal individuals without dysphagiaJacqui E. Allen, Cheryl J. White, Rebecca J. Leonard, Peter C. Belafsky10.1016/j.otohns.2009.11.008Otolaryngology - Head and Neck Surgery 142, 2 (2010)2010-02-01Otolaryngology - Head and Neck Surgery2010-02-011422S0194-5998(09)X0016-1Laryngology and Neurolaryngology208213http://www.otojournal.org/article/PIIS0194599809016532/abstract?rss=yesAbstract: Objectives: This study aimed to quantify the effects of head rotation on upper esophageal sphincter (UES) pressure in healthy subjects using a novel high-resolution manometry (HRM) system.Study Design: Prospective study.Setting: Nagasaki University Hospital.Subjects and Methods: Eighteen asymptomatic Japanese male adult volunteers were studied. A solid-state HRM was positioned to record resting UES pressure. After endoscopically confirming on which side of the pyriform sinus the manometric sensor was positioned within the hypopharynx, we measured the maximum and mean values of the resting UES pressure and the length of the zone of the UES along the esophagus with the patients in the following positions: 1) neutral and straightforward head position (NSF), 2) turning the head in the direction of the side in which the sensor was positioned (HSS), and 3) turning the head in the opposite direction of the side with sensor (HOS).Results: The maximum and mean values of the resting UES pressure were statistically higher in HSS than in NSF (P = 0.0001 and P < 0.0001, respectively), and were statistically lower in HOS than in NSF (P < 0.0001 and P < 0.0001, respectively). The length of the zone of the UES was statistically shorter in HOS than in NSF (P < 0.0001), but there was no significant difference in resting UES pressure along the esophagus between HSS and NSF (P = 0.3024).Conclusion: The present study provided us with physiological information regarding normal UES pressure in relation to head rotation. This data will be of aid to future clinical and investigative swallowing studies. Additionally, the current study provides evidence of the safety and usefulness of the head rotation maneuver for dysphagic patients.Influence of head rotation on upper esophageal sphincter pressure evaluated by high-resolution manometry systemKenji Takasaki, Hiroshi Umeki, Hidetaka Kumagami, Haruo Takahashi10.1016/j.otohns.2009.10.033Otolaryngology - Head and Neck Surgery 142, 2 (2010)2010-02-01Otolaryngology - Head and Neck Surgery2010-02-011422S0194-5998(09)X0016-1Laryngology and Neurolaryngology214217http://www.otojournal.org/article/PIIS019459980901715X/abstract?rss=yesAbstract: Objective: The localization of upper airway obstruction in patients with obstructive sleep apnea (OSA) may optimize treatment. Nasoendoscopy during propofol sedation allows such an evaluation, but the effect of this drug on respiratory patterns and muscle relaxation is unknown. The objective of the present study was to determine through polysomnography whether propofol would change sleep parameters.Study Design: Prospective study of subjects submitted to polysomnography under sedation with propofol.Setting: Tertiary referral center.Subjects and Methods: Fifteen non-obese subjects (4 controls/11 OSA patients) were submitted to two diurnal polysomnograms (90-120 minutes of sleep), with and without the use of propofol. The parameters presence of snoring, apnea-hypopnea index (AHI), oxygen desaturation, and sleep architecture were compared.Results: The use of propofol did not induce snoring in the control subjects, whereas 100 percent of the OSA patients snored. AHI and mean oxygen saturation (SaO2) did not differ significantly between examinations with and without sedation. However, minimum SaO2 differed significantly (P < 0.05) with sedation, being lower during propofol sedation. Propofol also significantly changed the sleep architecture, with a significant increase in N3 sleep (P < 0.005) and total abolishment of rapid eye movement sleep (P < 0.0005) during propofol sedation.Conclusions: These preliminary results allow us to infer that sedation with propofol changes sleep architecture but permits respiratory evaluation, because the main respiratory parameters evaluated in OSA are maintained. These preliminary results support the view that nasoendoscopy under propofol sedation is a promising examination for management of this disease.Propofol-induced sleep: Polysomnographic evaluation of patients with obstructive sleep apnea and controlsFábio A.W. Rabelo, Adriano Braga, Daniel S. Küpper, José A.A. De Oliveira, Fernando M. Lopes, Pedro Luiz Vaz de Lima Mattos, Shirley G. Barreto, Heidi H. Sander, Regina M.F. Fernandes, Fabiana C.P. Valera10.1016/j.otohns.2009.11.002Otolaryngology - Head and Neck Surgery 142, 2 (2010)2010-02-01Otolaryngology - Head and Neck Surgery2010-02-011422S0194-5998(09)X0016-1Sleep Medicine218224http://www.otojournal.org/article/PIIS0194599809017112/abstract?rss=yesAbstract: Objectives: Although published abstracts have the advantage of being prominent and concise, their