Ronald G. Amedee

Fine-needle aspiration biopsy

Objectives: Fine‐needle aspiration biopsy (FNAB) is a technique in which a fine needle is introduced into a mass, cellular material is aspirated, and a cytological diagnosis is rendered. It separates reactive and inflammatory processes that do not require surgical intervention from neoplasia and benign from malignant tumors. FNAB lends itself to the diagnosis of palpable head and neck masses, in particular, those that persist following antibiotic treatment.

Nasal provocation testing as an international standard for evaluation of allergic and nonallergic rhinitis

Standardized nasal provocation testing (NPT) has been shown to be a safe and very useful tool in the diagnosis of allergic and nonallergic rhinitis. However, in the United States, its use has been mostly limited to scientific investigations, and it has not yet been widely accepted as a standard diagnostic procedure in clinical practice. NPT aims to identify and quantify the clinical relevance of inhalant allergens or occupational irritants. During NPT, nasal respiratory mucosa is exposed to an airborne substance suspected to cause symptoms in the respective individual. Clinical reactions are monitored in a controlled and standardized fashion. Nasal secretions, symptoms such as itching, sneezing and, most importantly, nasal obstruction are assessed as well as ocular, bronchial, cutaneous, and systemic reactions. To achieve objective data on changes in nasal airflow and patency after the challenge, anterior rhinomanometry and acoustic rhinometry have been included in the standard protocol of NPT. By monitoring changes of nasal airflow on one hand and of nasal geometry on the other hand, these methods display nasal function in a graphic way just as speech and pure tone audiometry do for auditory function. Also, by their objective nature, these methods offer a clear and internationally comparable standard. This review outlines a protocol for NPT and discusses practical applications and clinical indications. The use of rhinomanometry and acoustic rhinometry as objective diagnostic tools is emphasized. For the diagnosis of allergic and occupational rhinitis, standardized NPT should be regarded as an international diagnostic standard.

Juvenile angiofibromas: Changing surgical concept over the last 20 years

Objectives: Nasopharyngeal angiofibroma is a rare tumor. Several surgical approaches have been established, including transpalatal, lateral rhinotomy, craniofacial, and midface degloving procedures. More recently, less invasive endonasal approaches have been used. In a retrospective study, we analyzed the outcome of surgical treatment for angiofibroma to determine whether an endonasal approach was as effective as other, more invasive techniques for removing the tumors.

Characterization of nitric oxide synthase isoforms expressed in different structures of the guinea pig cochlea

Nitric oxide synthase (NOS) activity and NADPH diaphorase staining has previously been reported in mammalian cochlea. Here we demonstrate immunoreactivity for neuronal-type NOS I and endothelial-type NOS III in the cochlea of the guinea pig. NOS I immunoreactivity was seen in inner and outer hair cells, and spiral ganglion cells. Staining for NOS I was also shown in basal and intermediate cells of the stria vascularis, spiral ligament cells, and the media of vessels near the modiolus. An antibody to NOS III stained primarily vascular endothelial cells. Some NOS III immunoreactivity was also detected in spiral ganglion cells. An antibody to the inducible-type NOS II did not stain any structure of the guinea pig cochlea, suggesting that this isoform is not expressed under physiological conditions. Nitric oxide produced by NOS I and/or NOS III may act as a neuromodulator in the organ of Corti and could also play a role as a regulator of cochlear blood flow.

Intratympanic dexamethasone and hyaluronic acid in patients with low-frequency and Ménière's-associated sudden sensorineural hearing loss.

Background: Steroids are widely used for the treatment of cochleovestibular disorders. Direct steroid application in the middle ear cavity, when combined with a round window membrane permeability-modulating substance, increases the level of the steroid reaching the target cells. We measured hearing in patients with idiopathic isolated low-frequency sensorineural hearing loss and in patients with sudden sensorineural hearing loss and a history of Ménières disease. Contradictory reports about effectiveness of intratympanic steroid therapy on vertigo control and hearing improvement in patients with Ménières disease exist in the literature. Methods: Eighteen patients with isolated low-frequency idiopathic sudden sensorineural hearing loss and 21 patients with sudden sensorineural hearing loss and a history of Ménières disease were prospectively evaluated. The acute effect of the intratympanic application of dexamethasone with hyaluronic acid on hearing outcome after failure of an initial standard treatment with intravenous steroid and vasoactive substances was assessed. Evaluation was based on standard pure-tone audiometry findings. Results: After intratympanic injection of dexamethasone and hyaluronic acid, 14 of the 18 patients with isolated low-frequency sensorineural hearing loss showed a significant improvement in hearing. After intratympanic therapy, 15 patients with a previous history of Ménières disease and idiopathic isolated low-frequency sensorineural hearing loss showed an improvement in hearing on pure-tone audiometry, four remained unchanged, and two showed a tendency toward a slight deterioration. Conclusion: Intratympanic combined dexamethasone/hyaluronic acid application provides a reliable and safe therapeutic option for improvement of hearing in patients with isolated low-frequency idiopathic sudden sensorineural hearing loss or sensorineural hearing loss resulting from Ménières disease who have failed intravenous steroid and vasoactive treatments.

