Pollutants in our water: effects on human health and the environment.

The American Academy of Otolaryngology-Head and Neck Surgery has concerns about the effects of our environment on human health. In this review we evaluate waterborne biologic organisms, microorganisms, and other disease-causing agents that might pollute our drinking water. Next, we evaluate chemical toxins that might pollute our drinking water. Then we examine our drinking water and wastewater treatment systems. Finally, we discuss management strategies.

Secondary tobacco smoke and preventive and protective measures.

The American Academy of Otolaryngology--Head and Neck Surgery has been concerned about the effect of environment degradation on health. There is particular interest in the deleterious health effects of secondary smoke. This report reviews the recent literature regarding passive smoke and clinical disorders and discusses management strategies.

Repair of mandibular fractures: plating vs. traditional techniques.

The treatment of mandibular fractures is a challenge for the otorhinolaryngologist-head and neck surgeon. Recent technologic advances have resulted in the development of rigid fixation techniques that hold promise for the early and optimal restoration of mandibular structure and function. The purpose of this article is to review the dental and orthopedic principles used in our mandibular fracture management, describe compression plating methodology, and discuss optimal techniques for its use. Results using rigid fixation procedures were compared with those using a variety of more traditional techniques in a retrospective analysis of 57 cases. The advantages, limitations, and indications for use of plating technology are discussed, and prevention of complications is emphasized.

Functional endoscopic sinus surgery: a brief review.

As a rule, functional endoscopic sinus surgery (FESS) is recommended for patients with chronic sinus problems that do not respond to medical treatment. For discussion of the surgical treatment to be useful we must first look at the importance of sinusitis, the medical diagnosis and treatment of sinusitis, the anatomic and pathologic considerations for the surgical treatment of sinusitis, the modern diagnosis of recurrent or persistent sinusitis and lastly, the surgical technique of functional endoscopic sinus surgery.

Stapedectomy in residency--the UAB experience.

A retrospective study of the resident-performed stapedectomies at the University of Alabama-Birmingham over the last 10 years was done. "Satisfactory" results, depending on the audiologic criteria used, were obtained in 60-64 percent of cases, far below the 90-95% success rate of established otologic surgeons. The reason for the low success rate is extremely limited experience, an average of 0.78 cases per residency at this institution. Other training programs have reported slightly higher success rates, all in the 60-80 percent range, but each had a higher average number of stapedectomies per resident. Some comments and suggestions are offered on the continuing controversy of stapedectomy in residency.

Transarterial embolization to control posterior epistaxis.

Posterior nasal epistaxis is a challenging problem for the otolaryngologist, particularly when patients are critically ill after significant blood loss. The purpose of this paper is to describe a new radiologic technique designed to enhance the treatment of acute nasal hemorrhage. Seven patients with posterior nasal epistaxis underwent portable, computerized, digital subtraction angiography before embolization. Results are presented, and the advantages and limitations of this approach are compared and contrasted with those of nasal packing and arterial ligation. We conclude that this new procedure permits rapid location of the bleeding source and safe, rapid placement of a maxillary arterial catheter for hemostasis by embolization.

Microlaryngology: an update on its modern use in laryngology--malignant early and advanced glottic carcinoma.

The modern use of microlaryngology is improving the diagnosis and treatment of early and advanced glottic laryngeal lesions. Microlaryngology is a microscopic laryngoscopic technique that is used to carry out laryngeal tumor evaluation and biopsy. For early, small, and advanced laryngeal glottic lesions, a microscope is used to view the larynx through a laryngoscope that is placed transorally. This is a precise method of microsurgery to biopsy and stage early and advanced malignant tumors of the glottic area of the larynx. Recent advances using microscopic visualization, microsurgical instruments, and a CO2 laser as a tool to control bleeding and to debulk the tumors of patients with advanced lesions enable the operating surgeon to visualize accurately the involvement by tumor of the overlying mucosa or the underlying muscles and cartilages in this area and sometimes to restore the airway. Precise knowledge regarding the microscopic locational extent of these tumors is important in developing appropriate options for treatment of early and advanced malignant neoplasms of the glottic area of the larynx in order to cure the disease and save the voice of the patient.

Palliative laser surgery for melanoma metastatic to the larynx: report of two cases.

Melanoma metastatic to the larynx is an extremely rare entity. This paper describes two patients previously treated for cutaneous melanoma who developed recurrent melanoma involving their larynges. Surgical excision of these lesions was accomplished with the carbon dioxide laser. Apparently, these two patients are the first reported cases of successful management of melanoma metastatic to the larynx using laser surgery. The paper also discusses the evolving history and diagnosis of laryngeal melanoma, the use of the carbon dioxide laser in the treatment of other laryngeal and tracheobronchial lesions, the incidence of cutaneous and mucosal melanoma of the head and neck, and the diagnostic evaluation and management of melanoma.

