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

During the past 10 years discrete middle ear congenital cholesteatomas have been detected with greater frequency in young children. The increased recognition of this condition is probably related to the pediatricians' greater awareness of this defect, their improved facility with pneumatic otoscopy, and effective audiometric and tympanometric screening procedures. This early detection while the lesions are small and localized facilitates their surgical removal. Clinically, it would appear that congenital cholesteatomas can be subdivided into two categories according to their anatomic locations. The anterior lesions present as an isolated pearl that arise from an area on the anterior surface of the malleus, are usually associated with normal hearing, and have pneumatized mastoids. The posterior lesions do not seem to originate from a clearly defined anatomic area, have a higher incidence of sclerotic mastoids, and erode the ossicular chain commonly producing a hearing loss. The anterior middle ear cholesteatoma probably arises from a persistent epidermoid formation, a structure that normally is present during fetal development of involutes by the 33rd week of gestation. The origin of cholesteatomas arising in the posterior middle ear space remains more controversial

The large vestibular aqueduct as an isolated anomaly of the temporal bone has been previously identified radiologically, and its association with sensory neural hearing loss has been recognized. It has not, however, been defined as a distinct clinical entity in children. We studied 12 children, ages 3 to 9 years, with downward-fluctuating progressive high-frequency neurosensory hearing losses whose symptoms were thought to be related to the isolated enlargement of the vestibular aqueduct identified by high-resolution computed tomographic scanning. Previously it had been assumed that a large vestibular aqueduct is a temporal bone dysplasia that is a variant of the Mondini type of deformity and that the associated hearing loss is congenital in nature. Our clinical observations, however, indicate that the hearing loss in children with an isolated enlargement of the vestibular aqueduct is acquired during childhood. The natural history of this progressive deafness is reviewed, and a pathophysiologic hypothesis is presented

A retrospective review of 64 total thyroidectomies performed at Memorial Sloan-Kettering Cancer Center was conducted. Only one patient had permanent hypocalcemia (1.6%) requiring calcium supplementation. Eight patients had a total of 11 complications, for a complication rate of 12.5%. These results are in sharp contrast to those published in 1972 from this institution, in which the permanent hypocalcemia rate was 29%. The reasons for this difference are discussed

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

Bony hemangiomas of the zygomatic bone are rare. This report represents the tenth citing in the literature. The most common signs and symptoms include swelling and pain or tenderness. Diagnosis can be made by plain radiographic studies followed by CT scanning or MRI. The treatment of choice is surgical excision with a rim of normal bone around the tumor. Malignant degeneration has not been reported unless radiotherapy had been used

The laryngocele and saccular cyst are uncommon anomalies of the larynx. Two patients, one with an internal laryngocele and one with a saccular cyst, were successfully treated by endoscopic laser marsupialization of their lesions. Since neither patient was found to be a suitable candidate for prolonged general anesthesia, the patients did not require a tracheotomy and were discharged the day after surgery. Both patients are doing well, with remarkable improvement in their voices persisting in their three year follow-up. The signs, symptoms, diagnosis, treatment, and indications for endoscopic laser treatment of internal laryngoceles and saccular cysts are discussed. Laser marsupialization of internal laryngoceles appears to be an acceptable mode of treatment

Indications for repair of nasal septum perforations include excessive crusting, recurrent bleeding, whistling, and pain. Large subtotal perforations usually are less symptomatic, but smaller defects (less than 1 cm) may need repair. Tragal cartilage with perichondrium autograft was used to repair these perforations. After the septal defect was debrided, this free graft was harvested and used to fill the defect. This technique was attempted in ten patients with septal perforations, none secondary to systemic illnesses. Nine of these patients had successful closure of their perforations