Marc S. Karlan

Myringotomy Tube Materials: Bacterial Adhesion and Infection

Postoperative infection after placement of myringotomy tubes is common. Surgeons and manufacturers of surgical devices have frequently substituted one material for another in middle ear prostheses without analyzing the interaction of material and infection. Implant material attributes are reviewed. Scanning electron micrographs are presented that demonstrate characteristic surface differences between materials and between the same material of different manufacturers. A preliminary clinical controlled study of the covariance of purulence with silicone vs fluorocarbon tubes demonstrates statistically significant differences. The implications of this information are discussed.

Comparison of Tracheal Damage from Laser-Ignited Endotracheal Tube Fires

Studies were undertaken by the Departments of Otolaryngology-Head and Neck Surgery and Anesthesiology at Northwestern University Medical School and the Medical College of Wisconsin (Milwaukee) to compare the potential for tissue injury to the trachea and lungs of canines. Polyvinylchloride (PVC), Rusch red rubber, and silicone tubes were tested. The effects of an intraluminal tube fire on the larynx and trachea were documented with laryngeal and bronchoscopic photographs taken immediately postburn and at the time of sacrifice six hours later. The most severe burns were associated with the PVC tube. Silica ash was seen in the airway after the silicone tube fires and raises the possibility of future problems with silicosis. Histological examination of the trachea showed acute injury in all of the animals; specimens from the dogs with the PVC tube fires demonstrated the most severe cellular damage.

Potentiation of infections by biomaterials: a comparison of three materials.

Biomaterial implants frequently potentiate infections in patients, yet rarely have we considered the interactions between bacteria and biomaterials responsible for this. There is extensive literature concerning suture materials of various types and a few studies comparing porous and solid implants. We have developed a simple, relatively atraumatic model for comparing rates of infection surrounding a biomaterial implant in paired single animal observations. Statistically significant differences between silicone and fluorocarbon implants and between silicone and bioglass implants are demonstrated. The relatively greater rate of infection with silicones is consistent with a previous clinical study. The further use of this model for evaluation of material-surface interfacial effects is proposed.

Posterior Commissure Laryngoscope for Carbon Dioxide Laser Surgery

A laryngoscope has been developed for microlaryngeal laser surgery in the posterior commissure of the larynx. The tip has been designed to facilitate exposure of one entire arytenoid and the posterior commissure. Other features include a concavity on the superior lip of the tip to hold the endotracheal tube anteriorly, a bifurcated smoke evacuation channel and a nonreflective finish. It is anticipated that this laryngoscope will be available in pediatric and adolescent sizes in addition to the adult size that we have worked with.

BIOSTEREOMETRIC ANALYSIS IN PLASTIC AND RECONSTRUCTIVE SURGERY A One-Step, On-Line Technique

Biostereometry is the measurement of living things (especially the human body) in 3 dimensions. Moire topography provides a simple, one-step method for mapping contours of the face, or other parts of the body--a method which has potential value for the plastic surgeon. A prospective study of the value and the uses of this method is now under way at our institution.

Universal endoscopic coupler for bronchoscopic CO2 laser surgery: a multi-institutional clinical trial.

REFERENCES 1. Panje WR, VanDemark 0, McCabe BF: Voice button prosthesis rehabilitation of the laryngectomee. Ann Otol Rhinol Laryngol 90:503-505, 1981. 2. Singer MI, Blom ED, Hamaker RC: Further experience with voice restoration after total laryngectomy . Ann Otol Rhinol Laryngol 90:498-502, 1981. 3. Donegan JO, Gluckman JL, Singh J: Limitations of the BlornSinger technique for voice restoration . Ann Otol Rhinol Laryngol 90:495-497 , 1981. 4. Singer MI, Blom ED: An endoscop ic technique for restoration of voice after laryngectomy. Ann Otol Rhinol LaryngoI89:528-533 , 1980. 5. Panje WR: Prosthetic vocal rehabilitat ion following laryngectomy : The voice button. Ann Otol Rhinol Laryngol 90:116-120, 1981. 6. Panje WR: Surgical-prosthetic restoration of voice following laryngectomy. New Horizons Otolaryngol Head Neck Surg 1:1-9, 1983. 7. Singer MI, Blom ED: Selective myotomy for voice restoration after total laryngectomy. Arch Otolaryngol 107:670-673 , 1981.

Gelatin film sandwich in tympanoplasty.

A technique is presented that utilizes two sheets of gelatin film as a sandwich to provide a scaffold for medial support and lateral cover to fascia grafts while permitting visual inspection of both fascia and tympanic membrane.

Anterior Cervical Pain Syndromes

The paucity of clinical findings in patients with glossopharyngeal neuralgia, superior laryngeal neuralgia, styloid process syndrome, hyoid syndrome, or carotidynia presents an enigma to the patient and the physician. Manifest symptoms appear extraneous or incongruous unless the essential element is identified. Common to all these syndromes is the radiation of pain over the neck and face, starting from the anterior cervical area of the neck. Case histories of seven patients are presented. The rationale of underlying pathophysiologic mechanisms is discussed and supported by relevant recent basic pain research, and conceptual speculations are presented.

Moiré photography as a means of topographical mapping of the human face.

Moiré photography provides a method for quantitative determination of the contours of the human body which requires minimal patient discomfort and provides results without computer or optical processing associated with other methods. The construction and operation of a Moiré apparatus is described and its application for the evaluation of the contours of the human face illustrated.

Complications of sinusitis: what to watch for.

Sinus infection remains a common cause of orbital inflammatory disease, and prompt diagnosis is essential. A team approach early in the course of the disease, with an otolaryngologist serving as coordinator, is recommended. If vigorous medical therapy fails, abscess formation should be suspected and surgical drainage instituted without delay. Of 24 patients hospitalized with complications of sinusitis, 13 were found to have acute inflammatory disease and 11 had mucocele formation. Mortality in patients with acute inflammatory was 30%; in those with intracranial extension of infection it was 67%.