Office treatment by cryotherapy for severe posterior nasal epistaxis--update.

We have used cryotherapy as an office treatment for severe posterior nasal epistaxis for 15 years. In 1971 we reported a retrospective study on 42 consecutive patients with severe posterior nasal bleeding; 26 had cryotherapy and 16 had anterior and posterior nasal packing. Our data showed that cryotherapy controlled epistaxis with less morbidity. We have now used cryotherapy for posterior epistaxis in over 450 patients. In this presentation we review the history of cryotherapy, rationale for treatment with cryotherapy, experimental tissue changes in cryotherapy, and the method for freezing in cryotherapy. We then discuss 50 recent patients with severe posterior nasal bleeding whom we have treated with cryotherapy. We have found that cryotherapy is a successful way to manage patients with severe posterior nasal bleeding.

Diagnosis and conservative surgical management of chondrosarcoma of the larynx.

The incidence, clinical findings, location, etiology, clinical diagnosis, and surgical treatment of chondrosarcoma of the larynx are discussed. Important features in the diagnosis and treatment of a chondrosarcomatous tumor of the larynx are demonstrated in a case report. The patient's chief complaint was episodic shortness of breath occurring with increasing frequency over a period of 12 months. Her dyspnea progressed in severity until an emergency tracheotomy was required for airway control. CT scan documented the attachment of the tumor to the right posterior lateral wall of the cricoid cartilage. Direct laryngoscopy and biopsy were done to obtain tissue for diagnosis. The histopathological examination revealed low-grade chondrosarcoma. The tumor was removed totally with a wide-margin mucous membrane incision and careful curettement. A definite difference in the consistency of the tumor compared to normal cartilage allowed complete excision of the tumor with minimal sacrifice of healthy cricoid cartilage. This presentation emphasizes the conservative surgical removal of these tumors and notes how a curette can be used for this removal.

Pseudocarcinomatous hyperplasia of the larynx due to Candida albicans.

A female patient presented with hoarseness. Findings on physical examination showed whitish true vocal cords. Laryngeal biopsies were performed on two two occasions. On the first biopsy a histopathological diagnosis of Candida albicans and acanthosis was controversial because the acanthosis resembled squamous cell carcinoma. On the second biopsy, several months later, the diagnosis of acanthosis was again controversial, but a diagnosis of pseudocarcinomatous hyperplasia was not determined until several months later. Finally, we can point out that pseudocarcinomatous hyperplasia can be associated with primary candidiasis and state that hoarseness, whitish true vocal cords, and pseudocarcinomatous hyperplasia can masquerade as squamous cell carcinoma of the larynx.

Office and operating room management of cardiac arrest.

Management of cardiac arrest depends on a four-minute period of potential reversibility. Success depends on immediate diagnosis, documentation of the onset of cardiac arrest, and establishment of treatment priorities. Pupillary dilation, complete in two minutes, serves to verify the onset and duration of cardiac arrest. Treatment involves two phases--the emergency phase of oxygenation and perfusion and the definitive phase of restoring the spontaneous effective heartbeat. The two mechanisms of cardiac arrest, ventricular fibrillation and asystole, are characterized, and the conditions necessary for each to occur are listed. The treatment of ventricular fibrillation is defibrillation, whereas ventricular asystole responds to cardiac stimuli--a precordial blow, epinephrine, or calcium. The mnemonic "SALT CAN ADD GOOD TIME" is suggested as a guide for drug dosage, and a treatment flowchart is outlined.

Prevention of fire hazards associated with use of carbon dioxide lasers.

In vitro experiments were performed to test the flammability of endotracheal tubes in the presence of CO2 laser beams Two types of tubes (Rusch and Portex) were exposed to laser beams at 15 or 30 W intensity for varying periods of time oxygen environments of 25% or 60%. Red rubber Rusch tubes were significantly (p less than 0.01) more resistant to ignition than plastic Portex tubes at both higher energy exposures and greater durations of exposure. Aluminum tape wrapping significantly (p less than 0.01) retarded ignition of both types of tubes. In view of this, a clinical protocol was developed using aluminum tape-wrapped red rubber tubes in 98 patients for 189 procedures requiring the use of a laser. In no case was ignition encountered.

Eosinophilic granuloma of the palatal mucosa in a nine-week-old infant.

Histiocytosis commonly presents as a disseminated disease in children under one year of age and is rare in infants less than three months of age. This case describes a nine-week-old infant with unifocal eosinophilic granuloma without bone involvement. One year after surgical excision the child is free of disease by roentgenographic and laboratory studies and is growing and developing normally. Thus our patient demonstrates several unique features, which include a young age at presentation without disease dissemination and an unusual site of tissue involvement without bone extension.