Otolaryngology最新文献

Tracheal stenosis has become an increasing complication following tracheostomy or prolonged intubation for mechanical ventilation and is directly related to trauma. Tracheal resection up to 4 to 5 cm with end-to-end anastomosis is the generally accepted treatment. However, tracheal resection carries mortality and considerable morbidity. From 1974 to 1977 all patients seen with tracheal stenosis, regardless of the etiology and age, were initially treated with a conserative surgical management. It consists of dilation, severance of the stenotic ring, intralesional injection of triamcinolone acetonide, and stenting with a silicone T tube for 90 days. Nine out of 11 patients had good results and enjoy an adequate airway without a tracheostomy tube. The longest follow-up is three years and the shortest is eight months. Intralesional injection of triamcinolone acetonide is essential for a successful treatment. No serious complications due to this treatment have occurred. This technique appears worthy of trial prior to contemplating a more extensive procedure.

With the recent demonstration of circulating immune complexes in a variety of malignant and nonmalignant diseases, we have examined the sera of head and neck cancer patients for evidence of soluble immune compleses. Using the Raji, cell test, we have shown that immune complexes are present in over 80% of the cancer sera examined as compared to less than 10% of normal control sera, and that these complexes persist following treatment of the patients by surgery or radiation therapy. These complexes may be acting as blocking factors which would account for the anergic state of these patients.

Several preliminary reports have appeared in the medical literature in respect to eustachian tube substitution since Zollner first described his inability to open the obstructed eustachian tube. These procedures have the disadvantage that the distal end of the eustachian tube subsitute is inaccessible by other than another operation. This paper is follow-up report to our clinical experience. The purpose of the experiment was to determine whether the middle ear was ventilated by the tympano-oropharyngeal substitute eustachian tube and whether ascending infection occurred. Fourteen ears underwent eustachian tube substitution. The natrual eustachian tubes of these ears were obliterated three to five months after eustachian tube substitution had been performed. The animals were killed three to four months after obliteration of the natural eustachian tubes. Studies of the decalcified sections showed an absence of infection in six of the ears, with mild to severe inflammation in the rest of the specimens.

Electromyographic recordings of the activity of the tensor veli palatini, tensor tympani, and stapedius muscles were obtained from several adult human subjects. Muscle responses were recorded under four stimulus conditions, ie, contralateral intense wide-band noise, air jet to the eye, swallow, and electrical stimulation of the tongue. The results indicated that the two tensor muscles responded to the same stimuli in similar patterns. The latter muscle differed from the response of the stapedius.

This review of 29 patients with relapsing polychondritis seen at the Mayo Clinic between 1962 and 1976 emphasizes the head and neck manifestations of the disease and the role of the otolaryngologist in its diagnosis and treatment. The major clinical features included inflammation of the pinna, eye involvement, nasal cartilage involvement, laryngotracheal involvement, arthropathy, hearing loss, costal chondritis, and fever. The erythrocyte sedimentation rate was often elevated, and mild anemia was not uncommon.

Reconstituted bovine collagen is an incomplete protein; it will not support bacterial growth and causes minimal local reaction. It has been used in numerous experiments on animals throughout the phylogenetic scale. With these facts, tympanoplasty was performed on 63 persons. Five years of follow-up indicate acceptable tympanic membrane repair with eight failures.

Although local anesthesia is ideal for cosmetic facial surgery, it must be prepared and administered with at least as much care and attention to detail as with general anesthesia. Relegating the responsibility to ancillary help in both hospital and office operating rooms adds to the legal jeopardy to which the surgeon is exposed. The choice and dosage of local anesthetics and safety measures to be followed in their usage are discussed.

The Epstein-Barr virus (EBV) is closely associated with nasopharyngeal carcinoma, suggesting an etiologic relationship. We have under-taken studies (1) to quantitate the relationship between antibody titers to EBV-associated antigens and nasopharyngeal carcinoma in American patients since most of the patients in previous studies were of either Asian or African descent and (2) to determine the relationship between antibody titers and the clinical course of the disease. Sera from patients with primary or recurrent nasopharyngeal carcinoma and from patients in remission, from patients with various other head and neck tumors (including occult primary lesions and lymphomas), and from normal controls were titrated for IgG antibodies to viral capsid antigen (VCA) and early antigen and IgA antibodies to VCA, using indirect immunofluorescence procedures previously detailed. High titers of antibodies to EBV-induced early antigens and VCA in the IgG fraction and VCA in the IgA fraction were frequently found in the sera of patients with nasopharyngeal carcinoma. A significant reduction in these titers was observed with clinical remission of the disease in treated patients. Preliminary findings suggest that EBV serology may be useful in the evaluation and treatment of patients with nasopharyngeal carcinoma and also in patients with cervical metastases from clinically occult promary sites in order to identify those with occult nasopharyngeal carcinoma.

Recent evidence indicates that endotracheal intubation is supplanting tracheostomy for the short-term treatment of airway obstruction in epiglottitis and croup. Care should be provided by a triumvirate of physicians to include and otolaryngologist, a pediatrician, and an anesthesiologist. Intensive care facilities are also a prerequisite. Standard tracheostomy should be considered in cases requiring intubation longer than 72 hours.