quality in the otolaryngology literature has not been studied. We sought to understand the limitations of relying on abstracts as the sole source of information about published research. In addition, we sought to identify specific opportunities for improving the quality of published articles and their associated abstracts.Methods: Studies of original research published in four major otolaryngology journals from January 2008 to June 2008 were included. Each study article and abstract was reviewed separately for 12 domains relating to study design, results, and conclusions. Good inter-rater reliability was established as part of the validation process.Results: Four hundred eighteen articles were identified for study, which included 75 percent clinical research and 25 percent basic science. The most common omissions in the abstract when compared with the complete article were study limitations (91% left out of abstract), geographic location (79%), confidence intervals (75%), dropouts or losses (62%), and harms and adverse events (44%). Conversely, the abstract often included information about research design (99%), sample size (92%), source of the data (81%), and quantitative results (67%). These results did not differ significantly with regard to article type, journal, or level of evidence.Conclusions: Readers of otolaryngology journals may form biased or inappropriate conclusions if they read only the abstract of a study, particularly with regard to study limitations, adverse events, and subject dropouts or losses. These results highlight the perils of using the abstract as a sole source of information.Do abstracts in otolaryngology journals report study findings accurately?Edward D. McCoul, Gennadiy Vengerovich, David H. Burstein, Richard M. Rosenfeld10.1016/j.otohns.2009.10.051Otolaryngology - Head and Neck Surgery 142, 2 (2010)2010-02-01Otolaryngology - Head and Neck Surgery2010-02-011422S0194-5998(09)X0016-1General Otolaryngology225230http://www.otojournal.org/article/PIIS0194599809017094/abstract?rss=yesAbstract: Objective: Hearing loss is the most common sensory disorder in the United States, afflicting more than 36 million people. Higher intakes of vitamins C, E, beta carotene, B12, and folate have been proposed to reduce the risk of hearing loss.Study Design: We prospectively evaluated the association between intake from foods and supplements of vitamins C, E, beta carotene, B12, and folate, and the incidence of hearing loss.Setting: Health Professionals Follow-up Study.Subjects and Methods: A total of 26,273 men aged 40 to 74 years at baseline in 1986. Participants completed questionnaires about lifestyle and medical history every two years and diet every four years. Information on self-reported professionally diagnosed hearing loss and year of diagnosis was obtained from the 2004 questionnaire, and cases were defined as hearing loss diagnosed between 1986 and 2004. Cox proportional hazards multivariate regression was used to adjust for potential confounders.Results: There were 3559 cases of hearing loss identified. Overall, there was no significant association between vitamin intake and risk of hearing loss. Among men aged ≥60 years, total folate intake was associated with a reduced risk of hearing loss; the relative risk for men aged ≥60 years old in the highest quintile compared with the lowest quintile of folate intake was 0.79 (95% confidence interval 0.65-0.96).Conclusions: Higher intake of vitamin C, E, beta carotene, or B12 does not reduce the risk of hearing loss in adult males. Men aged ≥60 years may benefit from higher folate intake to reduce the risk of developing hearing loss.A prospective study of vitamin intake and the risk of hearing loss in menJosef Shargorodsky, Sharon G. Curhan, Roland Eavey, Gary C. Curhan10.1016/j.otohns.2009.10.049Otolaryngology - Head and Neck Surgery 142, 2 (2010)2010-02-01Otolaryngology - Head and Neck Surgery2010-02-011422S0194-5998(09)X0016-1General Otolaryngology231236http://www.otojournal.org/article/PIIS0194599809016477/abstract?rss=yesAbstract: Objective: To evaluate the accuracy of clinical assessment of adenoidal obstruction based on a standardized score of the degree of mouth breathing and speech hyponasality (nasal obstruction index [NOI]) in comparison to nasal fiberoptic endoscopy.Study Design: Cross-sectional study with planned data collection.Setting: Outpatient clinics of the Departments of Maternal and Pediatric Sciences and Specialized Surgical Sciences, University of Milan, Italy.Subjects and Methods: Children aged three to 12 years with adenoidal obstruction suspected on the grounds of persistent/recurrent otitis media or perceived obstructive nasal breathing were eligible. Ear, nose, and throat examination, allergy testing, NOI measurement, and nasal fiberoptic endoscopy to assess the degree of adenoidal hypertrophy were performed. Agreement between the NOI and adenoidal hypertrophy grade was assessed in the patients as a whole and by clinical subgroups.Results: