Endaural or postaural incision for myringoplasty: does it make a difference to the patient?

The aim of this study was to find out from patients who had undergone a myringoplasty via either an endaural or postaural approach whether or not they had experienced problems or symptoms relating to their scar, and if these differed depending on which incision had been used. A questionnaire was sent to 91 patients who had undergone myringoplasty between 18 and 62 months earlier. Thirty‐four patients who had undergone previous or subsequent ear surgery were excluded. The only statistically significant difference found between groups having either a postauricular or endaural incision was in how likely others were to comment on their scar. There seem to be few long‐term sequealae relating to the scar from myringoplasty. From a patient perspective, between 18 and 62 months postoperatively, there was very little difference in symptoms or problems whether or not an endaural or a postaural incision had been used for the surgery.     

Chronic cough as a sign of laryngeal sensory neuropathy: diagnosis and treatment

Chronic cough is often attributed to reflux, postnasal drip, or asthma. We present 28 patients who had chronic cough or throat-clearing as a manifestation of sensory neuropathy involving the superior or recurrent laryngeal nerve. They had been identified as having sudden-onset cough, laryngospasm, or throat-clearing after viral illness, surgery, or an unknown trigger. Cough and laryngospasm were the most common complaints. Seventy-one percent of the patients had concomitant superior laryngeal nerve or recurrent laryngeal nerve motor neuropathy documented by laryngeal electromyography or videostroboscopy. After a negative workup for reflux, asthma, or postnasal drip, these patients were treated with gabapentin at 100 to 900 mg/d. Symptomatic relief was achieved in 68% of the patients. Sensory neuropathy of the recurrent laryngeal nerve or superior laryngeal nerve should be considered in the workup for chronic cough or larynx irritability. Symptomatic management of patients with cough and laryngospasm due to a suspected sensory neuropathy may include the use of antiseizure medications such as gabapentin.     

听觉耐受下降与耳鸣

听觉耐受下降(decreased sound tolerance)是指对声音的容忍度降低,或指对声音的敏感性增强,包括听觉过敏,厌声症,恐声症〔1〕。耳鸣是指在周围环境中无相应声源或电刺激存在的情况下,患者自觉耳内或颅内有声音的一种主观感觉;常伴或     

Clonazepam in the pharmacological treatment of vertigo and tinnitus

We carried out a retrospective survey of 25 years of clinical experience with the use of clonazepam as a vestibular and tinnitus suppressant in the pharmacological treatment of vestibular or cochleovestibular disorders due to different causes. We reviewed the medical records of 3,357 outpatients treated with a 0.5 or 1.0-mg daily dosage of oral clonazepam during 60-180 days. Complete or substantial control of vertigo or nonvertiginous dizziness was achieved in 77.4% of the vertigo patients. Tinnitus was improved in 32.0% of the tinnitus patients. Light or mild drowsiness, depression, nightmares, or lowering of libido, reported by 16.9% of the patients as adverse side effects, tended to subside with continued therapy. We concluded that clonazepam is a very useful and safe drug for the symptomatic treatment of patients suffering from cochleovestibular disorders.     

Surgical approaches in angiofibroma

During a nine year period fifty nasopharyngeal angiofibromas thirteen of whom had recurrent tumour were treated surgically. Thirty-one patients in whom the tumour was limited to the nasopharynx or those with superior spread into ethmoids or sphenoid sinuses were removed by a transpalatal route alone or in combination with other approaches. Tumours having lateral extensions into pterygopalatine or infratemporal fossae or the cheek, or those with simultaneous superior and lateral spread underwent a transmaxillary excision. In two of the three cases having intracranial spread the tumour was removed successfully from below. There was no mortality. The usefulness and versatility of the transmaxillary approach in extensive and recurrent cases is emphasised. Computerized tomography was found to be a vital adjunct in pre-operative evaluation. The pros and cons of other approaches are also briefly discussed.     

Endaural or postaural incision for myringoplasty: does it make a difference to the patient?

The aim of this study was to find out from patients who had undergone a myringoplasty via either an endaural or postaural approach whether or not they had experienced problems or symptoms relating to their scar, and if these differed depending on which incision had been used. A questionnaire was sent to 91 patients who had undergone myringoplasty between 18 and 62 months earlier. Thirty-four patients who had undergone previous or subsequent ear surgery were excluded. The only statistically significant difference found between groups having either a postauricular or endaural incision was in how likely others were to comment on their scar. There seem to be few long-term sequealae relating to the scar from myringoplasty. From a patient perspective, between 18 and 62 months postoperatively, there was very little difference in symptoms or problems whether or not an endaural or a postaural incision had been used for the surgery.     

