Retronasal testing of olfactory function: an investigation and comparison in seven countries.

Flavor perception is to a large extent determined by olfaction, and persons who lost their sense of smell consequently complain about strongly reduced enjoyment of food. The retronasal olfactory function is especially important for flavor appreciation. The aim of this study was to compare retronasal function across different cultures and to develop a test that is applicable across cultures. Identification of 39 retronasal applied odor probes was tested in a total of 518 participants of seven countries; 292 of them were healthy, and 226 exhibited a smell disorder. A retest was performed with 224 of the healthy participants. Furthermore, all participants were tested for orthonasal threshold, identification, and discrimination ability. Significant cultural differences in identification ability were found in 92% of the probes. The 20 probes that could be identified above chance in healthy participants of all countries and that could differentiate between patients and controls were selected for the final retronasal test. This test was well able to differentiate between controls and patients in different countries and showed a good coherence with the orthonasal test (r = 0.80) and a good retest-reliability (r = 0.76). Furthermore, it is age-independent. The strong cultural differences observed in retronasal identification underline the necessity to develop a culturally independent instrument. This retronasal test is easy to apply and can be used across different countries for diagnostics and clinical research.

Transcaruncular electrocoagulation of anterior ethmoidal artery for the treatment of severe epistaxis.

OBJECTIVE: The irrigation of the upper third of the nasal fossa is supplied by the anterior ethmoidal artery. We describe a surgical technique to deal with epistaxis due to anterior ethmoidal artery bleeding. PATIENTS AND METHODS: From January 2006 to March 2010 transcaruncular coagulation of the anterior ethmoidal artery was done on nine patients with epistaxis of the upper third of the nasal fossa. RESULTS: The procedure was successful on all cases. No bleeding relapse, major complications, or nasal or orbital sequelae were present in any of the patients. DISCUSSION/CONCLUSIONS: Transcaruncular electrocoagulation of the anterior ethmoidal artery is a safe and effective technique to deal with upper third nasal fossa bleeding.

Oncologic and functional results of near-total laryngectomy.

OBJECTIVE: To report the oncologic and functional outcome of patients undergoing near-total laryngectomy. STUDY DESIGN AND SETTING: A retrospective analysis was carried out from 1991 through 1998. RESULTS: Eighty-seven patients underwent near-total laryngectomy. The Kaplan-Meier overall survival, cause-specific survival, and relapse-free survival estimates at 5 years were 48.2%, 75.8%, and 72.4%, respectively. Univariate analysis revealed prognosis significance for location, stage, and pathologic cervical lymph node status. Five percent of the patients developed local recurrence, 16% recurrence in cervical lymph nodes, and 10% distant metastasis. Pharyngocutaneous fistula was the most frequent complication (48%). Seventy-seven percent of cases achieved voice preservation. Symptomatic aspiration was noted in 12.3% of cases. CONCLUSION: Near-total laryngectomy can be a successful surgical procedure for selected patients; it does not replace total laryngectomy but reduces its indications. Voice preservation can be achieved in most cases. SIGNIFICANCE: Near-total laryngectomy enhances the speech rehabilitation options for the laryngectomy patient by adding a physiologic, nonprosthetic tissue technique.

Functional neck dissection for the clinically negative neck: effectiveness and controversies.

This study was performed to evaluate the effectiveness of functional neck dissection in controlling metastasis to the clinically negative (cN0) neck, focusing on recurrences in the pathologically negative (pN0) neck and the role of extracapsular spread in the cN0 neck. A series of 172 patients (253 dissected fields) treated for cN0 laryngeal or hypopharyngeal cancer with a 5-year minimum follow-up is presented. Occult metastasis was observed in 30% of the patients. Extracapsular spread was present in 39% of the positive nodes. The neck recurrence rate was 5.2%. Surgical specimens from cases of neck recurrence in pN0 necks were reevaluated for micrometastasis by immunostaining with antibody for cytokeratins. The immunohistochemical findings were positive in 1 of 4 cases. Functional neck dissection provides good neck control and survival rates for the cN0 neck. The accurate prognostic significance of extracapsular spread in cN0 necks is still unknown. Micrometastasis alone may be insufficient to explain recurrences in pN0 necks.

Surgical management of recurrent parathyroid cyst.

Parathyroid cysts are rare lesions of uncertain embryological origin, usually presenting as a painless mass in the lower part of the neck. Clinical presentation usually mimics a thyroid nodule, and fine needle aspiration with demonstration of high parathyroid hormone levels in fluid is often required to establish the diagnosis. In addition to difficulty in diagnosis, the best treatment for these uncommon lesions remains controversial. We present a case of recurrent parathyroid cyst after several fine needle aspirations managed by surgery, and discuss the relevant associated literature.