The effects of chronic otitis media with effusion on the measurement of transiently evoked otoacoustic emissions

Otoacoustic emissions (OAEs) are low‐level acoustic sounds of cochlear origin that can be recorded from the external auditory canal under well‐controlled conditions. They are a natural by‐product of normal auditory physiology and may be divided into two general categories: spontaneous and evoked emissions. These emissions provide an objective, non‐invasive measurement of cochlear function that is accurate, rapid, and simple to perform. The clinical utility of OAEs has been extensively described in both normally hearing subjects and subjects with sensori‐neural hearing loss. The primary clinical applications of these emissions appear to be in neonatal screening and ototoxic monitoring.

Hearing loss as a complication of stapes surgery

During a 10-year period (1984–1994) 1229 stapes operations for otosclerosis were performed at our respective institutions by experienced surgeons well trained in the various techniques. Procedures included 691 stapedectomies, 234 small-fenestrae stapedotomies, and 304 revision operations. These primary and revision cases resulted in 20 ears with severe sensorineural hearing loss or anacusis noted during the immediate postoperative period. This article will critically evaluate those procedures that resulted in profound hearing loss and attempt to determine possible reasons for this occurrence. It is hoped that these data will allow surgeons to identify before and/or during surgery patients at risk for development of this complication and therefore decrease the overall morbidity rate of this exacting procedure. (Otolaryngol Head Neck Surg 1996;115:324–8.)

Olfactory function after microscopic endonasal surgery in patients with nasal polyps

A controlled prospective study on 31 patients with nasal polyps was performed to evaluate the time course of olfactory function after endonasal surgery. A modified Connecticut Chemosensory Clinical Research Center (CCCRC) olfactory function test was used to measure olfactory threshold, odor identification ability, and odor discrimination ability. The test was performed in all patients 1–3 days before surgery (V1), 7–10 days after surgery (V2), and after 1 (V3), 2 (V4), 3 (V5), and 6 (V6) months. Mean olfactory threshold in the CCCRC butanol test was 4.19 at V1 (= moderate hyposmia). At V2, it decreased to 3.46 (= severe hyposmia), before increasing to 5.16 at V3 and 5.22 at V4 (= mild hyposmia). After the second postoperative month, olfactory threshold decreased again until the end of the study: 5.13 at V5 and 4.87 at V6 (= moderate hyposmia). The time course for odor identification ability and odor discrimination ability showed comparable results. This study demonstrates that olfactory function is impaired in patients with nasal polyps. Endonasal sinus surgery might improve olfactory function with best results within 3 months after surgery.

Breathe Right nasal strips and the respiratory disturbance index in sleep related breathing disorders.

This investigation assesses the effects of Breathe Right nasal strips on the respiratory disturbance index (RDI) measured by polysomnography in patients suffering from obstructive sleep apnea and snoring. The positive effect of these strips on nasal ventilation was shown in earlier studies. Twenty-six patients with an RDI higher than 10 in an initial measurement underwent a second preoperative polysomnography with Breathe Right nasal strips in place. Nineteen of these 26 patients showed reduction of RDI during the second night of polysomnography using the nasal strips, indicating that nasal obstruction seems to be a predominant factor in the etiology of snoring and apnea in these individuals. Demographic data, medical history, rhinoscopy, clinical assessment of pharyngeal obstruction (Muellers maneuver), as well as anterior rhinomanometry and acoustic rhinometry were used to identify typical findings correlating with a positive effect of the Breathe Right nasal strips on the RDI: 1. Hyperplasia or hypertrophy of the lower turbinates, septal deviation, and/or allergic rhinitis. 2. None or only minor pharyngeal obstruction. 3. Age less than 55 years. If a positive effect is seen during polysomnography with the strips in place, patients will most likely profit from an improvement of nasal ventilation. This may help to target more effectively septal or turbinate surgery if applicable. In other cases, if a significant RDI reduction is obtained by the use of the nasal strips, they could also offer a noninvasive modality of treatment, especially since the high degree of co-morbidity in this group of patients can sometimes make a surgical approach less favorable.

Head and neck paragangliomas: Report of 175 patients (1989–2010)

Attention of the otorhinolaryngologist needs to be drawn to the versatile aspects of head and neck paragangliomas (PGLs).