David N.F. Fairbanks

Uvulopalatopharyngoplasty complications and avoidance strategies.

Reports of uvulopalatopharyngoplasty complications were elicited from 72 locations in the United States. We asked physicians to report all complications that had occurred in the 9 years since the operation was introduced. Sixteen fatalities were reported; respiratory distress was the most common cause. Forty-six cases of nasopharyngeal stenosis were reported and 42 cases of palatal incompetence were reported. Hemorrhages and wound dehiscences were also reported. A retrospective analysis of the complications was made and diagnostic-therapeutic strategies are discussed with respect to prevention of complications.

Complications of Nasal Packing

getting perfect exposure of the anterior part of the larynx-without overextending the patients neck-while providing constant, equal pressure and stability to the larynx. This device eliminates the need for having one of the assistants apply pressure to the larynx and allows the surgeon to concentrate more fully on the laser procedure. The laryngeal depressor can be attached to one of the suspension devices available. It has been used in eleven cases, in conjunction with a pre-made maxillary tooth protector) (made of acrylic), and provided good protection to the teeth from the pressure of the laryngoscope.

Nonsurgical treatment of snoring and obstructive sleep apnea.

Self-help remedies, such as exercise, weight loss, sleep positioning, avoidance of sedatives, and use of anti-snore devices may be helpful in mild snorers, but are of limited use in patients with obstructive sleep apnea. Drug therapy with stimulants is also for mild cases and side effects are limiting factors. CPAP is highly effective in patients whose apnea is severe enough to enforce compliance. In all these nonsurgical treatments, the prospect of a lifetime of drug therapy or mechanical ventilation is quite disheartening; when given a reasonable hope for a more permanent cure, most patients will opt for surgical management.

Otic topical agents.

Ototopical preparations are available for the treatment of obstruction, dermatitis, pain, and infection of the ear canal and the mastoid and tympanic structures. Most preparations contain alcohol and some type of mild acid, both of which provide nonspecific antiseptic activity against fungi and bacteria. For bacterial infections the combination of neomycin and polymyxin offers the best therapeutic spectrum against common pathogens. Ototoxicity from topical use in man is a theoretic possibility but not a practical problem. Chloramphenicol (otic) is an alternative in infections caused by bacteroides, but not by the more common P aeruginosa. When otic preparations are too painful for application through a tympanic perforation, an ophthalmic preparation may be more acceptable.

Topical Therapeutics for Otitis Media

In chronic draining ear associated with a tympanic membrane perforation, cholesteatoma, or both, the infection is that of bacterial contamination. Both aerobic and anaerobic organisms are found, notably Pseudomonas, staphylococcus, and enteric organisms, particularly bacteroides. The disease exists because of a structural defect in the middle ear cleft, which requires surgery as definitive treatment. Medical therapy is valuable as a temporary measure in preoperative preparation, and in prevention and management of intracranial extension. Topical therapy with antibiotic ear drops is often helpful, but also important is local care with cleansing, drying, and antiseptic solutions or powders. Therapy is usually directed toward the Pseudomonas organisms with aminoglycoside-polymyxin combination otic drops. However, Bacteroides fragilis now looms as an important pathogen in 13% of affected patients. Chloramphenicol otic drops are indicated when such an infection is suspected or identified.

Dental and Allergic Aspects of Sinusitis and Nasal Polyposis: A Review

The proximity of the maxillary sinus floor to the first, second, and third molar teeth predisposes it to contiguous dental disease. Infections of dental origin are usually mixed bacterial growth with anaerobic species predominating; extended-spectrum penicillins or cephalosporins are recommended. The patient with atopic allergy is susceptible to bacterial infection; combined therapy with antimicrobials, corticosteroids, and antihistamines is advised. The large solitary antrochoanal polyp is successfully managed with maxillary sinus surgery alone. Multiple ethmoidal polyps in children suggest cystic fibrosis, and in adults, the asthma triad syndrome. Thorough surgical management of the sinuses combined with antimicrobial and topical corticosteroid therapy is recommended.

Cocaine: friend or foe?

tigating the use of cocaine injections for local anesthesia. Unfortunately, he and several assistants became heavily dependent on the drug through self-experimentation. Dr. Halstead was whisked away from public scrutiny to the Caribbean Islands, where associates hoped to cure his cocaine addiction, but sadly he turned to the opiates instead. Before the tum of the century, cocaine had become the active ingredient in a variety of patent medicines, tonics, wines, and soft drinks that became enormously popular. Great quantities of cocaine were imported into the United States and were sold without restrictions. But the social impact soon became apparent. Violence and heinous crimes were attributed to the drug by lay writers bent on social reform, and cocaine lost all social respectability. It soon became viewed as a greater threat to society than the opiates. In 1914, cocaine and the Cocaine: Friend or foe?

Obstructive sleep apnea: Therapeutic alternatives

Effective treatment is contingent on the establishment of a correct diagnosis and the identification of pathophysiologic conditions affecting the upper airway. Snoring and obstructive sleep apnea (OSA) are manifestations of airway incompetence in the collapsible part of the airway-that segment between the larynx and the nasopharynx where there exists no rigid support. A number of factors, acting singly or in concert, lead to the airway collapse. They can be categorized as in Table 1. The list of possible conditions is rather extensive, but a thorough upper-airway examination is a fairly routine process in an otolaryngologist’s office, Thyroid studies, cardiopulmonary and neurological assessments, and polysomnographic studies all provide valuable diagnostic information that dictates treatment.

Nasal Septal Perforations: Surgical Management

Educational objectives: To understand the various causes of nasal septal perforations and the rhinologic principles for their prevention and to exercise the strategies for successful surgical closure of nasal septal perforations or for nonsurgical management of their symptoms.

Antimicrobial Therapy in Otolaryngology Part I: An Overview

Educational objectives: To understand the proper use and limitations of antibiotics and the emerging resistance patterns and to obtain better results with antibiotic therapy as a result of insights into different methods of prescribing antibiotics.