The aim of this study was to examine the training methods and needs of Otolaryngology-Head and Neck Surgery (OTO-HNS) residents to independently perform open tracheostomy (OT). An anonymous 26-items questionnaire pertaining to OT teaching aspects was distributed to all 93 Israeli OTO-HNS residents during March–June 2016. Residents were categorized as ‘juniors,’ if they were in their post-graduate year (PGY)-1 and PGY-2; ‘mid-residency’ (PGY-3 and PGY-4); or ‘seniors’ (PGY-5 and PGY-6). Response rate was 74% (n = 69). There were 25 ‘juniors’ (36%), 24 ‘mid-residency’ (35%) and 20 ‘seniors’ (29%). Overall, the responses of the 3 groups were similar. Forty-seven (68%) residents estimated that there are ≥ 50 tracheostomies/year in their hospital, which roughly corresponds to an exposure of ~ 8 tracheostomies/year/resident. There was an inconsistency between the number of teaching hours given and the number of hours requested for OT training (23% received ≥ 5 h, but 82% declared they needed ≥ 5 h). Eighty-two percentage reported that their main training was conducted during surgery with peer residents or senior physicians. Forty-five (65%) feel competent to perform OT, including juniors. Due to the need to perform OT in urgent scenarios, the competency of OTO-HNS resident is crucial. Training for OT in Israeli OTO-HNS residency programs is not well structured. Yet, residents reported they feel confident to perform OT, already in the beginning of their residency. Planned educational programs to improve OT training should be done in the beginning of the residency and may include designated ‘hands-on’ platforms; objective periodic surgical competence assessments; and specialist’s feedback, using structured assessment forms.

Objectives: Vertigo associated with rhinosinusitis has seldom been reported, and the pathophysiologic mechanism is still vague. Our aim was to evaluate sinugenic vertigo with computerized dynamic posturography (CDP) and suggest a possible pathophysiologic mechanism.Methods: We conducted a prospective study of 16 patients with a clinical and radiologic diagnosis of rhinosinusitis made between January 2007 and December 2008. All patients underwent CDP on the first 2 days after diagnosis. Patients with abnormal CDP results and/or complaints of vertigo underwent follow-up CDP when healthy.Results: Five patients complained of a new onset of vertigo. The CDP demonstrated a combined disorder in 3 of them, even though the vestibular signs were intact. On follow-up examination, all 3 patients were asymptomatic, and the follow-up CDP values were normal.Conclusions: We report a surprising 20% prevalence of sinugenic vertigo associated with abnormal results on CDP. Our results might possibly indicate that the somatosensory system of the paranasal sinuses plays a major role in the pathophysiologic mechanism of sinugenic vertigo.

Objective Significant morbidity and rarely mortality have been described in parapharyngeal space infections in children; hence, the decision on the timing of surgical intervention might be crucial. The aim of this study was to compare the accuracy of plain x-rays, ultrasonography (US), and contrast-enhanced computed tomography (CT) in demonstrating a parapharyngeal abscess. Methods A retrospective study on all patients with parapharyngeal abscess admitted and operated on from January 1996 to December 2000 was carried out. Charts were reviewed for patients’ demographics, symptoms and signs, details of workup, intraoperative findings, and culture results. The CT scans were reviewed for the presence of a rim enhancement, a presence of a definable wall, and fluid-fluid level and were correlated with the plain x-rays and US results and intraoperative findings. Results Eighteen patients with proven parapharyngeal infection were included: 10 with proven abscess and 8 with cellulitis. The sensitivity and specificity of lateral neck radiograph and US were low compared with a specificity of 87.5 while evaluating fluid-fluid level seen on the CT scan, sensitivity of 58.3% for the presence of a definable abscess wall, and a sensitivity of 100% for the presence of a prominent wall. Conclusions Our study demonstrates good rates of accuracy of CT scan for diagnosing a parapharyngeal abscess. Our study suggest that it is appropriate to obtain a CT scan upon presentation in all children with suspected parapharyngeal abscess and that a CT scan is proven to be a useful diagnostic tool in establishing a treatment plan.

