Background Gas pressure balance is essential for maintaining normal middle ear function. The mucosal surfaces of the middle ear, the mastoid air cell system (MACS), and the Eustachian tube (ET) play a critical role in this process; however, the extent that each of these factors contributes to overall middle ear ventilation is unknown. The objective of this study was to determine if the ET alone can maintain normal middle ear pressure without the MACS. To do this, we reviewed subjects who had their MACS completely removed with translabyrinthine (TL) surgery for vestibular schwannoma. Methods A retrospective chart review was done to collect pre and postoperative tympanometry data from patients who underwent resection of vestibular schwannoma. Data from the operative side was compared to the non-operative side at 2 years post-op. Results Twenty-four patients were included in this study. Of these, 63 % achieved a type A tympanogram at 2 years post-op in the TL resection group, implying an ability to maintain middle ear pressure in the absence of a mastoid cavity. Because some had negative pressures post TL resection, the average change in pre and postoperative pressure was -37.5 daPa for the operative side and 7.8 daPa for the non-operative side. This was significantly different. Discussion The difference for change in pre and postoperative pressure and compliance between operative and non-operative side might be expected from the ET plugging during TL resection. However, more interesting are those patients in whom the ET presumably reopens, and in these subjects, despite having no mastoid compartment at all, and the space obliterated with fat, they were still able to maintain normal ventilation of the middle ear space. Conclusion Our findings imply that the ET alone is adequate to ventilate at least the reduced middle ear space following TL surgery in most subjects, and perhaps in 100 % if the ET hadn't been plugged during surgery. Hence, the mastoid air cell system, even when healthy, is not needed to maintain air in the middle year cleft.

Objectives: To assess the effectiveness of nurse-led triage of outpatient referrals in an academic pediatric otolaryngology practice.Methods: Three hundred consecutive outpatient referrals were reviewed and triaged by two otolaryngology registered nurses and two attending pediatric otolaryngologists. The nurses received triage training. The referrals were triaged as 'routine' (to be seen within 2-3 months), 'semi-urgent' (to be seen within 6 weeks), or 'urgent' (to be seen within 2 weeks). Weighted Kappa statistics (correcting for chance agreement) were performed to assess for the degree of agreement. After the consultation visits, patient records were reviewed to determine whether any referrals had been inappropriately triaged by the nurses.Results: Overall, there was substantial agreement between all raters. Specifically, weighted Kappa statistics were as follows: surgeon 1, nurse 1: 0.708; surgeon 1, nurse 2: 0.670; surgeon 2, nurse 1: 0.762; surgeon 2, nurse 2: 0.647; nurse 1, nurse 2: 0.756; and surgeon 1, surgeon 2: 0.784. Review of patient charts after consultation showed that no referrals were deemed to be inappropriately triaged and no urgent cases had been missed.Conclusions: Our model of nurse-led triage of outpatient referrals was found to be effective and safe. Similar systems may be considered in other areas of medicine as a viable and acceptable alternative to the traditional physician-led triage practice. (C) 2015 Elsevier Ireland Ltd. All rights reserved.

1 Dalhousie Pediatric Craniofacial Group, Department of Surgery, IWK Health Centre, Dalhousie University, P.O. Box 9700, Halifax, Nova Scotia, Canada B3K 6R8 2 Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada B3K 6R8 3 Division of Pediatric Otolaryngology, Rady Children’s Hospital, University of California-San Diego, San Diego, CA 92123, USA

Objectives: To assess the need for post-tonsillectomy admission in children under the age of three years.Design: A retrospective case-control study.Method: Medical records of 127 children under the age of three years who underwent tonsillectomy with or without adenoidectomy were reviewed for complications and compared to 127 gender-matched controls between three to four years of age.Results: Overall complication rate in the study group was 9.4% (12 of 127). Early complications (3.1%) were respiratory related, while late complications (6.3%) were due to dehydration and hemorrhage. Comparable complication rate was observed in the control group (8.7%, P>0.05); early complication rate of 3.1% and late complication rate of 5.5% was ascertained. Similar types of complications occurred in the control group.Conclusions: Post-tonsillectomy complication rates were low and no significant difference was observed between the study and control groups. This suggests that postoperative admission for children younger than three years of age may not be necessary in all cases. (C) 2014 Elsevier Ireland Ltd. All rights reserved.

