A case of severe, persistent epistaxis is described, which ceased only after the use of oral contraceptives was discontinued. An attempt is made to elucidate both the pathogen responsible for the epistaxis in this case, and the relationship between epistaxis and estrogen overdose in general.

Conclusion. The hemilaryngeal flap is a technique for hypopharyngeal reconstruction with the use of adjacent uninvolved tissue. The technique's advantages are that it is technically simpler than other surgical techniques for hypopharyngeal reconstruction, and involves no donor site morbidity. Its disadvantages are that it only can be employed in tumors which are confined to one side of the hemilarynx, and also there is always potential for skip lesions and incomplete resection. Objective. To determine the indications, oncologic considerations, complication rate and survival of the surgical technique. Materials and methods. A meta-analysis of the available literature using the Medline database. Results. There are 86 reported cases. The surgical technique was used only when one side of the hypopharynx was spared. Pharyngocutaneous fistulae developed in 16 patients (19%) and 2 patients developed pharyngeal stenosis. The technique was employed with advanced squamous cell carcinoma of the hypopharynx and the survival rates are similar to those reported when other reconstruction techniques are used.

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.

OBJECTIVE: To provide a description of surface electromyography (sEMG) of spontaneous saliva swallowing (SSS) and monitoring of swallow rate in patients with salivary gland diseases.STUDY DESIGN: Numbers of SSS obtained during 2 hours of sEMG monitoring were compared with sialometry data for healthy volunteers (n = 100), patients with Sjogren syndrome (n = 10), and patients after parotid gland (n = 15) and submandibular gland (n = 16) surgery.RESULTS: Normative: I SSS every 2 minutes and 15 seconds; Sjogren: I SSS every 13 minutes (P < 0.001); parotid gland surgery: I SSS every 3 minutes and 24 seconds (P = 0.26); submandibular gland surgery: I SSS every 5 minutes and 04 seconds (P < 0.05). Sjogren patients and patients after submandibular surgery had hyposalivation correlated with less SSS.CONCLUSION: The established normal rate of SSS makes this modality applicable for evaluating salivary flow for potentially identifying and ruling out abnormalities. Parotid gland surgery does not significantly affect salivary flow rate. Sialometry combined with sEMG monitoring give a clinician more reliable data to evaluate salivary gland disorders than sialometry alone.

Objectives: To give a description of normal surface electromyography (sEMG) aspects of uninterrupted (continuous) drinking and to establish normal sEMG values for swallowing 100 mL of water.

Background. Skeletal nasal changes in elderly people have been extensively investigated, but data on variation of the endonasal architecture with age do not exist. We evaluated endonasal parameters in an elderly population as computed with those in a young group.Methods. Acoustic rhinometry measurements were performed on 165 participants in the age range of 20-93 years, The rhinograms provided the endonasal volume from the nostril entrance to a 7.0 cm cephalic point (VO-7) and the minimal cross-sectional areas (MCA1 and MCA2). Statistical analysis was performed by Pearson correlation and one-way analysis of variance, using age as a continuous or categorical variable.Results. There was no statistical difference in gender distribution within each age group. The results obtained for the left and fight nostrils were similar. Endonasal volume VO-7 and the narrowing areas MCA1 anti MCA2 significantly increase with age, except for men over 80 years in which a relative decrease was observed,Conclusion. Acoustic rhinometry examination of the endonasal architecture in a healthy Young and elderly population demonstrated a gradual increase of endonasal volumes and minimal cross-sectional areas with age,

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.

OBJECTIVESEndonasal operations such as septoplasty, rhinoplasty, nasal septal reconstruction and conchotomy, as well as endoscopic sinus surgery, especially when combined with turbinectomy and/or submucous resection of the septum, may produce bleeding and postoperative hematoma requiring postoperative hemostatic measures. Since nasal packing may cause pain, rhinorrhea and inconvenience, a more effective and less uncomfortable hemostatic technique is needed.OBJECTIVESTo compare the hemostatic efficacy of the second-generation surgical sealant (Quixil in Europe and Israel, Crosseal in the USA) to that of nasal packing in endonasal surgery.METHODSWe conducted a prospective randomized trial that included 494 patients (selected from 529 using exclusion and inclusion criteria and completed follow-up) undergoing the above-mentioned endonasal procedures. Patients were assigned to one of three surgical groups: septoplasty + conchotomy + nasal packing or fibrin sealant (Group 1); ESS + nasal packing or fibrin sealant (Group 2); and ESS + septoplasty + conchotomy + nasal packing or fibrin sealant (Group 3). The hemostatic effects were evaluated objectively in the clinic by anterior rhinoscopy and endoscopy and assessed subjectively by the patients at follow-up visits.RESULTSPostoperative hemorrhage occurred in 22.9-25% of patients with nasal packing vs. 3.12-4.65% in the fibrin sealant groups (late hemorrhage only). Drainage and ventilation of the paranasal sinuses, which are impaired in all cases of packing, remained normal in the fibrin sealant group. There were no allergic reactions to the sealant.CONCLUSIONSOur results show that fibrin sealant by aerosol spray in endonasal surgery is more effective and convenient than nasal packing. It requires no special treatment, e.g., antibiotics, which are usually used if nasal packing is involved.