In this study, the objective was to evaluate the presence of estrogen receptors alpha and beta (ER alpha and ER beta) in cases of papillary carcinoma of the thyroid gland and to assess the practicality of this test. Immunohistochemical stains were performed for both ER alpha and ER beta, for evaluation of immunoreactivity in 90 papillary carcinomas. Three variables were evaluated in each sample: the intensity of the staining both nuclear and cytoplasmatic, and the spread of the stain over the sample. None of the histological samples showed immunoreactivity for ER alpha. Positive immunoreactivity results for ER beta were found in tissue samples in 66.6% (60 cases). The study shows that ER beta has no significant specification for differentiation between papillary carcinoma and other malignant lesions of the thyroid, while ER alpha is undetectable in this lesion. The ER testing in cases of papillary carcinoma of the thyroid gland is nonspecific and might be not necessary.

The aims of this study is to evaluate the presence of estrogen receptors alpha (ERα) in thyroid lesions and to assess the practicality of this test in view of numerous disagreements on the subject. Immunohistochemical stains were performed for ERα, for the evaluation of immunoreactivity in 296 pathological thyroid tissue samples. We evaluated the intensity of the nuclear and cytoplasmatic staining and the spread of the stain over the sample. Thirty cases of the breast cancer served as a control group. None of the histological thyroid samples showed immunoreactivity for ERα. No difference was found between the various lesions in regard to this absence. The ERα rate of expression in the breast cancer samples was 60%. The ERα is undetectable in the histological samples of benign and malignant thyroid lesions. Further investigation is necessary in the laboratory immunohistochemical workup in order to exclude a possibility of non-specific staining.

BACKGROUND The objective of this study was to evaluate the presence of estrogen receptors (ER) alpha and beta in various thyroid lesions and to assess the practicality of this test. MATERIAL/METHODS Immunohistochemical stains were performed for both ERalpha and ERbeta, for evaluation of immunoreactivity in 296 thyroid tissue samples that consisted of 150 goiters, 90 papillary carcinomas, 19 follicular adenomas, 15 Hurtle cell adenomas, 6 Hashimoto thyroiditis, 5 anaplastic carcinomas, 4 medullary carcinomas, 4 follicular carcinomas, 2 Hurtle cell carcinomas, and 1 squamous cell carcinoma of the thyroid. Three variables were evaluated in each sample: The intensity of the staining both nuclear (1) and cytoplasmic (2), and the spread of the stain over the sample (3). RESULTS None of the histologic samples showed immunoreactivity for ERalpha. Positive immunoreactivity results for ERbeta were found in tissue samples from all of the different groups of diagnoses, both benign and malignant lesions as well as in normal thyroid tissue. No significant difference was found between the various thyroid lesions. CONCLUSIONS The study shows that ERbeta is the only ER detectable in thyroid tissue. However, ERbeta expression has no significant specifications for differentiation between benign and malignant lesions of the thyroid. ERalpha is undetectable in the thyroid. Further investigations are necessary mainly in the laboratory immunohistochemical workup.

OBJECTIVES:Transnasal endoscopic management of subperiosteal orbital abscess (SPOA) secondary to acute rhinosinusitis has become very popular over the past two decades. We describe our transnasal endoscopic approach for orbital complications secondary to acute rhinosinusitis (SPOA and orbital abscess) and the efficacy criteria that can be used to ensure complete drainage.METHODS:The charts of all patients who underwent surgery at Assaf Harofeh Medical Center between January 1993 and June 2007 were reviewed. Age, sex, clinical findings, antibiotic treatment, surgical procedure and outcome were recorded.RESULTS:Nineteen patients with SPOA and three with orbital abscess underwent surgery during which wide exposure of the periorbita was performed. If the abscess was not identified, bidirectional orbital manipulation, while simultaneously keeping a seeker in the abscess space under endoscopic view, enhanced its identification and successful drainage. An immediate reduction in palpable orbital pressure was used as an efficacy criterion for adequate drainage.CONCLUSION:The transnasal endoscopic approach for SPOA and orbital abscess can be enhanced by wide exposure of the periorbita and bidirectional orbital manipulation. Keeping track of orbital pressure during surgery by palpating the eye can be used as an efficacy criterion for assessing adequate drainage.

