Faculty Bibliography

A questionnaire was sent to 152 surgeons to survey complications associated with the implantation of the Nucleus multichannel cochlear implant. Complications were categorized as life-threatening; major, if they necessitated revision surgery; or minor, if they resolved spontaneously or with minimal treatment. A total of 55 complications occurred in 459 reported operations for an overall complication rate of 11.8%. There were no deaths, but there was one life-threatening complication, a case of meningitis. There were 23 (4.8%) major complications, most of which involved flap design or electrode insertion (and included the case of meningitis). There were 32 (7%) minor complications. Most of the complications might have been avoided by proper training, planning of the operations, and careful attention to detail. We recommend that all prospective implant surgeons attend a device-specific training course and practice in the temporal bone laboratory

The effect of otitis media on emerging language was examined in a group of 1-year-olds. Based on pneumatic otoscopy, 15 babies were considered to be free of otitis media in both ears at 80% or more of their first year medical visits (otitis free) and 12 infants had bilaterally positive otoscopy results at 30% or more of their visits (otitis positive). Outcome measures at 1 year included the Bayley Scales of Infant Development (Bayley, 1969) and the Sequenced Inventory of Communication Development (SICD; Hedrick, Prather, & Tobin, 1984) Receptive and Expressive scales. No significant differences were detected on either the Bayley or the SICD Receptive scale. However, the otitis positive group exhibited significantly lower expressive language scores than the otitis free group, suggesting that impairments in language expression may be evident as early as 1 year of age in children with otitis media.

Among the more common manifestations of acquired immunodeficiency syndrome (AIDS) are tumors and infections that occur in regions treated by the bronchoesophagologist. In reviewing our institutional experience in the diagnosis and treatment of 396 patients with AIDS in 1987, we have noted that 226 (57%) had some form of pneumonia and 133 (34%) had candidiasis. In this communication we discuss the various types of bronchopulmonary, oropharyngeal, and esophageal infections that have been reported among AIDS patients. We also review the universal precautions and specific guidelines recommended for safeguarding the bronchoesophagologist and other health care workers who treat these patients.

Computed tomography is currently used as an adjunct to oral contrast studies in the diagnosis and management of esophageal and posterior pharyngeal perforation. We present the CT findings of a surgically proven iatrogenic pyriform sinus perforation. Although extravasation of contrast material was depicted by pharyngography, the site of perforation could not be demonstrated. Knowledge of the pattern of spread of pharyngeal neoplasms was essential for correct interpretation of CT. In our patient the perforation was caused by traumatic passage of an Ewald tube, an unusual and previously unreported complication

The contrast material-enhanced computed tomographic (CT) scans of 18 patients at risk for acquired immunodeficiency syndrome (AIDS) who had painless facial swelling were reviewed. All scans demonstrated parotid cysts and diffuse homogeneous cervical adenopathy. The cysts were bilateral in all but three cases. Eleven of 13 patients tested had antibodies to the human immunodeficiency virus (HIV), and two of the five untested patients later developed AIDS. The authors believe that the CT findings of multiple parotid cysts and cervical adenopathy suggest that the patient may be infected with the HIV virus, and the radiologist should alert the referring physician so that appropriate precautions and treatment may be initiated

A group of 46 high-risk infants (graduates of a neonatal intensive care unit) and 19 full-term infants were observed prospectively for middle ear status beginning at 40 weeks' postconceptional age. All infants were born to families living in low socioeconomic urban neighborhoods. Pneumootoscopy was used to determine the presence or absence of middle ear effusion during periodic medical and nonmedical visits throughout a 1-year period. Of all infants studied, 91% had at least one episode of otitis media with effusion during the observation interval. There were no differences in the percentages of visits during which high-risk and full-term infants experienced either normal middle ears bilaterally or otitis media with effusion in one or both ears. Furthermore, the age of onset of otitis media with effusion was similar for the two groups of babies. No differences were found between boys and girls in the age of onset for otitis media or in the percentage of visits at which otitis media with effusion was detected. Hispanic infants experienced their initial episode at significantly younger ages than did black infants in the sample. Both groups had similar percentages of visits attributable to otitis media with effusion during the observation period. The results indicate a high incidence among the infants studied and similar otologic courses for neonatal intensive care unit graduates and full-term infants during the first year of life.

A technique utilizing the midfacial degloving approach in the repair of nasal septal perforations in 24 patients is reported. The midface degloving approach was limited to patients with septal perforations greater than 3 cm and failed prior attempts at surgical closure. Bilateral posteriorly based unipedicled flaps were utilized in the septal closure. Complete closure was accomplished in 75% (18/24) of cases, with a follow-up of one to three years. Complications included reperforation in 25% (6/24) of cases and partial vestibular stenosis in 20% (5/24) of cases. A modification of our technique, relining the nasal floor with postauricular full-thickness skin grafts, has alleviated vestibular stenosis

Aspergillus is a fungus with world-wide distribution and a common endogenous contaminate of the upper respiratory tract. It has become an increasingly recognized pathogen in the paranasal sinuses. In its pathologic state it presents in one of several forms that may represent a continuum of the disease: allergic, noninvasive, invasive, and fulminant. The progression and prognosis of these disease depends on the location and immunologic status of the patient. This case represents the fourth reported case of a nonimmunologic compromised patient with intracranial extension of aspergillosis. The patient presented with unilateral pansinusitis and radiographic evidence of orbital and anterior cranial fossa invasion. This case illustrates the difficulty of establishing the diagnosis of invasive aspergillosis and differentiating it from neoplastic entities. Radiographs and photomicrographs will be presented to establish this premise