Otolaryngology - Head and Neck Surgery

Going to the next level: Health care's evolving expectations for evidence

2009-10-01

Abstract: Rhinologic literature has historically relied on lower levels of evidence to make prescriptive recommendations for use of new technology and procedures. However, as the medical profession has moved to embrace the principles of evidence-based medicine, expectations for minimum standards of evidence have risen. The resulting high-quality efficacy outcomes data have become the linchpin of informed decision making by physicians, payers, and health care systems. While many challenges remain in this transition to higher evidence expectations, none are insurmountable. It has become the responsibility of the organized medical profession to play a role in influencing and supporting production of high-quality outcomes research.

Readability analysis of patient information on the American Academy of Otolaryngology–Head and Neck Surgery website

Jewel Greywoode, Eric Bluman, Joseph Spiegel, Maurits Boon — 2009-10-01

Abstract: Objective: To evaluate the readability of patient-oriented online health information (OHI) presented on the American Academy of Otolaryngology–Head and Neck Surgery (AAO–HNS) website.Study Design: Review of the Flesch-Kincaid (FK) grade level for 104 articles on the AAO–HNS website.Methods: The FK grade level for 104 articles was determined using the readability calculator available within Microsoft Office Word 2003. The interobserver reliability for the FK grade level was determined by calculating the intraclass correlation coefficient (ICC) for 52 entries.Results: The average FK grade reading level of the articles was 10.8 (range 6.3-16.7; 95% CI, 10.4-11.2). Eighty-one percent of the articles were written at a ninth grade level or higher. The intraclass correlation was good (r = 0.83) for the 52 articles that were independently reviewed.Conclusions: This analysis has shown that the average reading level for each article on the AAO–HNS site was higher than the recommended sixth grade reading level. Although the AAO–HNS site is written at a higher level than that suggested for the general public, it is important to realize that readability is just one consideration in the evaluation of OHI comprehension. Physicians need to be cognizant of their patients' ability to read and comprehend written information and tailor their educational material appropriately.

Pepsin as a causal agent of inflammation during nonacidic reflux

Tina L. Samuels, Nikki Johnston — 2009-11-01

Abstract: Objective: To investigate the contribution of pepsin to inflammation attributed to nonacidic gastric reflux via analysis of inflammatory cytokine and cytokine receptor gene expression in pepsin-treated human hypopharyngeal epithelial cells in vitro.Study Design: Translational research.Setting: This study was performed in an academic research laboratory.Subjects and Methods: Human hypopharyngeal epithelial cells were incubated with or without pepsin (0.1 mg/mL) at pH 7.4, 37°C, overnight. Expression of 84 inflammatory cytokines and cytokine receptors was analyzed via RT2 qPCR array.Results: Expression of a number of inflammatory cytokines and receptors was altered in human hypopharyngeal epithelial cells following overnight treatment with pepsin at neutral pH. Greater than 1.5-fold change in gene expression was detected for CCL20, CCL26, IL8, IL1F10, IL1A, IL5, BCL6, CCR6, and CXCL14 (P < 0.05).Conclusion: Exposure of hypopharyngeal cells to pepsin in a nonacidic environment induces the expression of several pro-inflammatory cytokines and receptors, including those known to be involved in inflammation of esophageal epithelium in response to reflux and which contribute to the pathophysiology of reflux esophagitis. These data indicate that refluxed pepsin may contribute to laryngeal inflammation associated with nonacidic gastric reflux, including that experienced by patients despite maximal acid suppression therapy.

Unexpected consequences of proton pump inhibitor use

Kenneth W. Altman, James A. Radosevich — 2009-11-01

Abstract: Proton pump inhibitors (PPIs) are among the most widely prescribed classes of medications for gastroesophageal and laryngopharyngeal reflux diseases. There is emerging evidence that the pathogenesis of disease in laryngeal mucosa is not just related to refluxed acid, but also the presence of pepsin and acidic microenvironments. The widespread use of PPIs is also calling into question potential complications of PPI use. This commentary expands upon these issues with other potential unexpected consequences, and considers the importance of determining a proper approach to patient management.

