Development of otorhinolaryngology (ORL) in Greece between 1880 and 1930.
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Greece↗
Biomedical subjects
S Manolidis
Publications and source records attributed to S Manolidis.
Classification and surgical management of orbital fractures: experience with 111 orbital reconstructions.
Orbital skeletal injuries are frequently associated with other significant injuries and require a substantial surgical effort to correct. The use of a unified classification of orbital injury may better predict the surgical effort required to correct such injuries and help with future comparisons of results. In an attempt to summarize the principles of reconstruction of the orbital skeleton following trauma and introduce a unified classification system for orbital injuries, a retrospective review of all consecutive orbital reconstructions in a tertiary care teaching hospital was conducted. The nasoethmoidal region was involved in 32%, the zygomatic complex in 50%, and the frontal region in 28% of orbital fractures. Of the orbital walls, four walls were involved in 5%, three walls in 17%, two walls in 30%, and one wall in 53%. Associated ocular and neurologic injury was encountered in 33% and 57% of patients, respectively. Regions of fixation ranged from one to eight. Bone grafts were used in 20% and titanium mesh in 34% of the orbits. In general, the authors recommend an aggressive approach to orbital injuries, addressing all associated injuries simultaneously.
Adolescent↗
Linkage of otosclerosis to a third locus (OTSC3) on human chromosome 6p21.3-22.3.
Clinical otosclerosis (OMIM 166800/605727) has a prevalence of 0.2-1% among white adults, making it the single most common cause of hearing impairment in this group. It is caused by abnormal bone homeostasis of the otic capsule with the consequent development of sclerotic foci that invade the stapedio-vestibular joint (oval window) interfering with free motion of the stapes. Impaired ossicular chain mobility results in a conductive hearing loss. We identified the first locus for otosclerosis (OTSC1) on chromosome 15 in 1998 and reported a second locus (OTSC2) on chromosome 7 last year. Here we present results of a genome wide linkage study on a large Cypriot family segregating otosclerosis. Results of this study exclude linkage to OTSC1 and OTSC2 and identify a third locus, OTSC3, on chromosome 6p. The defined OTSC3 interval covers the HLA region, consistent with reported associations between HLA-A/HLA-B antigens and otosclerosis.
Chromosome Mapping↗
Surgical anatomy of the temporal bone: an atlas.
This atlas demonstrates the usefulness of reconstructed high-resolution CT for planning temporal bone surgery. The first part focuses on a sagittal plane, the second on a rotated longitudinal plane, and the third on a rotated transverse plane. We believe knowledge of temporal bone anatomy in these planes facilitates surgical planning by showing anatomic relationships and providing a customized map for each patient. This decreases the likelihood of surgical mishap and improves teaching.
Anatomy, Artistic↗
Practice patterns versus practice guidelines in pediatric otitis media.
OBJECTIVE: To study the practice patterns of physicians and their adherence to an evidence-based practice guideline (PG) on pediatric otitis media with effusion. We hypothesized that overall knowledge of the recommendations from the guidelines would be less than 75%, and that specialist physicians would have better knowledge of the recommendations than generalist physicians. METHODS: We performed a survey study of 1167 otolaryngologists, pediatricians, and pediatric otolaryngologists. Each physician was sent a 6-item survey asking about their practice patterns and treatment preferences for young children with otitis media with effusion. We compared responses between different specialties. RESULTS: The overall response rate was 48%. Only 8 (1.4%) of the 558 responding physicians answered all 6 items congruent with the PG. Overall, pediatricians, otolaryngologists, and pediatric otolaryngologists had similar total scores, but different scores on individual items. CONCLUSIONS: These results indicate that the practice patterns of pediatricians, otolaryngologists, and pediatric otolaryngologists differ from the recommendations of an evidence-based PG. In particular, 2 items covering key treatment recommendations were answered in agreement with the PG by fewer than half of the physicians. It is not clear from this study whether these discrepancies were due to poor dissemination or knowledge concerning the PG, or disagreement with its recommendations.
Child↗
Thyroid surgery: a comparison of outcomes between experts and surgeons in training.
OBJECTIVES: Our objective was to compare the results of thyroid surgery performed by residents in a large metropolitan public hospital (MPH) with those performed by faculty in a large private hospital (PH) setting. METHODS: All records of thyroid surgery performed by otolaryngologists for the period between 1986 and 1998 were reviewed. Inclusion criteria were adequacy of data and follow-up. Ninety-two thyroid procedures performed by residents in an MPH were compared with 181 thyroid operations in a PH setting performed by the faculty of these residents for differences in accuracy of diagnostic studies, operative parameters, and complication rates. RESULTS: The demographic distribution in both groups was similar. Presenting symptoms were twice as frequent in the MPH group (45% vs 22%). More total thyroidectomies were performed in the PH group (49% vs 32%). Blood loss, operative time, and hospitalization days were similar in both groups. Preoperative fine needle aspiration and intraoperative frozen section results showed sensitivities and specificities that were comparable. No permanent vocal cord paralysis was observed in either group. Permanent hypocalcemia was more frequent in the PH group (8.8%:PH vs 5.1%:MPH). CONCLUSIONS: The results of thyroid surgery performed by residents in training in an Otolaryngology-Head & Neck Surgery program in an MPH, measured by rates of complications, length of hospitalization, and duration of surgery, are similar to those of faculty at a PH setting in groups of patients with very similar characteristics.
