Dimitrios Assimakopoulos

Treatment of Ménière's disease by intratympanic gentamicin application

Ménières disease is a vestibular disorder characterized by episodic vertigo, tinnitus, fluctuant hearing loss, and ear fullness, with vertiginous attacks being the most disabling complaint. The effectiveness of conservative treatment has been variable, while surgical techniques provide more permanent relief from vertigo, but pose possible morbidity and cochlear risk. Intratympanic administration of gentamicin has been proposed as an alternative for patients with debilitating Ménières disease who have failed to respond to standard medical treatment. The goal of such treatment is to control vertigo by partially or completely destroying the vestibular system, while at the same time maintaining hearing. In this review we present the current medical literature on pathophysiology, pharmacokinetics, administration methods, dosage, treatment protocols, and problems related to intratympanic administration of gentamicin for patients with MD. Intratympanic gentamicin administration is a simple medical modality for treatment of persistent vertigo in patients with Ménières disease. According to recent world research protocols, we propose the instillation of gentamicin by transtympanic injection, as a quick, easy, well-tolerated, ambulatory and cost-effective technique. Drug solution concentrations should be dependent on the frequency, intensity and duration of vertigo spells, as well as the degree of existing hearing loss, thus providing progressive vertigo relief with a low possibility of secondary deafness.

The role of the facial nerve latency test in the prognosis of Bell's Palsy

Eighty patients with idiopathic facial nerve palsy were evaluated by the facial nerve latency test. Depending on the latency time, the patients were classified into the following four groups: group A patients had normal latency times (3.25 msec); group B patients had slightly extended latency times (4 to 7 msec) and a mean of 5.6 msec; group C patients had extended latency times (10 to 14 msec) and a mean of 10.2 msec; and group D patients displayed complete disappearance of evoked compound muscle action potential (no responses).

Treatment of Nasal Polyposis in Byzantine Times

The goal of this study was to describe the therapeutic methods and surgical techniques used during Byzantine times (ad 3241453) for a disease that has occupied physicians since antiquity:nasal polyps. The original Greek-language texts of the Byzantine medical writers, most of which were published after the 17th century, were studied in order to identify the early knowledge of the definition, symptoms, conservative treatments, and surgical intervention in cases of this disease. A considerable number of conservative treatments, etiologic and local (with inunctions or blowing of caustic substances), with evident influence from Roman medicine, were identified even in the early Byzantine medical texts (4th century). Further, some surgical techniques were described that seem to constitute evolution of the Hippocratic tradition. From the study of the original texts of Byzantine medical writers, their interest in the rhinological diseases is evident; in the case of nasal polyps, new techniques were mentioned. The first meticulous intranasal surgical removal of polyps was described. These techniques, obviously developed during the Hellenistic period, initially influenced European medicine and later the rest of the world.

A Rare Nasal Tip Skin Metastasis of a Basaloid Squamous Cell Carcinoma of the Larynx

Basaloid squamous cell carcinoma (BSCC) is a highrade histologic variant of squamous cell carcinoma of the arynx. Typical patients are usually elderly men with a istory of tobacco or alcohol abuse. According to previous eports, the tumor presents at advanced stage III or IV, with egional neck lymph node metastases at presentation. Disal metastases to the lung, liver, bone, brain, and skin were eported in 44% of cases. To the best of our knowledge, only 1 case of BSCC of he larynx metastatic to the skin of the nasal tip has been eported in the literature. We describe a new case of BSCC f the larynx with nasal tip skin metastasis.

Primary Local Amyloidosis of the Palate

A45-year-old woman presented with a feeling of fullness of her left ear. Otoscopy, audiometry, and tympanometry were unremarkable. Flexible nasopharyngoscopy revealed the existence of yellow lesions on the superior surface of the left and right lateral borders of the soft palate and smaller lesions on the posterior surface of the nasopharynx (Fig 1). On palpation, the masses were firm and painless. Biopsy of the lesions revealed the presence of segments of connective tissue with overlying nonkeratinized stratified squamous epithelium. The underlying dermis contained deposits of a homogeneous eosinophilic substance that stained characteristically with Congo red. Further complete laboratory evaluation of the patient did not reveal systemic involvement by the disease. A diagnosis of primary amyloidosis of the palate and nasopharynx was established. No therapeutic measures were provided. The patient is currently under observation, and no progression of the lesion has been observed at 2-year follow-up. The protocol of the study of this patient was reviewed and approved by the Scientific Committee of the hospital that represents the local Institutional Review Board.

