Faculty Bibliography

Primary or secondary tracheoesophageal puncture with a speaking prosthesis has provided rehabilitation of speech in most patients after total laryngectomy. Persistent constrictor spasm is thought to be responsible for a small percentage of these patients' inability to speak with the prosthesis. Management of these patients has included bougienage and pharyngeal myotomy and/or pharyngeal neurectomy. Botulinum toxin injections of the cricopharyngeus muscle complex in six patients have been successfully used diagnostically and therapeutically for tracheoesophageal puncture failures. The assessment, technique, and results are discussed

Pneumoparotitis is a rare cause of enlargement of the parotid gland; it is often misdiagnosed and therefore incorrectly treated. We report three pediatric cases of self-induced pneumoparotitis and detail the clinical presentation, pathogenesis, radiographic findings, and treatment options. We also review the literature on the subject. In children, inflammatory swelling of the parotid gland is usually due to acute viral or bacterial infection, juvenile recurrent parotitis, or allergic, autoimmune, or systemic disease. Infrequently, swelling may result from air being forced through Stensen's duct, resulting in pneumoparotitis. This may occur as a transient or recurrent phenomenon. Recurrent parotid insufflation is not entirely benign and may predispose to sialectasias, recurrent parotitis, and even subcutaneous emphysema

Voice-onset time (VOT) was measured in plosive-initial syllables uttered by five cochlear implant users prior to and repeatedly at intervals after activation of their speech processors. In 'short-term' experiments, the elicitation set was read after the subject's processor has been off for 24 h, then turned on them off again. Four out of five implant users increased voiceless and/or voiced VOTc (VOT corrected for changes in syllable duration) from preimplant baselines to final recordings made 1-3 years later. Measured acoustic correlates of speech 'posture' (average SPL, F0, and low-frequency spectral slope) changed concurrently. Results in the short-term study were largely consistent with the long term. Significant multiple regressions relating changes in VOTc to accompanying changes in postural correlates were found in both studies. This outcome is consistent with hypotheses that predict changes in both VOTc and in postural correlates with the restoration of some hearing and that allow for linkages between the two. Some of the reliable VOTc increases obtained over the long term that were not correlated with postural changes may have been caused directly by auditory validation of articulatory/acoustic relations that underlie synergisms for phoneme production

We establish criteria for anesthetic forehead flap reconstructions and evaluate the effect of mathematical models and computer simulation of the operation in preoperative and perioperative planning. We study a case series of 13 patients in an academic tertiary referral medical center. Most patients had nasal defects after Mohs' surgery for tumor ablation. Patients were followed up for 2 years after reconstructive surgery. Three patients underwent midline forehead flap nasal reconstructions, and 10 patients underwent paramedian forehead flap nasal reconstructions. We used patient satisfaction and physician evaluation of aesthetic form and function restoration as the main outcome measures. There were no major complications. Minor complications included short-term pincushioning in all patients, scar contracture that resolved after 8 months in one patient, and forehead necrosis after primary closure of the upper forehead in one patient. Computer simulation correlated two-dimension flap design to the transposition process. We conclude that the forehead flap is the optimal reconstructive modality for resurfacing large nasal defects. The paramedian forehead flap is superior to the midline forehead flap for nasal reconstruction, especially for distal tip reconstructions. Mathematical models and computer simulation of the reconstructive procedure that relate the two-dimensional flap design to the transposition process reveal subtle geometric relationships of the flap transposition that facilitate the design of the optimal flap for reconstruction

Paired-comparison judgments of quality were obtained from 20 hearing-impaired listeners for speech processed through simulated compression hearing aids varying in release time (60, 200, 1000 ms) at three different compression ratios (1.5, 2, 3:1) and for three different background noises (ventilation, apartment, cafeteria). Analysis revealed that the main effect of release time did not have a significant effect on perceived quality. The interaction between release time and noise type was found to be significant. While no significant difference in preference for release times was evident for the ventilation noise, the longer release times (200 and 1000 ms) were preferred for the higher level noises (apartment noise, cafeteria noise). Post hoc testing revealed that the mean preference scores for the 200- and 1000-ms release time were significantly greater than that of the 60-ms release time with the competing cafeteria noise (p < 0.05). Analysis of individual subject data revealed statistically significant preferences that differed from the group mean, suggesting that individualized fitting of this parameter of a compression hearing aid might be warranted