Adult↗
High incidence of complications encountered in chronic otitis media surgery in a U.S. metropolitan public hospital.
OBJECTIVES: To examine the incidence and nature of complicating factors in surgery for chronic otitis media (COM) in a metropolitan public hospital in the United States. METHODS: A retrospective review was performed over 2 years in a metropolitan public hospital to identify cases of surgery for chronic ear disease with the following complicating factors: intracranial or extracranial abscess, labyrinthine fistula, dural dehiscence with or without associated encephalocele or meningocele, or extensive involvement of the facial nerve by cholesteatoma with or without paralysis. RESULTS: Thirty-three of 90 consecutive operations for COM (37%) met criteria for complicated chronic otitis media (CCOM). The majority (85%) of patients had cholesteatoma involvement. Most patients (73%) were managed by an extended modified radical mastoidectomy. An additional 31 procedures were required in these 33 patients for control of complications. There was no iatrogenic sensorineural hearing loss or facial paralysis. CONCLUSIONS: The incidence of CCOM in this large, U.S. metropolitan public hospital is similar to that observed in developing nations. CCOM significantly complicates chronic ear surgery and substantially increases the use of resources. Maintaining functional hearing is possible, but difficult, and should be considered secondary to prevention of further complications and eradication of disease. Access to health care and proper follow-up are crucial in prevention of CCOM.
Adolescent↗
Use of reconstructed sagittal computed tomography images to plan middle cranial fossa surgery.
OBJECTIVE: To facilitate planning in temporal bone surgery for the middle cranial fossa approach by using sagittal reconstructed temporal bone computed tomography images. STUDY DESIGN: Comparison of anatomic measurements on random high-resolution, reformatted computed tomography scans of the temporal bone. METHODS: High-resolution computed tomography of 10 normal temporal bones in the axial and coronal planes was obtained, and two-dimensional sagittal reconstructions were performed using a commercial software program. Eight anatomical relationships between neural and/or vascular structures were measured. Representative images were inverted to recreate the plane of the middle cranial fossa approach. RESULTS: Anatomical relationships among the vestibule, superior semicircular canal, internal auditory canal, internal carotid artery, and middle cranial fossa exhibited a high SD in the 10 subjects. The sample size and the large range for the eight anatomical relationships precluded the detection of a significant difference between right and left temporal bones or sex and age of the patient. CONCLUSION: The present report presents a novel, practical measurement protocol for rapidly evaluating important individual anatomical differences in patients before middle cranial fossa surgery. Inverted sagittal reconstructions facilitate presurgical planning for the middle cranial fossa approach by 1) assessing critical anatomical relationships before surgery and 2) providing customized measurements between vital landmarks and the first in vivo measurements. This decreases the likelihood of surgical mishaps and improves teaching by providing the first in vivo measurements of practical anatomical relationships in the sagittal plane.
Adult↗
Unrecognized benign paroxysmal positional vertigo in elderly patients.
Balance disorders in elderly patients are associated with an increased risk of falls but are often difficult to diagnose because of comorbid chronic medical problems. We performed a cross-sectional study to determine the prevalence of unrecognized benign paroxysmal positional vertigo (BPPV) and associated lifestyle sequelae in a public, inner-city geriatric population. Dizziness was found in 61% of patients, whereas balance disorders were found in 77% of patients. Nine percent were found to have unrecognized BPPV. Multivariate analysis demonstrated that the presence of a spinning sensation and the absence of a lightheadedness sensation predicted the presence of unrecognized BPPV. Patients with unrecognized BPPV were more likely to have reduced activities of daily living scores, to have sustained a fall in the previous 3 months, and to have depression. These data indicate that unrecognized BPPV is common within the elderly population and has associated morbidity. Further prospective studies are warranted.
Accidental Falls↗
Outcomes and quality of life in conductive hearing loss.