A total of 202 children were enrolled: 54.9 percent had otological diseases and 45.1 percent had perceived obstructive nasal breathing. Most of the children (79.2%) showed mild or moderate clinical nasal obstruction. Adenoidal hypertrophy ranged from no obstruction (18%) to severe obstruction (38%). There was no substantial agreement between the NOI and the degree of adenoidal obstruction in the population as a whole and in all the clinical subgroups. False positive findings were significantly more frequent among allergic children (50%) than non-allergic children (22.4%, P = 0.009).Conclusion: Clinical assessment based on the NOI is incapable of accurately predicting the degree of adenoidal obstruction. In children with clinical nasal obstruction not explainable by adenoidal size, the clinician should consider, among causes of more anterior obstruction, nasal allergy.Clinical assessment of adenoidal obstruction based on the nasal obstruction index is no longer useful in childrenPaola Marchisio, Sara Torretta, Pasquale Capaccio, Susanna Esposito, Elisa Dusi, Erica Nazzari, Anna Bossi, Lorenzo Pignataro, Nicola Principi10.1016/j.otohns.2009.10.027Otolaryngology - Head and Neck Surgery 142, 2 (2010)2010-02-01Otolaryngology - Head and Neck Surgery2010-02-011422S0194-5998(09)X0016-1Pediatric Otolaryngology237241http://www.otojournal.org/article/PIIS0194599809017124/abstract?rss=yesAbstract: Objective: To determine whether air quality influences the prevalence of pediatric frequent ear infections and respiratory allergy.Study Design: Case-control study.Setting: Academic medical center.Subjects and Methods: The National Health Interview Survey child sample for the calendar years 1997 through 2006 was analyzed, extracting 12-month prevalence data for the following three disease conditions: frequent (≥3 within 12 months) ear infections, respiratory allergy, and seizures (nonrespiratory control condition). Based on information from the Environmental Protection Agency, yearly historical data for the air quality criteria pollutants carbon monoxide, nitrous dioxide, sulfur dioxide, and particulate matter were tabulated. Graphical and linear regression analyses were conducted to determine the influence of air quality on each of the disease conditions.Results: A total of 126,060 children were studied (51.4% male, mean age 8.6 yrs). Overall, the 12-month prevalence for three or more ear infections, respiratory allergy, and seizures was 6.6%, 11.7%, and 0.7%, respectively. Air quality steadily improved over the study period. Statistically significant positive regression coefficients were obtained for each of the criteria pollutants with ear infections (all P < 0.001), with regression coefficients ranging from 0.007 (particulate matter) to 11.2 (sulfur dioxide). For respiratory allergies, nonstatistically significant regression coefficients for the criteria pollutants were obtained (range <0.001-0.379, all P ≥ 0.409). For the nonrespiratory condition seizures, nonsignificant regression coefficients were again identified (all P ≥ 0.404).Conclusions: Better air quality is significantly associated with lower prevalence of pediatric frequent ear infections but is not associated with the prevalence of pediatric respiratory allergy. Improvements in air quality may be implicated in the decreased rates of pediatric ear infections over time.Air quality improvement and the prevalence of frequent ear infections in childrenNeil Bhattacharyya, Nina L. Shapiro10.1016/j.otohns.2009.10.052Otolaryngology - Head and Neck Surgery 142, 2 (2010)2010-02-01Otolaryngology - Head and Neck Surgery2010-02-011422S0194-5998(09)X0016-1Pediatric Otolaryngology242246http://www.otojournal.org/article/PIIS0194599809016659/abstract?rss=yesAbstract: Objective: To examine the results of health-related quality-of-life questionnaire scores from profoundly deaf children fitted with at least one cochlear implant (CI) and to compare their responses with those of normal-hearing mates of similar age and their parents.Study Design: Cross-sectional study utilizing a generic quality-of-life questionnaire designed to be completed by both parents and children independently of each other.Setting: Questionnaires completed at various summer camps designed for children with CIs in Texas and Colorado.Subjects and Methods: Eighty-eight families from 16 states were divided into two subgroups by age of cochlear implantation: an eight- to 11-year-old group and a 12- to 16-year-old group. The KINDL-R Questionnaire for Measuring Health-Related Quality of Life in Children and Adolescents was distributed, and CI participants completed the questionnaire independently of their participating family member.Results: CI users in both age groups scored similarly to their normal-hearing peers and their parents. Younger CI users scored their family domain lower compared with their normal-hearing peers. Teen CI users scored the school domain lower compared with their parents. Among CI participants, earlier