Today, obstructive hypertrophic tonsils are completely resected to remove the obstruction. Since tonsillar tissue has important protective characteristics, it is more logical to resect only the obstructive tonsillar tissue and leave remnants in the tonsillar beds, thereby presuming to preserve the immunological function of the tonsillar tissue. However, it is as yet unclear whether or not rehypertrophy of this remnant of the tonsils and/or tonsillitis reoccur in the long-term.To evaluate the remnants of the tonsils 10-14 years post-tonsillotomy in children who suffered from obstructive sleep apnea syndrome (OSAS) due to obstructive tonsils.We conducted a retrospective study, telephone survey and selective physical examination of 33 children who had obstructive hypertrophic tonsils (suffered from OSAS due to hypertrophic tonsils), and underwent tonsillotomy (TT) at Assaf Harofeh Medical Center between July 1990 and April 1993, and compared them with a group of 16 children treated by tonsillectomy (TE) for the same diagnosis.No statistically significant difference was found between the TT and TE groups in all parameters compared: non-obstructing tonsils recurred (97% vs. 87%); snoring (3% vs. 12.5%); recurrent tonsillitis (6% vs. 6.25%); and recurrent obstruction and unilateral enlargement (3% vs. 12.5%).TT is as effective as TE for the long-term treatment of children suffering from OSAS due to hypertrophic tonsils.

OBJECTIVE: To compare rates of hypothyroidism following three types of partial thyroidectomy for multinodular goiter.STUDY DESIGN AND METHODS: All cases of partial thyroidectomies (hemi-, near-total, or subtotal) carried out at one Israeli and one Russian medical center (1990-2006) were retrospectively studied to determine the incidence of hypothyroidism after each procedure.RESULTS: There were 881 near-total, 1538 subtotal, and 1051 hemithyroidectomies (total 3470). Postoperative follow-up was 2 to 15 years. Twenty-eight percent of the hemithyroidectomy patients Suffered permanent hypothyroidism compared to 100% of the near-total and 87% of the subtotal patients. Forty-six percent of the hemithyroidectomy patients suffered temporary hypothyroidism compared to 100% of the near-total and 93% of the subtotal patients.CONCLUSION: Subtotal and near-total thyroidectomies produced a rate of hypothyroidism close to that of total thyroidectomy compared to 28% after hemithyroidectomy.SIGNIFICANCE: Partial thyroidectomies provide no decisive advantage over total thyroidectomies in terms of subsequent requirements of supplemental hormone therapy. (C) 2008 American Academy of Otolaryngology-Head and Neck Surgery Foundation. All rights reserved.

No conclusive data are available regarding the influence of the microbial content of a peritonsillar abscess (PTA) on the development of recurrence. We conducted the current study to evaluate the effect of microbiologic growth on the recurrence rate of PTA and the need for tonsillectomy. Of 469 patients with PTA, 295 patients who underwent bacteriologic studies were subdivided into 2 groups, nonrecurrent group (273 patients) and recurrent group (22 patients), and their results were compared. A higher rate of anaerobic growth (10 anaerobic pathogens, 57.1% of total pathogens found) was identified in the recurrent PTA group compared with the nonrecurrent group (39 anaerobic pathogens, 45.8%), with a higher rate of anaerobic growth in the recurrent group in the first episode (60% vs. 45.8% in the nonrecurrent group) (odds ratio, 1.76; sensitivity, 80%; specificity, 45%). Anaerobic bacterial growth correlates with a higher rate of recurrence, and may serve as an additional relative indicator for tonsillectomy.

