Raymond L. Hilsinger

Ramsay Hunt Facial Paralysis: Clinical Analyses of 185 Patients:

In a prospective study of 1507 patients, evaluated consecutively for facial palsy in the Cranial Nerve Research Clinic at the Kalser Permanente Medical Center, Oakland, California, between 1966 and 1976, 185 cases (12%) were diagnosed as Ramsay Hunt syndrome. In 46 cases (25%), the diagnosis of herpes zoster was confirmed by acute and convalescent serum titers for varicella-zoster virus. In 139 cases (75%), viral titers were not performed and the diagnosis was based on the characteristic clinical presentation of the Ramsay Hunt syndrome. The data were subjected to multivariate analysis evaluating age, sex, race, signs and symptoms at onset, severity of paralysis, associated medical problems with concomitant neurologic deficits, and response to therapy. These were compared with data of 1202 patients with Bells (herpes simplex) palsy. The facial palsy of Ramsay Hunt syndrome was found to be more severe, to cause late neural denervation, and to have a less favorable recovery profile than Bells (herpes simplex) facial palsy. Prognostic factors and treatment recommendations are discussed.

Idiopathic facial paralysis, pregnancy, and the menstrual cycle.

The records of 42 women with Bells palsy during pregnancy, and of 91 nonpregnant women, whose dates of onset of Bells palsy and of the preceding menstrual cycle were precisely known, were studied for factors that might show relation between pregnancy or the menstrual cycle and Bells palsy. Of the 42 cases in pregnancy, 31 occurred in the third trimester, five in the first two weeks postpartum, and six in the first two trimesters combined. Our calculated frequency of Bells palsy in pregnant women is 45.1/100,000 births; for nonpregnant women of the same age group the calculated incidence is 17.4/100,000 per year. No causative relation was found between toxemia, hypertension or primigravidity, and Bells palsy. Over 60% of the cases in nonpregnant women occurred in the first 14 days of the menstrual cycle with peaks on the first and seventh days and near ovulation. No clear evidence for an etiologic relationship was seen with edema or hormonal changes in either pregnancy or the menstrual cycle. A number of factors in pregnancy and the menstrual cycle suggested an etiologic role for herpes simplex virus reactivation in Bells palsy. There was no evidence that prednisone treatment is contraindicated during pregnancy.

A comparison of masticatory function in patients with or without reconstruction of the mandible

The functional benefits of mandibular reconstruction following a composite resection remain unclear. Although microvascular surgical techniques have dramatically increased the predictability of bone and soft‐tissue reconstruction towards presurgical anatomic norms, the specific factors responsible for improved function remain controversial. Objective measures of masticatory function need to be more clearly determined before the predictability and efficacy of reconstructive approaches is established.

Relation of lymph‐node metastasis to histopathologic appearance in oral cavity and oropharyngeal carcinoma: A case series and literature review

A number of histopathologic parameters in squamous cell carcinoma of the oral cavity and oropharynx have been identified as having a statistically significant correlation with regional lymph‐node metastasis. These parameters have been inconsistent and not readily reproducible.

Recurrent bell's palsy: Analysis of 140 patients

Of 1,700 patients with facial paralysis seen in a retrospective study from 1969 through 1977 and 280 patients seen prospectively from 1983 through 1986, 7.1% had recurrence of Bells palsy. In this group, the frequency of ipsilateral recurrence was equal to that for contralateral recurrence. The mean age at onset of Bells palsy was 33.0 years; Bells palsy recurred a mean of 9.8 years later. Recurrent facial paralysis did not indicate a worse prognosis for recovery regardless of which side was affected. There was no statistical difference between results for male patients or female patients, nor was there a statistically significant sex predominance, except in the age group 10 to 19 years. In our results, computed tomography (CT) scan in patients with recurrent Bells palsy detected no facial‐nerve neuroma. Of 77 patients followed a mean of 33 years after the first episode (range, 2.8 to 60 years), none showed progressive facial‐nerve dysfunction or any signs of tumor. We conclude that an ipsilateral recurrence of facial paralysis without documented evidence of a tumor does not warrant a transmastoid decompression of the facial nerve. The results of our analysis were verified prospectively as well as retrospectively. A new classification system is introduced for ease of computer analysis and for simplified discussion of recurrent facial paralysis.