implantation and longer CI use resulted in higher quality-of-life scores.Conclusion: Children with CIs experience quality of life similar to that of normal-hearing peers. Parents are reliable reporters on the status of their child's overall quality of life.The children speak: An examination of the quality of life of pediatric cochlear implant usersBetty Loy, Andrea D. Warner-Czyz, Liyue Tong, Emily A. Tobey, Peter S. Roland10.1016/j.otohns.2009.10.045Otolaryngology - Head and Neck Surgery 142, 2 (2010)2010-02-01Otolaryngology - Head and Neck Surgery2010-02-011422S0194-5998(09)X0016-1Pediatric Otolaryngology247253http://www.otojournal.org/article/PIIS0194599809016453/abstract?rss=yesAbstract: Objective: Establish the time required to perform cochlear implantation (CI) in academic settings.Study Design: Historical cohort study.Setting: German and American academic centers.Patients: A total of 2639 patients underwent CI (1997-2007). We excluded patients receiving an experimental device or technique and those with abnormal cochlear anatomy or incomplete charts, leaving 2253 for analysis.Intervention: Unilateral, bilateral, and revision CI with devices approved in the U.S. and Europe.Main Outcome Measures: Mean surgical time (ST) and total operating room time (TORT).Results: Mixed model analysis was used; estimated marginal means were calculated in minutes after adjusting for random effect of individual surgeon. There were no differences between unilateral (ST = 171, TORT = 245) and revision CI (ST = 160, TORT = 232), but bilateral procedures were longer (ST = 295, TORT = 377, P < 0.001). In unilateral surgeries, Cochlear Limited (CL) devices were implanted faster (ST = 165, TORT = 225) than Advanced Bionics (ABC) (ST = 183, P = 0.001; TORT = 240, P = 0.023) or MedEl (ST = 193, P < 0.001; TORT = 253, P = 0.002) devices. There were no differences for unilateral CI between ABC and MedEl devices. For revision CI, ABC devices (ST = 141, TORT = 219) were implanted faster than CL devices (ST = 181, P = 0.001; TORT = 266, P < 0.001). There were no differences by age group or between Germany and the U.S. ST and TORT were shorter for 575 CIs performed in the final two years of the study (unilateral CI: ST = 145, TORT = 209; bilateral CI: ST = 259, TORT = 330; revision CI: ST = 138, TORT = 205). For unilateral CI, ST and TORT decreased yearly (linear regression, P < 0.001) and inversely correlated with surgeon experience (linear regression, P < 0.01).Conclusions: We report the time required to perform CI in academic settings—data that are vital for cost-benefit analyses and assessing new CI techniques.Time of cochlear implant surgery in academic settingsOmid Majdani, Theodore A. Schuman, David S. Haynes, Mary S. Dietrich, Martin Leinung, Thomas Lenarz, Robert F. Labadie10.1016/j.otohns.2009.10.025Otolaryngology - Head and Neck Surgery 142, 2 (2010)2010-02-01Otolaryngology - Head and Neck Surgery2010-02-011422S0194-5998(09)X0016-1Otology and Neurotology254259http://www.otojournal.org/article/PIIS0194599809015873/abstract?rss=yesAbstract: Objective: To investigate the ability to detect the in vivo cochlear changes associated with vasopressin-induced and surgically induced endolymphatic hydrops using MRI at 3 tesla (T).Study Design: Prospective, animal model.Setting: Animal laboratory.Subjects and Methods: In group 1, five guinea pigs underwent post–gadolinium temporal bone MRI before and after seven and 14 days of chronic systemic administration of vasopressin by osmotic pump. In group 2, five guinea pigs underwent temporal bone MRI eight weeks after unilateral surgical ablation of the endolymphatic sac. Three-tesla high-resolution T1-weighted sequences were acquired pre- and postcontrast administration. Region of interest signal intensities of the perilymph and endolymph were analyzed manually. Quantitative evaluation of hydrops was measured histologically.Results: Gadolinium preferentially concentrated in the perilymph, allowing for distinction of cochlear compartments on 3.0-T MRI. The T1-weighted contrast MRI of vasopressin-induced hydropic cochlea showed significant increases in signal intensity of the endolymph and perilymph. Surgically induced unilateral hydropic cochlea also showed increased signal intensity, compared with the control cochlea of the same animal, but less of an increase than the vasopressin group. The histological degree of hydrops induced in the vasopressin group was comparable to previous studies.Conclusions: In vivo postcontrast MRI of the inner ear demonstrated cochlear changes associated with chronic systemic administration of vasopressin and surgical ablation of the endolymphatic sac. Understanding the MRI appearance of endolymphatic hydrops induced by various methods contributes to the future use of MRI as a possible tool in the diagnosis and treatment of Ménière's disease.Magnetic resonance imaging of guinea pig cochlea after vasopressin-induced or surgically induced endolymphatic hydropsAllen