OBJECTIVE:Orbital complications (OC) secondary to acute rhinosinusitis (ARS) in children are uncommon, but can result in severe morbidity and mortality if not treated appropriately. These complications are more common in older children. We evaluate the disease and its management in children aged 2 and under.MATERIAL AND METHODS:Fifty-two records of children aged 2 and younger with OC secondary to ARS between 1993 and 2002 were reviewed retrospectively. Parameters recorded included age, gender, clinical symptoms and signs, CT findings, duration of hospitalization, treatment before and during admission, cultures and outcome.RESULTS:Forty-eight children were diagnosed with periorbital cellulitis, 4 with subperiosteal abscess and none with orbital abscess or cavernous sinus thrombosis. All were managed conservatively except 1 who underwent surgery. CT scan performed in 8 children revealed sinusitis in only 7. Average length of hospitalization was 3.6 days for preseptal cellulitis and 6.5 for postseptal cellulitis.CONCLUSION:SOC secondary to ARS mandates meticulous multidisciplinary follow-up in hospital. CT scan and surgery are indicated in cases of ophthalmoplegia, proptosis, decreased visual acuity or failure of conservative treatment within 48 hours. However, most children aged 2 and younger respond well to conservative treatment and no surgical intervention is required.

Background Disruption in the balance of the nasal flora influences infectious diseases of the nose. We characterized the changes in nasal flora of the middle meatus of patients with a symptomatic deviated nasal septum before and after septoplasty. Methods The study cohort included 33 patients with symptomatic deviated nasal septum who underwent septoplasty from 1998 to 2001. Cultures from the middle meatus were taken preoperatively and 1 month postoperatively. Results Fifty-two percent of the preoperative cultures and 76% of the postoperative cultures were positive. The preoperatively cultured bacteria were similar to those usually cultured from the nose of a healthy individual–-mainly Staphylococcus aureus and Corynebacterium. The postoperative cultures included bacteria not considered as being nasal flora and infrequently cultured from the nose: Pseudomonas, Haemophilus influenza, and Staphylococcus coagulase negative. Conclusion Symptomatic septal deviation does not influence nasal flora. The bacterial changes without clinical complaints that we found postseptoplasty might call for a more in-depth workup.

OBJECTIVE:Endoscopic endonasal Draf II frontal sinusotomy is indicated for a variety of pathologies such as mucocele and non-responsive chronic frontal sinusitis. However, this approach is challenged and controversial. The objectives were to evaluate the advantages, disadvantages, indications, and rate of complications of this approach, without the use of a navigation system.METHODS:The files and computed tomography (CT) scans of 25 patients who underwent endoscopic endonasal Draf II sinusotomy at Assaf Harofeh Medical Center between 1999 and 2002 were reviewed.RESULTS:Thirty-one frontal sinuses were operated on and follow-up was between 18 and 62 months (average 30.3). Twenty-two sinuses (71%) had previous surgery. The Draf II procedure was used in 3.7% of all cases during the survey period. The most frequent indication for surgery was inflammation (48%) followed by mucocele (28%). In all but 2 sinuses (93%), the frontal floor between the lamina papyracea and the middle concha was drilled out. Twenty-four patients (96%) were successfully ventilated. No major complications were noted.CONCLUSIONS:The Draf II approach can be used safely and successfully without a navigation system, including cases of revision endoscopic sinus surgery. Correct interpretation of the surgical field and a CT scan are crucial for success. Careful patient selection is essential for this procedure.

