Faculty Bibliography

Lymphatic malformations of the upper aerodigestive tract can present therapeutic challenges. Symptoms associated with these lesions include bleeding, dysphagia, changes in speech, and dyspnea. Surgical therapy is recommended, which often leads to functional interference and cosmetic deformities. Laser photocoagulation of these malformations can control symptoms and may be repeated as necessary, preserving tissue and function. The results in four patients treated with the carbon dioxide laser and in five patients treated with the neodymium-YAG laser were reviewed. Reduction of bulk and improvement of symptoms were achieved in all patients, most of whom required multiple treatments. The average duration of each procedure was 30 minutes. All patients were discharged from the hospital on the same day or 1 day after laser therapy with minimal morbidity. The indications, evolving technique, and results of laser therapy are discussed

Bulimia nervosa is an eating disorder found predominantly in young females and characterized by binge-purge cycles as well as medical and psychological problems. The patient with bulimia may present to the otolaryngologist with an upper aerodigestive complaint. It is of paramount importance that the otolaryngologist be cognizant of the disease in order to refer the patient for further therapy

One hundred twelve patients (116 ears) were treated for recurrent and residual cholesteatoma. A retrospective review revealed that 66% had undergone canal wall down mastoidectomy at the previous surgery. The surgical procedure at revision was selected on the basis of an intraoperative assessment of the extent of disease, and clinical prediction of eustachian tube function. The average period of follow-up was 3.4 years. Revision surgery was successful in providing the patient with a safe, dry ear in 105 (91%) of 116 cases. Surgical principles and hearing results are presented

A case of mycotic aneurysm of the intracavernous carotid artery is reported and the literature is reviewed on this uncommon entity. Nineteen cases have been reported, most often occurring in the clinical setting of meningitis. Management recommendations include angiographic confirmation of aneurysm and follow-up with magnetic resonance imaging during antibiotic therapy. Evidence of aneurysm enlargement is an indication for endovascular trapping of the aneurysm or carotid occlusion.

Although composite data from separate subjects can be used to generate single-subject estimates, intersubject variation precludes rigorous ocular pharmacokinetic analysis. Therefore, a rabbit model in which sequential aqueous and vitreous humor samples were obtained following the administration of the quinolone fleroxacin was developed. Mean data from individual animals were used for pharmacokinetic analysis. Following direct intravitreal or systemic drug administration, sequential paracenteses did not alter pharmacokinetic constants or ocular penetration and were not associated with an increase in ocular protein; contamination of vitreous humor with blood was minimal (less than 0.1%). Following direct injection or intravenous administration, vitreous humor concentration-time data were best described by one- and two-compartment models, respectively. The maximum concentration and the penetration into the aqueous and vitreous humors were 1.54 and 0.5 micrograms/ml and 27 and 10%, respectively. Elimination rates from aqueous and vitreous humors and serum were similar following parenteral drug administration. Drug elimination following direct injection was rapid, and the elimination rate from the vitreous humor was not prolonged by the coadministration of probenecid. Our animal model provides a new approach to the rigorous examination of the ocular pharmacokinetics of quinolone antimicrobial agents in the eye.

Primary synovial sarcoma is an unusual tumor of the head and neck. Fewer than 75 cases have been reported in the literature. We have treated 7 additional cases; 3 in the hypopharynx, 2 in the parapharyngeal space, 1 in the oral pharynx and 1 in the posterior triangle of the neck. An enlarging cervical mass, voice change, and dysphagia were among the presenting complaints. CT revealed solitary nonhomogenous tumors from 3 to 7 cm in diameter. Microscopically, all cases showed a biphasic cellular pattern verified by immunohistochemical staining. Multimodality treatment consisted of surgery and postoperative radiation therapy with 3 patients receiving chemotherapy. Although the original pathology report was incorrect in 3 cases, clinical suspicion for synovial sarcoma ensured proper diagnosis.

Although excisional biopsy has traditionally been required to diagnose cervical tuberculosis (TB), fine needle aspiration biopsy (FNAB) has also been found to be useful. The presentation and management of 47 patients diagnosed with cervical TB between 1984 and 1988 were retrospectively reviewed. Chest x-rays were normal in 58% of the patients, and purified protein derivative (PPD) skin testing was positive in 96%. When FNAB was used, TB could be suspected in 83% of cases and definitively established in 62%. Open biopsy correctly diagnosed cervical TB in all masses excised. Medical therapy alone resulted in resolution of disease in 94% of patients diagnosed by FNAB, and subsequent excisional biopsy was necessary in only one patient. The results suggest that FNAB is a useful initial procedure in the diagnosis of cervical TB. Excisional biopsy should be reserved for cases where no diagnosis by FNAB can be made, or for persistent cervical disease despite full-course antituberculous chemotherapy

Injury to either the peripheral or central nervous system results in the accumulation of growth factors at the wound site. Some of these growth factors have been shown to participate in the neural repair process. Adult auditory neurons grown in dissociated spiral ganglion cell cultures are injured (i.e. bilateral axotomy) as a result of the initial preparation of these cultures. Therefore, cell cultures of dissociated spiral ganglia provide a model for the study of repair processes of adult auditory neurons (e.g. effects of exogenous growth factors on the process of neuritogenesis by injured neurons). Auditory neurons do not survive in these dissociated ganglion cell cultures when only exogenous NGF is added to the defined culture medium. Previous work has identified substrate bound basic fibroblast growth factor (bFGF) as a survival factor for adult auditory neurons in vitro. Auditory neurons cultured on substrate bound bFGF also do not show increased survival in response to the addition of increasing concentrations of nerve growth factor (NGF) to the defined medium. This is in sharp contrast to the pronounced neurite outgrowth-promoting effects (concentration dependent) observed when exogenous NGF is added to adult auditory neurons cultured on substrate bound bFGF. We propose that several neuronotrophic factors (e.g. TGFB1, bFGF, NGF and other neurotrophins) are active in the spiral ganglions' response to injury. Several of these growth factors (i.e. bFGF, NGF) act in cooperation to promote the regeneration or repair of severed or traumatized neuritic processes.

The development of human hearing from the 26th week of fetal life to the third year post natal life is reviewed. The human fetus can perceive, react, and store auditory information from the 26th week of fetal life. This ability appears to play a role in the development of language. Infants by the 2nd to 3rd month of postpartum life have categorical perception for most phonemes whether or not these phonemes are native to their own language. The infant has a difference limen similar to that of the adult. The infant threshold is higher; the single-to-noise ratio is greater in infants than adults; and the infant's temporal processing is slower than that of the adult.