Otolaryngology–Head and Neck Surgery

OBJECTIVE

To determine hearing recovery in patients with idiopathic sudden hearing loss treated with varying amounts of oral steroids.

STUDY DESIGN AND SETTING

A retrospective chart review (n = 75) in a tertiary care clinic examined sudden hearing loss patients treated with 1 60-mg prednisone taper, 1 course of steroid less than a 60-mg taper, or any 2 courses of oral steroid.

RESULTS:

Overall, 35% of the patients recovered a clinically significant amount of hearing. Recovery was associated with immediate treatment (within 2 weeks from onset), better hearing at the onset of treatment, and treatment with the higher dose of prednisone in patients with just 1 additional symptom (dizziness or tinnitus). Patients tended to continue to experience some recovery in hearing up to 4 months after treatment.

CONCLUSION:

Immediate treatment of patients with unilateral idiopathic sudden hearing loss and additional symptoms (dizziness or tinnitus) with a 14-day course of 60 mg prednisone (with taper) is recommended. EBM rating: B-3.

OBJECTIVE

Surgical removal of large (>3 cm) acoustic neuromas is associated with poor long-term facial nerve function results and higher complication rates. This study analyzes whether long term facial nerve function and the incidence of neurological and vascular complications is improved by resection of large acoustic neuromas in 2 or 3 stages.

PATIENTS AND METHODS

Among 660 patients who underwent surgical resection of acoustic neuromas between 1989 and 2002 by the senior author (J.M.K.), 34 (5%) patients underwent a staged resection of their large-sized tumors: stage I via a retrosigmoid craniotomy and stage II via a translabyrinthine approach. A retrospective chart review was performed. Tumor size, completeness of tumor removal, tumor recurrence, facial nerve function, and any complications were noted.

RESULTS:

The average tumor size was 4.4 cm with a mean postoperative length of follow-up of 6 years after the last surgery. Thirty-one patients underwent a 2-staged resection and 3 patients underwent a 3-staged resection. After their last surgery, 32 (94%) patients had excellent long-term facial function grades of House-Brackmann (H-B) I, one was H-B III, and one was H-B VI. All patients had a total or near-total (>98%) resection. There were no tumor recurrences on follow-up MRI scans. From these 71 operations, no patients required reoperation for a CSF leak. There were no deaths, strokes, hydrocephalus, or meningitis.

CONCLUSION:

In conjunction with the reported technical refinements, staged resection of large tumors significantly reduces morbidity and improves long-term facial nerve function. EBM rating: C.

OBJECTIVE

The effect of sustained silence was studied on the emergence of tinnitus perception in 120 normal hearing young adult Caucasians and African Americans.

STUDY DESIGN AND SETTING

After sitting in a sound booth for a period of 20 minutes, participants were asked to complete a questionnaire documenting whether they perceived sounds in the silent setting and descriptions of the sounds they heard.

RESULTS:

Tinnitus-like sounds were perceived in 64% of listeners overall. No significant differences in tinnitus perception were observed between males and females. However, there was a significant difference in tinnitus perception between Caucasian and African American subjects, with tinnitus sounds emerging in sustained silence less frequently in African American listeners. Tinnitus emerged quickly in a majority of subjects (less than 4 minutes) and African American subjects who perceived tinnitus heard a greater number of individual tinnitus-like sounds than did Caucasian subjects. Ring (57%), buzz (21%), pulse (22%), heartbeat (21%), and hum (14%) were the most common sounds heard, with ring being the most common overall tinnitus perception.

CONCLUSIONS AND SIGNIFICANCE

Few investigators have documented at the emergence of tinnitus in normal hearing subjects. Results of the current study found significant differences in tinnitus perception between Caucasian and African American subjects, but found no significant differences when comparing males and female subjects. EBM rating: C.

OBJECTIVES:

To determine if the severity of hearing loss due to semicircular canal transection (SCT) in Pseudomonas otitis media (POM) is a function of the extent of the labyrinthine injury.