The AIDS epidemic has become one of the most important public health problems of this century. As the prevalence of HIV infection continues to rise, health care practitioners in all geographic regions can expect greater clinical exposure to patients infected with HIV. We conducted an anonymous survey of all practicing otolaryngologists in Ohio and California to investigate regional differences in attitudes, knowledge, and practices regarding the care of patients infected with HIV. We also examined the data with respect to year of completion of residency training to identify differences in attitudes or practices among otolaryngologists who trained in the era of AIDS (post-1982 graduates) in comparison with their predecessors (pre-1982 graduates). In comparison with Ohio otolaryngologists, California otolaryngologists reported more frequent clinical encounters with HIV-infected patients and displayed significantly better knowledge regarding the otolaryngologic aspects of HIV infection. Californians were more likely to support the right of an HIV-infected physician to maintain an unrestricted practice and would be less likely to disclose their HIV status to their patients and hospital if they were to become infected with HIV. Post-1982 graduates had more frequent encounters with HIV-infected patients than did pre-1982 graduates and demonstrated a better fund of knowledge. Although Californians were more likely than Ohioans to routinely double glove in surgery, the overall double gloving rate was low at 21%. Californians were no more likely than Ohioans to routinely use protective eyewear, water-impervious gowns, or indirect instrument-passing techniques in surgery. No differences were observed in prevalence of protective surgical precautions between pre-1982 and post-1982 graduates.(ABSTRACT TRUNCATED AT 250 WORDS)

Herniation of the temporomandibular joint into the external auditory canal has been reported as a result of trauma, neoplasia, infection, inflammatory processes, or developmental malformations. This paper reviews the intimate relation of the temporomandibular joint to the temporal bone as well as the literature describing temporomandibular joint herniation into the external auditory canal. Four cases of temporomandibular joint herniation into the external auditory canal resulting from otologic surgery are presented. Their characteristic location, clinical and radiographic findings are described and contrasted to previously reported cases. Despite striking displacement of the temporomandibular joint into the external auditory canal, there were no clinical symptoms referable to this finding. The absence of symptoms distinguished this postoperative etiology of temporomandibular joint herniation from other etiologies mentioned above

BACKGROUND: Despite numerous refinements in microsurgical technique and instrumentation, the microvascular anastomosis remains one of the most technically sensitive aspects of free-tissue transfer reconstructions. MATERIALS AND METHODS: Concurrent with the development of microsurgical techniques, various anastomotic coupling systems have been introduced in an effort to facilitate the performance and reliability of microvascular anastomoses. The microvascular anastomotic coupling device (MACD) studied here is a high-density, polyethylene ring-stainless steel pin system that has been found to be highly effective in laboratory animal studies. Despite its availability for human clinical use over the last 5 years, reported clinical series remain rare. Our clinical experience with this MACD in 29 head and neck free-tissue transfers is reported herein. RESULTS: Thirty-five of 37 (95%) attempted anastomoses were completed with 100% flap survival with a variety of donor flaps, recipient vessels, and clinical contexts. Two anastomoses were converted to conventional suture technique intraoperatively, and one late postoperative venous thrombosis occurred after fistulization and vessel exposure. CONCLUSIONS: We conclude that the MACD studied here is best suited for the end-to-end anastomosis of soft, pliable, minimally discrepant vessels. Previous radiation therapy does not appear to be a contraindication to its use. Interpositional vein grafts may also be well suited to anastomosis with the device. When carefully and selectively employed by experienced microvascular surgeons, this MACD can be a safe, fast, and reliable adjunct in head and neck free-tissue transfer reconstructions, greatly facilitating the efficiency and ease of application of these techniques

An expanded polytef (polytetrafluoroethylene [ePTFE]) soft-tissue patch was used in nine patients to reconstruct postparotidectomy defects and prevent Frey's syndrome. All nine cases were constructed primarily using either a 1- or 2-mm-thick patch depending on the depth of the defect. All nine patients achieved excellent, nearly normal contour that approximates the uninvolved side. None complained of Frey's syndrome. Average follow-up to date is 12 months