Biofilm presence in humans with chronic suppurative otitis media

2009-11-01

Abstract: Objective: To study the presence of biofilm formation in humans with chronic suppurative otitis media (CSOM).Study Design: Cross-sectional study.Setting: Tertiary academic hospital.Subjects and Methods: Patients undergoing middle ear surgery between July 2006 and March 2008. Tissue samples were obtained from 25 patients, of which 20 specimens were successfully processed for this study. The remaining samples were not analyzed due to sample damage or loss during preparation. Of the 20 specimens studied, 10 were harvested as the experimental group from patients with CSOM and the other 10 harvested as controls from patients undergoing otologic surgery for acoustic neuroma, cochlear implant, or routine tympanoplasty. Ages ranged from 26 to 74 years (mean 45 yrs). Male-to-female ratio was 2:3. Scanning electron microscopy and confocal laser scanning microscopy were used to identify the presence of biofilms. Live-dead staining was used to assess whether bacteria present were viable. The outcome measured was the presence of adherent biofilms on middle ear mucosa.Results: Biofilms were present in six of 10 samples (60%) from the CSOM group, but only in one of 10 control samples (10%). Comparative analysis revealed a statistically significant difference (P < 0.05) in the presence of biofilms in specimens from the CSOM group versus the control group.Conclusion: Biofilms were statistically more common in patients with CSOM compared with control patients.

Clinical efficacy of initial intratympanic steroid treatment on sudden sensorineural hearing loss with diabetes

2009-10-01

Abstract: Objective: The purpose of this study is to compare the efficacy of intratympanic steroid injection (ITSI) with that of systemic steroids as an initial treatment of sudden sensorineural hearing loss (SNHL) with diabetes.Study Design: Prospective, nonrandomized multicenter clinical trial.Setting: Multicenter study in Busan and Masan, South Korea.Subjects and Methods: A total of 114 sudden SNHL patients who were diagnosed with diabetes were divided into peroral (PO) group (n = 48), intravenous (IV) group (n = 32), and intratympanic (IT) group (n = 34). In the PO group, prednisolone was used orally for 10 days, per schedule. In the IV group, prednisolone was administered intravenously for seven days, followed by oral administration of tapered doses for another several days. In the IT group, dexamethasone was injected into the tympanic cavity four times within a two-week period. Hearing outcome was assessed before and after the treatment.Results: All groups showed significant improvement with criteria of 15 dB (P < 0.05). However, there was no significant difference in hearing gain and recovery rate among groups (P > 0.05). Systemic steroid treatment was stopped for two patients in the IV group and for one in the PO group due to uncontrolled hyperglycemia. However, in the IT group, there were no patients who failed to control their blood sugar level.Conclusion: ITSI is as effective as systemic steroid treatment for sudden SNHL patients with diabetes and it can avoid undesirable side effects. Therefore, we consider ITSI to be a more reasonable alternative as an initial treatment for sudden SNHL patients with diabetes.

Hearing outcomes of daily intratympanic dexamethasone alone as a primary treatment modality for ISSHL

Seok Min Hong, Chan Hum Park, Jun Ho Lee — 2009-11-01

Abstract: Objective: Intratympanic (IT) dexamethasone offers a good method for avoiding systemic side effects in patients with sudden idiopathic sensorineural hearing loss (ISSHL). However, in most studies, IT was used as a salvage treatment for patients whose hearing failed to improve with the initial systemic treatment, or as an addition to conventional oral steroid protocols. Therefore, we investigated the outcomes of IT steroid administration as a primary treatment modality for ISSHL.Study Design: Randomized controlled study.Setting: Tertiary referral center.Subjects and Methods: Two treatment methods, IT dexamethasone or oral prednisolone, were randomly assigned to 63 participants. A group of 32 patients (IT group) with ISSHL received IT dexamethasone once a day for eight days. A separate group of 31 patients (oral group), received oral prednisolone, also for eight days. We compared the hearing outcomes in the two groups.Results: We have found that the outcomes for patients treated with IT dexamethasone as a primary treatment modality for the management of ISSHL presented no difference in pure-tone averages or hearing recovery rate compared with patients treated with oral steroids. However, differences were noted for hearing thresholds according to frequency: the threshold improvement at low frequencies (250, 500, and 1000 Hz) was not statistically significant between groups; at high frequencies, particularly 4000 and 8000 Hz, the threshold improvement was statistically higher in the oral group than in the IT group.Conclusion: IT dexamethasone might be a good primary treatment method for ISSHL; but, for the management of ISSHL, we should keep in mind the differences in hearing outcomes with regard to frequency.