METHODS:

POM was induced bilaterally in 45 guinea pigs. After 2 to 4 days, SCT was performed in one 1 on the horizontal canal, the superior canal, or both the horizontal and the superior canals. Auditory-evoked brainstem responses were measured before and after SCT.

RESULTS:

POM was induced bilaterally in all animals. Elevation of click thresholds was found in almost all SCT ears of all 3 groups; however, there were no significant differences between groups. Comparing the SCT ear to the contralateral, control ear, mean hearing losses in the horizontal, superior, and horizontal + superior SCT groups were 23 dB, 27 dB, and 24 dB, respectively.

CONCLUSIONS

Hearing loss does not correlate with extent of labyrinthine injury in POM in the guinea pig. EBM rating: B-2.

OBJECTIVE

Compare the efficacy of pressed scar tissue grafts to standard fascia and areolar tissue grafts for use in tympanoplasty.

STUDY DESIGN

A retrospective review of a prospective computerized database of tympanoplasty and mastoid surgeries at an academic, tertiary care practice was performed. Search parameters were set to find all patients who underwent tympanoplasty with or without mastoidectomy with use of various grafting materials for repair of tympanic membrane perforation from 1996 to 2002. All ages were included. Patients with cholesteatoma at the time of surgery were excluded. The short-term graft take rate was evaluated at 30 to 90 days to identify any differences in results using the standard fascia and areolar grafts vs. pressed scar tissue grafts. Other parameters that may have an influence on outcome were analyzed including mastoidectomy, infection, perforation size, perforation location, age of patient, primary vs. revision surgery, number of previous surgeries, postauricular vs. transcanal approaches, and medial vs. lateral grafting techniques. Hearing results were analyzed to see whether the use of scar tissue grafts resulted in equivalent outcomes compared to standard graft materials.

RESULTS:

There were no statistically significant differences in short-term tympanic membrane closure rates in subjects undergoing surgery using standard fascia/areolar tissue grafts and pressed scar tissue grafts. Hearing results were also statistically equivalent regardless of graft material used. The only parameter that was somewhat associated with successful closure of tympanic perforation was use of the postauricular approach compared to the transcanal approach.

CONCLUSIONS

Pressed scar tissue grafts are as efficacious as standard fascia and areolar tissue grafts when used to repair tympanic membrane perforations. Pressed scar tissue graft can be used successfully in cases such as revision tympanoplasty when standard tissue grafts are not available or difficult to obtain. EBM rating: B-3.

OBJECTIVES:

Complications in the central nervous system (CNS) from acute otitis media (AOM) and chronic otitis media (COM) are becoming fewer, although they still represent a challenge for early recognition, adequate treatment, and satisfactory results. This retrospective study analyzed clinical data and therapeutic options in 33 patients with intracranial involvement resulting from otitis media. Important clinical features of intracranial complications and the sequence of the most efficient therapeutic maneuvers are discussed.

METHODS:

Charts of six patients with AOM and 27 patients with COM associated with CNS complications were analyzed for clinical presentation, imaging, and therapeutic approach.

RESULTS:

Ages ranged from 6 months to 79 years, with no gender predilection. Persistent fever, headache, and purulent otorrhea were the main symptoms. Proteus mirabilis, Enterococcus, and Pseudomonas aeruginosa were the most common microorganisms in COM, and Pneumococus and Haemophilus were the most common microorganisms in AOM. Nineteen patients (58%) presented with more than 1 CNS complication, resulting in a total of 56 complications, including 26 cases of otogenic brain abscess, 21 cases of meningitis, 5 cases of lateral sinus thromboses, two cases of subdural empyemas, 1 case of epidural empyema, and 1 case of meningocele. Surgical interventions included craniotomy and drainage of the abscess (n = 17), open mastoidectomy with abscess drained through the mastoid (n = 10), open mastoidectomy alone (n = 8), and closed mastoidectomy (n = 2). Twelve patients who underwent craniotomy had subsequent mastoidectomy for recurrent abscess. At the 6-month, 66% of patients presented without sequelae, 24% presented with sequelae, and 9% died.

CONCLUSION:

Early identification and prompt clinical and surgical intervention with mandatory drainage of the middle ear (primary disease), was essential for better outcome.