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.

Endoscopic sinus surgery (ESS), especially when combined with turbinectomy and/or with submucous resection of the septum, may involve postoperative bleeding that might end with nasal packing. Nasal packing causes pain, rhinorrhea, and inconvenience and may not stop the postoperative bleeding. The aim of our study was to compare the hemostatic properties of the second-generation surgical sealant Quixil (Crosseal) with those of nasal packing in ESS. We performed a prospective randomized trial in 64 consecutive patients who underwent ESS and presented excessive intraoperative and/or postoperative bleeding. They were allocated by the sealed-envelope method into two groups. A routine ESS procedure was ended with Merocel nasal packing in group 1, and with aerosol application of Quixil sealant at the operative site in group 2. The hemostatic effects were evaluated objectively in the clinic by anterior rhinoscopy and endoscopy and assessed subjectively by the patients at follow-up visits. In group 1, various types of postoperative bleeding occurred in 25% of patients. In group 2 there was no postoperative bleeding, except for 1 case of late hemorrhage (3.12%). Drainage and ventilation of the paranasal sinuses were not impaired. There were no allergic reactions to the glue. We conclude that aerosol application of fibrin glue can be readily performed in ESS, requires no special treatment (antibiotics), and appears to have an adequate hemostatic effect. The use of this second-generation glue in ESS appears to stop nasal bleeding well and to be relatively safe and convenient.

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

OBJECTIVE. Surface electromyographic studies were performed on 440 normal adults to establish normative database for duration of muscle activity during swallowing and drinking clinically useful for outpatient ENT department.STUDY DESIGN: Prospective observational study of healthy volunteers.METHODS., Parameters evaluated during swallowing include the timing of activity of the orbicularis oris, masseter, submental, and infrahyoid muscle groups covered by platisma. Five tests were examined including voluntary single swallows of saliva ("dry" swallow), voluntary single water swallows as normal, voluntary single swallows of excessive amount of water (20 mL), continuous drinking of 100 mL of water (duration and number of swallows), monitoring of spontaneous swallowing of saliva during,l hour period. The duration of oral, pharyngeal, and initial esophageal stages of swallowing (mean + SD) were measured for groups of adults of different age (18-30, 31-40, 41-50, 51-60, 61-70, 70+ years old).RESULTS: Normative data for duration of muscle activity during single swallowing and continuous drinking are established for healthy adults. The duration of swallows and drinking in all tests showed insignificant increase with the age except for the geriatric group, in which this tendency is statistically significant (1-dimensional analysis of variance, SPSS, Chi-square criterion, 95% confidence interval). There was no statistically significant difference between male and female adults duration of muscle activity during single swallowing and continuous drinking in all age groups (P greater than or equal to 0.05). The relevance and clinical utility of new and alternative measures, in particular, are discussed.CONCLUSION: Surface EMG of swallowing is a simple and reliable noninvasive method for screening evaluation of swallowing with low level of discomfort during the examination. Stage-by-stage evaluation of duration can be very important for topical diagnosis of etiology of dysphagia. The normative timing of events data can be used for evaluation of complaints and symptoms, as well as for comparison purposes in preoperative and postoperative stages and in EMG monitoring during ENT treatment. These parameters represent stages required for normal deglutition, and can be used to identify abnormalities in ENT patients, and provide a basis for comparison of swallowing performance both within and between patients.

