Dietary chloride as a possible determinant of the severity of exercise-induced asthma.

Dietary sodium chloride (NaCl) has been shown to alter the severity of exercise-induced asthma, but it is not known if the sodium and chloride ions have independent effects in this regard. The hypothesis tested in the present study was that both a low sodium, low chloride diet and a high sodium, low chloride diet would improve post-exercise pulmonary function in subjects with exercise-induced asthma (EIA) compared to a normal NaCl diet (NSD); but that neither of these diets would have an effect on post-exercise pulmonary function in control (non-EIA) subjects. Eight subjects who suffered from EIA and eight subjects who did not (control) took part in a double-blind crossover study. Pre- and post-exercise pulmonary function was assessed after 2 weeks on a NSD, a low NaCl diet (LSD, low sodium, low chloride) or a sodium bicarbonate diet (NaHCO3 diet, high sodium, low chloride). A 1 week washout period occurred between diets. Altering dietary sodium or chloride had no effect on pre-exercise (baseline) pulmonary function in either group or on post-exercise pulmonary function in control subjects. However, both the LSD and the NaHCO3 diet lessened the deterioration in post-exercise pulmonary function in EIA subjects. Comparing results from pre- to post-exercise, forced expiratory volume in 1 s (FEV1) at 15 min post-exercise differed significantly (P < 0.05) between diets [mean (SEM) 7 (4)% on the LSD, 14 (4)% on the NaHCO3 diet, and 19 (2)% on the NSD]. Similar patterns were observed for forced vital capacity (FVC), forced expiratory flow rate at 25%-75% FVC and peak expiratory flow rate. The NaHCO3 diet lessened the deterioration of post-exercise pulmonary function, but not to the extent of LSD. These data suggest that both sodium and chloride contribute to the worsening of EIA symptoms seen after consuming a normal or high NaCl diet.

Gastroesophageal reflux and pediatric otolaryngologic disease: the role of antireflux surgery.

OBJECTIVE: To determine the role of antireflux surgery in the treatment of gastroesophageal reflux-induced otolaryngologic disease (GEROD). DESIGN: A retrospective medical record analysis was performed. Patient demographics, otolaryngologic disease secondary to gastroesophageal reflux (GER), method of GER diagnosis, medical treatment used before antireflux surgery, and response to surgical intervention were considered. SETTING: Tertiary care children's hospital. PATIENTS: Among patients undergoing antireflux surgery between January 1, 1996, and December 31, 1999, children with GEROD were included in the study. INTERVENTIONS: Children with GEROD who failed medical therapy underwent antireflux surgery. MAIN OUTCOME MEASURES: The demographics of patients requiring antireflux surgery for treatment of their otolaryngologic disease and their clinical response to surgery were reviewed. RESULTS: Fourteen (17%) of 82 children, ranging in age from 48 days to 3 years (mean age, 9.7 months), who underwent antireflux surgery for GER at our institution between 1996 and 1999 were diagnosed as having GEROD. Twelve (86%) of the 14 patients were found to have upper airway abnormalities, including subglottic edema, fixed subglottic stenosis, reflex apnea, and recurrent croup. Two patients (14%) had severe chronic sinusitis and otitis media. Nine (64%) of the 14 had normal neurologic function for their age vs 5 (36%) who had neurologic impairment. After antireflux surgery, all 14 patients with GEROD had complete resolution of clinical symptoms. CONCLUSIONS: Gastroesophageal reflux has an important role in the cause of numerous otolaryngologic disorders. Although medical management should remain the mainstay of GER therapy, antireflux surgery provided definitive and successful treatment of potentially life-threatening manifestations of GEROD.

Autosomal dominant familial frontonasal dermoid cysts: a mother and her identical twin daughters.

A dermoid cyst is an ectodermal cyst that contains an epithelial lining as well as adnexal structures, and may occur in numerous areas of the body. The nasal dermoid accounts for 1% of all dermoid cysts and 3-12% of head and neck dermoid cysts. While there have been familial cases reported, a genetic inheritance for nasal dermoids has not been suggested. We present the first reported case of a mother and her identical twin daughters who were all found to have evidence of frontonasal dermoid cysts. Our case and a review of literature seem to implicate an autosomal dominant inheritance in certain instances of nasal dermoids.

Reversing click polarity may uncover auditory neuropathy in infants.