OBJECTIVES:

Pulsating electromagnetic (EM) radiation emitted by mobile phones is often incriminated for causing tissue alterations by caloric effects. In particular, the eye and the ear were regarded as possible “hot spots,” with heating up to 1°C, in which EM radiation might have negative effects. If so, these temperature increments should be large enough to cause vestibular excitation. In this study, we attempted to verify this theory by clinical testing and in vitro experiments.

METHODS AND MEASURES

In our laboratory, a simulated GSM signal (889.6 MHz/2.2 W) was applied to 1 ear at a time, while video nystagmography was performed. The experimental setup was similar to that used for caloric (hot and cold water) testing of the peripheral vestibular organ. Data were evaluated by a computer system. There were 13 volunteers (26 ears) included in our study. In an additional experiment, temperatures of human temporal bones were measured by thermography, while a continuous or pulsating EM field was applied.

RESULTS:

In no volunteer could EM radiation-induced nystagmus be recorded. This corresponds well to our findings that in the human temporal bone very weak caloric effects could only be found in the tissue layers next to the radiation source (antenna of the mobile phone), whereas deeper regions (horizontal semicircular canal) seemed unaffected (at least less than 0.1°C).

CLINICAL SIGNIFICANCE

These results do not support the theory that mobile phone-induced EM radiation may cause caloric negative effects in the human ear.

OBJECTIVE

To investigate the anatomic relationship between utricle, saccule, and stapes footplate, and adapt the stapes prosthesis tip to reduce postoperative vertigo.

STUDY DESIGN

Five temporal bones were serially sectioned and stained, and the distance from the inner lining of stapes footplate to saccule and utricle, respectively, were measured. The Fisch prosthesis was modified with a slope of 45 degrees at its tip to adapt to the anatomic configuration of the vestibule. Fisch's original piston or the modified piston was used in 174 ears (Group I) and 108 ears (Group II), randomly.

RESULTS:

There was no statistically significant difference in hearing improvement between the 2 groups (P > 0.5). However, postoperative vertigo was significantly reduced when the modified prosthesis was inserted (P < 0.005).

CONCLUSIONS

The modified piston improved the hearing to the level of the original piston, and the incidence of postoperative vertigo was significantly decreased.

SIGNIFICANCE

A modified prosthesis is presented for a patient undergoing stapedotomy.

OBJECTIVES:

Head and neck squamous cell carcinoma (HNSCC) is notoriously resistant to chemotherapy. The sphingolipid ceramide and its analogs have been demonstrated to exert antitumor activity in many cell types; however, the effectiveness of these analogs has been limited by potency and solubility. This study focuses on the effects of novel highly soluble cationic pyridinium-ceramides, alone and in combination with various chemotherapeutic agents, on cell survival, telomerase activity, and cell cycle arrest in HNSCC cell lines in vitro.

METHODS:

The concentration of pyridinium-ceramides and chemotherapeutic agents that inhibited cell growth by 50% (IC₅₀) was determined by MTT cell survival assays. The cell cycle profiles were determined by flow cytometry. Telomerase activity was determined by telomerase repeat amplification protocol (TRAP) assay.

RESULTS:

Treatment of the human UM-SCC-22A (SCC of the hypopharynx) cells, as well as various other HNSCC cell lines, with C₆-Pyr-Cer resulted in the inhibition of cell survival with an IC₅₀ concentration of approximately 250 to 300 nM at 96 hours, whereas its IC₅₀ was greater than 1000 nM in noncancerous Wi-38 human lung fibroblasts, and adult human epidermal keratinocytes. Moreover, treatment with C₆-Pyr-Cer also resulted in cell cycle arrest in G0/G1, which correlated with a significant inhibition of telomerase activity in UM-SCC-22A cells. Additional results demonstrated that the combination of C₆-Pyr-Cer with gemcitabine (GMZ) or doxorubicin (DOX), which have the lowest IC₅₀ concentrations among various chemotherapeutic drugs in these cells, enhances the effects of these drugs in the inhibition of telomerase and cell growth.