Direct drug application to the round window: A comparative study of ototoxicity in rats

2009-11-01

Abstract: Objective: To assess the validity of inducing ototoxicity in rats by applying a sponge soaked in kanamycin and furosemide on the round window.Study Design: Basic, randomized, nonblind experimental study.Setting: Animal models of cochlear damage and reliable methods of local drug delivery are fundamental to study hearing loss and to design new therapies.Subjects and Methods: Four experimental groups of six Wistar rats with different methods of drug administration were used: (1) injection of subcutaneous kanamycin (400 mg/kg) and intravenous furosemide (100 mg/kg); (2) local application of a sponge soaked in saline close to the round window; (3) animals for which the sponge was soaked in a solution containing kanamycin (200 mg/mL) and furosemide (50 mg/mL); and (4) sham-operated rats. The tympanic bulla was exposed using a ventral approach, and a bullostomy was performed to visualize the round window membrane. Cochlear function was assessed by measuring the auditory brainstem response, and hearing thresholds in response to click and tone burst stimuli were determined as peak and interpeak latencies. At the end of the study, cochlear histology was analyzed.Results: Systemic administration of kanamycin and furosemide induced profound hearing loss and severe hair cell damage. Local delivery of these ototoxic drugs caused comparable damage but avoided the systemic side effects of the drug. Sham-operated and saline control animals did not experience functional alterations.Conclusion: Situating a sponge soaked in kanamycin and furosemide on the round window membrane through the ventral approach is a reliable method to provoke local ototoxicity in rats.

Complications/adverse effects of maxillomandibular advancement for the treatment of OSA in regard to outcome

2009-11-01

Abstract: Objective: To evaluate adverse effects/postoperative complications and surgical response rate of maxillomandibular advancement for the treatment of severe obstructive sleep apnea syndrome.Study Design: Case series with chart review.Setting: Otolaryngology Head and Neck Surgery Department in a teaching hospital.Subjects and Methods: A total of 59 consecutive severe sleep apnea patients underwent maxillomandibular advancement. Systemic complications were evaluated from medical charts. Functional adverse effects and cosmetic consequences were evaluated by questionnaires. The treatment outcome was assessed by polysomnography.Results: Fifty patients were evaluated. They had a mean age of 46.4 ± 9.0 years. No serious postoperative complication was observed. The most frequent local complication was mental nerve sensory loss. Most patients reported cosmetic changes. The mean apnea-hypopnea index decreased from 65.5 ± 26.7 per hour to 14.4 ± 14.5 per hour (P < 0.0001). Light-sleep stages were also decreased (P < 0.0001), whereas deep-sleep stages were increased (P < 0.001).Conclusion: Maxillomandibular advancement can induce local adverse effects and cosmetic changes, but they seem to be considered as secondary to the patients according to the surgical outcome.

In vitro testing of tympanostomy tube occlusion

Ethan G. Sherman, Patrick J. Antonelli, Roger Tran-Son-Tay — 2009-11-01

Abstract: Objective: Tympanostomy tubes (TTs) are commonly rendered nonfunctional by mucus plug formation. The purpose of this study was to determine whether an in vitro model could be developed to assess TT plug formation with results consistent with human trials.Study Design: An ear chamber was designed to mimic middle ear air and mucus flow conditions in post-TT otorrhea. TT occlusion was tested and correlated to published in vivo results.Methods: TTs that had previously been studied in vivo (Goode “T” and Reuter Bobbin collar buttons) were placed in the model chamber. Pooled, homogenized human middle ear mucus and an analog, egg white, were delivered at 80 μL per hour through the TTs. An air bolus was delivered every two minutes to simulate swallowing. Chamber pressure was monitored over 2.5 hours. Occlusion was determined by a pressure peak and visual confirmation.Results: Obstruction was found in 60 percent of the Reuter Bobbin and 40 percent of the Goode TTs using the mucus analog. These results are similar to those reported from previous in vivo studies. No plugging was reported for either TT using homogenized human ear mucus.Conclusions: The in vitro TT chamber simulates the in vivo environment and yields results consistent with in vivo observations. This model system may allow for rapid prototyping and evaluation of new TTs that may be less vulnerable to occlusion.

