Faculty Bibliography

PURPOSE OF REVIEW: This article reviews the recent literature on functional rhinoplasty for the most important contributions in the field. RECENT FINDINGS: Surgical techniques for improving the internal nasal valve include upper lateral cartilage fold-in flap, splay graft, alar batten graft, Z-plasty, and the alloplastic Monarch implant. The Nasal Obstruction Septoplasty Effectiveness (NOSE) score and the Rhinoplasty Outcomes Evaluation score have been applied to objectify outcomes in functional rhinoplasty. Functional endoscopic sinus surgery (FESS) and rhinoplasty continue to be safely used in the same surgical sitting. SUMMARY: The last few years have seen improved perspective on what surgery can do, substantiating the inherent difficulties of establishing reproducible outcomes in form and function of the nose

Cochlear implant users' spectral resolution is limited by both the number of implanted electrodes and channel interactions between electrodes. Current steering (virtual channels) between two adjacent monopolar electrodes has been used to increase the number of spectral channels across the electrode array. However, monopolar stimulation is associated with large current spread and increased channel interaction. Current focusing across three adjacent electrodes (tripolar stimulation) has been used to reduce electrode current spread and improve channel selectivity. In the present study, current steering and current focusing were combined within a four-electrode stimulation pattern (quadrupolar virtual channels), thereby addressing the need for both increased channels and reduced current spread. Virtual channel discrimination was measured in 7 users of the Advanced Bionics Clarion II or HiRes 90K implants; virtual channel discrimination was compared between monopolar and quadrupolar virtual channels at three stimulation sites. The results showed that quadrupolar virtual channels provided better spectral resolution than monopolar virtual channels. The results suggested that quadrupolar virtual channels might provide the "best of both worlds" improving the number of spectral channels while reducing channel interactions.

We report a case of vascularised fibula osteocutaneous flap used for composite cervical spinal and posterior pharyngeal wall reconstruction, in a patient with recurrent skull base chordoma, resected by an anterior approach via median labio-mandibular glossotomy approach. Bone stability and pharyngeal wall integrity were simultaneously restored.

The role that otolaryngologist Ross McIntire, MD, played in the care of Franklin Delano Roosevelt, 32nd President of the United States, was documented by reviewing primary source material pertaining to the relationship of McIntire and Roosevelt. This included material from various archives including the Franklin D. Roosevelt Presidential Library at Hyde Park, New York; United States National Archives; and numerous autobiographies and diaries. McIntire's belief in the value of confidentiality and to provide information only on a need-to-know basis is consistent with the strategy that he had devised earlier for protecting his patient's privacy. In the context of his time and his position, Dr McIntire served his patient and his country well by making appropriate medical and wise personal judgments. The career of Dr Ross T. McIntire, otolaryngologist and personal physician to the 32nd president of the United States, engenders a sense of honor to our profession.

Parent cultural adaptation and preschool behavioral and socioemotional functioning were examined in a community sample of urban families from diverse cultural backgrounds. Participants were 130 families of children (mean age = 4.1 years) attending eight public Pre-Kindergarten programs in urban communities. Parents completed a measure of cultural adaptation that taps into acculturation and enculturation, and teachers reported on children's externalizing problems, internalizing problems and adaptive behavior in the classroom. Parents' ethnic identity was a significant predictor of children's functioning. The retention of parents' culture of origin and specific aspects of acculturation are related to positive outcomes in a sample of culturally diverse families of preschoolers living in urban communities. Bicultural parents (those with high ethnic and US American identity) had children with lower levels of internalizing problems and higher levels of adaptive behavior relative to parents who were not bicultural. Implications for enhancing positive child outcomes through the promotion of parental ethnic identity are discussed

We introduce a novel wireless, low-power neural stimulation system for use in freely behaving animals. The system consists of an external transmitter and a miniature, implantable wireless receiver-stimulator. The implant uses a custom integrated chip to deliver biphasic current pulses to four addressable bipolar electrodes at 32 selectable current levels (10 microA to 1 mA). To achieve maximal battery life, the chip enters a sleep mode when not needed and can be awakened remotely when required. To test our device, we implanted bipolar stimulating electrodes into the songbird motor nucleus HVC (formerly called the high vocal center) of zebra finches. Single-neuron recordings revealed that wireless stimulation of HVC led to a strong increase of spiking activity in its downstream target, the robust nucleus of the arcopallium. When we used this device to deliver biphasic pulses of current randomly during singing, singing activity was prematurely terminated in all birds tested. Thus our device is highly effective for remotely modulating a neural circuit and its corresponding behavior in an untethered, freely behaving animal.