CONCLUSIONS

These data suggest that the novel C₆-Pyr-Cer with high solubility and bioavailability may lead to the development of new therapeutic strategies that target telomerase for the treatment of HNSCC.

OBJECTIVE

Determine whether survival for second primary head and neck cancer is truly poorer than survival for first primaries.

METHODS:

From the Surveillance, Epidemiology and End Results database, 2 cohorts were constructed. One cohort consisted of patients with exactly 1 head and neck primary malignancy; the second cohort consisted of patients with exactly 2 head and neck primaries, restricted to second primaries of the tongue, tonsil, glottic larynx, and hypopharynx with squamous cell carcinoma (SCCA) histology. Demographic and extent of disease data were extracted. For each primary site, matched Kaplan-Meier survival analysis was conducted comparing overall survival between the two cohorts matching for primary site, year of diagnosis, age, gender, and cancer stage.

RESULTS:

A total of 242 cases of second head neck primary were successfully matched to patients with single primary disease. Among 96 patients with oral tongue SCCA, mean (median) survival was 40.1 (28) months after the second primary diagnosis versus 52.2 (32) months for matched single primary patients (P = 0.552, log-rank test). Among 45 tonsillar carcinomas, mean survival was 42.8 (30) versus 90.9 (NA) months for the second primary and single primary cohorts, respectively (P = 0.028). Among 52 matched glottic carcinomas, mean survival was 46.4 (27) versus 103.5 (120) months for the 2 cohorts, respectively (P < 0.001). Among 49 hypopharyngeal carcinomas, mean survival was 35.6 (19) versus 53.9 (21) months, respectively (P = 0.373).

CONCLUSIONS

Survivals for second primary head and neck malignancies may be poorer than survivals for comparable first primaries, but in this analysis we did not find this difference to be statistically significant for all subsites. Second primary survival will vary from site to site. EBM rating: B-3.

Our study evaluated the effectiveness of neoadjuvant chemotherapy and concomitant chemotherapy with radiotherapy compared to standard surgery and radiation therapy in patients with resectable stage III/IV head and neck squamous cell carcinoma. Forty-two eligible patients received neoadjuvant chemotherapy (cisplatin 100mg/m 2 intravenously day 1, and 5-fluorouracil 1g/m 2 /day continuous infusion days 1–5 every 3 weeks for 3 courses) followed by radiotherapy (65–70 Gy in 32–39 fractions to the primary site and lymph nodes; 50 Gy in 25–28 fractions to areas at risk) and concomitant chemotherapy (cisplatin 80mg/m 2 intravenously every 3 weeks starting on day 1 of radiotherapy). Neoadjuvant therapy induced grade 4 cytopenias (12/42 patients) and grade 4 gastrointestinal toxicities (7/42 patients). Concomitant radiochemotherapy-induced grade 4 toxicities (6 patients). Neoadjuvant chemotherapy biopsy-proven complete responses were 15 of 42 patients (36%), partial responses in 23 of 42 patients (55%), and an overall response rate of 91%. Thirty-seven of 38 responders received concomitant radiochemotherapy. Complete responses in 35 of 42 patients (83%), partial response in 7 of 42 patients (7%), and overall response in 90%. The 3-year disease-free and overall survival for chemotherapy plus radiotherapy versus surgery plus radiotherapy: 61% versus 43% (P = 0.17) and 71% versus 43% (P = 0.02). These data suggest that a randomized trial of concomitant radiochemotherapy versus neoadjuvant plus concomitant radiochemotherapy should be considered. EBM rating: B-2.

OBJECTIVE:

Severe ballistic or avulsion injuries to the face create complex, composite defects. We report the results of an aggressive management algorithm to optimize facial form and function: (1) the initial encounter, (2) definitive reconstruction with vascularized tissue, and (3) aesthetic and prosthetic refinement.

STUDY DESIGN AND SETTING:

Retrospective case series of 49 patients in 2 tertiary care institutions. Patients were evaluated for age, gender, mechanism of injury, anatomic subsites involved, surgical procedures, flaps utilized, complications, and functional outcomes.