Construct validity of a simulator for myringotomy with ventilation tube insertion

Peter G. Volsky, Brian B. Hughley, Shayn M. Peirce, Bradley W. Kesser — 2009-10-01

Abstract: Objectives: To establish construct validity of an anatomic model as a simulator for myringotomy with ventilation tube insertion and to assess its subjective appeal.Study Design: Cross-sectional, repeated-measures comparative evaluation of simulator.Setting: University academic otolaryngology residency program.Subjects and Methods: Using an anatomic model of the human auricle, ear canal, eardrum, and middle ear space, 18 otolaryngologists of various levels of training performed 10 timed procedures: myringotomy with ventilation tube insertion. Errors were recorded, and participants reported the quality of their experience.Results: Both time-to-completion and errors per trial discriminated novices from non-novice participants; novices (02:23, 95% confidence interval [CI], 01:42-03:04) were 3.6 times slower than non-novices (00:39, 95% CI, 00:35-00:43) and 6.5 times more error prone (novices 2.16 errors/trial, 95% CI, 1.68-2.64; non-novices 0.33 errors/trial, 95% CI, 0.21-0.45). Errors were strongly correlated with prior surgical experience. All participants required more time to complete the first trial, and their performance stabilized thereafter. Overall, the simulation was perceived as a valuable experience.Conclusion: Our model is a valid platform for simulating myringotomy with ventilation tube insertion. The model discriminates novices from non-novices, has a learning curve, and is perceived to be a valuable and realistic teaching tool by users.

Oropharyngeal flora changes after tonsillectomy

2009-10-01

Abstract: Objective: We aimed to investigate the effect of tonsillectomy on oropharyngeal flora in children who underwent tonsillectomy for chronic recurrent tonsillitis.Study Design and Setting: A prospective study was performed comprising patients with chronic recurrent tonsillitis who underwent tonsillectomy at the Department of Otolaryngology, Cerrahpasa Medical School. Incisional core biopsies of excised tonsils were also performed. Swabs and core biopsy specimens were transferred and maintained in Stuart's medium and sent to the Department of Microbiology and Clinical Microbiology at Cerrahpasa Medical School for microbiologic evaluation.Subjects and Methods: Oropharyngeal swabs and tonsillar core biopsy specimens from 31 patients operated on for recurrent tonsillitis were cultured. Follow-up oropharyngeal swabs were cultured one month after tonsillectomy.Results: There was no significant difference between the preoperative and postoperative isolation rate of the potentially pathogenic bacteria. Normal aerobic flora did not change significantly. However, the isolation rate of the Neisseria species dropped (P = 0.097) but did not reach statistical significance. Among anaerobes, Bacteroides fragilis, one of the major anaerobic bacteria, dropped significantly (P = 0.007). The Propionibacterium acnes isolation rate increased significantly (P = 0.009).Conclusion: Oropharyngeal anaerobic bacterial flora decreases after tonsillectomy in recurrent tonsillitis patients. The isolation rate for bacteria of the normal flora and potentially pathogenic bacteria does not change. Tonsils with recurrent infections may become a nidus for anaerobic bacteria. In patients with chronic recurrent tonsillitis, tonsillectomy may help change anaerobic bacterial oropharyngeal flora to the normal flora found in healthy individuals.

Volume and distances of the maxillary sinus in craniofacial deformities with midfacial hypoplasia

2009-11-01

Abstract: Objective: Craniofacial deformities (CFDs) frequently accompany midfacial hypoplasia. The authors evaluated characteristics of maxillary sinuses that had CFDs with variable degrees of midfacial hypoplasia.Study Design: Cross-sectional survey with chart review.Setting: Department of Plastic and Reconstructive Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.Subjects and Methods: We investigated 40 patients with CFDs having midfacial hypoplasia. Study group 1 (SG 1) consisted of eight patients with Crouzon syndrome (16 maxillary sinuses). Study group 2 (SG 2) consisted of 10 patients with midfacial hypoplasia after palatoplasty (20 maxillary sinuses). Study group 3 (SG 3) consisted of 22 patients with Pruzansky grade I hemifacial microsomia (22 maxillary sinuses on the affected sides). Data on volume and three-dimensional distances (height, width, and depth) from computed tomography were collected and compared with each corresponding control group. Correlation coefficient between volume and the three distances was also calculated.Results: The volume, height, width, and depth of the maxillary sinus were significantly decreased in SG 1 (P < 0.01). In SG 2, only the depth was significantly decreased (P < 0.05). In SG 3, there were no significant differences in any parameters. A multiple-regression analysis between the volume and the three distances showed a statistically significant relationship for width in SG 1, width and height in SG 2, and all distances in SG 3.Conclusion: There were differences in the structure of the maxillary sinuses among patients with different CFDs.

