Gary F. Moore

Extended follow‐up of total inferior turbinate resection for relief of chronic nasal obstruction

Total inferior turbinectomy has been proposed as a treatment for chronic nasal airway obstruction refractory to other, more conservative, methods of treatment. Traditionally, it has been criticized because of its adverse effects on nasophysiology. In this study, patients who had previously undergone total inferior turbinectomy were evaluated with the use of an extensive questionnaire. It confirms that total inferior turbinectomy carries significant morbidity and should be condemned.

Transient salivary gland hypertrophy in bulimics

Transient salivary gland hypertrophy is a reported clinical finding in patients with bulimia.1, 2 A retrospective chart review of 49 patients enrolled in the University of Nebraska Medical Center Eating Disorders Program with a diagnosis of bulimia showed 29% (14/49) had at some time either parotid and/or submandibular gland hypertrophy noted on physical exam. Resolution of the salivary gland enlargement occurred in all of our patients after treatment of their bulimia. Bulimia must, therefore, be considered in the differential diagnosis of salivary gland hypertrophy, and treatment should be directed at the underlying behavioral disorder.

Lightning and its effects on the auditory system

Patients struck by lightning can present with a wide variety of unusual otologic problems including burns to the external auditory canal, tympanic membrane rupture, middle ear injury, and sensorineural hearing loss.

Jugular foramen peripheral nerve sheath tumors

Though jugular foramen nerve sheath tumors are uncommon, they involve a critical area of the skull base. Therefore, a precise classification system is needed to accurately define the extent of these tumors and reflect their surgical management. A series of seven cases is reviewed incorporating such a classification system to illustrate the management of these lesions using the in‐fratemporal fossa type A approach.

The use of full-thickness skin grafts for the skin-abutment interface around bone-anchored hearing aids.

Objective To review the complication rate encountered with the use of full-thickness skin grafts to establish the skin-abutment interface around bone-anchored hearing aid implants. Study Design Retrospective chart review. Setting Tertiary referral center. Patients Fifteen patients who underwent bone-anchored hearing aid placement over a 4-year period. Intervention Each percutaneous titanium implant and abutment was placed into the temporal bone following the standard Branemark technique. Eight procedures were performed in two stages, and seven were performed as single-stage procedures. In all cases, the skin-abutment interface was established by use of a full-thickness skin graft inset around the implant. Main Outcome Measures The incidence of complications resulting in skin graft loss, time from implantation to bone-anchored hearing aid use, additional procedures for revision of the interface, and complicating medical factors in the patient population. Results Seven patients (46.7%) experienced loss of the full-thickness skin graft around the abutment. Four of these seven had complicating medical factors associated with impaired wound healing: two with diabetes mellitus, one of whom was also a smoker, and two patients who were receiving inhaled steroids for treatment of asthma. Of the seven patients who lost skin grafts, two healed by secondary intention, two underwent repeated full-thickness skin grafting, and three underwent galeal rotation flaps with split-thickness skin grafting, one of which eventually required a scalp flap. No patient experienced loss of the implant. Conclusion The use of full-thickness skin grafts for establishment of the skin-abutment interface around bone-anchored hearing aid implants is associated with a high rate of graft loss. Although salvage techniques can successfully establish the interface after skin graft failure, alternative methods should be considered, especially in high-risk patients.

Early Versus Late Gold Weight Implantation for Rehabilitation of the Paralyzed Eyelid

Objectives/Hypothesis The purpose of this study is to evaluate the outcomes and complications associated with early gold weight implantation for management of the paralyzed eyelid.

Revision Tympanoplasty Utilizing Fossa Triangularis Cartilage

Objectives/Hypothesis A small percentage of fascia graft tympanoplasties fail. Cartilage tympanoplasty has a reputation for excellent graft healing but potentially sacrifices maximum hearing improvement and creates difficulty in postoperative follow‐up resulting from opacity and immobility. We sought to use a tissue thicker than fascia but thinner than tragal cartilage to repair tympanic membranes that had failed previous fascia grafting. Our hypothesis was that use of the thinner cartilage would maintain the excellent healing rate and resistance to chronic negative pressure while improving hearing and mobility.

“How i do it” – Otology and neurotology: A specific issue and its solution: Use of full thickness skin grafts in canalplasty

Split thickness skin grafts have uniformly been used in the past as the tissue of choice to line the external auditory canal during canalplasty. The success rate of STSG has been reported to be approximately 95%. From our experience with institutionalized patients and their special problems, we have observed that STSG appears to have a greater degree of postoperative contracture, exposing epithelialized bone which has less resistance to trauma than the normal tissue of the EAC. With this in mind, a full thickness skin graft was utilized to line the EAC in conjunction with canalplasty. The use of FTSG in the institutionalized mentally retarded patient has shown no evidence of restenosis or recurrent infection, and we feel it is the treatment of choice in this type of patient and should be considered in the occasional patient who fails a split thickness skin graft canalplasty. Longer term follow-up is required to determine whether FTSG should supplant STSG as the tissue of choice in canalplasty.

Systemic side effects of transtympanic steroids

OBJECTIVE Review largest series of patients treated with transtympanic steroids, including outcomes, steroid dosing and adverse outcomes. Review first reported cases of systemic side effects from transtympanic steroids. METHODS A retrospective case series of 166 patients who underwent placement of transtympanic Silverstein tube with microwick for steroid administration was reviewed. RESULTS 5/166 patients developed systemic side effects, 9/166 patients developed local side effects. 48/166 (29%) of patients had a persistent perforation after therapy. The percent of patients with improvement as a function of symptoms: hearing loss 42%, tinnitus 56%, vertigo 68%, aural fullness 25% and dysequilibrium 66%. CONCLUSIONS While our study revealed a significant risk of persistent tympanic membrane perforation, the incidence of systemic and local side effects from transtympanic steroid administration is low.

Salvage of an infected hydroxyapatite cement cranioplasty with preservation of the implant material.

Preformed hydroxyapatite (HA) implants can be used for reconstruction of cranial and maxillofacial defects. Traditionally, infected alloplastic implants must be removed. The unique chemical composition of preferred HA, as well as the small pore size and lack of a fibrous reaction, confers relative resistance to infection. However, these implants require extensive planning and prefabrication. On the other hand, HA cement mixed with water forms a microporous implant that can be readily and quickly contoured during surgery. In addition, HA cement can be better contoured to fit the defect without any surrounding dead space. Theoretically, this should further the resistance to infection. After careful review of the literature, we report the first case of salvage of an infected HA cement cranioplasty with preservation of the implant material.