George A. Gates

Effectiveness of adenoidectomy and tympanostomy tubes in the treatment of chronic otitis media with effusion

To study the effectiveness of adenoidectomy and of the placement of tympanostomy tubes in the treatment of chronic otitis media with effusion, we randomly assigned 578 children, aged four through eight years, to receive bilateral myringotomy and no additional treatment (Group 1), placement of tympanostomy tubes (Group 2), adenoidectomy (Group 3), or adenoidectomy and placement of tympanostomy tubes (Group 4). The 491 children who underwent one of these treatments were examined at six-week intervals for up to two years. The mean time spent with effusion of any type in either ear over the two-year follow-up in the four groups was 51, 36, 31, and 27 weeks, respectively (P less than 0.0001), comparing Group 1 with each of the other groups. Hearing was equivalent in Groups 2, 3, and 4, and was significantly better than in Group 1. The most frequent sequela, purulent otorrhea, occurred one or more times in 22, 29, 11, and 24 percent of the subjects in Groups 1, 2, 3, and 4, respectively (P less than 0.001). Adenoidectomy plus bilateral myringotomy lowered the overall post-treatment morbidity (as measured by hearing acuity in the most severely affected ear [P = 0.0174] and the number of surgical retreatments required [P = 0.009]) more than did tympanostomy tubes alone and to the same degree as did adenoidectomy and tympanostomy tubes. We conclude that adenoidectomy should be considered when surgical therapy is indicated in children four to eight years old who are severely affected by chronic otitis media with effusion.

Effect of adenoidectomy upon children with chronic otitis media with effusion

To investigate the mechanism whereby adenoidectomy influences the subsequent course of patients with chronic otitis media with effusion, we analyzed, on the basis of adenoid size, the outcomes of 476 children randomly assigned to receive, after paracentesis and aspiration of the middle ear, either no treatment, tympanostomy tubes, adenoidectomy, or both. The two groups receiving adenoidectomy did significantly better than those who did not, and the effect was independent of adenoid size. This suggests that reduction of the adenoidal bacterial reservoir may be the mechanism whereby adenoidectomy is effective.

Estrogen receptors in the temporomandibular joint of the baboon (Papio cynocephalus): An autoradiographic study☆

Using an autoradiographic method, the temporomandibular joint (TMJ) complex of five aged female baboons was studied for the presence of receptors for estradiol-17 beta. The study was performed in an effort to learn more of the pathophysiology of this joint and in an attempt to provide a scientific basis to explain the reported preponderance of women who seek and undergo treatment for signs and symptoms referable to the TMJ. This experiment revealed that the TMJ complex contains numerous cells with receptors for estrogen, particularly the articular surface of the condyle, articular disk, and capsule. Muscles of mastication contained relatively fewer receptors. As a result, one may postulate a role for the sex steroid hormones in the maintenance, repair, and/or pathogenesis of the TMJ. Additional studies are necessary to fully determine the significance of hormone receptors in this site and any correlation between diseases of the TMJ and the endocrine status of affected patients.

Post-tympanostomy otorrhea

Otorrhea is the most common complication of surgical drainage of the tympanum for the treatment of chronic secretory otitis media. Otorrhea present at the first postoperative visit may be due to the operative procedure, the underlying disease process, or both. After analyzing data from 525 operations on 1045 ears of 396 children with chronic secretory otitis media, and finding an over‐all incidence of immediate postoperative otorrhea of 3.4%, we conclude that preparation of the ear canal with povidone iodine and the postoperative prophylactic use of an antimicrobial‐corticosteroid topical preparation provides optimal control of postoperative wound infection. Sporadic increases in the incidence of postoperative otorrhea may be due to extrinsic factors such as outbreaks of upper respiratory infection.

Infectious diseases of the sphenoid sinus

Thirty‐one patients with sphenoid sinusitis were treated from 1978‐1982. Twenty patients had infections contiguous with other paranasal sinus disease. Five of these patients had fungal sinusitis. Eleven patients were seen with isolated sphenoid sinusitis; 3 were secondary to trauma and 8 were due to nontraumatic causes. Possible etiologies include upper respiratory infections, developmental abnormalities, and water forced into the nasal cavity during swimming. The immunocompromised patient is more likely to present with minimal symptoms with a fungal infection, and aggressive diagnostic and therapeutic measures should be undertaken. Because the symptoms of headache, nasal stuffiness, proptosis, ptosis and decreased visual acuity may be interpreted as an intracranial, neurological, or vascular problem, a misdiagnosis may be made. A high index of suspicion for sphenoiditis should be maintained. Therapy involves a combination of medical (antimicrobial agent) and surgical (sinus drainage and marsupialization) management.