OBJECTIVE: The goal was to measure quality of life (QOL) and hearing-specific functional status before and after treatment of conductive hearing loss (CHL). STUDY DESIGN AND SETTING: A prospective, longitudinal, outcomes-based study was performed at an academic medical center. RESULTS: Mean baseline QOL scores in CHL patients were comparable with those of the general population. Audiometric studies indicated significant improvements in hearing threshold in all treated patients. There was no significant improvement in mean global QOL scores after treatment of CHL, although there was little room for improvement over baseline. The hearing-specific instrument did demonstrate significant improvements in emotional and social/situational hearing status after treatment. Patients treated with hearing aids had poorer baseline QOL and hearing status than patients treated with surgery and tended to show declines in QOL and only partial improvement in hearing-specific functional status after treatment. CONCLUSIONS: Treatment of CHL resulted in improvements in hearing-specific functional status, although changes were difficult to detect with a global QOL instrument.
Adolescent↗
Complications associated with labyrinthine fistula in surgery for chronic otitis media.
OBJECTIVE: Labyrinthine fistula (LF) is encountered during surgery for chronic otitis media (COM) with an average frequency of 7.5%. This study was undertaken to investigate the prevalence of coexisting complications with LF in surgery for COM. STUDY DESIGN AND SETTING: A retrospective review of 111 consecutive cases of COM surgery performed by the same surgeon in a large metropolitan teaching public hospital in the United States serving the inner city population. RESULTS: There were 23 (21%) LFs in 111 patients. The majority of cases were revision surgery with an average of 2.6 operations per patient. Other complications were encountered in 18 (78%) of the 23 patients with an LF: 5 (22%) encephaloceles, 9 (39%) dehiscences of the tegmen, 12 (52%) patients with facial nerve involvement by cholesteatoma, and 2 (8.7%) patients with facial nerve paralysis. These patients required extensive surgery for correction of their concurrent complications. CONCLUSION: Compared with those cases in which a fistula was not found, the ratio of the above complications were as follows: encephalocele, 1:9; facial nerve involvement by cholesteatoma, 1:11.3; facial nerve paralysis, 1:3.8. SIGNIFICANCE: Patients with neglected COM have an incidence of an LF twice that reported in the literature. The prevalence of associated complications with LF requiring extensive surgery is significantly higher than that observed in noncomplicated COM cases.
Chronic Disease↗
Use of plain radiography and computed tomography to identify fish bone foreign bodies.
INTRODUCTION: Fish bones are the most common aerodigestive foreign bodies in adults. Radiographic studies, often ordered for diagnosis, have questionable utility. METHODS: With a laryngoscope, bones from 10 fish species were placed in a variety of positions in a human head and neck cadaver specimen. Plain films and CT scans were obtained and evaluated by blinded readers. RESULTS: Plain radiography exhibited a sensitivity and specificity of 39% and 72%. Cooking did not grossly change radio-opacity. The species of fish affected visibility in soft tissue, without correlation to the characteristic optical density of each species. Bones placed orthogonal to the film in the vallecula were most readily identified. CT scanning correctly identified 9 of 10 bones. CONCLUSIONS: Plain radiography poorly visualizes fish bone foreign bodies in soft tissue; visibility varied with fish species, location, and orientation. CT is the test of choice to radiographically diagnose fish bone impactions.
Adult↗
In vivo measurements of temporal bone on reconstructed clinical high-resolution computed tomography scans.
PURPOSE: To retrospectively assess the accuracy of measurements of temporal bone anatomy made from reconstructed clinical high-resolution computed tomography (HRCT) scans. METHODS: Nine HRCT scans were performed on unselected clinical cases in which the subjects had a temporal bone study judged to be normal. The orbitomeatal line was prescribed for the direct axial sections. Variations in head position (rotation at the neck and lateral bending of the neck) were corrected by using the software supplied by the manufacturer. All measurements were done on standard 1-mm axial sections and axial reconstructions obtained from 1-mm coronal slices. The images were viewed at 4000 Hounsfield units (HU) window width and 1000 HU window level. Measurements (n = 3) made on 1-mm direct axial HRCT scans were compared with the measurements made on reconstructed axial HRCT images from the same nine patients. These values were also compared with published cadaver data. RESULTS: The measurements obtained from axial reconstructed and direct HRCT series approximated each other in each of the nine individual studies and also fell within the range of published cadaver values. They demonstrated the expected normal temporal bone variability between individuals. CONCLUSION: Useful anatomic approximations can be measured in vivo from reconstructed clinical HRCT images. Pitfalls are improper window settings, head tilt, and rotation. This protocol is widely available and can be implemented retrospectively from clinical HRCT scans.
Adult↗
Malignant glomus tumors.
