Applications of hyperbaric oxygen in otolaryngology head and neck surgery: facial cutaneous flaps

Hyperbaric oxygen therapy is of significant benefit in the setting of an ischemic flap of the head and neck. Mechanistically, hyperbaric oxygen decreases local tissue edema and improves oxygen delivery to compromised tissues. Both capillary and fibroblast in-growth occur at a greater rate with hyperbaric oxygen therapy, and there is an increase in the tensile strength of the wound. Additional indications in the head and neck include traumatic composite amputations, necrotizing soft-tissue infections, and osteoradionecrosis of the facial skeleton.     

Nanotechnology in otolaryngology

This article provides a background on nanotechnology and discusses the applications of nanotechnology to medicine, specifically to otolaryngology.     

Allergy in otolaryngology

Otolaryngologic allergy concerns itself greatly with the teachings and influence of the late French Hansel, M.D., and his principles of optimal dosage. Later Herbert Rinkel, M.D., was to contribute the titration technique which allowed for a more systematic administration of antigens. Other areas such as provocative testing for foods as well as more controversial areas were later developed. These included cytotoxic testing as well as emphasis on clinical ecology techniques. The otolaryngologist has been equipped to handle all phases of nasal problems including allergy by 1. management of obvious surgical problems, 2. symptomatic approach with medical methods, 3. environmental controls when indicated and 4. immunotherapy. The last method includes titration as well as radioimmunoassay techniques (RAST). The author's conjecture regarding the future direction of allergy management from the otolaryngologist's view point is also given. Personal observations and anecdotes of some of the pioneers in the field are included.     

Bioinformatics in otolaryngology

This article reviews the recent literature on microarray analysis, bioinformatics techniques, and genomics in relation to the study of carcinogenesis of head and neck cancers.     

Telemedicine in otolaryngology

More research is needed in otolaryngology telemedicine, but it would be a mistake to stop at only determining if telemedicine is as good as an in-person exam. The digital image recorded in a telemedicine encounter can be manipulated to increase diagnostic information not currently available. Radiologists currently take a chest radiograph in which a chest mass or the tip of an nasogastric tube is difficult to visualize, and by inverting the gray scale or viewing other digital manipulations of that image, the mass or tube tip becomes obvious. Examples in otolaryngology might include images of the larynx manipulated to better demonstrate the inflamed tissue of reflux, or images of the tympanic membrane manipulated to better demonstrate early retraction. Despite dramatic and likely continued decreases, equipment cost is still an issue. Current research points to good consumer acceptance, and certainly with each new generation the technology is more readily accepted. As Nesbitt [4] points out, it is certainly not difficult to look to the future and see ubiquitous broadband with video as common as telephone, or even extreme broadband enabling robotics and virtual reality TV with three-dimensional touch. Robotics and genomics will eventually play a greater role in telemedicine and our lives in general. Applications for remote diagnosis in biologic warfare defense and homeland security are currently raising interest in telemedicine. Telemedicine will be combined with new technological advances such as virtual "fly-through" computerized axial tomography examinations. Instead of performing an exploratory tympanotomy, surgeons will use computer programs to "fly through" and examine all aspects of a patient's middle or even inner ear. Spectral imaging of the eardrum, larynx, or oropharynx will immediately identify bacteria without cultures, or gram stain, and potential malignancy without biopsy. By measuring fluorescence emitted from an oropharynx illuminated with a specific visible or nonvisible light spectrum, spectral imaging will be able to provide instant identification of bacteria or evidence of malignant changes. The underlying principles of a successful business model must continue to be applied, with the most critical ingredient for telemedicine's success being the filling of specific health care needs. As long as the need is there, telemedicine in otolaryngology will advance.     

Meta-analysis in otolaryngology

OBJECTIVE: To examine the results of meta-analyses in otolaryngology and compare these results with the individual component studies that constitute each meta-analysis. DESIGN: A retrospective review of the literature. MAIN OUTCOME MEASURES: Studies that conducted pooled statistical systematic analyses indexed on MEDLINE for the 10-year period from January 1989 to January 1999 were selected for keyword or subject headings of meta-analysis and otolaryngology (N = 22). Analysis consisted of a modified funnel graph depiction of the individual studies that made up each meta-analysis. Each meta-analysis was evaluated for consistency among these individual studies and comparison of the median result with the weighted mean meta-analysis result. In addition, the methodologic quality of each meta-analysis was assessed in terms of the rigor with which component studies were evaluated. RESULTS: Ten (46%) of the 22 meta-analyses did not provide the individual study results that made up their meta-analyses. The results of 10 studies (46%) were similar to the median result of their individual component studies. The results of 2 studies (9%) differed from this median result, with widely heterogeneous component study results. CONCLUSIONS: A large proportion of meta-analyses in otolaryngology (46%) fail to provide the individual study results necessary to analyze the meta-analysis result critically. Most remaining studies do provide results that accurately compare with the median of their component study results. Only a small proportion of meta-analyses were found to have disparate results, and each appropriately discusses the heterogeneity of the individual studies that comprise their meta-analysis.     

Steroids in otolaryngology

Steroids are increasingly being used to treat a wide spectrum of otolaryngological disorders. It is important for ear-nose-throat surgeons to understand the short- and long-term complications associated with steroid use. The aim of this study was to review the role of steroids in common ear-nose-throat disorders. Corticosteroid therapy has been shown to be effective in the management of idiopathic facial nerve palsy, allergic rhinitis, acute sinusitis, sinonasal inflammatory polyposis, and croup. The therapeutic efficacy of steroids in the management of Meniere's disease, sudden idiopathic sensorineural HL, chronic otitis media, and vestibular neuronitis remain controversial.     

Flexible oesophagogastroscopy in otolaryngology

We describe a technique of flexible endoscopy of the upper aerodigestive tract which provides excellent visualization for diagnostic and therapeutic purposes in ENT practice. With the present day need to reduce costs it is helpful to reduce inpatient workload and perform procedures as day cases where appropriate. The previous criticisms of flexible oesophagoscopy by ENT surgeons are unfounded and indeed there are situations where flexible endoscopy is superior to rigid examination. We would recommend that tuition in the use of the flexible gastroscope should be an integral part of ENT training.