Endoscopic surgical treatment of nasal and paranasal sinus inverted papilloma.

Most of the papers written in the past regarding surgical treatment of nasal and sinus inverted papilloma recommend aggressive surgical treatment-usually a medical maxillectomy with external or transantral ethmoidectomy. However, since the introduction of endoscopic diagnostic and surgical techniques for the treatment of nasal and sinus disease, the treatment of inverted papilloma requires review. In Europe, Waitz and Wigand1 and Draf* routinely treat inverted papilloma endoscopically, reserving extensive surgery for papilloma involving the maxillary sinus or for recurrent disease. Fifteen cases of inverted papilloma of the nose and paranasal sinuses are discussed in this article. Ten cases represent inverted papilloma treated primarily with endoscopic sinus surgery; five were endoscopically treated for secondary or recurrent disease. All primarily treated patients had disease limited to the nose, nasal cavity, ethmoid, sphenoid, or medial wall of the maxillary sinus. The one patient in whom a recurrence in the maxillary sinus developed laterally underwent a medial maxillectomy for control. All patients treated endoscopically have had their disease followed for a minimum of 1 year, with an average of 3 years. Four patients in this study had traditional surgery involving medial maxillectomy and ethmoidectomy for an initial diagnosis of inverted papilloma. These patients manifested recurrent papilloma into the sphenoid sinus bilaterally in one case, frontal sinus in another, and the maxillary sinuses in two other cases, and all patients have papilloma controlled endoscopically. Endoscopic nasal and sinus diagnosis and surgery is appropriate for diagnosis, followup, and treatment of both limited and recurrent inverted papilloma, provided all patients are made aware of the possibility of recurrent and need for more extensive surgery as a result.(ABSTRACT TRUNCATED AT 250 WORDS)

Experimental evidence against middle ear oxygen absorption.

The present theory of eustachian tube (ET) function and middle ear (ME) ventilation posits that oxygen absorbed by the ME mucosa causes negative ME pressure which is relieved by periodic opening of the ET during swallowing and yawning. After developing a method to cannulate the ET of mongrel dogs we connected the cannulas hermetically to manometers. This system excluded ET function and tested the oxygen absorption capacity of the ME. When we controlled respiration and maintained blood gas PO2 and PCO2 at normal levels, we were unable to find any manometric evidence of negative pressure of gas absorption in the dog ME. Lowering the PCO2 and raising the PO2 of the blood by hyperventilation caused negative ME pressure which could be measured manometrically. We confirmed these findings with the tympanometer. Raising the PCO2 and lowering the PO2 by hypoventilation caused positive pressure in the ME. There is no evidence in these experiments that O2 absorption occurs or causes negative ME pressure in the dog. To the contrary there is evidence that elevated blood levels of the more diffusible CO2 cause an increase in the ME pressure and lowered CO2 level causes a negative ME pressure.