RESULTS:

Forty defects were gunshot wounds, 9 resulted from major avulsive trauma. Involved sites included 13 oromandibular, 21 midface/upper face, and 15 combined sites; 54 free flaps were utilized, 21 were soft tissue and 33 contained bone. No flap failures occurred. Function and cosmesis were best in the oromandibular only group, and worst in the combined group with nasal and/or orbital tissue loss.

CONCLUSION:

Treatment of severe facial trauma requires early tissue debridement with bony repair and/or stenting to minimize scar contracture. Free tissue transfer techniques allow simultaneous reconstruction of the bony framework and overlying tissues. Multiple secondary procedures are frequently required for optimal aesthetic restoration. EBM rating: C.

OBJECTIVES:

The purpose of this study was to investigate and share the experiences at The University of Texas M. D. Anderson Cancer Center in diagnosing, treating, and following patients with neurothekeoma. We report 13 cases.

STUDY DESIGN

Case series. The clinical, surgical, and pathology records of the 7 patients with neurothekeoma treated at M. D. Anderson Cancer Center were retrospectively reviewed. In addition, the pathology records of 6 patients reviewed by the Department of Pathology for diagnosis only were retrospectively reviewed.

RESULTS:

Nine patients were women. Their mean age was 30 years (median, 24 years). Six of the lesions were on the head or neck, 4 were on extremities, and 2 were on the trunk, and the location of 1 was not recorded. Two lesions had been previously diagnosed, histologically, as leiomyosarcomas, 1 as a malignant nodular hidradenoma, and 1 as a clear cell hidradenoma. All the lesions had the characteristic nested pattern of growth, with various degrees of myxoid background. Mitotic figures and marked cellular pleomorphism were not common. Six cases were treated with wide local excision. A lesion of the nasal ala was excised by using Möhs micrographic surgery. Most cases were limited to the dermis, but 2 lesions infiltrated subcutaneous tissue and skeletal muscle. All patients were without evidence of disease at 8 months median follow-up range (0 to 35 months).

CONCLUSION:

Neurothekeoma is a benign neoplasm occurring usually in women and commonly in the head and neck. Because it may be locally invasive, treatment with wide local excision using frozen section control of margins is recommended. Care must be taken in the pathologic diagnosis of cutaneous neoplasms, and neurothekeoma should be considered in the differential diagnosis for spindle cell lesions.

SIGNIFICANCE

Neurothekeoma is commonly misdiagnosed, pathologically and clinically, and it can be treated successfully with surgical excision. EBM rating: C.

OBJECTIVE

This article describes a surgical approach that has been applied to managing primary tumors in the pterygopalatine fossa and secondary tumors involving the pterygopalatine fossa.

PATIENTS AND METHODS

The Barbosa approach was modified by adding a lateral incision in the mandibular gingivobuccal fold from the canine tooth to the retromolar area. This technique was applied to nine patients with primary and secondary tumors in the pterygopalatine fossa. All patients had been observed by clinical examinations, MRI, and CT examinations.

RESULTS:

This technique allowed a large, inferiorly based flap to be raised, which includes the parotid gland. The masseter and temporalis muscles were divided horizontally, and the ascending ramus of the mandible was osteotomied between the mandibular angle and the sigmoid notch and reflected to expose the tumor in the pterygopalatine fossa and maxillary sinus. We have applied this technique in 9 patients. Of the 9 patients in our study, 5 (55%) were male and 4 (45%) were female. The median age of the patients at the time of operation for primary and secondary tumors in the pterygopalatine fossa was 49.5 years (range, 19–66 years). Four of the 9 patients had primary tumors in the pterygopalatine fossa. One patient had a tumor in the pterygoaplatine fossa extending into the maxillary sinus, 2 patients had tumors occurring in the maxilla involving the pterygopalatine fossa, 2 patients had tumors from the deep lobe of the parotid gland to the pterygopalatine fossa, and 1 patient had extracranial meningioma. Nine patients have been followed up from 3 months to 9 years and 6 months, and 1 patient had recurrence 2 years and 2 months postoperatively.