Paraneoplastic syndromes in patients with cancer of the larynx and hypopharynx

Paraneoplastic syndromes may be the first sign of a malignancy. They are systemic, nonmetastatic manifestations associated with a variety of malignant neoplasms and occurring in a minority of cancer patients. These associations of symptoms and signs are not directly related to the site or local manifestations of a malignant tumor or its metastases, but their recognition may facilitate the detection of malignancies or recurrences. Paraneoplastic syndromes are categorized into 6 types: dermatologic or cutaneous, endocrine, hematologic, neurologic, osteoarticular or rheumatologic, and ocular. Different oncotypes have rarely been associated with paraneoplastic syndromes in patients with cancer of the larynx and hypopharynx. The world literature has been reviewed.     

Laryngotracheal stenosis repair using cartilage-derived morphogenic proteins: A pilot study

OBJECTIVES: This pilot study evaluated the role of cartilage-derived morphogenic proteins (CDMPs) as promoters of cartilage growth and differentiation and as a possible alternative to autologous cartilage grafts in laryngotracheal reconstruction. METHODS: In phase 1, 6 New Zealand rabbits underwent subperichondrial injection of CDMP-1, CDMP-2, or CDMP-3 in the right thyroid ala and normal saline solution in the left thyroid ala as controls. In phase 2, 14 rabbits underwent anterior cricoid split and interposition of a fibrillar collagen sponge saturated with normal saline solution, CDMP-2, or CDMP-3. RESULTS: In both phases, saline solution failed to induce new cartilage or bone growth. Small foci of cartilage and/or bone formation were observed within the thyroid subperichondria of those rabbits injected with CDMP-2 or CDMP-3. In phase 2, a few small foci of new cartilage and/or bone formation were observed at the edges of the cricoid split with CDMP-2 and CDMP-3. Conclusions: A different carrier of CDMP, a change in dosage, or a combination of CDMPs might yield more significant neochondrification. The role of CDMPs as promoters of cartilage and differentiation could not be disqualified in this study and should be further investigated.     

Options for salvage after failed initial treatment of anterior vocal commissure squamous carcinoma

Persistence or recurrent cancer in the anterior commissure (AC) after primary radiotherapy may remain localized to its pretreatment anatomical site. If so, endoscopic CO₂ laser excision, in experienced hands, may achieve complete tumor excision and result in cure for many patients. Occasionally, second and third recurrences may be similarly salvaged by further endoscopic surgery. The use of the vertical hemilaryngectomy is an alternative treatment for similar localized lesions, with a higher first time surgical tumor eradication rate, but with a more protracted hospitalization and a less satisfactory voice and swallowing outcome. In both types of such surgical salvage, CT scanning must demonstrate no evidence of cartilage invasion or destruction. When there is evidence of minimal thyroid cartilage invasion, then the supracricoid partial laryngectomy is an alternative conservation option, and is likely to result in a cure, with the retention of a voicing larynx without a stoma. When the tumor has increased in size from the original pretreatment dimension and/or site, then imaging must be used to identify possible cartilage invasion, in which case the likelihood of tumor eradication by endoscopic or external vertical partial laryngectomy is highly unlikely. The indications for the routine use of total laryngectomy for the treatment of recurrent or persistent cancer involving the AC must be reviewed; there is current evidence that cure can be achieved by a less radical procedure. However, total laryngectomy may remain the only treatment option for advanced or aggressive first time recurrence, or in patients who develop subsequent recurrence following previous less aggressive surgery (endoscopic or external).     

The communication game: dump and play.

Communication entails much more than formulating a linguistic code to map underlying intents. It entails the utilization of a role-taking attitude in reconciling communicative obstacles that arise from significant speaker-listener discrepancies in form or code, reference or representation, and license or acceptability. Young children communicate in a "talk to" fashion that essentially is issuing or dumping messages. As role-taking attitudes become acquired, communicative efforts change from merely dumping messages to active resolution of communicative obstacles in an effort to achieve the message of best fit for a particular situation.     

Spontaneous cerebrospinal fluid otorrhoea: case report and literature review

Cerebrospinal fluid otorrhoea may occur through the temporal bone both in children and adults. In children it is generally associated with labyrinthine malformations and usually presents with hearing loss in a child with recurrent meningitis. In adults it is sequel to direct head injury, otologic or neurotologic surgery or infection. More rarely this pathology is described as being "spontaneous", occurring without any history of trauma, surgery or infection. Spontaneous cerebrospinal fluid otorrhoea in adults may present with dull symptoms such as a blocked ear or short term conductive hearing-loss. The anatomic site of this fistula is the tegmen tympani which may have a microscopic or macroscopic bone deficiency or sometimes even a "silent" meningoencephalic herniation. The authors describe a case of spontaneous cerebrospinal fluid otorrhoea occurring in an adult patient with bilateral absence of the tegmen tympani and review the literature regarding this specific. They suggest that its actual occurrence may be underestimated. Special attention should be given to adult patients with recurrent or persistent middle ear effusion. Any suspicion should be followed by meticulous imaging and surgical exploration since this may be a lifethreatnening situation.     