Postoperative monitoring in free tissue transfer patients: Effective use of nursing and resident staff

Ryan S. Jackson, Ronald J. Walker, Mark A. Varvares, Michael J. Odell — 2009-09-07

Abstract: Objectives: To compare the outcomes of two different free flap monitoring protocols and determine whether nursing staff can safely and effectively monitor free flaps.Study Design: Historical cohort study on all head and neck free tissue transfer patients from August 2003 to August 2007.Setting: Tertiary care teaching institution.Subjects and Methods: The patients were divided into two groups according to monitoring protocol. Group A (n = 49) had free flaps monitored primarily by resident physicians, while Group B patients (n = 45) were evaluated primarily by nursing staff. Demographic and outcomes data, including complications, reoperations, length of hospital stay, and flap viability, were then compared.Results: Overall, 28 (57%) patients in Group A and 16 (37%) in Group B had at least one complication (P = 0.05). Only eight patients in each group had major complications. There were 25 (27%) patients who required further intervention in the operating room: 18 (37%) in Group A and seven (16%) in Group B (P = 0.03). Only 12 (13%) patients returned to the operating room for concerns of flap viability: seven from Group A and five from Group B. The median length of hospital stay was 11 days for both groups (P = 0.76). The flap success rate was 95 percent, with three failures in Group A and two in Group B (P = 0.72).Conclusions: A monitoring protocol utilizing trained nursing staff has no detrimental effect on free tissue transfer outcomes. This may be used to optimize resident time within the current duty-hour restrictions.

2D-DIGE proteomic characterization of head and neck squamous cell carcinoma

2009-11-01

Abstract: Objective: Identify proteins that are differentially expressed between head and neck squamous cell cancer (HNSCC) and patient-matched normal adjacent tissue, and validate findings in a separate patient cohort.Study Design: Cross-sectional study of surgical specimens.Setting: Tertiary care academic medical center.Subjects and Methods: Laser capture microdissection and two-dimensional difference gel electrophoresis were used previously to establish proteomic profiles for tumor and normal adjacent tissue from 14 patients. Here, significance analysis of microarray was used to rank candidate biomarkers. Spots meeting statistical and biological criteria of significance were analyzed by liquid chromatography and tandem mass spectrometry to obtain protein identifications. The expression pattern of the highest-ranked candidate biomarker (cornulin) was validated in a larger, independent patient cohort (n = 68) by immunohistochemical staining of a tissue microarray.Results: Of 732 spots, 117 (15.9%) met criteria for significance. Identities were obtained for 39 spots, representing 17 different proteins. Four proteins were novel in the context of HNSCC: glutathione synthetase, which was upregulated; and cornulin (squamous epithelial heat shock protein 53), guanylate binding protein 6, and heat shock 70 kDa protein 5 (glucose-regulated protein, 78 kDa), which were downregulated. Cornulin functions in the stress response in normal squamous epithelium, and reduced expression has been proposed as a marker of susceptibility to laryngopharyngeal reflux and other stressors. Loss of cornulin expression was confirmed in an independent HNSCC patient cohort (P < 0.001).Conclusions: Downregulation of cornulin is a prominent feature of the molecular signature of HNSCC identified by comparative proteomics. Cornulin may represent a link between HNSCC and other pathologies arising in stratified squamous epithelium.

Additional diagnostic value of 18F-FDG PET-CT in detecting retropharyngeal nodal metastases

Hyung Ro Chu, Jin Hwan Kim, Dae Young Yoon, Hee Sung Hwang, Young-Soo Rho — 2009-11-01