Background. Many studies have demonstrated the effectiveness of mandibular distraction osteogenesis (MDO) in alleviating the micrognathia-associated upper airway obstruction but very few studies have focused on long-term dental outcomes. Objective. To report the effect of MDO on developing deciduous molars in the distraction area. Methods. A retrospective chart review was performed to identify patients with Pierre Robin sequence who underwent MDO with documented long-term dental assessments. Results. Ten children (mean age at surgery 69.8 days; 6 boys and 4 girls) were included for analysis. All patients underwent bilateral MDO with an inverted L-shaped osteotomy to avoid injuring tooth buds. The dental developmental stage was primary dentition in all children. Overall, 3 patients developed minor dental problems involving 4 molar teeth (2 root malformations and 2 shape anomalies) but they did not require any interventions. Conclusion. Significant primary molar developmental complications were not seen in our patients. The use of internal distractor device with an inverted L-shaped osteotomy seems to be a safe surgical approach in regards to dental outcomes.

OBJECTIVE:To assess wait times for surgery and radiotherapy in head and neck cancer patients from the Maritime provinces.METHODS:A retrospective chart review of 275 Maritime head and neck cancer patients treated between 2007 and 2009 by the tertiary Otolaryngology-Head and Neck Surgery Service at the Queen Elizabeth II Health Sciences Centre (QEII HSC) in Halifax, Nova Scotia, was conducted to assess surgical and radiotherapy wait times.RESULTS:The mean wait time from referral to assessment by a head and neck surgeon was 15 days. The mean wait time from the initial consultation with a head and neck surgeon to surgery was 33 days, with 42% waiting more than 28 days and 18% waiting more than 42 days for surgery. The mean wait time from surgery to postoperative radiotherapy was 74 days, with 94% of patients waiting more than 42 days. The mean wait time from referral to Radiation Oncology to assessment by a radiation oncologist was 10 days. The mean wait time from ready to treat to radiotherapy was 21 days, with 74% of patients waiting more than 14 days.CONCLUSION:Maritime head and neck cancer patients wait longer than established guidelines for both surgery and radiotherapy and may be at increased risk for negative outcomes because of delayed treatment.

Rhabdomyomas are rare benign tumours of striated muscle tissue that can be divided into cardiac and extracardiactypes. Cardiac rhabdomyomas are associated with tuberous sclerosis, whereas extracardiac varieties are notassociated with any particular syndrome. Approximately 70% of rhabdomyomas found outside the heart occur inthe head and neck. Rhabdomyomas are typically solitary lesions, although multifocal lesions have been described;however, there have been no reports of malignant transformation to rhabdomyosarcomas. There have been 32 casesof laryngeal rhabdomyoma reported. Of these, 10 cases were reported in the supraglottic space. We present the 11threported case of a supraglottic rhabdomyoma, and the first to be managed with laser resection without recurrenceof the tumour.

Otolaryngology–Head and Neck SurgeryVolume 143, Issue S2 p. P152-P152 Poster Presentation Post Cancer Treatment: Whistle Deformity Lip Reconstruction James Belyea BSc, James Belyea BSc presenterSearch for more papers by this authorRobert Hart MD, Robert Hart MDSearch for more papers by this authorJonathan Trites MD, Jonathan Trites MDSearch for more papers by this authorMark Taylor MD, FRCSC, Mark Taylor MD, FRCSCSearch for more papers by this author James Belyea BSc, James Belyea BSc presenterSearch for more papers by this authorRobert Hart MD, Robert Hart MDSearch for more papers by this authorJonathan Trites MD, Jonathan Trites MDSearch for more papers by this authorMark Taylor MD, FRCSC, Mark Taylor MD, FRCSCSearch for more papers by this author First published: 20 June 2017 https://doi.org/10.1016/j.otohns.2010.06.246Read the full textAboutPDF ToolsRequest permissionExport 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 onEmailFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume143, IssueS2August 2010Pages P152-P152 RelatedInformation

A whistle deformity is defined as a deficiency in the vertical length of the lip so that the free margins of the upper and lower lips do not meet normally, giving the appearance of whistling. This is a common secondary deformity of the vermilion in patients with cleft lip. A case involving a 61-year-old man who developed a whistle deformity as a result of two wedge resections and postoperative radiotherapy for treatment of squamous cell carcinoma of the lower lip is presented. Hyaluronic acid-based tissue filler and autologous microfat transplantation to the lower lip were used for definitive management of the patient's whistle deformity. After one year of follow-up, the patient was pleased with the overall result and noted marked improvement of his oral competence and overall appearance of the lip. The present case demonstrates that microfat transplantation is a viable option for correcting a whistle deformity, not only after surgery, but also following adjuvant radiotherapy - both of which potentially reduce graft viability secondary to decreased vascularity of the recipient site.