Orbital cellulitis in childhood. Medical-surgical treatment

Orbital cellulitis is an uncommon complication resulting from a spectrum of disorders commonly found in pediatric practice. It usually occurs as a complication of infection of the paranasal sinuses, although it also can be caused by eyelid or dental juries, dental infection and external ocular infection. We studied the clinical, microbiological, and therapeutic features of 152 children diagnosed as periorbital cellulitis and 27 children with orbital cellulitis admitted to our hospital in a 16-year period from January 1983 to December 1998. Twenty-four percent of patients (43 cases) had positive cultures. Thirty children with septal or preseptal cellulitis developed neurological or ophthalmological complications. Intravenous or oral antibiotic administration was effective in 150 patients, but a significant proportion required surgery of the paranasal sinus or orbit (16%).     

Atypical sinusitis in adults must lead to looking for cystic fibrosis and primary ciliary dyskinesia

HYPOTHESES/OBJECTIVES:: In adults, purulent pansinusitis or nasal polyposis starting early in life or that is permanently infected or associated either with chronic bronchial infection, infertility, or situs inversus are uncommon. In these atypical cases of chronic sinusitis (ACS), a primary dysfunction of the mucociliary clearance can be suspected. Adult patients with ACS were therefore investigated to detect primary ciliary dyskinesia (PCD) or cystic fibrosis (CF). STUDY DESIGN: Open, prospective study. PATIENTS AND METHODS: Forty-two patients with ACS were investigated with ciliary beat frequency and ultrastructure analysis in nasal cells and cystic fibrosis transmembrane conductance regulator (CFTR) gene mutation analysis in blood leukocytes. RESULTS: The diagnosis of PCD was confirmed in seven (17%) patients. At least one CFTR gene mutation was detected in 16 (38%) patients. The diagnosis of CF was suggested in three (7%) compound heterozygous patients. Another 13 (31%) patients were heterozygous for a CFTR gene mutation or a complex allele. Comparison of clinical features of ACS showed that only a family history of chronic sinusitis (P <.01) or chronic bronchitis (P <.02) and the presence of diffuse bronchiectasis (P <.0001) or serous otitis media (P <.0001) were significantly more frequent in PCD patients than in patients carrying CFTR gene mutations or those without PCD or CFTR gene mutations. CONCLUSIONS: ACS should be considered a remarkable entity in which congenital abnormalities of epithelial cells are frequently detected (55% of patients). The higher frequency of mutations in ACS patients compared with the general population suggests that heterozygoty for CFTR gene mutation could be a sinusitis-causing status.     

Traumatic ophthalmoplegia: A complication of fractures of the zygomaticomaxillary complex. Review of etiology with report of an unusual case

Ocular muscle imbalance is a common complication in fractures of the zygomaticomaxillary complex. Involvement can be direct; caused by entrapment of either the muscle or tendon in the fracture; or indirect, produced by central or peripheral damage to the cranial nerves supplying the muscles, massive orbital edema or hemorrhage. A case of complete paralysis of the extraocular muscles caused by a critical reduction of the size of the orbit as a result of fracture of the zygomaticomaxillary complex is described.     

Physiology of the eustachian tube in the pathogenesis and management of middle ear effusions

Eustachian tube function studies were carried out in patients with concurrent or recent middle ear effusions. Radiographic techniques were employed in assessing tubal response to liquid flow. Studies of air flow and air pressure were carried out using a Madsen bridge, and depended on the presence of either a perforation or a tympanostomy tube. Most of the Eustachian tubes studied showed varying degrees of obstruction or abnormal distensibility or both, often depending on the direction of flow, or on whether pressures were increased or reduced. Quite apart from other factors which may contribute to intrinsic oxextrinsic obstruction of the Eustachian tube, its compliance appears to play an important role in determining its function. In particular, compli. ance appears to be an important factor in the response of the Eustachian tube to increased positive or to negative pressures. Elimination of the causes of both nasal obstruction and abnormal nasopharyngeal secretions may alleviate problems in the function of the Eustachian tube which seem attributable to increased tubal compliance.     