CONCLUSION:

This technique is especially useful to tumors in the pterygopalatine fossa and tumors in the pterygopalatine fossa extending into the maxillary sinus.

OBJECTIVE

To investigate the quality of life after partial laryngectomy versus total laryngectomy for recurrent laryngeal carcinomas after radiotherapy. STUDY DESIGN AND SETTING: A retrospective study performed at least one year after treatment. This study was performed in a university hospital.

RESULTS:

Twenty-three patients (N = 12 partial laryngectomy, N = 11 total laryngectomy) with recurrent laryngeal cancer after radiotherapy were included in the study. Three different questionnaires, 1) EORTC Quality of Life Questionnaire (QLQ)-C30 Dutch version 3.0, 2) EORTC-H & N 35, and 3) the Voice Handicap Index, were sent to all patients. The only major difference in quality of life of patients after partial laryngectomy versus total laryngectomy was found to be smell and taste related. No other differences were found.

CONCLUSION:

We did not find much difference in quality of life after treatment with a partial laryngectomy or a total laryngectomy in patients with recurrent laryngeal cancer after radiotherapy.

OBJECTIVE:

To determine the feasibility and accuracy of fine-sectioned frozen-section analysis of the sentinel lymph node (SLN) in cN0 oral cavity and oropharynx squamous cell carcinoma.

STUDY DESIGN:

Thirty-one patients were included and underwent lymphoscintigraphy a day before surgery and marking of the SLN. Intraoperatively, the SLNs were identified using a gamma probe, excised, and analyzed using fine-sectioned frozen section. The remaining SLN tissue was fixed in formalin for further staining and immunohistochemical analysis. An elective neck dissection was performed in all patients and all excised lymph nodes were examined for metastatic disease.

RESULTS:

SLNs were identified preoperatively by lymphoscintigraphy as well as by gamma probe intraoperatively in all patients. A total of 82 sentinel lymph nodes were excised and analyzed by fine-sectioned frozen section. Micrometastases were found in 16 out of the 82 SLNs, upstaging 14 out of 31 patients (45%) from cN0 to pN+. Furthermore, a total of 1295 lymph nodes from the neck dissection specimens were analyzed, confirming only one more metastatic disease. Sensitivity and negative predictive value of SLN biopsy were 93% and 94% respectively for frozen section analysis.

CONCLUSION:

Our study shows that SLN biopsy in cN0 neck of patients with oral cavity and oropharyngeal carcinoma is both feasible and accurate. Provided that larger studies confirm our results, an elective neck dissection may become unnecessary if fine-sectioned frozen-section analysis of the SLN shows no nodal metastases in patients with cN0 oral cavity and oropharynx carcinoma.

OBJECTIVE:

This study demonstrates that intravocal fold injection of autologous fat obtained by liposuction technique is simple, and the functional results durable for patients with unilateral vocal fold paralysis due to injury to the recurrent laryngeal nerve.

STUDY DESIGN:

41 patients with unilateral paralysis of the vocal fold due to injury to the recurrent laryngeal nerve received intravocal fold injection of autologous fat. Autologous fat, harvested from the lower abdomen by liposuction technique, was filtered out and injected through a needle into the vocal fold by using endolaryngeal microsurgery. Clinical follow-up after the injection was carried out from 1 month to 2 years.

RESULTS:

Voice function dramatically improved compared with the parameters examined before the operation. Vocal function continued to improve as time passed during the second year after injection.

CONCLUSIONS:

Intravocal fold injection of autologous fat obtained by liposuction technique is simple, and the functional results durable for patients with unilateral vocal fold paralysis due to injury to the recurrent laryngeal nerve.

SIGNIFICANCE:

The effectiveness continued for more than 2 years in most patients.

OBJECTIVE:

The purposes of this study are to investigate the impact of topical anesthetic alone and with concurrent laryngeal telescopic examination on acoustic characteristics of vocal fold function. Comparison with phonation in controlled conditions may imply diagnostic information from the examination.

