摘要:

AbstractMultiple site specific procedures have been proposed to treat obstructive sleep apnea syndrome (OSAS). Midline glossectomy (MLG) is a procedure that directly enlarges the hypopharyngeal airspace using the carbon dioxide laser. The initial experience of 12 patients is presented. Midline glossectomy as the sole procedure was performed on 11 patients who had failed uvulopalatopharyngoplasty (UPPP) and who were felt to have significant hypopharyngeal collapse on physical examination and Müller's maneuver. One patient with primary hypopharyngeal narrowing underwent MLG. Five (42%) were considered responders with Respiratory Disturbance Index (RDI) decreasing from 60.6 per hour to 14.5 per hour. In seven nonresponders, there was no significant change in the RDI (62.6 events per hour to 48.4 events per hour). Cephalometric analysis showed that responders tended to be more retrognathic (sella‐nasion‐supramentale (S‐N‐B = 74.4° )) than nonresponders (S‐N‐B = 79.3° ). Responders were significantly less obese (body mass index (BMI = 30.6)) than nonresponders (BMI = 37.9). There were five minor complications including minor bleeding (n = 3), prolonged odynophagia (n = 1), and minor change in taste (n = 1). There were no major complications, and no persistent difficulties with speech or swallowing. These results demonstrate that direct surgical modification of the tongue base and associated structures can significantly impact obstructive apnea. Midline glossectomy or similar procedures may be useful in a subset of pati

ISSN:0023-852X    

DOI:10.1288/00005537-199108000-00001

出版商:John Wiley&Sons, Inc.    

年代:1991

数据来源: WILEY

摘要:

AbstractThe initial improvement in hearing following stapedectomy usually deteriorates with the passage of time. We studied the long‐term results of stapedectomies performed on 42 patients (49 ears) between 1959 and 1969 who had a minimum follow‐up of 18 years. Both air conduction (AC) and bone conduction (BC) thresholds progressively deteriorated over the long term. The degree of BC loss paralleled that expected from presbycusis alone. A greater deterioration was noted in the AC levels, producing a recurrent conductive hearing loss in the speech frequencies. Age at the time of surgery had no effect on the long‐term outcome. Comparison of the average preoperative speech discrimination scores (SDS) to the 1‐year postoperative SDS and the long‐term SDS revealed a 1.1% and 16.7% drop, respectively. The improvement in the average speech reception threshold (SRT) obtained 1 year postoperatively deteriorated by less than 1 dB per year over the long term. Patients with a higher SDS (more than 95%) preoperatively fared better in the maintenance of speech discrimination than those with a lower SDS (less than 95%). The preoperative SRT level was predictive of the timing for the requirement of hearing amplification. The postoperative hearing deterioration appeared to be caused by presbycusis, combined with a recurrent conductive loss in the speech frequencies rather than cochlear otosclerosis. Although the decline in hearing following stapedectomy exceeds the rate of hearing loss due to presbycusis, many individuals, after successful stapes surgery, are able to delay the need for hearing amplification for longer periods than had been previously

ISSN:0023-852X    

DOI:10.1288/00005537-199108000-00002

出版商:John Wiley&Sons, Inc.    

年代:1991

数据来源: WILEY

摘要:

AbstractAlthough first described in 1983, allergicAspergillussinusitis (AAS) has yet to gain wide recognition among otolaryngologists and pathologists. We have treated three patients with a history of asthma, nasal polyposis, and recurrent pansinusitis who fit the description of allergicAspergillussinusititis. Histopathologically, mucinous material with abundant eosinophils and Charcot‐Leyden crystals (“allergic mucin”) is interspersed with fungal hyphae. Immunologic characteristics include serum total immunoglobulin E (IgE) elevation, increased RAST classes, and cutaneous reactivity to molds.A retrospective analysis of the histopathology of 82 patients with chronic sinusitis was also undertaken. Eleven additional patients with classic allergic mucin were identified, but were found to be without evidence of fungal elements. The clinical features of all 14 patients are reviewed revealing the spectrum of disease. The difficulties of diagnosis and a therapeutic protocol which includes wide local debridement and postoperative use of systemic steroids are disc

ISSN:0023-852X    

DOI:10.1288/00005537-199108000-00003

出版商:John Wiley&Sons, Inc.    

年代:1991

数据来源: WILEY

摘要:

AbstractCiprofloxacin, a fluorinated quinolone with high efficacy againstPseudomonas aeruginosa, was used in the treatment of 10 consecutive patients with malignant external otitis. All patients had skull base osteomyelitis documented by nuclear and computed tomography (CT) scans. Dosages of 1.5 g of ciprofloxacin daily were used for a mean average of 10 weeks. All patients were considered cured with a minimum follow‐up of 18 months after completion of therapy. A new classification of malignant external otitis (MEO) is presente

ISSN:0023-852X    

DOI:10.1288/00005537-199108000-00004

出版商:John Wiley&Sons, Inc.    