Radiographic comparison of three methods for nasal saline irrigation.

Objective To compare intranasal distribution of saline solution delivered by three popular methods for nasal saline irrigation.

Thyroglossal duct carcinoma: a large case series.

Thyroglossal duct cysts (TDCs) are common congenital abnormalities of thyroid development. Carcinoma occurs rarely in patients with TDCs. In a large case series drawn from medical records at a health maintenance organization from 1971 through 1995, 14 cases of carcinoma in a TDC were found. This represents the largest known reported case series to date. Demographics, diagnosis, and treatment methods are reviewed. We recommend the Sistrunk operation and evaluation of the thyroid gland and neck for potential abnormality that would necessitate thyroidectomy and lymph node dissection. Long-term follow-up incorporating clinical examination is mandatory.

Computer-Generated Three-Dimensional Reconstruction of the Cochlea

Computer-generated three-dimensional reconstructions of the nerve fibers from the organ of Corti to the spiral ganglion were used to determine the optimum maximal length of the cochlear implant electrode. The spiral ganglion within the modiolus is much shorter than the organ of Corti. The spiral ganglion has turns and reaches no higher than the middle of the second turn of the organ of Corti, which has turns. The spiral ganglion is concentric and basal with respect to the organ of Corti. The spiral ganglion dendrites within the osseous spiral lamina of the basal turn project radially, nearly perpendicular to the central axis of the modiolus. Upon entering the modiolus, they turn basally at an angle of approximately 120 degrees. The projection of dendrites within the osseous spiral lamina became increasingly oblique as the ganglion extended apically. The organization of the cochlear nerve results from the spiraling of the ganglion. These findings are in agreement with previous reports. Implications of these findings and their possible relevance to the optimum length of the cochlear implant electrode are discussed with reference to cochlear damage resulting from longer electrodes.

Acute Superior Laryngeal Nerve Palsy: Analysis of 78 Cases

Acute superior laryngeal palsy is often clinically unrecognized and frequently overlooked. Yet, this motor paralysis occurs more frequently than facial paralysis. Like acute facial paralysis, superior laryngeal palsy often occurs as part of a cranial polyneuritis that is probably related to herpes simplex virus reactivation. Rotation of the larynx and shortening of one vocal cord have been found in such diverse syndromes as vestibular neuronitis, migraine and tension headaches, unexplained cough, tinnitus aurium, globus hystericus, and carotidynia. Electromyographic studies suggest that laryngeal spasm may be caused by faulty regeneration of the superior, rather than the recurrent, laryngeal nerve.

Efficacy of tonsillectomy for recurrent throat infection in adults

Objective/Hypothesis: Sore throats result in health care visits, use of oral antibiotics, and days off work or school for many patients who do not meet American Academy of Otolaryngology—Head and Neck Surgery (AAO‐HNS) guidelines for tonsillectomy. We sought to determine whether tonsillectomy would benefit this group. Study Design: Retrospective analysis of the medical records of all patients aged 16 years or older who had tonsillectomy at our institution between 1988 and 1993. Methods: Number of clinic visits, number of throat cultures positive for streptococci, and number of prescriptions for oral antibiotics recorded for 147 patients during the 2‐year periods before and after tonsillectomy were tabulated. Statistical comparisons were made using the Students t test. Mean number of clinic visits and oral antibiotics prescribed for throat infection before tonsillectomy were significantly higher than after tonsillectomy. Results: Patients who had throat cultures positive for streptococci had more preoperative clinic visits and use of oral antibiotics than patients whose throat cultures were not positive for streptococci. When surveyed by telephone, most (>87%) of the respondents reported that they had fewer and less severe sore throats, required fewer days off work or school, and would recommend the procedure. Conclusions: Our results suggest that early tonsillectomy in patients with recurrent throat infection may result in improved patient satisfaction, better health, and improved utilization of medical resources.