Systematic functional assessment of nasal dyspnea: surgical outcomes and predictive ability.

OBJECTIVE: Evaluate the ability of a systematic preoperative evaluation to determine the most appropriate procedures for patients undergoing functional septorhinoplasty and to accurately predict postoperative outcomes. STUDY DESIGN: Case series with chart review. SETTING: Tertiary care military hospital. SUBJECTS AND METHODS: Fifty-nine consecutive patients from a quality control database who underwent functional rhinoplasties for nasal dyspnea were evaluated. All patients underwent a full preoperative assessment using intranasal manipulation to determine the area(s) contributing to their nasal dyspnea. Rates of success for the predictive ability and for the functional outcome were determined for each side of the nose by comparing preoperative visual analog scale (VAS) scores (1-10) to postoperative scores. RESULTS: Overall there was a 91% success rate in predicting the outcome of surgery and a 95% success rate in improving nasal dyspnea at 1 year. There was no statistically significant difference in improvement between different surgical groups (septoplasty ± alar strut grafts ± spreader grafts) or between primary surgeries and revisions. CONCLUSION: Using a systematic approach to evaluate patients for nasal dyspnea, it is possible to predict and improve outcomes by choosing the most appropriate surgery for each individual.

The case for open forehead rejuvenation: a review of 1004 procedures.

OBJECTIVE: To review the role of open forehead procedures in upper-face rejuvenation. METHODS: The clinical records of consecutive patients undergoing a coronal or trichophytic brow-lift from July 1, 1993, to June 30, 2005, were reviewed. Patient demographics and complication rates were tabulated and compared with published rates for endoscopic brow-lifts. Patient questionnaires were sent to correlate subjective outcome measures with objective clinical record data. To obtain population-based perceptions, 200 women aged 30 to 70 years were surveyed at a local mall. RESULTS: A total of 628 coronal and 376 trichophytic forehead-lifts were performed for which there were clinical records. There were 6 revisions (0.57%), no hematomas, 12 cases of permanent numbness (1.20%), 7 cases of permanent alopecia (0.70%), and no cases of permanent frontal branch weakness. The adjusted response rate for the questionnaire was 64.0% (416 of 650). CONCLUSIONS: Open procedures in this series had a complication rate equal to or lower than published rates in endoscopic brow-lift series. Open brow-lift procedures are an effective means of upper-face rejuvenation and, when performed correctly, demonstrate high rates of patient satisfaction.

Comparison of approaches for oral cavity cancer resection: lip-split versus visor flap.

OBJECTIVE: To compare lip-split and visor flap approaches to the oral cavity in terms of morbidity, margins, and locoregional recurrence. DESIGN AND SETTING: Retrospective case series at the University of Washington, Seattle. METHODS: Seventy patients undergoing resection of advanced (T4) anterior oral cavity squamous cell carcinoma requiring fibula reconstruction were grouped according to surgical access procedure performed (lip-split [LS] or visor flap [VF]). Data on surgical morbidity, margin status, and outcomes were compared. RESULTS: Recurrence rates and positive margins were similar for both groups. Rates of postoperative fistulae were 6.8% (LS) vs 0% (VF) and for oral incompetence 14.6% (LS) vs 6.9% (VF). Most of the fistulas (37.5%) were in irradiated patients. Neither group had any malunions. CONCLUSIONS: There is no significant difference in pathological margins or rates of local recurrence when using either the lip-split or the visor approach. The lip-split approach has a higher rate of postoperative fistula formation than the visor flap approach; fistula formation may be associated with previous irradiation.

The effects of aging and hearing loss on distortion product otoacoustic emissions.

OBJECTIVE: We sought to demonstrate the rate of change in distortion product otoacoustic emission (DPOE) amplitude with age in relation to hearing loss in an unselected adult population. Study design and setting We conducted a cross-sectional observation study involving the Framingham Offspring Cohort. Age changes in DPOE amplitude for frequencies of f2 from 1 to 8 kHz adjusted for pure-tone threshold level were assessed by multivariate linear regression. RESULTS: The women showed a mean hearing threshold-adjusted loss in high-frequency DPOE amplitude of 0.6, 2.1, 2.6, and 1.1 dB/per decade at the f2 frequencies of 1, 2, 4, and 8 kHz, respectively. In contrast, the men showed no effect of age on the DPOE amplitude independent of hearing loss. Emissions were reduced or absent in the noise notch frequencies. The rate of change with age in DPOE amplitude was significantly less than the rate of change in pure-tone thresholds in both the men and the women. CONCLUSION: Women lose DPOE amplitude from both age and hearing threshold loss. Men lose more DPOE amplitude than do women, and the loss is proportional to the degree of loss of hearing threshold sensitivity. The differential effect whereby age-related hearing loss affects thresholds more than emissions suggests that strial atrophy may be a pathophysiologic factor. SIGNIFICANCE: The use of DPOE measures for screening and monitoring cochlear status of adult women should take into account the age, pure-tone thresholds, and noise exposure status of the subjects.