年代:1991

数据来源: WILEY

摘要:

AbstractEarly detection of drug‐induced hearing loss is best accomplished by monitoring hearing at the ultra‐high frequencies. Unfortunately, at these frequencies, sound pressure at the tympanic membrane (TM) critically depends on the placement of the sound source and on the size and shape of each individual external ear. Thus, presentation of the same sound may yield substantially different sound pressures in different ears. Moreover, only a slight change in the position of an earphone may yield large changes in sound pressure at the tympanic membrane. As a consequence of these characteristics, the reliability of ultra–high‐frequency audiometry is poorer than at conventional audiometric frequencies. However, for the early detection of ototoxicity, it is necessary only to monitor for increases in thresholds. Accordingly, a sound‐delivery system was developed which fixes the relative position of the sound source and the ear. This system ensures that sounds at the same level may be presented during different test sessions. To assess the stability of ultra–high‐frequency thresholds, normal hearing subjects were tested in sessions separated by several weeks. Thresholds were obtained between 1 and 16 kHz and were found to be reliable. It is concluded that this type of system can be used for monitoring the ototoxic effects of

ISSN:0023-852X    

DOI:10.1288/00005537-199108000-00005

出版商:John Wiley&Sons, Inc.    

年代:1991

数据来源: WILEY

摘要:

AbstractPatients struck by lightning can present with a wide variety of unusual otologic problems including burns to the external auditory canal, tympanic membrane rupture, middle ear injury, and sensorineural hearing loss.Four patients who incurred various otologic problems, including one patient with previously unreported bilateral oval window fistulas following lightning injury, are presented. Audiologic, otologic, and surgical findings are reviewed as well as patient follow‐up and outcom

ISSN:0023-852X    

DOI:10.1288/00005537-199108000-00006

出版商:John Wiley&Sons, Inc.    

年代:1991

数据来源: WILEY

摘要:

AbstractDue to the uncertainty of optimal timing for facial nerve repair after severe trauma, a study was designed to investigate facial nerve repair in micro‐pigs by grafting at intervals after nerve transection ranging from 0 to 90 days. Following adequate time for regeneration, it was possible to electrically stimulate across the nerve graft in all animals. No significant difference existed between operative groups for electrophysiologic testing. Axon counts demonstrated a trend toward a lower regeneration rate in more delayed grafts. This trend and the ease of grafting with less scar and nerve stump resection suggest that the best results may be obtained with grafting as early as possible. Grafting at 21 days, the peak of neuron cell‐body metabolic activity, did not produce better results. Since statistically significant differences do not exist between individual groups, grafting several months after trauma can be successful, if medically necess

ISSN:0023-852X    

DOI:10.1288/00005537-199108000-00007

出版商:John Wiley&Sons, Inc.    

年代:1991

数据来源: WILEY

摘要:

AbstractThe activity of the posterior cricoarytenoid muscle during respiration has been well investigated electromyographically. Its activity during phonation, however, has not been studied systematically. We, therefore, focused our attention on the phonatory activity of the posterior cricoarytenoid muscle to confirm whether it also contracts during phonation, as has been reported by some researchers. In our series of 12 adult dogs, the posterior cricoarytenoid was active in 11 dogs and inactive in one dog during phonation. Our present study also showed that the posterior cricoarytenoid activity was stronger for phonation than for inspiration in 6, stronger for inspiration than for phonation in 3, and the same for phonation and inspiration in 2 dogs. The results obtained from the present electromyographic evaluation demonstrated that the posterior cricoarytenoid is activated during phonation. The authors believe that the posterior cricoarytenoid muscle has phonatory function and that the phonatory effect of this muscle on the vocal cord may play an important role in precise glottis control.

ISSN:0023-852X    

DOI:10.1288/00005537-199108000-00008

出版商:John Wiley&Sons, Inc.    

年代:1991

数据来源: WILEY

摘要:

AbstractDuring the past 18 years, 102 singular neurectomies (SN) were performed on 95 patients with chronic cupulolithiasis of the posterior canal sense organ. Bilateral sequential singular neurectomies were performed in 7 patients and unilateral singular neurectomies in 88 patients. Ninety‐nine (97%) of the 102 singular neurectomies completely eliminated the positional nystagmus and vertigo produced by the involved (undermost) ear in the Hallpike maneuver. Following three singular neurectomies (3%), there was improvement but incomplete relief from the positional nystagmus. A sensorineural hearing loss caused by the singular neurectomies occurred in four patients (4%). A thorough knowledge of the surgical and histologic anatomy of the round window niche and singular canal, together with the use of local anesthesia to allow monitoring of a vestibular response to singular neurectomy are essential for effectiveness and safet

ISSN:0023-852X    

DOI:10.1288/00005537-199108000-00009

出版商:John Wiley&Sons, Inc.    

年代:1991

数据来源: WILEY

摘要:

AbstractThe influence of the nasal septum and respiration, evaluated by the total nasal resistance (TR) on the development of the nasomaxillary complex, was studied in 42 identical twins. An understanding of this influence is important for a determination of whether surgery involving the nose should be performed in children.Comparison within and between twins with different septal deformities indicated that the cartilaginous nasal septum influences the development of the nose and the anteroposterior dimensions of the maxilla. Anterior septal deformities resulted in underdeveloped cartilaginous noses and a shorter anteroposterior dimension for the maxilla. No relation was found with regard to posterior septal deformities, which may be considered as part of the development of the midface. Vertical dimensions of the face were related to TR. Increased values of TR were significantly related to a shorter maxillary height. This may not express a causal relationship but rather genetically determined shorter facial dimensions.

ISSN:0023-852X    

DOI:10.1288/00005537-199108000-00010

出版商:John Wiley&Sons, Inc.    

年代:1991

数据来源: WILEY