OBJECTIVE: To identify patients with primary auditory neuropathies whose cochlear potentials to a 100 microsec click persist after click cessation and simulate synchronous auditory brain stem responses (ABRs) at high intensities. DESIGN: ABRs to condensation and rarefaction clicks, as well as Maximum Length Sequence ABRs and one transtympanic electrocochleogram (ECochG), were collected from five infants with absent middle ear muscle reflexes and normal or near normal otoacoustic emissions. These infants failed ALGO screens, which used alternating polarity clicks, and/or failed full ABRs done elsewhere with alternating polarity clicks. RESULTS: When ABRs were collected in response to a single polarity pulse, they revealed robust and reproducible wave forms over 4 to 6 msec that initially were mistaken for a normal ABR by the referring agents. However, when condensation and rarefaction click data are compared, the waveforms change polarity when the stimulus is inverted. Furthermore, the waveforms fail to shift in latency as the intensity of the stimulation is reduced. Transtympanic ECochG on one of the children revealed the same polarity reversal and fixed latency functions, confirming that they were cochlear rather than neural responses. CONCLUSIONS: Comparing responses with positive versus negative polarity clicks may help separate ABRs from cochlear potentials and alert clinicians to the possibility of an auditory neuropathy. Therefore, absent or abnormal ABRs in the presence of normal otoacoustic emissions need not always implicate a purely "central disorder," but might be consistent with dysfunction between outer hair cells and primary afferent fibers.

Mastoiditis in children.

Fifty-seven children were seen over a 10-year period, 1984-1994, at two large pediatric referral centers with a diagnosis of mastoiditis. Twelve had acute infection and 45 had chronic manifestations. Clinical presentations and recovered bacterial pathogens were identical to those reported in earlier literature although the incidence of both acute and chronic mastoiditis has decreased markedly since 1950. The availability of computed tomographic (CT) scans during this decade has improved the management of chronic disease by defining the location of cholesteatomas and the extent of disease as well as possible anatomic variations and potential complications encountered during surgery. CT scanning is indicated in acute disease when there is suspicion of chronic suppuration or destruction of the mastoid.

The use of autogenous fat, fascia, and nonvascularized muscle grafts in the head and neck.

We have reviewed the transplantation of autogenous fat, fascia, and nonvascularized muscle. Although none of these tissues satisfies all of the requirements for an ideal transplantation material, understanding the indications and each material's limitations will broaden the surgeon's armamentarium when soft-tissue grafting is desired. Although the use of autogenous fat grafts in head and neck surgery has been associated with some unpredictability, fat remains an excellent choice for obliteration of frontal sinuses, for myringoplasty, and for limited soft-tissue augmentation. In most applications, significant resorption of the transplanted fat can be expected, and it should be compensated for accordingly by initial overcorrection. Future research endeavors, including development of preadipocyte transplants and hormonal manipulation of fat grafts, will perhaps improve results of transplantation. The grafting of fascia has been shown to be a very reliable technique, especially when tensile strength is required of the transplant material. In grafts, fascia is much more predictable than fat, in that the majority of the fascia survives as living tissue that retains its original characteristics. A relative lack of three-dimensional bulk, however, limits the use of fascia in soft-tissue augmentation. The transplantation of nonvascularized muscle, because of its enormous metabolic requirements, almost always results in death of the muscle cells and subsequent partial replacement by fibrous tissue. Free muscle grafts therefore have very limited application, except in circumstances in which fibrous tissue obliteration of small defects (such as the nasofrontal duct or eustachian tube) is the desired result. In clinical situations in which maintenance of the substance or bulk of the transplanted material is of paramount importance, consideration should be given instead to the transfer of vascularized tissue. For this purpose, numerous simple and composite flaps of fascia, fat, muscle, and other tissues are now available. Vascularized tissue transfers are certainly not the solution to every reconstructive problem, however. When properly selected and applied, the transplantation of fat, fascia, and occasionally muscle remains an important option for soft-tissue replacement in head and neck surgery.

Granular cell tumor of the larynx: report of two pediatric cases.

Granular cell tumors are uncommon neoplasms of the head and neck that usually involve the tongue. The larynx is an atypical site of involvement in adults and a rare site in children. We report two cases of subglottic granular cell tumors, one in a 10-year-old boy and the other in a 6-year-old girl. Although both were initially misdiagnosed as having asthma, radiologic, laryngoscopic, and histologic evaluation of the obstructions eventually furnished the correct diagnosis. The patients were successfully treated by surgical excision of their subglottic masses. The history, presentation, pathologic findings, management, and prognosis of this rare pediatric laryngeal tumor are explored.

Meibomian gland adenocarcinoma of the eyelid metastasizing to parotid lymph nodes.

Meibomian Gland Adenocarcinoma (MGA) is a rare tumor of the eyelid. We present two patients with this tumor that metastasized to the ipsilateral parotid nodes, along with a description of the disease and its response to various modes of treatment.