STUDY DESIGN:

Thirty males evaluated as having a normal voice were included in the study. The subjects were asked to phonate sustained /i/ with a naturally comfortable pitch and loudness in three consecutive experimental sequences as “control condition,” “anesthetic condition,” and “telescopic condition.” Acoustic analysis of fundamental frequency, jitter, shimmer, and harmonic to noise ratio in the three different conditions were executed.

RESULTS:

The mean and standard deviation of Fo in control condition, anesthetic condition, and telescopic condition were 130.1 ± 18.5 Hz, 125.7 ± 19.7 Hz, and 173.2 ± 35.1 Hz, respectively. The telescopic condition showed more negative change than that in control condition and anesthetic condition in other parameters. There was a significant difference (P < 0.001) between control condition and telescopic condition in all four parameters.

CONCLUSIONS:

This study showed that anesthesia has little effect on voice performance for subjects with a normal voice. On the other hand, the acoustic characteristics changed significantly during telescopic performance. When doing interpretation of acoustic data, the abnormality of the acoustic characteristics might be the result of the procedures and not reflect vocal pathology. Laryngeal variations due to manipulation of telescope should be ruled out.

OBJECTIVES:

To delineate a technique that avoids the complications associated with surgical closure of long-term or permanent tracheostomy (LTT).

STUDY DESIGN:

A case series that describes the technique and clinical outcomes.

METHODS:

Thirty-seven of 300 patients with a previously established LTT underwent primary surgical closure of their stoma after their underlying disease had been resolved. The surgical technique combined a turnover flap with medialization of fibroadipose tissue, followed by additional closure with an advancement skin flap.

RESULTS:

After a mean follow-up of 3.2 years, no patient developed major complications. Four patients developed minor complications, which responded to conservative treatment. In all patients, the functional results were satisfactory, as were the cosmetic results, with the exception of 1 case. None required retracheostomy.

CONCLUSION AND SIGNIFICANCE:

This simple and reliable new surgical technique for closing LTT avoids the potential failures and complications encountered in previously published procedures.

OBJECTIVES:

To evaluate the efficacy of ultrasound-guided percutaneous closed drainage in the management of abscesses in the head and neck.

STUDY DESIGN:

Prospective, controlled study.

METHODS:

From January 1998 to December 1999, patients presenting with a unilocular abscess in the head and neck and who subsequently underwent echo-guided percutaneous drainage were enrolled in the study.

RESULTS:

Fourteen patients were enrolled in the study. No patients needed open surgical drainage afterward. By our protocol, only 8 patients had an indwelling catheter. After treatment, all patients were cured of their disease completely without any complication.

CONCLUSIONS:

Ultrasound-guided percutaneous closed drainage is a safe and effective procedure and might be most beneficial in well-defined and/or unilocular abscess in the head and neck. Closed drainage could be tried initially in an abscess of the deeper visceral spaces and will not impede any subsequent intervention by surgery. Hospital stay can be shortened and potential surgical complications may be avoided by using this procedure.

OBJECTIVE:

To determine the safety and efficacy of a new soft palate implant procedure for the reduction of snoring.

STUDY DESIGN AND SETTING:

Fifteen healthy patients with primary snoring due to palatal flutter were enrolled into this prospective study after clinical and endoscopic examination and polysomnography. The average age of the patients was 41.2 ± 8.6 years with a body mass index of 26.2 ± 2.5 kg/m 2 . The Anti-Snoring Device consists of a delivery tool with a cylindrical implant of braided polyester filaments. Under local anesthesia, three implants intended for permanent implantation were placed into the soft palate. Snoring-related symptoms were assessed by visual analogue scales (VAS), polysomnography, and the SNAP system at baseline and 90 days postoperatively.

RESULTS:

All implants were placed without complications. Only minor discomfort was reported in four cases within the first three days postprocedure. At the 90-day follow-up snoring was reduced from 7.3 ± 1.6 to 2.5 ± 2.1 (VAS, P < 0.01) and from 347 ± 239 to 264 ± 168 snoring sounds/hour (SNAP, P > 0.05). Polysomnography did not show any deterioration of sleep or breathing. Speech, swallowing, and taste were unchanged.