Abstract: Objective: This study investigated whether preoperative 18fluorine-fluorodeoxyglucose positron emission tomography-computed tomography (PET-CT) scanning improved the diagnosis of retropharyngeal lymph node (RPLN) metastasis in patients with head and neck squamous cell carcinoma (HNSCC) relative to conventional imaging alone.Study Design: Case series with chart review.Setting: University hospital cancer center.Subjects and Methods: Sixty-three patients with HNSCC underwent RPLN dissection in accordance with our indications and were subsequently divided into two groups: CT/magnetic resonance imaging (MRI) only (group A, n = 33) and CT/MRI with PET-CT (group B, n = 30). The preoperative radiological findings of each group were compared with the RPLN histopathologic findings, which served as the standard of reference.Results: RPLN metastasis was confirmed histopathologically in 17 of 63 patients (27.0%): eight from group A and nine from group B. With the additional use of PET-CT in group B, the sensitivity (88.9%), specificity (85.7%), and accuracy (86.7%) were higher than the respective values in group A (62.5%, 60.0%, and 60.6%). The positive and negative predictive values for group B (72.7% and 94.7%, respectively) were also higher than those for group A (33.3% and 83.3%, respectively). False-positive results were obtained in 10 patients from group A and three patients from B; false-negative findings occurred in three patients from group A and one patient from group B. The predictive power of the radiological findings was statistically significant in group B (P = 0.0017), with an odds ratio of 47.987 (95% confidence interval, 4.3-535.0).Conclusion: 18F-FDG PET-CT, when used in combination with CT/MRI, increases diagnostic efficacy in the detection of RPLN metastases and may therefore be useful in screening high-risk patients.

Anatomical variations of the spinal accessory nerve and its relevance to level IIb lymph nodes

2009-09-18

Abstract: Objective: This study was conducted to identify anatomical variations of the spinal accessory nerve (SAN) in the upper neck, the landmark of the anterior and inferior border of level IIb, and to evaluate the nerve's effect on the border and the number of lymph nodes (LNs) in level IIb.Study Design and Setting: Case series with planned data collection.Subjects and Methods: A total of 181 neck dissections (NDs) were prospectively enrolled in this study. The relation between the SAN and adjacent structures (internal jugular vein [IJV], sternocleidomastoid muscle [SCM], cervical plexus) and the number of LNs in level IIb was investigated.Results: The SAN crossed the IJV ventrally in 72 cases (39.8%) and dorsally in 104 cases (57.4%), and passed through the IJV in five cases (2.8%). The SAN ran along the inner surface of the SCM and sent branches to the SCM without penetration of the muscle in 83 cases (45.9%), whereas in 98 cases (54.1%) the nerve sent branches to the SCM by penetration. Cervical plexus contribution to the SAN was seen from C2 in 96 cases (53.1%), C2 and C3 in 69 cases (38.1%), and C3 in 16 cases (8.8%). The mean number of LNs of level IIa and level IIb was 6.5 and 8.2 in cases in which the SAN crossed the IJV ventrally, and 6.8 and 5.4 in dorsally crossing cases. LNs included in the neck level IIb in ventrally crossing SAN cases were significantly larger than the dorsally crossing cases (P < 0.05).Conclusions: Our results may help to minimize the incidence of injuring the SAN in the upper neck during ND. Neck level IIb would contain more LNs if the course of the nerve leans toward the ventral side.

Prevention of unplanned pharyngocutaneous fistula in salvage laryngectomy

Krishnamurthi Sundaram, Jared M. Wasserman — 2009-11-01

Pharyngocutaneous fistula formation is the most common complication after laryngectomy. Salvage laryngectomies in patients treated with organ-preservation protocols are associated with higher rates of postoperative complications (13%-39%). These patients are best repaired by using regional myocutaneous flaps or free-tissue transfers. We present the formula used by the senior author at the Downstate Medical Center and affiliated hospitals in his last 11 cases, in which healing occurred without unplanned fistula formation, and length of stay was 10 days. Prior to the introduction of the formula, out of nine salvage laryngectomies (historical controls), the same surgeon had six cases of wound dehiscence and unplanned occurrence of a pharyngocutaneous fistula (67%). In these nine cases, one or more components of the formula were not used. Results using this fistula reduction formula appear superior to other reported attempts at fistula rate reduction and thus warrant reporting.