F. Marshall, Valerie L. Jewells, Peter Kranz, Yeuh Z. Lee, Weili Lin, Carlton J. Zdanski10.1016/j.otohns.2009.10.006Otolaryngology - Head and Neck Surgery 142, 2 (2010)2010-02-01Otolaryngology - Head and Neck Surgery2010-02-011422S0194-5998(09)X0016-1Otology and Neurotology260265http://www.otojournal.org/article/PIIS0194599809016660/abstract?rss=yesAbstract: Objective: To investigate the effectiveness and safety of intratympanic methylprednisolone perfusion (IMP) through a microcatheter in patients with sudden sensorineural hearing loss (SSNHL) who failed a conventional treatment.Study Design: Prospective clinical study.Setting: This study was conducted in Nanjing Drum Tower Hospital, Nanjing University Medical School.Subjects and Methods: Patients who had failed a minimum 10-day conventional treatment were included. Twenty-six patients in the study group (SG) received methylprednisolone perfusion through a microcatheter placed into the tympanum once a day for 10 days and the conventional treatment. Twenty-three patients who received a second conventional treatment (no steroid) served as the comparison group (CG). All patients were followed up for three months after the end of treatment.Results: The effective rates for SG and CG were 50 percent (61.9% when only patients with an interval from onset to IMP ≤ 60 days were included) and 21.7 percent, respectively (χ2 = 4.194, P = 0.041). The pure-tone average improvement was 20.2 ± 15.6 dB in SG, and 9.2 ± 13.7 dB in CG (z = 2.51, P = 0.011). In SG, hearing improvement at low frequencies was better than that at high frequencies. The interval from onset to IMP affected the efficacy of IMP.Conclusion: IMP through a microcatheter is a promising treatment for refractory SSNHL. The data suggest that the treatment may be more effective when administered at the earlier stages of SSNHL when the conventional treatment has failed.Hearing evaluation of intratympanic methylprednisolone perfusion for refractory sudden sensorineural hearing lossWandong She, Yanhong Dai, Xiaoping Du, Chenjie Yu, Feng Chen, Junguo Wang, Xiaoming Qin10.1016/j.otohns.2009.10.046Otolaryngology - Head and Neck Surgery 142, 2 (2010)2010-02-01Otolaryngology - Head and Neck Surgery2010-02-011422S0194-5998(09)X0016-1Otology and Neurotology266271http://www.otojournal.org/article/PIIS019459980901660X/abstract?rss=yesAbstract: Objectives: 1) To measure prevalence of hearing impairment (HI) in schoolchildren living in poverty in Peru. 2) To identify risk factors for HI and assess its impact on academic performance.Study Design: Cross-sectional.Setting: Elementary schools in an asentimiento humano (shantytown) near Lima, Peru, October 2008 to March 2009.Subjects: Schoolchildren (n = 335), ages six to 19 years.Methods: Audiological health was assessed with pure-tone audiometry, tympanometry, and otoscopy. The primary outcome was HI, defined as average threshold >25 dB HL for 0.5, 1, 2, and 4 kHz, in one or both ears (per World Health Organization/International Organization for Standardization). A questionnaire on health history was administered to parents. Statistical analysis included univariate analysis for χ2 values and odds ratios (ORs), and multivariate logistic regression.Results: HI prevalence: 6.9 percent (95% confidence interval [CI] 4.2%-9.6%). Risk factors for HI (OR, 95% CI, P value): neonatal jaundice (5.59, 1.63-19.2, 0.015), seizure (7.31, 2.50-21.4, 0.0013), hospitalization (4.01, 1.66-9.68, 0.003), recurrent otitis media (5.06, 1.98-12.9, 0.002), past otorrhea (4.70, 1.84-12.0, 0.003), family history of HI at <35 years (2.91, 1.19-7.14, 0.026), tympanic membrane abnormality (13.8, 4.48-42.7, <0.001), cerumen impaction (15.8, 4.71-53.1, <0.001), and eustachian tube dysfunction (4.87, 1.74-13.7, <0.001). HI was an independent predictor of academic failure (3.36, 1.15-9.82, 0.03).Conclusions: Impoverished Peruvian schoolchildren were four to seven times more likely to experience HI than children living in higher-income countries. Untreated middle ear disease in the context of limited access to pediatric care was a major risk factor for HI. Furthermore, HI was associated with worse scholastic achievement. These results support prioritization of pediatric ear health as an essential component of the global health agenda, especially in resource-poor countries.Hearing impairment and poverty: The epidemiology of ear disease in Peruvian schoolchildrenJosephine A. Czechowicz, Anna H. Messner, Edith Alarcon-Matutti, Jorge Alarcon, Gina Quinones-Calderon, Silvia Montano, Joseph R. Zunt10.1016/j.otohns.2009.10.040Otolaryngology - Head and Neck Surgery 142, 2 (2010)2010-02-01Otolaryngology - Head and Neck Surgery2010-02-011422S0194-5998(09)X0016-1Otology and Neurotology272277http://www.otojournal.org/article/PIIS0194599809016556/abstract?rss=yesAbstract: Objective: To investigate the spectrum of disease presentation and clinical management of primary external auditory canal cholesteatoma (EACC).Study Design: Case series with chart