CONCLUSION:

The Anti-Snoring Device is a new surgical tool offering a simple and minimally invasive procedure. Our data demonstrate that the treatment is safe and effective with good patient acceptance. Further patient follow-ups are needed to evaluate the long-term results.

OBJECTIVES:

Radiofrequency surgery is a minimally invasive technique for the treatment of the tongue base in sleep-disordered breathing. The aim of this study was to evaluate the changes in upper airway anatomy induced by radiofrequency surgery with MRI.

STUDY DESIGN AND SETTING:

10 patients with sleep-disordered breathing were treated with radiofrequency surgery at tongue base. MRI measurements were performed before and after surgery with the help of a recently published protocol.

RESULTS:

The mean total number of energy delivered per patient was 4750 ± 1641 Joule. Relevant changes could be observed neither for tongue volume or dimension nor for retrolingual space.

CONCLUSIONS:

Changes in upper airway anatomy could not be demonstrated. The effects of radiofrequency surgery of the tongue base may more likely be a result of changes in upper airway collapsibility.

SIGNIFICANCE:

Functional effects of surgical interventions in sleep-disordered breathing should be considered in addition to mechanistic concepts alone.

OBJECTIVE:

The aim of this study was to investigate the effects of topotecan (Hycamtin), a topoisomerase I inhibiting anticancer agent, on antioxidant enzymes (SOD, CAT, and GSH-Px) and TBA-RS values of the submandibular glands of the rabbits.

STUDY DESIGN AND SETTING:

The study was conveyed in two groups (Group I, II) and control with a total of 24 rabbits. Eight rabbits in group I received intravenous (i.v.) topotecan (0.25 mg/kg once daily) for 3 days. Eight rabbits in group II received i.v. topotecan (0.5 mg/kg once daily) for 3 days. On the 15th day after administration of topotecan, sub-mandibular glands were removed and levels of the SOD, CAT, and GSH-Px and the TBA-RS in the sub-mandibular glands of the rabbits were examined.

RESULTS:

SOD, CAT, and GSH-Px values were significantly higher in high-dose topotecan group compared to control group (P < 0.05). SOD and TBA-RS values were significantly higher in high-dose topotecan group compared to low-dose topotecan group (P < 0.05).

CONCLUSION:

It was concluded that, to prevent the hazardous effects of oxygen free radicals due to topotecan, antioxidant enzymes SOD, CAT, and GSH-Px were increased. The higher levels of the TBA-RS values in group II showed that permanent damage was present because of high-dose topotecan administration in the submandibular glands of the rabbits.

OBJECTIVES:

Some of these measures to control posterior epistaxis cause loss of nasal respiration and put the patient on those related risks.

STUDY DESIGN AND METHODS:

The efficiency of a new pneumatic nasal tamponade (Rapid Rhino) was compared with a choanal balloon tamponade that has been used in our department for years in a prospective randomized study in patients with posterior epistaxis. The new pneumatic tamponade was used on the affected side only and nasal ventilation of the contralateral side was possible.

RESULTS:

Because of the successful use of the new pneumatic tamponade in most of the patients, epistaxis could be controlled without bilateral obstruction of nasal respiration. The use of the new pneumatic tamponade was evaluated to be less painful by the patients than choanal balloon tamponade.

CONCLUSION:

In an adapted therapeutic regime, the new pneumatic tamponade seems to have its place before using bilateral nasal respiration obstructing measures.

Various lesions can cause conductive hearing loss in a patient with a normal tympanic membrane. These include congenital ossicular anomaly, otosclerosis, and congenital or acquired ossicular fixation and discontinuity. We had an experience with a patient who presented with a conductive hearing loss in both ears, in which small pieces of the long process of the incus were absent and had been replaced with fibrous tissues in both ears. No other abnormalities, such as postinflammatory changes or fixation of the ossicles, were found. Because the long process of the incus undergoes remodeling through resorption and rebuilding throughout life, failure of the remodeling or impaired vascular supply to the long process of the incus may have been the cause of the conductive hearing loss in this patient.