Background: The purpose of this paper is to describe the outcome of biofeedback training of nasal muscles in cases of nasal valve stenosis and collapse. The present study was performed to investigate the best way of using surface electromyography (sEMG) in biofeedback training of muscles involved in nasal valve function. In the present study, we present the way of biofeedback training of these muscles introducing the intranasal placement of sEMG electrodes and a home exercise program.Methods: A nonrandomized pilot study of patients presenting with symptoms of obstructed nasal breathing was conducted. All selected patients (n = 15) demonstrated nasal valve stenosis with a positive Cottle maneuver and clinically evident nasal valve collapse. Follow-up ranged from 9 to 12 months. Treatment included surface and intranasal EMG biofeedback-assisted specific strategies for nasal muscle education and a home exercise program of specific nasal movements.Results: All patients exhibited variable subjective improvement. In 86.66% (n = 13), the improvement was proved objectively and there was no need for operation. In 13.33% (n = 2), an endonasal operation was recommended.Conclusion: Relieve of obstructed nasal breathing after nasal valve stenosis and/or collapse can be achieved with biofeedback training of nasal muscles and a home exercise program as described. It helps a significant cohort of patients with symptoms of obstructed nasal breathing to avoid surgical intervention. (c) 2005 Elsevier Inc. All rights reserved.

Orbital complications secondary to acute sinusitis are rare in children. They include preseptal cellulitis; an orbital subperiosteal abscess (OSA); an orbital abscess (OA), which may cause deterioration of visual acuity and restriction of globe motility; and finally, a life-threatening cavernous sinus thrombosis, meningitis, and/or a brain abscess. Orbital CT scan is the most accurate tool in the work-up of orbital complications.

The rate of nerve regeneration is a critical determinant of the degree of functional recovery after injury. Here, we sought to determine whether treatment with the neuroprotective compound, agmatine, with or without nerve reconstruction utilizing a regional autogenous vein graft would accelerate the rate of facial nerve regeneration. Experiments compared the following seven groups of adult male rats: (A) Intact untreated controls. (B) Sham operation with interruption of the nerve blood supply (controls). (C) Transection of the mandibular branch of the facial nerve (generating a gap of 3 mm) followed by saline treatment. (D) Nerve transection with unsutured autogenous vein (external jugular) graft reconstruction plus saline treatment. (E) Nerve transection with sutured vein graft approximation (coaptation of the proximal and distal nerve stumps) plus saline. (F) Nerve transection with sutured vein graft followed by agmatine treatment (four daily intraperitoneal injections of 100 mg/kg agmatine sulfate). (G) Nerve transection with unsutured vein graft followed by agmatine treatment. Functional recovery, as assessed by grading vibrissae movements and by recording nerve conduction velocity and numbers of regenerated axons, indicated that either vein reconstruction or agmatine treatment resulted in accelerated and more complete recovery as compared with controls. But best results were observed in animals that underwent combined treatment, i.e., vein reconstruction plus agmatine injection. We conclude that agmatine treatment can accelerate facial nerve regeneration and that agmatine treatment together with autogenous vein graft offers an advantageous alternative to other facial nerve reconstruction procedures.

Background: Fine-needle aspiration biopsy has been well established as a diagnostic technique for selecting patients with thyroid nodules for surgical treatment, thereby reducing the number of unnecessary surgical procedures in cases of non malignant tumors.Objectives: To evaluate the sensitivity, specificity, accuracy, and positive and negative predictive values of FNAB in cases of a solitary thyroid nodule.Methods: The preoperative FNAB results in 170 patients who underwent thyroidectomy due to a solitary thyroid nodule were compared retrospectively with the final postoperative pathological diagnoses.Results: In cases of a solitary thyroid nodule, FNAB had a sensitivity of 79%, specificity of 98.5%, accuracy of 87%, and a positive and negative predictive values of 98.75% and 76.6% respectively. All cases of papillary carcinoma diagnosed by FNAB proved to be malignant on final histology, while 8 of 27 cases of follicular adenoma detected by perioperative FNAB were shown to be malignant on final evaluation of the surgical specimen.Conclusions: FNAB cytology reduces the incidence of thyroidectomy since this method has an excellent specificity and sensitivity and a low rate of false-negative results. It proved to be cost-effective and is recommended as the first tool in the diagnostic workup in patients with thyroid nodules.

