Ear stapling: a risky and unproven procedure for appetite suppression and weight loss.

In an effort to achieve weight loss, many people are pursuing alternative medical interventions. Widely available as a variant of acupuncture, ear stapling (in which a surgical staple is placed in the conchal bowl of the ear) is reported by practitioners to decrease the appetite and induce weight loss. This practice lacks proven efficacy and has a significant risk of infection and deformity. We report a series of 3 patients who developed complications from ear stapling and present this article to describe the practice so that physicians will be prepared when encountering a staple in the ear.

Botulinum toxin type-A in the treatment of glabellar lines.

The current literature and state of the art on use of botulinum toxin type-A in the treatment of glabellar rhytids was reviewed. Botulinum toxin type-A is a safe and effective way to manage glabellar rhytids. Mastery of the anatomy of the glabellar region, familiarity with the products currently available on the market and judicious dosing results in excellent cosmetic results with minimal adverse events.

Cervical tuberculosis: a decision tree for protecting healthcare workers.

OBJECTIVES/HYPOTHESIS: The clinical presentation of cervical tuberculosis (TB) is a unique challenge to the otolaryngologist. To minimize the risk of nosocomial transmission, otolaryngologists must suspect the diagnosis and be familiar with recommendations for TB prevention. STUDY DESIGN: Scientific review. METHODS: We review current literature and recent changes in TB prevention strategies including the Centers for Disease Control and Prevention "Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005." RESULTS: Nosocomial transmission may occur from either unrecognized pulmonary disease or from aerosolization of tubercle bacilli during diagnostic procedures. History of prior TB infection, residence in a country where TB is endemic, close contact with a TB patient, or positive tuberculin skin test should raise suspicion of cervical TB. Physical examination findings may include painless, unilateral cervical lymphadenopathy. Children and human immunodeficiency virus infected patients present unique challenges, as these groups may have atypical presentations. When cervical TB is suspected, the provider should always screen for pulmonary and laryngeal disease. Fine needle aspiration with polymerase chain reaction or culture may accurately identify cervical TB. In rare cases, excisional biopsy may be required. CONCLUSIONS: To facilitate interpretation and rapid diagnosis while minimizing risk to health care providers, we provide a decision tree based on new federal guidelines and the clinical experience of a team of infectious disease specialists and otolaryngologists.

Dermatopathic lymphadenitis of the head and neck.

Dermatopathic lymphadenitis is a histopathologic diagnosis of patients with enlarged lymph nodes classically in the setting of a variety of inflammatory erthrodermas without known malignancy. While considered a benign histopathologic finding, differentiation of this disorder from mycosis fungoides or lymphoma can be difficult.