review.Setting: Specialty teaching hospital.Subjects and Methods: Ten cases of primary EACC were identified in nine patients treated over 14 years (1995-2009). Cases were reviewed with regard to demographics, presentation, physical examination, CT findings, and clinical management.Results: The most common symptoms were otalgia and hearing loss, followed by otorrhea and tinnitus. Erosion was present in the mastoid air cells in seven patients, middle ear in six, temporomandibular joint in two, otic capsule in two, and fallopian canal in one patient. Eight of nine patients were managed with serial debridement.Conclusions: EACC is associated with adjacent bony erosion, most often involving the inferior EAC. Despite the potentially destructive nature of these lesions, most cases can be successfully managed with serial debridement.Conservative management of advanced external auditory canal cholesteatomaE. Ashlie Darr, Christopher J. Linstrom10.1016/j.otohns.2009.10.035Otolaryngology - Head and Neck Surgery 142, 2 (2010)2010-02-01Otolaryngology - Head and Neck Surgery2010-02-011422S0194-5998(09)X0016-1Short Scientific Communications278280http://www.otojournal.org/article/PIIS019459980901729X/abstract?rss=yesAbstract: Radio-guided surgery is an established means for surgeons to identify a target of interest for biopsy or excision. This technique is used for a variety of malignancies as well as minimally invasive parathyroid surgery. The primary radionuclide used for these procedures is technetium-99m (Tc-99m), but others have been used. Use of 18fluorine-fluorodeoxyglucose (18F-FDG) in oncology has proliferated. This has created the opportunity to use 18F-FDG as a potential radio tracer in the operating room. A pilot study of three patients with non-iodine avid thyroid cancers undergoing 18F-FDG–guided revision thyroid cancer surgery is reported. Radiation exposure to operating room personnel was measured. Radiation exposure to the surgeon and staff members of an operating room is well below the limits of the National Regulatory Commission. Therefore, utilization of this radiopharmaceutical intraoperatively should not be limited in the future because of concern regarding exposure of operating room personnel to radiation.Intraoperative radiation exposure with the use of 18F-FDG–guided thyroid cancer surgeryCharles Nalley, Kim Wiebeck, Twyla B. Bartel, Donald Bodenner, Brendan C. Stack10.1016/j.otohns.2009.11.005Otolaryngology - Head and Neck Surgery 142, 2 (2010)2010-02-01Otolaryngology - Head and Neck Surgery2010-02-011422S0194-5998(09)X0016-1Short Scientific Communications281283http://www.otojournal.org/article/PIIS0194599809015769/abstract?rss=yesTracheoesophageal puncture (TEP) is an effective and preferred means by which alaryngeal patients can achieve post-laryngectomy speech. While TEP has traditionally been performed in the operating room (OR) with the patient under general anesthesia, the availability of the transnasal esophagoscope has allowed TEP to be performed as an unsedated, office-based procedure. Additional advantages include a reduction in surgery time and procedure-related cost, and improved collaboration between the otolaryngologist and the speech pathologist to achieve improved clinical outcomes.Unsedated office-based tracheoesophageal puncture using a novel guidewire techniqueDouglas Sidell, Murtaza Ghadiali, Dinesh K. Chhetri10.1016/j.otohns.2009.09.030Otolaryngology - Head and Neck Surgery 142, 2 (2010)2010-02-01Otolaryngology - Head and Neck Surgery2010-02-011422S0194-5998(09)X0016-1Clinical Techniques and Technology284285http://www.otojournal.org/article/PIIS0194599809015800/abstract?rss=yesMöbius syndrome is a rare congenital disorder characterized by complete or partial facial paralysis, with or without paralysis of other cranial nerves, and occasional limb and/or orofacial malformations. It occurs in one of every 50,000 live births, and affects boys and girls equally. Many patients have a foreshortened upper lip with exposed incisors, and experience oral incompetence, poor articulation, and exposure dental caries from bilateral facial paralysis. Facial reanimation surgery performed using gracilis muscle transfer has been shown to improve drooling, speech, and facial animation. Despite successful facial animation, many patients still experience speech difficulties related to the foreshortened upper lip.Upper lip elongation in Möbius syndromeRobin W. Lindsay, Tessa A. Hadlock, Mack L. Cheney10.1016/j.otohns.2009.09.034Otolaryngology - Head and Neck Surgery 142, 2 (2010)2010-02-01Otolaryngology - Head and Neck Surgery2010-02-011422S0194-5998(09)X0016-1Clinical Techniques and Technology286287http://www.otojournal.org/article/PIIS0194599809016118/abstract?rss=yesA 57-year-old male presented to our clinic with an eight-year history of a slowly growing mass behind his right ear. There was no trauma or surgical intervention in his history. Physical examination revealed a 4 cm × 3 cm, nonfluctuant, mobile mass