Modification of the mandibular genial osteotomy for “drop down” access to the base of the tongue

Bagrat Lalabekyan, Colin Hopper, Paul Norris, Francis Vaz, Nicholas Kalavrezos — 2009-11-01

Approaches to tumors of the tongue base are difficult because inadequate access may result in incomplete tumor resection. The tongue base can be approached by either a lip-split mandibulotomy or a mandibular lingual release. Although the lip-split mandibulotomy technique is considered the standard approach to the tongue base and floor of the mouth, it has major disadvantages: facial scarring, risk of malunion at the osteotomy site, and fistula formation. The mandibular lingual releasing access is performed through the neck dissection approach and does not cause any facial scarring. During the lingual approach, muscles of the hyomandibular complex are detached from the mandible. Deterioration of the hyomandibular complex can cause ptosis of the larynx and compression of the esophagus and result in dysphagia and aspiration. To avoid laryngeal ptosis, Stanley proposed detachment of the geniohyoid muscle and the anterior bellies of digastric muscles with a mucoperiosteal flap, which is reaffixed afterward via interdental sutures. Other well-known laryngeal suspension modalities are suture traction and the use of fascia lata. The pedicled genial osteotomy was described by Merrick et al in 2007. This method of laryngeal suspension is the most reliable, although it has some technical issues, which could be improved. We describe our modification of the pedicled genial osteotomy during mandibular lingual releasing access.

Penetrating facial injury from a wooden chopstick

Min-Su Kim, Jeong Hun Jang, Min-Hyun Park — 2009-09-07

A 46-year-old man presented to the emergency room with a stab injury inflicted one hour earlier by a wooden chopstick during a quarrel with his friends. He complained of throat pain radiating to the left ear and difficulty swallowing. Neurological examination on arrival revealed no deficit. A 1-cm-long skin laceration was present in the left preauricular area (). On inspection of the throat, part of the wooden chopstick protruding through the posterior oropharyngeal wall was visible. Neck CT revealed a low-density object extending from the preauricular skin to the oropharynx (). The object pierced the skin and passed through the left parotid gland. It traversed posteriorly to the mandibular ramus and into the parapharyngeal, retropharyngeal, and prevertebral spaces. The object passed between the internal carotid artery and the internal jugular vein. CT images did not show any evidence of hematoma or damage to vessels.

Isolated fracture of the malleus handle

Özmen Öztürk, Cüneyd Üneri — 2009-08-31

A 61-year-old male patient with a history of right-sided sudden hearing loss in 1980 presented with progressive deterioration of hearing bilaterally for five years. In 1980, the patient consulted a local otolaryngologist with the complaints of sudden onset hearing loss and otalgia in his right ear after manipulation of his ear canal with his index finger while showering. The diagnosis at that time was otitis, and he began a course of antibiotics. Since 1980, the patient had been seen by various otolaryngologists and the problem that was causing the hearing loss was unnoticed.

Fibrous dysplasia of the temporal bone presenting as an external auditory canal mass

Yu-Chien Wang, Yen-An Chen — 2009-09-02

A 20-year-old male was referred to our outpatient clinic with the complaint of left progressive hearing loss over several years. Otolaryngologic examination revealed a smoothly contoured bony mass bulging from the anterior wall of the external auditory canal (EAC) (). Pure tone audiometry showed left conductive hearing loss and an air-bone gap of 20 dB. High-resolution CT of the temporal bone demonstrated an expansile lesion with a “ground glass” appearance in the left petrous bone, displacing the anterior wall of the EAC posteriorly (). Temporal bone fibrous dysplasia, monostotic type, was diagnosed on the basis of radiological images. The patient decided not to receive canalplasty after being informed about the unpredictability of fibrous dysplasia and its tendency to recur. He received regular follow-ups at our outpatient department.

Donor site metastasis after pectoralis major myocutaneous flap reconstruction for oral squamous cell carcinoma

Senniappan Kartikeyan, Mridula Shukla, Manoj Pandey — 2009-08-28

In spite of development in the field of microvascular surgery and free flap repair, pectoralis major myocutaneous flap still remains the workhorse of surgical oncologists for head and neck reconstruction after tumor ablation.

Sudden deafness as a presenting symptom of chronic hepatitis B with acute exacerbation

Chi-Che Huang, Wei-Bin Lin, Po-Hung Chang, Kai-Chieh Chan, Ta-Jen Lee — 2009-09-02

Although the etiologies of sudden sensorineural hearing loss (SHL) remain unknown, several viruses have been strongly implicated as having causative roles, such as mumps, herpes simplex, and cytomegalovirus. However, hepatitis B virus (HBV) has not been associated with sudden SHL except in a case of fluctuant SHL found after hepatitis B vaccination. We report a case of chronic hepatitis B (CHB) with acute exacerbation that initially presented only as unilateral sudden SHL.

