Faculty Bibliography

Cholesteatoma is a difficult disease to treat as demonstrated by the relatively high recidivism rate attained by the best of surgeons. The concept of recidivism encompasses all reoccurrence of the disease, regardless of the theorized origins. This is a term that should be accepted so that some uniformity may be introduced into the evaluation of this disease. A standard reporting format that includes the extent of the disease, the eustachian tube function, the integrity of the ossicles, and a uniform description of the surgical procedure would enhance future evaluations of this disease. The future of otology still lies in finding new ways to eradicate this disease and to avoid recidivism

Successful treatment of cholesteatoma in children is based on the same principles of therapy used in adults. A clinical profile of children with acquired cholesteatoma is compared with that of adults. Issues related to aggressiveness of disease, pathophysiology, diagnostic problems, and treatment approaches are discussed

A prospective, randomized study comparing the effectiveness of two nasal steroid sprays, flunisolide and beclomethasone dipropionate, in the treatment of nasal obstruction associated with allergic or vasomotor rhinitis has been conducted at New York University Medical Center-Bellevue Hospital. All patients underwent routine history and physical examinations and a modified radioallergosorbent test. Paranasal sinus films were used to exclude patients with sinusitis. The Rhinotest microprocessor rhinomanometer was used to quantify pretreatment and posttreatment total nasal air flow and resistance during a period of 2 months. These findings were assessed in conjunction with the patients' subjective complaints. Results demonstrated that anterior rhinomanometric assessment of the nasal airway during inhalant therapy correlated well with the patients' own subjective impressions of nasal air flow. Both steroid inhalants were effective; however, flunisolide provided for earlier and more substantial symptomatic relief. Beclomethasone dipropionate had milder side effects

Various histochemical and immunocytochemical stains were useful in the diagnosis of six unusual head and neck neoplasms that included spindle-cell squamous carcinoma, synovial sarcoma, mucoepidermoid carcinoma, melanoma, T-cell lymphoma, and B-cell lymphoma. Close cooperation with a pathologist ensured rapid diagnosis and the initiation of appropriate therapy. Three cases required special histochemical stains to make a diagnosis or determined tumor differentiation. The three other cases would have been identified as poorly-differentiated tumors of unknown origin without the use of special immunocytochemical stains. These latter findings influenced our final therapeutic strategy, which emphasizes the uses of special stains and studies to accurately identify tumors of the head and neck

Thirty cases of congenital cholesteatomas of the cerebellopontine angle (CPA) treated over a period of 20 years are reviewed with regard to their clinical features, the pathophysiology of their symptoms, and their management. The predominant symptoms were related to cranial nerves VII and VIII and headaches. Signs and symptoms were divided into those caused by local involvement of the cholesteatoma, increased intracranial pressure, or both. Diagnostic procedures from invasive procedures such as ventriculography to more sophisticated noninvasive procedures including computed tomography and magnetic resonance imaging are discussed. The surgical management of 27 congenital cholesteatomas was accomplished via a posterior cranial fossa approach. Total excision of the cholesteatoma was the aim but was carried out in only five (18%) patients because of concern regarding the preservation of nearby neurovascular structures. Partial excision was possible in 22 (82%) patients. To minimize re-formation, the residual cholesteatoma was carefully cauterized with the aid of the operating microscope and bipolar diathermy without damaging surrounding neurovascular structures. Follow-up has ranged from 2 to 15 years, with four (13%) cases of re-formation.

Massive fibro-osseous lesions of the frontal and ethmoidal sinuses are rare. If left untreated, these lesions can produce chronic infection, orbital complications, and/or intracranial events. In the past, resection of these lesions has usually been subtotal and a risk of damage to intracranial structures existed, particularly to the dura, due to poor exposure, and a high recurrence rate was also present. We have treated eight such lesions with a combined craniofacial approach for total resection with resolution of symptoms, without recurrence, and without occurrence of cerebrospinal fluid leak, damage to the orbital contents or intracranial structures, or resultant cosmetic deformity.

The development of a retropharyngeal hematoma following a whiplash injury is a rare occurrence. The potential for airway compression necessitates rapid assessment and treatment. An 80-year-old man who had been receiving long-term aspirin therapy sustained a retropharyngeal hematoma following a motor vehicle accident. Management consisted of tracheostomy, neck exploration, and evacuation and drainage of the hematoma. To the best of our knowledge, there are less than 20 citations of traumatic retropharyngeal hematoma in the English literature. Retropharyngeal hematoma has been associated with cervical extension/flexion injuries, anticoagulation therapy, great-vessel trauma, and foreign body ingestion

CT and MRI are the primary imaging modalities used to evaluate the various regions of the head and neck. From the preceding discussion one can see clearly that the choice of the appropriate imaging modality depends on a number of variables. There is no indisputable 'winner' under all anatomical or pathological circumstances. The advantages and disadvantages of CT and MRI in certain clinical settings have been discussed. The information provided will enable one to exercise a rational choice in the selection of imaging modalities

Internal maxillary artery ligation is effective in treating epistaxis. Occasionally a patient may continue to hemorrhage after this procedure. Evaluation of postoperative angiograms reveals several factors accounting for the failure of internal maxillary artery ligation. These factors include incomplete ligation of vessels, alternative dominance of vessels, and reconstitution of flow through collaterals. Eleven such patients have been successfully treated with angiography and embolization. There was one complication of skin slough in the region of the columella. Embolization is a useful modality in the management of these difficult cases