behind the right auricle (). The overlying skin was blue-purple in color. CT scans revealed a mass with a dense content and no contrast enhancement. There was no invasion to the temporal bone or auricular cartilage. The mass was excised under local anesthesia, including the overlying skin. Pathological diagnosis was reported as epidermoid cyst.Postauricular epidermal cystFuat Buyuklu, Evren Hizal10.1016/j.otohns.2009.10.016Otolaryngology - Head and Neck Surgery 142, 2 (2010)2010-02-01Otolaryngology - Head and Neck Surgery2010-02-011422S0194-5998(09)X0016-1Clinical Photographs288289http://www.otojournal.org/article/PIIS0194599809015812/abstract?rss=yesA five-year-old male was referred to the pediatric otolaryngology clinic with recurrent right anterior epistaxis and unilateral nasal obstruction. There was no history of systemic disease, neurologic changes, trauma, or foreign body insertion. He had no significant medical or surgical history. Upon examination, he was noted to have an obstructing friable right intranasal mass (). Anterior rhinoscopy was normal on the opposite side. The remainder of his head and neck examination was normal. Imaging studies revealed a lobular heterogeneous nasal mass causing mass effect on the septum and lateral nasal wall. There was no erosion or remodeling of bone, and no extension outside of the nasal cavity. No prominent feeding vessels were identified. The mass was excised endoscopically using image guidance. Intraoperatively, the mass was noted to have a single pedicle attachment to the nasal septum. Under direct visualization, the posterior septal attachment was lysed. Due to the size of the mass, it could not be extracted through the nose. It was pushed into the nasopharynx and removed transorally. The final histopathologic diagnosis was lobular capillary hemangioma. On follow-up at eight months, the patient reported resolution of his epistaxis and improved nasal breathing, and fiberoptic endoscopy revealed no evidence of recurrence.Lobular capillary hemangioma of the nasal cavity in a five-year-old boyMargo McKenna Benoit, Daniel S. Fink, Matthew T. Brigger, Donald G. Keamy10.1016/j.otohns.2009.09.035Otolaryngology - Head and Neck Surgery 142, 2 (2010)2010-02-01Otolaryngology - Head and Neck Surgery2010-02-011422S0194-5998(09)X0016-1Clinical Photographs290291http://www.otojournal.org/article/PIIS0194599809013291/abstract?rss=yesCholesterol granuloma (CG) of the orbit is a rare entity caused by a foreign body reaction against cholesterol crystals. It has been reported in several locations, such as the peritoneum, lungs, breast, lymph nodes, kidney, and testis. Within the head and neck location, it has been mostly reported in association with bony structures, such as the mastoid antrum and air cells of the temporal bone. It has also been reported in the jaw, nasal sinuses, and base of the skull. We present two new cases of CG of the orbit and focus on controversial treatment considerations.Cholesterol granuloma of the orbitRaúl González-García, Leticia Román-Romero10.1016/j.otohns.2009.08.001Otolaryngology - Head and Neck Surgery 142, 2 (2010)2009-09-28Otolaryngology - Head and Neck Surgery2009-09-281422S0194-5998(09)X0016-1Case Reports292293http://www.otojournal.org/article/PIIS0194599809012194/abstract?rss=yesOrbital apex syndrome (OAS) is a complex of symptoms resulting from damage to cranial nerves III, IV, V1, and VI in association with optic nerve dysfunction. Development of an infectious internal carotid artery (ICA) aneurysm after OAS is extremely rare. Herein, we report on a patient with OAS caused by invasive fungal sphenoiditis in whom an infectious aneurysm of the supraclinoid portion of the ICA occurred within five days and resulted in death.Rapid development of an infectious aneurysm of the internal carotid artery from orbital apex syndromeSang-Chul Lim, Jeong-Uk Choi, Soon-Ho Bae10.1016/j.otohns.2009.07.002Otolaryngology - Head and Neck Surgery 142, 2 (2010)2009-09-28Otolaryngology - Head and Neck Surgery2009-09-281422S0194-5998(09)X0016-1Case Reports294295http://www.otojournal.org/article/PIIS0194599809012145/abstract?rss=yesEmbryologically, the thyroid gland originates from the lingual foramen cecum. Its migration through the neck leads to the formation of the thyroglossal tract, which degenerates during embryological life.A dual nodular thyroid ectopy, presenting with massive bleeding during pregnancy, treated by Sistrunk procedureChristophe Reynaud, Omar Sabra, Guillaume Chambon, Jean Gabriel Lallemant, Benjamin Lallemant10.1016/j.otohns.2009.06.748Otolaryngology - Head and Neck Surgery 142, 2 (2010)2009-09-17Otolaryngology - Head and Neck Surgery2009-09-171422S0194-5998(09)X0016-1Case Reports296297http://www.otojournal.org/article/PIIS0194599809013205/abstract?rss=yesMetastatic tumors to the external auditory canal (EAC) are exceedingly rare. In the vast majority of cases, these metastases occur in the latter stages of the disease process. To the best of our knowledge