Subgaleal endoscopic browlift with absorbable fixation.

Rejuvenation of the upper third of the face by browlift has been performed endoscopically since the early 1990s and is commonly done in the subperiosteal plane with variable methods of fixation. The longevity of browlift recently has been questioned, as has the optimal plane of dissection and ideal type of fixation. From review of the literature, published study of brow soft tissue mechanics, and long-standing clinical experience with this procedure, we describe the senior author's (J.R.T.) rationale for and technique of subgaleal rather than subperiosteal endoscopic browlift. The author's technique has evolved from previous reports to now incorporate advances in absorbable fixation. Both male and female patients have been treated, as well as patients with pre-existing brow assymmetries, with excellent, durable results.

Hyperbaric oxygen therapy for sudden sensorineural hearing loss: a prospective trial of patients failing steroid and antiviral treatment.

OBJECTIVE: To investigate the safety and efficacy of hyperbaric oxygen therapy (HBOT) in adult patients with sudden sensorineural hearing loss (SSNHL) who fail standard of care steroid and antiviral therapy. STUDY DESIGN: Prospective cohort study. SETTING: An urban tertiary referral center. PATIENTS: Nine adult patients presenting with SSNHL from December 2002 through February 2004. Patients with acute onset SSNHL of greater than 30 dB in three contiguous frequencies who failed to show audiometric improvement after 2 weeks of systemic steroids and antivirals were enrolled. INTERVENTIONS: Study patients received HBOT at 2.0 atmospheric pressure for 90 minutes while breathing 100% oxygen under a clear plastic hood in the chamber. Treatments were administered daily for 10 days over a 2-week period. MAIN OUTCOME MEASURES: Pre-and postHBOT mean hearing gains measured in decibels for pure-tone audiometry at 0.5, 1, 2, 3, and 4 KHz for bone and additional 8 KHz for air; pure-tone averages for air and bone; speech reception thresholds; and speech discrimination levels. Patient-reported subjective recovery rates (completely, substantially, partially, not improved) were also recorded. RESULTS: Overall, two patients had a dramatic improvement, and one patient had a dramatic improvement in his speech discrimination without improvement in other audiometric measures. Six patients had no demonstrable hearing gains. Two patients had complications of serous otitis media requiring myringotomy and pressure equalizing tube placement. No other complications were observed. CONCLUSIONS: Secondary HBOT after failure of systemic steroid and antiviral therapy may be associated with hearing gains in some patients with SSNHL.