Otolaryngology最新文献

Hearing loss, tinnitus, and vertigo have long been associated with Paget's disease of the bone. We reviewed the records of 463 patients with Paget's disease who were seen in the otolaryngology department. Hearing loss was common. It was our observation that mixed hearing losses were part of the disease process. Sensorineural hearing loss was the most frequent loss, but it usually was not part of the disease process. Tinnitus, vertigo, or both were seen in about 20% of these patients.

The syndromes of Pickwickian, Ondine's curse, and primary alveolar hypoventilation are respiratory disorders manifesting increased sleepiness and irregular respiratory rhythms. These disorders are currently grouped as hypersomnia with periodic breathing (HPB). Polygraphic techniques have lead to a reasonable hypothesis as to the pathophysiology of the multiple variants of HPB. Discernible causes of HPB have been attributed to both central and peripheral factors. Peripheral factors encompass those conditions relating to upper airway obstruction. An acromegalic person suffering the HPB syndrome secondary to laryngeal stenosis is described.

A surgical procedure is described that minimizes the lifting of the hairline in rhytidectomy by locating most of the incision inside the hair. Traction of the skin is directed at producing a soft, rounded contour. The author reports good results on 30 patients in two years' time. Appropriateness of rhytidectomy depends on psychologic factors and on biologic rather than chronologic age. Operation under general anesthesia is preferred and should be confined to a simple procedure. However, blepharoplasty, rhinoplasty, and mentoplasty are often performed at the same time. Forehead lifting is a desirable associated procedure in which the incisions can be joined. Cutting of the muscle fibers is preferred to resection of the frontal corrugator. Minilifting to obtain Oriental slant eyes is considered a wasted effort.

The Leyla retractor is a self-retaining retractor used in the translabyrinthine removal of acoustic neuroma and middle fossa surgery. It is used to maintain constant, even pressure on a decompressed sigmoid sinus and cerebellum in translabyrinthine surgery and the temporal lobe in middle fossa surgery. The Leyla retractor provides excellent exposure and greater freedom and dexterity for the neurotologist.

Search of the literature thus far indicates no prior description of rhinophyma occuring in tuberous sclerosis. There have been numerous reports of the usual skin lesion, adenoma sebaceum, together with the associated manifestations of severe mental retardation and convulsive seizures. In a 27-year-old woman, full-blown, severely deforming rhinophyma had its onset one year prior to her hospital admission. The family, horrified by her appearance, desired surgical intervention. The report includes a review of the literature and a description of the patient and of the surgical technique employed. The question of the desirability and difficulty involved in skin grafting is discussed, as are the microscopic findings and postoperative course. Particular attention is directed toward differential diagnosis and associated findings.

One hundred seventeen patients with advanced squamous cell carcinoma of the head and neck were treated and placed randomly between two combination protocols, one with adriamycin and the other without. Responses (more than 50% tumor regression) were 67% overall with 63% responding to the combination without adriamycin and 82% responding to the protocol containing it. The increase in the response rate seen with the addition of adriamycin was not statistically significant. The degree of response to chemotherapy was reduced by prior radiotherapy.

Chronic bacterial tonsillitis can be validly supported etiologically by quantitative bacteriologic methods. The following observations are based on a recognition that the mere presence of bacteria is much less significant than the level of bacteria present. The chronically infected adult patient may be characterized by tonsils subclinically harboring greater than 10(5) bacteria/gm as opposed to the control patient with 10(3) bacteria/gm. Useful features in predicting high bacterial levels are (1) low number of crypts, (2) presence of nodal hypertrophy, and (3) tonsils small by actual size. Estimated tonsil size, determined preoperatively, shows no statistically significant correlation with either actual size or degree of tonsil sepsis.