there has been only one case report of metastatic esophageal adenocarcinoma to the EAC. We present the first reported case of an EAC mass as the initial presenting symptom of a metastatic esophageal adenocarcinoma. Institutional review board approval was obtained.Metastatic esophageal adenocarcinoma presenting as an external auditory canal massKevin W. Lollar, Charles A. Parker, Benjamin D. Liess, Jessica Wieberg10.1016/j.otohns.2009.07.017Otolaryngology - Head and Neck Surgery 142, 2 (2010)2009-09-28Otolaryngology - Head and Neck Surgery2009-09-281422S0194-5998(09)X0016-1Case Reports298299http://www.otojournal.org/article/PIIS0194599809016623/abstract?rss=yesBurton et al discussed the Cochrane review on homeopathic medicines. Comments such as homeopathic medicine is “a promising area of research” (Dr. Couch) and the “benefit of doubt has now shifted” (Dr. Burton) left me bewildered.A more skeptical review of homeopathyMichael Hopfenspirger10.1016/j.otohns.2009.10.042Otolaryngology - Head and Neck Surgery 142, 2 (2010)2010-02-01Otolaryngology - Head and Neck Surgery2010-02-011422S0194-5998(09)X0016-1Letters to the Editor300300http://www.otojournal.org/article/PIIS0194599809016635/abstract?rss=yesDr. Hopfenspirger takes Dr. Couch and me to task for two statements in our comments on the Cochrane review of homeopathic medicines for adverse effects of cancer treatment. I can only respond for myself. On re-reading what I wrote in the original commentary, I find it hard to imagine that anyone would think I was a supporter of, or even a “believer” in, homeopathic medicine.Response to: A more skeptical review of homeopathy, from Michael HopfenspirgerMartin J. Burton10.1016/j.otohns.2009.10.043Otolaryngology - Head and Neck Surgery 142, 2 (2010)2010-02-01Otolaryngology - Head and Neck Surgery2010-02-011422S0194-5998(09)X0016-1Letters to the Editor300300http://www.otojournal.org/article/PIIS0194599809017689/abstract?rss=yesTonsillectomy and adenoidectomy (T&A) is the first-line surgical treatment for the management of pediatric obstructive sleep apnea/hypopnea syndrome (OSAHS). However, contrary to the initial reports, recent studies demonstrated higher rates of persistence of OSAHS after T&A. It was emphasized that T&A for pediatric OSAHS patients with smaller tonsils, narrower epipharyngeal airspace, and more poorly developed maxillary and mandibular protrusion had poorer response. Therefore, different and advanced surgical approaches, such as uvulopalatopharyngoplasty and orthognatic surgeries (maxillomandibular expansion, distraction osteogenesis, etc.), were offered.Lingual tonsillectomy for the management of persistent obstructive sleep apnea after adenotonsillectomy in childrenGörkem Eskiizmir10.1016/j.otohns.2009.11.021Otolaryngology - Head and Neck Surgery 142, 2 (2010)2010-02-01Otolaryngology - Head and Neck Surgery2010-02-011422S0194-5998(09)X0016-1Letters to the Editor301301http://www.otojournal.org/article/PIIS0194599809017136/abstract?rss=yesThis is the second book on structural fat injection by Dr. Sydney Coleman. Dr. Coleman has established his secure stature as one of the leading experts in fat transfer technique and understanding. He has dedicated several decades of clinical practice, research, and teaching to the topic. He has developed principles of fat grafting that serve as the fundamentals of the practice for many surgeons. He may be the most influential proponent of structural fat grafting for the rejuvenation of the aging face; many surgeons ascribe to his techniques and approach to the practice. This second volume, Fat Injection: From Filling to Regeneration, is co-edited by Dr. Riccardo F. Mazzola and serves as a valuable sequel to Dr. Coleman's first book on the subject.Fred G. Fedok10.1016/j.otohns.2009.10.053Otolaryngology - Head and Neck Surgery 142, 2 (2010)2010-02-01Otolaryngology - Head and Neck Surgery2010-02-011422S0194-5998(09)X0016-1Book Review302302http://www.otojournal.org/article/PIIS0194599809018889/abstract?rss=yesContents10.1016/S0194-5998(09)01888-9Otolaryngology - Head and Neck Surgery 142, 2 (2010)2010-02-01Otolaryngology - Head and Neck Surgery2010-02-011422S0194-5998(09)X0016-1FrontmatterA3A3http://www.otojournal.org/article/PIIS0194599809018890/abstract?rss=yesEditorial Board10.1016/S0194-5998(09)01889-0Otolaryngology - Head and Neck Surgery 142, 2 (2010)2010-02-01Otolaryngology - Head and Neck Surgery2010-02-011422S0194-5998(09)X0016-1FrontmatterA12A12http://www.otojournal.org/article/PIIS0194599809018907/abstract?rss=yesSociety Page10.1016/S0194-5998(09)01890-7Otolaryngology - Head and Neck Surgery 142, 2 (2010)2010-02-01Otolaryngology - Head and Neck Surgery2010-02-011422S0194-5998(09)X0016-1FrontmatterA14A14http://www.otojournal.org/article/PIIS0194599809018919/abstract?rss=yesInformation for Readers10.1016/S0194-5998(09)01891-9Otolaryngology - Head and Neck Surgery 142, 2 (2010)2010-02-01Otolaryngology - Head and Neck Surgery2010-02-011422S0194-5998(09)X0016-1FrontmatterA16A16