OBJECTIVES/HYPOTHESIS: To ascertain the incidence of malignancy in a large glomus and skull base series and to compare the clinical course of such patients with those who do not have malignant skull base lesions. STUDY DESIGN: Retrospective review of all skull base surgery cases treated at the Otology Group between 1970 and 1995. RESULTS: In a series of 175 jugulotympanic glomus tumors, 9 cases (5.1%) were identified. The surgery required for their extirpation is more extensive than nonmalignant glomus tumors. Attendant deficits and mortality from these procedures are accordingly greater. Five-year survival in this limited population was 72%. Prolonged periods of survival are possible with distant metastases. CONCLUSIONS: This rate of malignancy should advocate against a watchful, waiting approach. Radiation therapy is not advocated as a primary modality for this type of tumor, as it may lead to recurrence/persistence with either subsequent malignant degeneration and metastases or local recurrence.
Adolescent↗
The use of positron emission tomography scanning in occult and recurrent head and neck cancer.
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Fluorodeoxyglucose F18↗
Facial nerve outcome in lateral skull base surgery for benign lesions.
OBJECTIVE: To statistically identify factors most important in affecting CN7 outcome in lateral skull base surgery for benign lesions. STUDY DESIGN: A retrospective review of 217 nonmalignancy lateral skull base procedures from 1970 to 1995 at the Otology Group in Nashville. METHODS: Charts were reviewed for epidemiology, histopathology, staging, type of CN7 mobilization (none, short, long, severance with reanastomosis, and resection), preoperative and postoperative CN7 function, surgery performed, and survival. RESULTS: Average House-Brackman (HB) scores for mobilizations were as follows: short, 1.65: long, 2.74: and grafting, 4.33. Factors found to affect outcome in a statistically significant fashion were preoperative HB score, staging, type of CN7 manipulation, and surgical approach. Meningiomas were found to have a worse outcome than glomus tumors. CONCLUSIONS: Complete resection of tumors should be performed with minimal manipulation of the facial nerve based on regional anatomy and tumor anatomy.
Adolescent↗
Temporal bone and lateral skull base malignancy: experience and results with 81 patients.
OBJECTIVE: This study aimed to examine predictive factors and treatment outcome and to devise a staging method for malignant lateral skull base disease. STUDY DESIGN: The study design was a retrospective review of all lateral skull base surgery cases. SETTING: The study was conducted at a tertiary referral center. PATIENTS: Of 317 lateral skull base lesions, 81 patients were found to have malignant disease. Three groups were identified, and the data were analyzed according to the following: epithelial malignancies, 30 patients; malignancies of salivary gland origin, 23 patients; and malignancies of mesenchymal origin, 28 patients. The mean age was 48.5 years with a range of 5-83 years. There were 42 males and 39 females. Our mean follow-up time was 54 months with a range of 1-180 months. Forty-three patients were alive without evidence of recurrent disease, 6 were living with disease, 25 were dead of disease, 3 died of other causes, and 4 were lost to follow-up. INTERVENTIONS: All patients underwent surgery with curative intent. Forty-two received adjuvant radiation, and 8 received chemotherapy. MAIN OUTCOME MEASURES: Treatment failure, survival, cranial nerve deficits, complications, and predictive factors were analyzed. RESULTS: A 58% treatment success rate was observed. Epithelial and salivary malignancy had a poorer prognosis, and pain and facial nerve dysfunction at presentation carried a worse prognosis. CONCLUSIONS: Lateral skull base malignancy is a rare entity that continues to challenge cranial base surgeons. Cranial nerve deficits and complications are frequent. The success rate of treatment is dependent on histology and disease extent.
Adolescent↗
Malignant mucosal melanoma of the head and neck: review of the literature and report of 14 patients.
BACKGROUND: Fortunately, primary malignant mucosal melanoma of the head and neck is a rare entity. A paucity of data elucidating the predictive factors as well as the unpredictable and aggressive biologic behavior of mucosal melanoma compound the vexing clinical situation. This review summarizes what the literature reveals about the epidemiology, patient survival, patterns of local recurrence, and local and distant metastasis of the disease. Over 1000 patients with this disease have been reported. Survivals at 5 and 10 years is 17% and 5%, respectively. Approximately 19% of patients present with lymph node metastasis and another 16% develop lymph node metastases after treatment, whereas 10% present with distant metastasis. Local metastasis does not affect survival; this is in sharp contrast with skin melanoma. Over 50% of patients experience local treatment failure, and salvage treatment is effective in only 25% of these cases. Local failure is the harbinger of distant metastases. Patients with nasal mucosal melanoma have a 31% 5-year survival rate, whereas sinus melanoma patients fare poorly, with a 0% rate of 5-year survival. METHODS: The authors conducted a retrospective review of 14 patients with characteristics similar to those in the literature in terms of outcome. RESULTS: The 5-year survival rate for these patients was 14%. Whole-body positron emission tomography was performed on 3 patients to detect metastatic disease. The patterns of local recurrence, distant metastasis, and survival for these patients were compared with the same data for patients described in the literature. CONCLUSIONS: Surgery appears to have the greatest efficacy in the management of mucosal melanoma, although radiation therapy may play an increasingly important role in the future.
Aged↗