Daniel A. Deems

Complications of Ethmoidectomy: A Survey of Fellows of the American Academy of Otolaryngology—Head and Neck Surgery

A survey regarding complications of sinus surgery was mailed to 6969 otolaryngologists; 3933 responses (56.44%) were obtained, and 3043 of these physicians (77.37%) reported that they performed ethmoidectomy. Completed questionnaires were available for review from 42.21% of all Academy fellows (2942 physicians). Responses were tabulated and summarized question by question. Physicians generally did not rate their residency training in ethmoidectomy highly. The survey confirmed that there has been a marked rise in the frequency of ethmoidectomy and in the amount of training in ethmoidectomy since 1985. Empirical complication rates were calculated for different procedures and time periods. Poisson regression models were then constructed to describe the rate of complications under varying conditions such as the type of surgery performed, time period, experience and training of the surgeon, and type of complication encountered. The models permitted determination of the statistical significance of variables in relation to Incidence of complications. The study did not demonstrate a clear and consistent statistical relationship between the incidence of complications, the type of surgery performed, and the quality of training. Moreover, physicians who provided data from record review tended to report higher rates than those who estimated responses. The majority of physicians discussed specific potential complications with their patients before surgery and routinely performed preoperative computed tomography. The study demonstrated that physicians who experienced complications at higher rates were more likely to discuss these complications with patients before surgery.

Olfactory-related changes in Alzheimer's disease: A quantitative neuropathologic study

Neuropathological studies of 10 confirmed cases of Alzheimers disease (AD) revealed increased numbers of neurofibrillary tangles and neuritic plaques in olfactory cortex compared to other brain regions. This was most evident when AD tissues were compared to tissues from seven gender- and age-matched controls. In the AD cases, examination of other brain regions which receive olfactory projections also revealed high concentrations of neuritic plaques and neurofibrillary tangles. These data also confirm previous observations that neurofibrillary tangle formation is more prevalent than neuritic plaque formation in AD. This is the first quantitative neuropathological study that demonstrates significant damage to various components of the central olfactory apparatus in AD. Our data suggest that damage to these areas may be related to the behavioral, emotional, and cognitive abnormalities commonly observed in affected patients. The use of antemortem evaluation of the olfactory system as a diagnostic tool for AD is discussed.

The effect of human olfactory biopsy on olfaction: A preliminary report

Normal human olfactory function is subject to a wide variety of factors. Although biopsy of human olfactory neuroepithelium has been reported by several researchers, there are no studies which have evaluated the effect of this procedure on olfactory function. In this retrospective study, we sought to determine if tissue removal from the olfactory cleft has an adverse influence on the sense of smell. Nineteen subjects underwent bilateral olfactory testing and subsequent endoscopic olfactory mucosal biopsy. All subjects were retested 6 weeks to 1 year after olfactory neuroepithelial biopsy. No statistical difference was found between olfactory tests performed before or after biopsy. These data suggest that biopsy of human olfactory neuroepithelium has no discernible adverse effect on the ability to smell.

Preservation of the stapedius tendon in laser stapes surgery

Objectives/Hypothesis: The stapedius tendon is routinely transected during stapes surgery. The objective of this study was to evaluate the technique of stapedial tendon preservation during stapes surgery and to compare results of these cases with cases where the stapedial tendon was not preserved. Study Design: Retrospective study. Methods: Four groups of patients were evaluated. Two groups had undergone stapes surgery with preservation of the stapedial tendon. One of these groups underwent a laser stapedotomy minus prosthesis (laser STAMP) procedure, while the other group had a prosthesis inserted. The other two groups had undergone laser stapedotomy with one of two different prostheses being used. Audiometric data were obtained and reviewed both preoperatively and at approximately 6 weeks postoperatively. Results: All groups had overall successful results demonstrating that stapedial tendon preservation is technically possible and does not compromise outcomes. Conclusions: Based on the results, it is recommended that the stapedius tendon be preserved whenever possible during laser stapes surgery. Reasons justifying its preservation are discussed. Laryngoscope, 108:1453–1458, 1998

Partial recovery of gustatory function after neurol tissue transplantation to the lesioned gustatory neocortex

The ability of homotypic cortical tissue grafts to induce recovery of function after a gustatory neocortex (GN) lesion was studied using the conditioned taste aversion (CTA) paradigm. On acquisition day, 26 GN-lesioned and 8 sham-lesioned rats were presented with a saccharin solution, followed by an injection of the illness-inducing agent lithium chloride (LiCl). On the test day, 2 days later, saccharin was presented again. The GN-lesioned rats showed significantly less aversion to saccharin on the test day, indicating that the lesion impaired their ability to form taste-illness association. Nine of the lesioned rats were then bilaterally transplanted with fetal GN tissue. Nine weeks after the transplantation, the rats were presented with a LiCl solution, which served as both a tastant and an illness-inducing agent. An NaCl solution, which tasted very similar to the LiCl solution, was used to test the CTA to salt 3 days later. The nontransplanted rats consumed significantly more LiCl than the transplanted and sham-operated rats on the acquisition day, but both transplanted and nontransplanted rats consumed more NaCl than sham-operated rats on the test day. Nissl and Golgi stainings showed numerous somata and extensive arborization of neurons within the grafts. The results indicate that fetal GN grafts can restore the ability to integrate gustatory and visceral inputs but not to form long-lasting taste-illness associations.

A ChemoSensory Questionnaire for Patients Treated for Cancer of the Head and Neck

Objectives: To investigate primary chemosensory issues experienced by patients who undergo treatment for cancer of the head and neck and to develop and assess a ChemoSensory Questionnaire (CSQ).

A comparison of mathematical models of nasal pressure-flow data and the contribution of compliant and inertial parameters

The fit of two mathematical models to nasal pressure-flow data from subjects with normal and pathological nasal airways is examined. The use of compliance and inertance parameters within these equations was assessed. Results indicate that the right hyperbolic and Rohers equation models gave analogous fits, and that the compliance and inertance parameters which are related to nasal pathology significantly increased the R/sup 2/ value of the fits.<<ETX>>

Obstructing nasopharyngeal epignathi causing polyhydramnios

multicentric cervical lesion in the fetus. In anticipation of postnatal upper airway obstruction expected in this neonate, an experienced pediatric airway management team assembled in the delivery suite a full complement of equipment necessary to secure any infants airway. At the time of planned cesarian section, the newly delivered infant immediately experienced respiratory distress. The airway was emergently secured by open (ventilating) bronchoscopy, followed by tracheotomy without untoward sequelae. The stable airway allowed work-up and surgical removal of a cystic teratoma in a controlled fashion several days later. As prenatal ultrasound diagnosis becomes both more sophisticated and prevalent, the otolaryngologist should be called upon to play an increasing role in perinatal decision-making regarding cases such as this and in planning for airway emergencies at the time of delivery. Assembly of an experience team and essential equipment/resources is paramount when the need for specialized intervention can be reliably predicted.