Michael H. Stevens

Acquired and congenital subglottic stenosis in the infant.

During the calendar year of 1974, the Intermountain Newborn Intensive Care Center at the University of Utah Medical Center had 603 admissions. A representative group of 293 charts were reviewed which indicated that 44% of these children were intubated from hours to weeks. The overall mortality rate for the 293 children was 29%. Eighteen of the 603 children were diagnosed as having subglottic stenosis. Fifteen of these children appeared to have acquired subglottic stenosis secondary to endotracheal intubation. Three children had congenital subglottic stenosis. Tracheostomy was necessary in the management of 15 patients. Ten of the 18 patients have survived and two of these patients still have tracheostomy tubes in place. The survival and thickness of the stenotic area are inversely proportional to the birth weight and the duration of intubation. Endoscopic excision, dilatation and stenting were techniques utilized in the treatment of these stenotic lesions. The extubation technique utilized is described. The factors involved in the production of acquired subglottic stenosis are presented along with suggestions to decrease the incidence of this problem in the intubated child.

Steroid-dependent anosmia.

Objective To document the response to steroids in patients remaining anosmic following endoscopic nasal and sinus polypectomy.

Selective management of early glottic cancer.

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.

Quantitative effects of nasal surgery on olfaction

A prospective study of 100 patients undergoing nasal surgery was done to quantitate the effects of nasal surgery on olfaction. Patients were evaluated pre- and postoperatively with regard to their subjective olfaction, and pre- and postoperative olfactograms were obtained using a simple office olfactometer. Thirty-two patients had normal olfaction during the course of study. Forty-nine improved following surgery. Eight patients had a decrease in olfaction after surgery. Two of these were related to allergic rhinitis. One patient had a total loss of olfaction following a septorhinoplasty. The authors conclude that most patients undergoing nasal surgery will have either an improvement or no change in olfaction after surgery.

Primary fungal infections of the paranasal sinuses

There has been an increase in the number of primary and secondary fungal infections of the paranasal sinuses in recent years. Aspergillosis and mucormycosis are the most common fungal infections involving the paranasal sinuses. In the past, fungal infections usually occurred in patients with uncontrolled metabolic diseases or compromised defense mechanisms as an acute, rapidly progressing process, often leading to the patients demise. Primary fungal infections may also be aggressive in otherwise healthy individuals. Physicians should be aware of these microorganisms in order to establish an early diagnosis by biopsy and to institute prompt surgical debridement and medical therapy.

Pain reduction by fibrin sealant in older children and adult tonsillectomy.

Objectives: Because tonsillectomy is a painful procedure in adults, this study was performed to see whether the addition of fibrin sealant (Tisseel) to the tonsillar fossa at the completion of tonsillectomy would reduce pain in adults and allow them to return to work sooner.

Absorbable gelatin film verses silicone rubber sheeting in orbital fracture treatment

Orbital floor fractures can result in herniation of orbital tissues and impairment of ocular function. In this experimental study, orbital defects were created surgically in cats. The gross and histologic healing of these defects was compared among animals implanted with silicone rubber sheeting or absorbable gelatin film and animals that received no implants. Both implanted animal groups demonstrated enhancement of healing. The absorbable gelatin film showed less migration, less inflammatory response, and improved healing. This animal study supports the use of absorbable gelatin film in the surgical management of orbital fractures.

Synergistic effect of alcohol on epidermoid carcinogenesis in the larynx.

Forty hamsters received weekly installations of benzopyrene into the larynx. Twenty of these also had 10% alcohol as their total liquid intake. Carcinoma of the larynx was seen in seven alcoholic vs two nonalcoholic hamsters, supporting the evidence in humans that alcohol is a factor in epidermoid carcinogenesis of the larynx.

Lead and the deafness of Ludwig van Beethoven

To reexamine the cause of Beethovens hearing loss because of significant recent articles.

Transnasal pituitary tumor surgery

Adequate exposure to the sphenoid sinus and pituitary can be obtained through the transnasal incision route. Complete tumor removal has been accomplished even with large tumors that extended not only intracranially, but also into the sphenoid sinus. This approach has been used in 25 patients