Nelu Laurian

Use of human amniotic membrane in otolaryngologic practice

Human amnion is a readily available allograft with low antigenicity, high antimicrobial potential, and the ability to foster cpithelialization. We have used human amniotic membrane in our department for replacing nasal mucosa in Rendu‐Osler‐Weber disease, as tympanic membrane grafts, and for covering head and neck sites after flap necrosis. Our experience shows moderate success for management of severe epistaxis and excellent results in covering surfaces after flap necrosis.

Reduction of Salivary Flow with Scopoderm Tts

Scopoderm transdermal therapeutic system (TTS) is a form of application permitting programmed release of scopolamine through the skin into the bloodstream. Scopoderm TTS is indicated for prevention of nausea and vomiting associated with motion sickness. The most common side effect associated with its use is dryness of the mouth. We have been using Scopoderm TTS for reducing salivary flow in patients with sialorrhea or with difficulties in swallowing normal amounts of salivary secretions. Good results were achieved with minimal discomfort from adverse effects. We recommend the use of Scopoderm TTS in selected cases of sialorrhea and drooling, preoperatively and postoperatively in patients undergoing surgery of oral, laryngeal, and pharyngeal lesions.

Epiglotto-Aryepiglottopexy: A surgical procedure for severe aspiration†‡

The loss of the protective function of the larynx is a severe complication of major ablative procedures in the upper aerodigestive tract and of certain severe neurological disorders. This may result in chronic life‐threatening aspiration. Anterior pharyngotomy was used to perform epiglotto‐aryepiglottopexy in four patients. The aim of this procedure is to close the laryngeal inlet and thus prevent aspiration without permanent loss of speech. In two of the patients, it was necessary to reoperate because of partial detachment of the epiglottis. This was performed successfully using the endoscopic approach. As a result, three patients have no aspiration and one has mild aspiration following epiglotto‐aryepiglottopexy.

Delayed brainstem auditory evoked responses in diabetic patients.

The incidence of subclinical central diabetic neuropathy is unclear due to difficulty in detecting latent alterations of central neural transmission process. The aim of this study was to evaluate a central neuroconductive mechanism in diabetics by brainstem auditory evoked responses (BAER). We found increased latencies of peaks I, III, V in diabetics as compared to control subjects. These BAER abnormalities were demonstrated in 62 per cent of insulin-controlled diabetics and in 33 per cent o patients treated by diet, or peroral drugs. No alterations in brainstem responses were observed in patients with latent diabetes. We did not find any correlation between the BAER abnormalities and the duration of the disease, the blood glucose level or the level of control of the diabetes.

Delayed brainstem auditory evoked reponses in experimental diabetes mellitus

The brainstem auditory evoked responses (BAER) were utilized for the evaluation of central neural transmission in alloxan-induced diabetes in rats. The mean latencies of waves I, III, V and the interpeak latencies III-V and I-V were prolonged in diabetic rats as compared to the same rats before alloxan administration. The incidence of abnormal BAER was more frequent in the group of rats with severe diabetes (82 per cent) than in mildly diabetic animals (42 per cent). Our results may suggest the presence of a central neuropathy in experimental diabetes, which can be detected by the method of BAER.

Can Uvulopalatopharyngoplasty Be Harmful to Eustachian Tube Function

A study of the Eustachian tube, incorporating nasendoscopy, tympanometry and pressure swallow test was undertaken in patients undergoing uvulopalatopharyngoplasty. Marked negative middle ear pressure indicating impairment of tubal function was found during the first 7 postoperative days. In patients receiving antibiotic treatment the Eustachian tube dysfunction was significantly alleviated. This dysfunction is probably due to a postoperative infective inflammatory process in the tonsillar fossa. Antibiotic treatment is recommended for patients undergoing uvulopalatopharyngoplasty, to improve the postoperative course. Patients with middle ear abnormalities and following middle ear surgery could be high-risk candidates for this operation and should be carefully evaluated.

Conservative surgical management of invasive differentiated thyroid cancer

The majority of well differentiated thyroid carcinoma are tumours of low grade malignancy. Laryngotracheal invasion by well differentiated thyroid carcinoma is an uncommon occurrence. The surgical management of patients with thyroid cancer invading the upper airway has primarily been by total laryngectomy. Other surgeons recommend in selected cases partial laryngeal and/or tracheal resection. A total of 122 patients with thyroid carcinoma were treated in our department between 1967 and 1982. Only seven patients with well differentiated tumours had airway invasion. In these seven patients we used a partial laryngeal and/or tracheal resection. In three of the patients with tracheal invasion a myoperichondrial flap was used for closing the tracheal defect. A partial resection of the larynx and trachea, and end to end anastomosis between the trachea and the remaining part of the larynx was performed in another four patients. The techniques used and a long-term follow-up are presented (Table I).

Study of Toynbee phenomenon by combined intranasopharyngeal and tympanometric measurements.

The Toynbee maneuver, swallowing when the nose is obstructed, leads in most cases to pressure changes in one or both middle ears, resulting in a sensation of fullness. Since first described, many varying and contradictory comments have been reported in the literature concerning the type and amount of pressure changes both in the nasopharynx and in the middle ear. In our study, the pressure changes were determined by catheters placed into the nasopharynx and repeated tympanometric measurements. New information concerning the rapid pressure variations in the nasopharynx and middle ear during deglutition with an obstructed nose was obtained. Typical individual nasopharyngeal pressure change patterns were recorded, ranging from a maximal positive pressure of + 450 to a negative pressure as low as −320 mm H2O.

Eliminating the Toynbee Phenomenon in Patients with Nasal Packs

Nasal packing is a common procedure in otolaryngology, but is not a completely innocuous procedure. Besides aggravating mouth breathing, complete nasal obstruction results in an annoying Toynbee phenomenon. In patients with bilateral anterior nasal packing, we recorded high pressure gradients in the nasopharynx and, in consequence, in the middle ear. Patients in whom rubber tubes were inserted between the gauze layers of the anterior nasal packs suffered no such inconvenience and showed no such gradients. Our work proves the value of using these tubes for pressure equalization when nasal packs are necessary.