Contribution of Exfoliative Cytology to the Diagnosis of Laryngeal Lesions

OBJECTIVE To estimate the diagnostic accuracy and reliability of exfoliative laryngeal cytology. STUDY DESIGN Over three years (1996-1999) cytologic smears were obtained from clinically suspicious laryngeal lesions during laryngoscopy in a total of 31 selected patients (28 males and 3 females with an age range from 28-90 years). The cytologic diagnoses were analyzed and correlated with the histologic and final clinical diagnoses in 17 and 14 cases, respectively. Cytologic identification of the exact histologic type of the lesion was evaluated in 17 patients from whom both cytologic smears and biopsy material were obtained. RESULTS The overall specificity was 100%, with no false positive diagnoses. The overall sensitivity was 93.3%, with one false negative cytologic diagnosis, in a case of non-Hodgkins lymphoma. Cytohistologic correlation showed complete agreement between cytologic and histologic diagnoses in five of six benign lesions, in four cases of dysplasia and in six cases of squamous cell carcinoma. The overall diagnostic accuracy of cytology was 96.7% CONCLUSION Exfoliative cytology by the smear technique is a reliable and accurate method in clinically suspected laryngeal lesions. Moreover, exfoliative cytology may be applied as the only alternative diagnostic method, especially in elderly patients with coexistent cardiorespiratory problems, when biopsy is not advisable or indicated.

Comparative study of evoked electromyography and facial nerve latency test in the prognosis of idiopathic facial nerve palsy in childhood

We report our results from the application of evoked electromyography (EEMG) and facial nerve latency testing (FNLT) in 30 children aged 4–14 years with idiopathic facial palsy. Our aim was to define the value of these tests as prognostic tools in Bells palsy. From the EEMG results we ascertained that, when the amplitude of the compound muscle action potential varied between 51% and 95% of the normal value, the neuronal damage is slight (neurapraxia). When the percentage value of muscle response decreases, the prognosis is worse. The results of the FNLT showed that, when the latency is within normal limits, the damage to the nerve is slight (neurapraxia). If the latency is prolonged, the prognosis is worse. Evaluation of our results and comparison with the index of facial nerve functional recovery showed that those two tests have a high percentage of correctness (100% for the EEMG and 96.7% for the FNLT) and a low percentage of error. We conclude that these tests are excellent for predicting the outcome of facial nerve palsy in childhood and we suggest that young patents undergo both so that the determination of the lesion may be as correct as possible.

Blunt trauma of the larynx and pneumomediastinum

Blunt injuries to the larynx can lead to problems involving aspiration, phonation, or respiration. Females tend to have slimmer, longer necks, predisposing them to a higher susceptibility to laryngeal injury, in particular supraglottic injury. Overall, males (77% vs 33%) tend to present with the highest percentage of traumatic laryngeal injuries, secondary to greater participation in violent sports and other activities. A predisposition to comminuted fractures in older persons is attributed to calcification. Minor lacerations, small hematomas, and nondisplaced single fractures may be managed with observation and serial examination. We report a 60-year-old woman with blunt anterior neck–laryngeal trauma (accidental fall and transverse hit on household utensil) presenting endolaryngeal hematomas and free air in the mediastinum, without evidence of laryngotracheal or pharyngoesophageal tear. Surprisingly, there was no bruise on inspection. She presented at the emergency room complaining of blunt anterior neck trauma, with various symptoms, including hoarseness, anterior neck pain, dysphagia, odynophagia, dyspnea, and hemoptysis. The

Highlights in the evolution of diagnosis and treatment of laryngeal cancer.

Objectives To present selected highlights from the evolution of diagnosis of laryngeal disease and treatment of laryngeal cancer from ancient Greece until the 20th century.

Professor Nicolas Taptas (1871–1955): A Pioneer of Post-Laryngectomy Voice Rehabilitation

Objective To report on the career of Professor Nicolas Taptas of Constantinople (1871–1955) and his contribution to the development of an artificial larynx.