BACKGROUND:The external approach is the golden standard for sinonasal tumor removal but is associated with several side effects, including facial scars, intracranial and extracranial complications, a long hospitalization period and high costs. Endoscopic sinus surgery enables resection of benign and selected malignant sinonasal tumors and has the advantages of no facial scars, better functional and structural preservation of the sinonasal complex, minimal trauma to surrounding tissue, a shorter hospitalization stay and lower costs.OBJECTIVES:To evaluate the advantages and limitations of endoscopic resection of benign and malignant sinonasal tumors, their recurrence and complication rates.METHODS:The medical and radiology records of 56 patients who underwent endonasal endoscopic resection of benign and malignant sinonasal tumors between 1996 and 2003 were retrospectively reviewed. Tumors located in the center of the nose and sinuses were endoscopically resected.RESULTS:Six cases of malignant tumor and 50 cases of benign tumor underwent resection by ESS. One of the patients with malignant tumor died, the remainder showing no evidence of disease on follow-up of 3-60 months (mean 26.8 months). Inverted papilloma was the most common benign tumor (40 patients). Seven patients (18%) had recurrence followed by endonasal resection. No major complications were recorded. Hospitalization stay was 2-7 days (mean 3.6 days).CONCLUSIONS:Endoscopic resection of benign sinonasal tumors that are centrally located in the nose and sinuses should be considered before the external approach is used. In very carefully selected cases of malignant tumors ESS is oncologically acceptable, but more experience is needed for discerning the indications for endoscopic resection of malignant tumors. The complication rate for endoscopic resection is low, there are no facial scars, hospitalization stay is short, and costs are low.

We conducted a prospective, randomized, double-blind pilot study of patients presenting with symptoms of obstructed nasal breathing to determine whether electrotherapy could provide nonsurgical symptom relief. Forty patients were divided into an electrotherapy group (n = 20) and a placebo group (n = 20). All selected patients demonstrated nasal valve stenosis with a positive Cottle maneuver and clinically evident nasal valve collapse. Treatment consisted of high-frequency transcutaneous and intranasal electric stimulation of nasal muscles for 15 minutes, 3 times a week for 10 weeks. Treated patients were followed for 10 to 12 months. Twelve patients in the electrotherapy group (60%) exhibited subjective improvement; in 8 cases (40%), the improvement was proved objectively. In the placebo group, 7 patients (35%) indicated subjective improvement; and in one case (50%), the improvement was proved objectively. Follow-up visits showed a rapid decline of positive results when treatment was discontinued. Therefore, we concluded that sure relief of nasal valve stenosis and collapse cannot be achieved with treatment by electric stimulation alone, and this method appears to have limited application. However, further studies are needed to determine whether electrotherapy used in combination with other treatments (e.g., biofeedback training or nasal springs) may provide more lasting relief for patients who want to avoid endonasal surgical intervention.

OBJECTIVE Surface electromyographic studies were performed on 440 normal adults to describe and evaluate different types of normal swallows clinically useful for ENT department. STUDY DESIGN Prospective observational study of healthy volunteers. METHODS EMG recordings were made using stick‐on surface electrodes. Rectified and filtered EMG signals were evaluated. Parameters evaluated include the graphic configuration of activity of the orbicularis oris, masseter, submental group, and infrahyoid muscles, the last 2 covered by platysma, during single swallowing and continuous drinking. Four tests were examined: voluntary saliva swallows, voluntary separate swallows as normal, voluntary separate swallows of excessive amount of water (20 mL), drinking of 100 mL of water. Graphic recording of activity of the above‐mentioned muscles during swallowing and drinking were evaluated for groups of adults of different ages. RESULTS There are several types of normal swallows as seen at the surface EMG records. There was no difference between EMG recordings of male and female swallows. Only group of elderly patients (age 70+) shows age‐induced differences in recorded swallows. There are two main types of normal swallow: single‐share and double‐share swallows. The oral phase of swallowing, being under conscious control, is very variable and should not be taken into consideration during evaluation of records. Final oral, pharyngeal, and initial esophageal stages of swallowing can be defined and evaluated at the rectified and filtered surface EMG record. CONCLUSION The normal muscle activity during swallows and drinking has several graphic patterns which can be identified and described similar to EKG records when surface EMG is rectified and filtered. The method of EMG recording is quick and simple, and can be used for screening and evaluation purposes in outpatient and inpatient ENT departments. These parameters represent activities required for normal deglutition, and can be used to identify abnormalities in ENT patients, and provide a basis for comparison of swallowing performance both within and between patients. These normal data form a valuable basis for future comparison with patients in pre‐ and postoperative stages and in EMG monitoring during ENT treatment.