We want to describe a case of neonatal laryngeal nodular fasciitis. A 5-day-old female presented with stridor. Fiberoptic transnasal laryngoscopy identified a smooth ball-valving mass obstructing the glottis. Direct microlaryngoscopy demonstrated a lesion originating from the right laryngeal ventricle. Endoscopic therapeutic and diagnostic subtotal biopsies relieved the airway obstruction. Pathologic analysis established nodular fasciitis as the diagnosis. Follow-up endoscopy showed complete resolution of this reactive lesion, and normal laryngeal function. Nodular fasciitis, rarely described in children's head and neck region, has never been reported in the larynx of a neonate. This patient's successful outcome suggests that conservative resection may be both diagnostic and curative.

BACKGROUND: Patients with ulcerative colitis are at increased risk for developing colorectal cancer. We have shown that Toll-like receptor-4 (TLR4) is overexpressed in human colitis-associated cancer (CAC) and that mice deficient in TLR4 are markedly protected against colitis-associated neoplasia. We wished to elucidate the specific contributions of TLR4 signaling by myeloid cells and colonic epithelial cells (CEC) in colitis-associated tumorigenesis. METHODS: TLR4-deficient mice or wildtype littermates (WT) were transplanted with bone marrow (BM) cells: TLR4(-/-) BM-->WT mice (TLR4-expressing CEC) and WT BM-->TLR4(-/-) mice (TLR4-expressing myeloid cells). Colitis-associated neoplasia was induced by azoxymethane (AOM 7.3 mg/kg) injection and 2 cycles of dextran sodium sulfate (DSS) treatment. RESULTS: The number and size of dysplastic lesions were greater in TLR4(-/-) BM-->WT mice than in WT BM-->TLR4(-/-) mice (P < 0.005). Histologically, TLR4(-/-) BM-->WT mice had greater numbers of mucosal neutrophils and macrophages compared to WT BM-->TLR4(-/-) mice. The chemokines KC and CCL2, important in recruitment of neutrophils and macrophages, respectively, were induced in mice expressing TLR4 in CEC rather than the myeloid compartment. The lamina propria infiltrate of mice expressing TLR4 in CEC was characterized by macrophages expressing Cox-2. Moreover, mice expressing TLR4 in CEC rather than the myeloid compartment had increased production of amphiregulin and EGFR activation. CONCLUSIONS: These findings indicate that TLR4 signaling on CEC is necessary for recruitment and activation of Cox-2-expressing macrophages and increasing the number and size of dysplastic lesions. Our results implicate innate immune signaling on CEC as a key regulator of a tumor-promoting microenvironment.

OBJECTIVE: We report a case of allergic fungal sinusitis causing bone erosion and diplopia. CASE REPORT: A 43-year-old man presented with a four-month history of increased nasal congestion and progressive diplopia. Clinical examination revealed bilateral nasal polyposis and a right lateral gaze deficit, consistent with a VIth cranial nerve palsy. Computed tomography of the paranasal sinuses demonstrated a large sellar mass with extensive bony erosion and both supra- and infra-sellar extension. An endoscopic approach to the sphenoid sinus, clivus and posterior cranial fossa with image guidance was performed, enabling surgical treatment involving nasal polypectomy, wide marsupialisation of the sphenoid sinus and removal of the extensive allergic fungal mucin. The patient awoke from anaesthesia with complete resolution of his diplopia. CONCLUSION: Otolaryngologists should be aware that approximately 20 per cent of patients with allergic fungal sinusitis demonstrate paranasal sinus expansion and bone erosion involving surrounding anatomical structures. Such patients may have clinical findings involving the orbit and cranial vault