Francis B. Quinn

Obstructive supraglottic schwannoma: a case report and review of the literature.

Objective At the conclusion of the current presentation, the participants should be able to describe the etiology, presentation, histopathologic identification, and treatment options for schwannoma of the larynx.

Normal Nasal Airway Resistance in Noses of Different Sizes and Shapes

Measurement of nasal airway resistance is becoming a common clinical technique. Accurate definition of the normal range of airflow is critical for maximal usefulness of this technique. Since typical nasal size and shape vary greatly with ethnic background, different norms for different ethnic groups may be appropriate. Nasal airway flow and resistance and external nasal size and shape were measured in 130 asymptomatic subjects (52 black, 56 white, and 22 Hispanic). Nasal length, width, columellar length, and nasolabial angle were similar for whites and Hispanics, but both groups differed significantly from blacks—even when changes attributable to biologic aging were factored out. In spite of these differences, there was no significant difference in any nasal airflow or resistance parameter among groups, suggesting that currently used airflow and resistance standards are valid for these three different ethnic groups.

Stapedectomy techniques in residency training

The KTP‐532 laser has decreased the technical difficulty involved in teaching and performing a stapedectomy in our residency program. Use of this laser has resulted in improved hearing and a decreased number of major and minor complications compared to an equal number of large fenestra stapedectomies performed with hand‐held instruments. The major disadvantages of the KTP‐532 laser are its cost and limited availability, and the inconvenience of a micromanipulator. The laser should not be relied upon entirely in performing a stapedotomy on a thick footplate. The University of Texas Medical Branch experience in training residents in both large and small fenestra stapedectomy is reported.

Magnet extraction of frontal sinus foreign body.

We report a metallic foreign body that entered through the anterior table of the frontal sinus, and rolled down to lodge in the nasofrontal duct. An electromagnet was used to remove the foreign body through a trephination.

Tumoral calcinosis in the neck

Tumoral calcinosis manifests soft-tissue calcification, usually near major joints. It variably includes hyperphosphatemia, elevated 1,25-dihydroxycalciferol, and an affected sibling. Serum calcium, alkaline phosphatase, and parathyroid hormone are normal. Tumoral calcinosis of the head and neck is very rare, but this diagnosis should be considered when x-ray film of a poorly defined mass shows irregular soft-tissue calcification.

Cerebrospinal fluid rhinorrhea 41 years after injury

A 44-year-old woman reported a 3-month history of intermittent left-sided watery nasal discharge that usually occurred when she leaned forward. She felt Huid running down her throat at night. She had no nasal obstruction and had normal olfaction. At first she denied any history of head trauma, but later recalled being accidentally hit in the face with an ax at the age of 3. There was no history of meningitis. Physical examination was completely normal except for the left-sided watery nasal discharge. There was a fine horizontal scar in the glabellar area-a result of her ax injury. The nasal fluid had a glucose of 57 and a protein of 18, similar to CSF. Sinus x-ray films were normal, and metrizamide cisternogram clearly demonstrated a defect in the Hoor of the anterior cranial fossa, with leakage of metrizamide into the sphenoid sinus (Fig. I) . Operative treatment was elected in order to close this CSF leak. A sublabial transseptal approach was made to the sphenoid sinus. When the sinus was opened, a leak of clear Huid from the anterior roof of the sinus was immediately apparent. The sinus was obliterated with fascia lata, muscle, and fat. The patient’s postoperative course was uneventful. Now, more than 1 year postsurgery, there has been no recurrence of leak.

Dissemination of computer skills among physicians: the infectious process model.

While the potential utility of computer technology to medicine is often acknowledged, little is known as to the best methods to actually teach physicians about computers. The current variability in physician computer fluency implies there is no accepted minimum required level of computer skills for physicians. Special techniques are needed to instill these skills in the physician and measure their effects within the medical profession. This hypothesis is suggested following the development of a specialized course for the new physician. In a population of physicians where medical computing usage was considered nonexistent, intense interest developed the following exposure to a role model having strong credentials in both medicine and computer science. This produced an atmosphere where there was a perceived benefit in being knowledgeable about the medical computer usage. The subsequent increase in computer systems use was the result of the availability of resources and development of computer skills that could be exchanged among the students and faculty. This growth in computer use is described using the parameters of an infectious process model. While other approaches may also be useful, the infectious process model permits the growth of medical computer usage to be quantitatively described, evaluates specific determinants of use patterns, and allows the future growth of computer utilization in medicine to be predicted.

An information system for head and neck tumors: Optimal use of abstracting and retrieval resources

This report describes a symbiotic interaction between a hospital tumor registry and the physicians in a medical school department of otolaryngology. The tumor registry is responsible for collecting central registry data, entering both central registry and department-specific data, performing routine data maintenance functions, and tracking the patients over time. The departmental physicians collect site-specific data and, after entry into a computer-based data base management system, can access the information without intermediaries and at their convenience. The result is a comprehensive information resource for head and neck cancer. The development of a medical subspeciality information system, as a satellite to the central registry mechanism, is noteworthy in its low cost, frequent physican use, better patient tracking, improved patient care, and increased clinical relevance of registry activites. A subtle but pervasive benefit is the increased sense of mission experienced by all concerned.

Acute necrotizing otitis media

CONCLUSION The identification of multiple endocrine neoplasia in this patient presenting with a glomus tympanicum had important implications, both for the patient and for her family, in which the syndrome was previously unrecognized. Evaluation of the patient’s family led to the early diagnosis of a number of additional cases, including the patient’s two children. In addition to early surgical intervention, genetic counseling was implemented. It was particularly fortunate that the patient with undiagnosed pheochromocytomas tolerated the angiogram without a hypertensive crisis. Farrior” pointed out the advisability of assaying urinary catecholamines in the evaluation of glomus tumors to avoid complications from occasional endocrine-active lesions. A possible relationship with multiple endocrine neoplasia in some cases provides another reason to consider this in the routine preoperative evaluation. In summary, this article presents a case of glomus tympanicum tumor occurring with multiple endocrine neoplasia Type 11. The simultaneous occurrence argues for a careful family history and thyroid examination and for routine urinary catecholamine estimations in patients with paragangliomas of the head and neck area.

Tumor responsiveness of squamous cell carcinoma to cisplatin

The addition of chemotherapy to planned multiple modality treatment of patients with advanced head and neck squamous cell carcinomas may improve survival rates, but individual tumor response is unpredictable. An assay for determining tumor responsiveness to specific chemotherapeutic agents would facilitate treatment selection.