Management of closed tracheal perforation following blunt trauma

John O'Callaghan, Siew Min Keh, Alwyn D'Souza — 2009-08-10

Tracheal perforation is a recognized complication of both endotracheal intubation and emergency tracheostomy. Less commonly, it can result from trauma to the chest, head, or neck. Injuries to the tracheobronchial tree are rare but life threatening; 78 percent die before admission, and 21 percent of those admitted die within two hours. We describe the conservative management of a case of a closed tracheal perforation following blunt trauma.

Angioleiomyoma of the nasal cavity: A rare cause of epistaxis

Jian He, Li-Na Zhao, Zhi-Nong Jiang, Shi-Zheng Zhang — 2009-07-09

Angioleiomyoma, a solitary and rare form of leiomyoma that usually occurs subcutaneously, accounts for about five percent of all benign soft tissue tumors and one-fourth to one-half of all superficial leiomyomas. Nasal angioleiomyoma is extremely rare, and no more than 35 cases of angioleiomyoma in nasal cavity and paranasal sinuses have been reported in the English-language literature. Herein, we report a new case of nasal angioleiomyoma with special histopathologic and immunohistochemical findings of this lesion. This case received the approval of the Ethics Committee for publication.

Correction

2009-11-01

The following article, which ran in the April 2007 issue of Otolaryngology-Head and Neck Surgery, contained an error. “Biofilm formation in cochlear implants with cochlear drug delivery channels in an in vitro model” by TA Johnson, KA Loeffler, RA Burne, CN Jolly, and PJ Antonelli, pages 577-582. Under the Materials and Methods section, page 579, Quantitative Microbiology subheading, “… and plating 100 mL on 5% sheep blood agar.” should have been “… and plating 100 μL on 5% sheep blood agar.”

Correction

2009-11-01

The following article, which also ran in the April 2007 issue of Otolaryngology-Head and Neck Surgery, contained the same typographical error noted in the previous correction.

Correction

2009-11-01

Due to a printer error, the figure in a letter to the Editor for the June 2008 issue of Otolaryngology-Head and Neck Surgery was distorted. Della Santina CC. Cochleostomy placement and vestibular injury. Otolaryngol Head Neck Surg. 2008 Jun;138(6):812-3. Please see the correct here.

2009-11-01

Editorial Board

2009-11-01

Society Page

2009-11-01

Information for Readers

2009-11-01

Otolaryngology - Head and Neck Surgery

Going to the next level: Health care's evolving expectations for evidence

Readability analysis of patient information on the American Academy of Otolaryngology–Head and Neck Surgery website

Pepsin as a causal agent of inflammation during nonacidic reflux

Unexpected consequences of proton pump inhibitor use

Biofilm presence in humans with chronic suppurative otitis media

Clinical efficacy of initial intratympanic steroid treatment on sudden sensorineural hearing loss with diabetes

Hearing outcomes of daily intratympanic dexamethasone alone as a primary treatment modality for ISSHL

Direct drug application to the round window: A comparative study of ototoxicity in rats

Complications/adverse effects of maxillomandibular advancement for the treatment of OSA in regard to outcome

In vitro testing of tympanostomy tube occlusion

Construct validity of a simulator for myringotomy with ventilation tube insertion

Oropharyngeal flora changes after tonsillectomy

Volume and distances of the maxillary sinus in craniofacial deformities with midfacial hypoplasia

Postoperative monitoring in free tissue transfer patients: Effective use of nursing and resident staff

2D-DIGE proteomic characterization of head and neck squamous cell carcinoma

Additional diagnostic value of 18F-FDG PET-CT in detecting retropharyngeal nodal metastases

Anatomical variations of the spinal accessory nerve and its relevance to level IIb lymph nodes

Prevention of unplanned pharyngocutaneous fistula in salvage laryngectomy

Modification of the mandibular genial osteotomy for “drop down” access to the base of the tongue

Penetrating facial injury from a wooden chopstick

Isolated fracture of the malleus handle

Fibrous dysplasia of the temporal bone presenting as an external auditory canal mass

Donor site metastasis after pectoralis major myocutaneous flap reconstruction for oral squamous cell carcinoma

Sudden deafness as a presenting symptom of chronic hepatitis B with acute exacerbation

Management of closed tracheal perforation following blunt trauma

Angioleiomyoma of the nasal cavity: A rare cause of epistaxis

Correction

Correction

Correction

Contents

Editorial Board

Society Page

Information for Readers