Cartilage of the baboon contains estrogen receptors

SummaryCastrated-adrenalectomized aged female baboons were injected with 3H-estradiol-17 B (E2) and killed one hour later. Specimens from all regions of the larynx and oral cavity were taken and processed for autoradiography. A consistent and heavy uptake of 3H-E2 by the perichondrium and cartilage was found in all laryngeal sections with cartilage present and in the articular cartilage of the condyle of the mandible. These data provide evidence that cartilage contains receptors for estrogen. These data along with data already present in the literature suggest that circulating estrogen may act directly on cartilage to modulate collagen synthesis and further that the loss in circulating estrogen associated with menopause might in part explain the large sexual dimorphism associated with the incidence of osteoarthritis.

Malignant Neoplasms of the Minor Salivary Glands

THE minor salivary glands are simple tuboalveolar glands with predominantly mucus-secreting and occasionally serous fluid-secreting acini. They are located in the submucosa of the oral cavity, nose and paranasal sinuses, pharynx, larynx, and tracheobronchial tree. Their secretory products coat, lubricate, and protect the epithelium from which they emanate. In the respiratory tract, they contribute to the mucous blanket that traps and clears exogenous particulate matter and is in equilibrium with the inspired air for exchange of heat and water vapor. In the oral cavity, the minor salivary glands contribute the bulk of the saliva not secreted at mealtime, which moistens .xa0.xa0.

Cisplatin and 5-fluorouracil chemotherapy in advanced or recurrent squamous cell carcinoma of the head and neck

Fifty‐three patients with advanced or recurrent squamous cell carcinoma of the head and neck (SCCHN) were treated with bolus cisplatin (CDDP) and 96‐hour infusion of 5‐fluorouracil (5‐FU). Twenty‐six patients with advanced disease (21 T4 and/or N3) and no prior therapy (NPT) received 2 to 3 cycles of chemotherapy prior to surgery and/or radiation. There were four complete responses (CR) and 12 partial responses (PR) to chemotherapy for an overall response rate of 61%. In 20 patients with locally recurrent or disseminated disease there was one CR and six PR for an overall response rate of 35%. All but one responding patient in both groups showed clear evidence of tumor response after the initial cycle of chemotherapy. Two of the five complete responders required at least three courses to achieve CR. Disease‐free survival was poor: only five of 26 patients in the NPT group remain alive and free of disease 8 to 28 months from initial therapy. CDDP and 5‐FU is an active combination for SCCHN, but survival benefit remains to be proven.

Quantitation of pneumatic otoscopy.

Pneumatic otoscopy has long been espoused as an easily and rapidly used, inexpensive method for routine evaluation of the tympanic membrane and middle ear. This widely used technique, however, has not been explored in a quantitative manner. Therefore, we measured the differential pressure and frequency of the pressure pulse used by a group of experienced otoscopists during routine pneumatic otoscopic examination. We found the pressure pulse varied from 170 to 520 mm H2O and the frequency varied from 2.2 to 4.9 pulses per second. We used a pneumatic pump to deliver a controlled pressure pulse—at a frequency of 4.0/sec—to the pneumatic otoscope. This device was used to measure the minimum pressure pulse necessary for the experienced otoscopist to merely detect tympanic membrane movement in normal ears. The threshold for visible movement ranged from 10 to 15 mm H2O. Thus, even the most gentle otoscopist used a pressure pulse an order of magnitude higher than the threshold for detection of visible movement in normal ears. The gap between the pressure pulse at threshold for visual detection of movement and that which is routinely used offers the possibility of increased sensitivity and specificity for this commonly used diagnostic tool. Preliminary data are presented from this study in which the pressure pulses required for visual detection of tympanic membrane movement in diseased ears were determined.

The effect of low-dose β-blockade on performance anxiety in singers

Summary Thirteen singing students received placebo or 20 mg of nadolol prior to their end-of-semester jury performance. The performance was repeated 48 h later with the cross-over drug regimen. Subjects musical performances were evaluated by a panel of judges (comprised of the subjects voice faculty). No statistically significant difference could be detected in the overall quality of the performance whether students were taking drug or placebo. Although the small number of subjects in this study precludes a definitive conclusion, these data, together with previous information, lead us to suggest that β-blockers are not useful in coping with nervousness in singing students.