Leland P. Johnson

Intractable Epistaxis: Transantral Ligation vs. Embolization: Efficacy Review and Cost Analysis

After posterior nasal packing, the two most common therapies for intractable epistaxis are transantral ligation of the internal maxillary artery and percutaneous embolization of the distal internal maxillary artery. However, optimal management of intractable posterior epistaxis remains controversial. We retrospectively reviewed the charts of 21 patients treated for intractable epistaxis and obtained data on presentation, risk factors, treatment, success rates, complications, and cost. Twelve patients received percutaneous embolization, five underwent transantral ligation, and four required both. The success rates for transantral ligation and percutaneous embolization were 89% and 94%, respectively. No mortality or serious morbidity occurred with either technique. A cost comparison revealed that transantral ligation was moderately less expensive than percutaneous embolization (

Intraoral ultrasound evaluation of peritonsillar abscess

5941 vs.

Selective management of early glottic cancer.

6783). Although some authors advocate transantral ligation or percutaneous embolization as the procedure of choice for intractable epistaxis, a direct comparison of efficacy and cost reveals that they are comparable procedures with specific strengths and weaknesses. We present our experience and a review of the literature, highlighting the indications and advantages of each technique. We conclude that the choice of treatment modality should be based on the benefits of each procedure as it pertains to the specific needs of the individual patient.

Transtympanic eustachian tuboplasty and tolerance of stenting materials.

Peritonsillar cellulitis and peritonsillar abscess are similar clinical entities with markedly different methods of treatment. Therefore, accurate diagnosis is paramount to appropriate treatment.

A review of the use of Avitene in otolaryngologic surgery.

Seventy patients with stage I and II glottic cancer were treated at the University of Utah School of Medicine hospitals from 1980 through 1987. Forty‐four patients had stage I cancer and 26 patients had stage II. The overall survival in the stage I group was 82%. Primary site control was 93% with only three deaths due to laryngeal cancer. Local control rates were 93% with CO2 laser excision, 80% with CO2 laser and irradiation, and 67% with radiation alone.

The effects of nasal closure on quality of life in patients with hereditary hemorrhagic telangiectasia: QOL Following Nasal Closure in HHT Patients

The purpose of this study was to evaluate various eustachian tube stenting materials in an attempt to develop a successful transtympanic eustachian tuboplasty technique. Eustachian tube mucosa was removed transtympanically in 40 feline ears. Ten ears were used as controls. Polyethylene, Silastic, and polyurethane stents were placed in 30 ears, 10 ears with each material. The ears were evaluated after a minimum of 8 weeks and the stents were removed. Eight weeks after stent removal the ears were assessed visually, tympanometrically, and by biopsies of the osseous eustachian tube mucosa. Inadequate middle ear ventilation as evidenced by persistent otitis media, persistent tympanic membrane perforations, or type B or type C tympanograms was found in 60% of control, 30% of Silastic-stented, 60% of polyurethane-stented, and 0% of polyethylene-stented ears. Small polyethylene stents were most successful in reestablishing eustachian tube function in this experiment.

Computed Tomography of Cervical Lymph Nodes: Staging and Management of Head and Neck Cancer

Chairmans Comments: Control of hemorrhage is a problem familiar to all otolaryngologists, whether the bleeding occurs post-tonsillectomy, from spontaneous epistaxis, or from major head and neck surgery. Operating room aids in obtaining hemostasis include pressure, hot packs (to accelerate the coagulation process), ligatures, hot cautery, electrocoagulation, and a variety of pharmaceutical products. This latter group is reviewed by Leland P. Johnson, MD, from the Division of Otolaryngology at the University of Utah, particularly microfibrillar collagen hemostat (Avitene). Dr Johnson brings the uses and abuses of this expensive but often invaluable material into sharp focus. This information is prepared under the sponsorship of the Committee on Drugs—Otolaryngology of the American Academy of Otolaryngology. George A. Gates, MD

Head and Neck Cancer Survival and Life-style Change

Epistaxis is the most common symptom of hereditary hemorrhagic telangiectasia (HHT). Complete nasal closure is one of the treatment options for patients with severe, intractable epistaxis. In our experience, this surgery can be life changing in a positive sense; but many patients as well as their physicians understandably fear that such a procedure will diminish certain aspects of quality of life (QOL).