The incidence of aminoglycoside antibiotic-induced hearing loss

The definition of ototoxicity in most clinical studies of aminoglycoside antibiotics is an increase in pure-tone threshold from a baseline audiogram greater than or equal to 15 dB at two or more frequencies, or greater than or equal to 20 dB at one or more frequencies. In this study, test-retest auditory threshold differences of this magnitude were found in a group of 20 normal volunteers who were not taking any known ototoxic drugs. Depending on which of the two criteria for ototoxicity are used, these data represent a 20% or 33% incidence of ototoxicity. We believe that many of the audiometric changes reported to represent aminoglycoside antibiotic ototoxicity may actually represent the normal test-retest variability of pure-tone audiometry. If this is true, the reported incidence of hearing loss due to aminoglycoside antibiotics may be exaggerated.     

A new role for computed tomography in the diagnosis and treatment of pyriform sinus fistula

Neck abscess located in or around the thyroid gland should raise the suspicion of acute suppurative thyroiditis, pyriform sinus fistula, a 3rd or 4th branchial cleft anomaly. Differentiating between these entities on a clinical basis is difficult. After treating the initial infection, computed tomography, barium esophagography, ultrasound, and endoscopy can be used in search of the fistulous tract that can be associated with a pyriform sinus fistula or a 3rd or 4th branchial anomaly. We present a case of a pyriform sinus fistula involving the use of oral contrast, combined with computed tomography, to delineate the tract and its surrounding structures. This method, in combination with endoscopy, aided in the removal of this branchial anomaly.     

The use of distortion product otoacoustic emissions in the estimation of hearing and sensory cell loss in noise-damaged cochleas

Distortion product otoacoustic emissions (DPOAE), permanent threshold shifts (PTS) and outer hair cell (OHC) losses were analyzed in a population of 187 noise-exposed chinchillas to determine the predictive accuracy (sensitivity and specificity) of the DPOAE for PTS and OHC loss. Auditory evoked potentials (AEP) recorded from the inferior colliculus of the brainstem were used to estimate hearing thresholds and surface preparation histology was used to determine sensory cell loss. The overlapping cumulative distributions and high variability in emission responses for both PTS and OHC loss made it difficult to predict AEP threshold and OHC loss from DPOAE level measurements alone. Using a strict criterion (i.e. emissions better than the 5th percentile of the preexposure DPOAE level, and PTS< or = 5 dB or OHC loss< or = 5%), it was found that the postexposure DPOAE level could be used with reasonable confidence to determine if the status of peripheral auditory system was either normal (i.e. PTS< or = 5 dB) or abnormal (PTS>30 dB or OHC loss>40%). However, the high variability of individual DPOAE responses resulted in a broad region of 'uncertainty' (i.e. 5 or = 50%) or PTS (> or = 35 dB) in noise-exposed chinchillas. Based on an exponential regression analysis of individual subjects, correlations were higher for PTS/DPOAE than for OHC loss/DPOAE.     

Dysphonia in infants

The definition of infant dysphonia is difficult because the physiological phonation itself may be extremely variable in newborns. In a wider sense, all voice utterings can be interpreted as dysphonia which deviate continuously in any of the parameters (timbre, pitch, intensity, or noise) from the normal. We differentiated 20 types of such pathological phonation. The most characteristic are: the hoarse (caused by inflammation or tumor of the vocal cords); the hollow (indicative of tracheal stenosis); the shrill (suggesting a CNS damage); the bleating (pathognostic of Down syndrome); the faint (a result of myogenic diseases); and the mewing cry (etiology: cri-du-chat syndrome). In a narrower sense dysphonia in infants is a kind of pathological phonation without evidence of neurological alteration or chromosomal aberration and without a verified laryngeal lesion. These infants utter pressed, harsh, or very high voice (hyperfunctional form) or a weak, inert cry (hypofunctional form). The dysphonic voice may be characterized also by sudden change in melody or in pitch (glide, shift, break, bitonality) and by turbulent noises. This type of newborn dysphonia is a result of the immature innervation of the larynx, it gradually improves and lateron spontaneously disappears. Perceptual evaluation, endoscopy, and acoustic analysis yield useful diagnostic information.     

Computer-aided surgery of the paranasal sinuses and the anterior skull base

Endoscopic or microscopic surgery for chronic rhinosinusitis with or without nasal polyps is a routine intervention in daily practice. It is often a delicate and difficult minimally invasive intervention in a narrow space, with a tunnel view of 4 mm in the case of endoscopy and frequent bleeding in chronically inflamed tissue. Therefore, orientation in such a "labyrinth" is often difficult. In the case of polyp recurrence or tumors, the normal anatomical landmarks are often missing, which renders orientation even more difficult. In such cases, computer-aided navigation together with images such as those from computed tomography or magnetic resonance imaging can support the surgeon to make the operation more accurate and, in some cases, faster. Computer-aided surgery also has great potential for education.