Nonmelanoma skin cancer of the head and neck II: surgical treatment and reconstruction.

Surgical treatment of non-melanoma skin cancers (NMSC) is most often straight forward and can be performed as an office-based procedure by non-surgically trained professionals. However, the cases that present to an Otolaryngology practice typically will involve difficult-to-treat lesions around the face and lesions that necessitate an in depth knowledge of how to balance the need for adequate surgical margins with the reconstructive contraints imposed by aesthetic subunits of the face. This article discusses modern concepts of surgical margins for NMSC, including the Moh's micrographic surgical technique, and then reviews the most common reconstructive strategies for difficult-to-treat areas on the face. The goal of this paper is to help the general Otolaryngollogists to understand the basic principles of surgical resection and reconstruction of NMSC lesions on the face.

Nonmelanoma skin cancer of the head and neck I: histopathology and clinical behavior.

Non-Melanoma skin cancer (NMSC) is the most commonly encountered malignancy in almost every area of practice, but the cases that present to an Otolaryngology practice will be advanced in nature. The major subtypes of NMSC include basal cell carcinoma, squamous cell carcinoma, dermatofibrosarcoma protuberans, merkel cell carcinoma, and adnexal malignancies. In this review, we present the epidemiology, histology, clinical presentation and management of these major subtypes. Further, we present background on multimodality treatment for NMSC lesions that have become metastatic from their primary site and an introduction to the behavior and treatment of NMSC lesions in patients who have received organ transplants. Understanding the clinical behavior of advanced NMSC is essential knowledge for a general Otolaryngologist.

Intratympanic steroids for idiopathic sudden sensorineural hearing loss.

OBJECTIVES: We undertook to evaluate the effectiveness of intratympanic (IT) steroid injections for treating idiopathic sudden sensorineural hearing loss (ISSHL) by performing a retrospective case series study in a private otology practice. METHODS: A total of 21 eligible patients with ISSHL were included. We defined ISSHL as a hearing loss of 20 dB or more at at least 3 consecutive audiometric frequencies that develops within 72 hours or less and cannot be attributed to any commonly identifiable cause of sudden hearing loss. Three IT injections of 0.4 mL of 62.5 mg/mL methylprednisolone solution were administered 1 week apart. The end point for the study was a clinically significant change in audiometric values, with a positive response determined to be a 10-dB or greater improvement in the 4-tone pure tone average and/ or a 15% or greater improvement in the word discrimination score. Audiometric data were recorded just before therapy and 1 week after the last IT treatment. The potentially confounding variables recorded included age, sex, "prompt treatment" (defined as treatment within 14 days from onset), concurrent or prior treatment with oral steroids, and severity of hearing loss. RESULTS: The overall response rate to the IT steroid protocol was 67% (14 of 21 patients), with a 95% confidence interval of 43% to 85%. Backward stepwise logistic regression identified "prompt treatment" as the only variable that significantly affected the outcome. The response rate of the "prompt treatment" cohort was 91% (10 of 11 patients), with a 95% confidence interval of 59% to 100%. CONCLUSIONS: These findings support the use of IT steroids as an early intervention in the treatment of ISSHL.

Proteomics: a primer for otologists.

OBJECTIVE: On July 9, 2003, the National Institutes of Health (NIH) released a new program announcement entitled "Proteomics in Auditory and Developmental Disease Processes." This initiative makes it clear that proteomic analysis in otology is a multi-year research priority for the NIH. The goal of this article is to describe the mechanics of modern proteomic techniques and review their applications in otology to date. DATA SOURCES: General articles from the proteomic literature were used to construct a review of modern proteomic techniques. For literature on proteomics in otology, MEDLINE and CRISP databases were searched by various topics in otology and cross-referenced with principle proteomic technologies. STUDY SELECTION: The criterion for selection was any study in otology that employs proteomic technology. CONCLUSIONS: Incredible progress has been made in proteomic technology. However, modern proteomic techniques are currently underutilized in otologic research. The NIH proteomics initiative referenced above, in combination with an understanding of the basic tools of modern proteomic science, should help motivate otologists to discover innovative ways to apply modern proteomic techniques to specific problems in otology.

The new histologic classification of chronic rhinosinusitis.

Two histologic patterns of disease are found in chronic rhinosinusitis. The first is dominated by eosinophilia and polypoid changes. Glandular hyperplasia and hypertrophy characterize the second. We present the evidence supporting the existence of these two patterns of disease and link these histologic patterns to the larger pathophysiologic processes that drive them. This histologic classification should be acknowledged both in the clinical setting and in laboratory research of chronic rhinosinusitis.

Surfactant in the middle ear and eustachian tube: a review.

There has been a recent surge in research on surfactant and surfactant proteins. Fields ranging from immunology to surface chemistry are making contributions to our understanding of this multifunctional compound. This paper reviews the literature on the structure and function of Eustachian tube surfactant. It covers the proposed functions of endogenous surfactant in normal physiology, as well as the experimental applications of exogenous surfactant in the treatment of otitis media. The analysis is based on four platforms of research: the role of surfactant in the innate immune system, the effect of surfactant on surface tension and Eustachian tube opening pressure, the capacity of surfactant to alter the rheological properties of mucus and the efficiency of the mucociliary system, and the ability of surfactant to mitigate oxygen free radical damage.