The purpose of the present study was to evaluate the haemostatic efficacy of fibrin sealant in patients with hereditary haemorrhagic telangiectasia (HHT) or Rendu-Osler-Weber disease suffering epistaxis. A retrospective observational study of patients with HHT who were admitted to an emergency room for anterior or posterior epistaxis during May 2000-March 2003. A total of 24 patients were evaluated, of whom 15 were managed with foam nasal packing during May 2000-March 2002 and another nine were treated during March 2002-March 2003 with 0.3 ml fibrin sealant spray (Quixil; Omrix, Belgium). The immediate and the distant results were compared. Immediate haemostasis was achieved in all seven patients treated with fibrin glue, with good healing of bleeding sites, no secondary bleeding, no inflammation, and no plaque or crists. Twelve months of follow-up monitoring (until October 2003) of atrophic changes of nasal mucosa, bleeding frequency and intensity proved absence of atrophy of nasal mucosa and decreased bleeding frequency. In this group, the bleeding episode duration averaged 2 min 35 s since the moment of admittance. In the nasal packing group, we found local swelling, pain, and slow healing of the bleeding site with accidental atrophy of nasal mucosa and no effect on further bleeding frequency and intensity. Removal of nasal packing frequently initiates secondary bleeding. The rates of these side effects were higher in comparison with the fibrin glue group. The bleeding episode duration was also longer. In patients with HHT suffering profuse epistaxis, fibrin glue is more effective and convenient for the patients as compared with foam nasal packing. It is also safer, since it lacks the complications that usually accompany packing as swelling, atrophy of the nasal mucosa, and secondary bleeding provoked by the removal of the pack.

Otolaryngology–Head and Neck SurgeryVolume 131, Issue 4 p. 558-559 Case Report Lingual Abscess: Secondary to Follicular Tonsillitis Ephraim Eviatar MD, Ephraim Eviatar MD Department of Otolaryngology–Head and Neck Surgery, Assaf Harofeh Medical Center, Zerifin, Israel Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, IsraelSearch for more papers by this authorKoby Pitaro MD, Corresponding Author Koby Pitaro MD [email protected] Department of Otolaryngology–Head and Neck Surgery, Assaf Harofeh Medical Center, Zerifin, Israel Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, IsraelReprint requests: Koby Pitaro, MD, Department of Otolaryngology, Assaf Harofeh Medical Center, Zerifin 70300, Israel; e-mail, [email protected]Search for more papers by this authorSamuel Segal MD, Samuel Segal MD Department of Otolaryngology–Head and Neck Surgery, Assaf Harofeh Medical Center, Zerifin, Israel Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, IsraelSearch for more papers by this authorAlexander Kessler MD, Alexander Kessler MD Department of Otolaryngology–Head and Neck Surgery, Assaf Harofeh Medical Center, Zerifin, Israel Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, IsraelSearch for more papers by this author Ephraim Eviatar MD, Ephraim Eviatar MD Department of Otolaryngology–Head and Neck Surgery, Assaf Harofeh Medical Center, Zerifin, Israel Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, IsraelSearch for more papers by this authorKoby Pitaro MD, Corresponding Author Koby Pitaro MD [email protected] Department of Otolaryngology–Head and Neck Surgery, Assaf Harofeh Medical Center, Zerifin, Israel Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, IsraelReprint requests: Koby Pitaro, MD, Department of Otolaryngology, Assaf Harofeh Medical Center, Zerifin 70300, Israel; e-mail, [email protected]Search for more papers by this authorSamuel Segal MD, Samuel Segal MD Department of Otolaryngology–Head and Neck Surgery, Assaf Harofeh Medical Center, Zerifin, Israel Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, IsraelSearch for more papers by this authorAlexander Kessler MD, Alexander Kessler MD Department of Otolaryngology–Head and Neck Surgery, Assaf Harofeh Medical Center, Zerifin, Israel Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, IsraelSearch for more papers by this author First published: 17 May 2016 https://doi.org/10.1016/j.otohns.2004.01.002Citations: 1Read the full textAboutPDF ToolsExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume131, Issue4October 2004Pages 558-559 RelatedInformation