Otolaryngology–Head and Neck Surgery

The intention of the following report is to present a concept for constructing a substitute glottis (neoglottis). The concept evolved over the years on the basis of anatomic studies and in the course of plastic reconstructions on patients. It is based on pedicled grafting of a voluntarily controllable—and hence trainable—musculature that might be transplanted into the larynx attached to a neurovascular pedicle. A rima glottidis might be imitated that could be opened and closed from a neutral position. During sleep the neoglottis would be in a relaxed, spasm-free position. A sensitive and tactile stimulus response ought to be possible, as should variations of the state of tension of the substitute vocal muscles.

Serial vestibular testing was performed on 34 patients undergoing cis-platinum chemotherapy and 12 age-matched normal subjects. Vestibular testing comprised caloric and low-frequency, sinusoidal rotational testing (0.01 to 0.16 Hz). Test-retest variability in the caloric and rotational vestibular assessment of the normal subjects formed the basis for evaluation of subclinical loss of vestibular function within our patient population. In spite of high-dose cis-platinum chemotherapy (100 mg/m²) with cumulative dosages to 1600 mg, no clear evidence of vestibular toxicity was found.

The deterioration of speech-understanding abilities in the aged that results from factors such as reduced speed and accuracy in processing has been well documented. The purpose of this study was to evaluate whether the geriatric population could benefit from a cochlear implant, despite the possibility of reduced processing abilities. Twenty patients, ages 65 to 85 years, with bilateral profound sensorineural hearing loss received the Nucleus multichannel cochlear prosthesis at NYU Medical Center. All patients underwent extensive preoperative medical and audiologic assessments to determine candidacy. The surgical procedure was well-tolerated by all patients. Mean postoperative test results revealed significant improvements in both auditory performance and quality of life as a result of implant usage. These data support the concept that although a reduction in the processing of sensory stimulation might exist, the elderly can process a new auditory code delivered by means of a cochlear implant.

Titanium implants in facial bones for retention of epitheses or dental bridges were used for reconstruction in cancer patients after tumor surgery. Even heavily irradiated bones could integrate the implants and bear the load from the epithesis. No major complications, such as wound infection, fistulation, or osteoradionecrosis, occurred after implant surgery. There was, however, an increased loss of implants with time after irradiation, especially in the orbital region. When hyperbaric oxygen was used as adjunctive treatment, implant losses were reduced.

Kawasaki disease is an acute febrile illness of unknown etiology that occurs primarily in childhood. Early diagnosis and treatment can reduce the risk of cardiac complications of Kawasaki disease, which carries a 1% to 2% mortality for cardiovascular events. Clinical features include: (1) fever (2) conjunctival injection (3) oral cavity changes (4) changes in the peripheral extremities (5) erythematous rash and (6) cervical adenopathy without suppuration. We describe three cases in detail and survey a series of 42 patients at our institution. Otolaryngologic manifestations were found to occur in the early stages of Kawasaki disease. The otolaryngologist may see these patients early in the disease and should be alert to the signs and symptoms for appropriate diagnosis and treatment. Characteristics of Kawasaki disease, difficulties in diagnosis during the initial febrile stage, and the importance of early diagnosis by the otolaryngologist is stressed.

A stained or colored perilymph would be a valuable tool to otologists for the detection of a perilymph fistula. We studied the effect of intravenously injected fluorescein on the inner ear in seven cats. Still and video photography was used to clearly document our findings. Intravenously injected fluorescein appeared within the soft tissue in less than 1 minute and stayed there for at least 31/2 hours. Fluorescence around the round window niche resulted from soft tissue (mucosal) fluorescence and extravasation of interstitial fluid (transudate). No fluorescence of perilymph was detected. Because of this, we do not believe intravenously injected fluorescein is useful in the detection of perilymph fistula. Intrathecal injection caused quick and intense staining of labyrinthine fluid.

This study evaluates the welding effect of argon laser on fascial grafts and its potential application in tympanoplasty. An animal model was designed so that surgically induced perforations of the lumbar fascia of the animals were grafted in an underlay fashion. Each graft was “spot welded” around the circumference of the perforation using a hand-held argon laser. Various lasing parameters were used on different grafts. Control perforations were grafted but not welded. A total of 96 perforations was studied. Weld sites were evaluated both histologically and by tensile strength measurement at the end of surgery, and at 7, 14, and 21 days postoperatively. Comparison with controls showed a higher tensile strength for welded grafts, which was most significant in the early postoperative period (p < 0.001). Histologically, it seems that the basic mechanism of fascial welding involves liquification and denaturation of extravasated proteins at the weld sites. Correlation between the extent of thermal damage on the tissues and the various lasing parameters is described. Based on the well-documented safety of argon laser in otologic surgery, and the successful welding of fascial grafts in this study, argon laser may prove beneficial in welding temporalis fascia grafts in tympanoplasty.