Current trends in rhinoplasty and the nasal airway.

The current trends in rhinoplasty and the nasal airway are discussed. The rhinoplastic ideal is that which is aesthetically pleasing while maintaining or improving the physiologic functions of the nose. It is important for the primary care physician to understand the different aspects of rhinoplasty so that he or she may determine which patients will have success with this surgery. Furthermore, the primary care physician will have a better understanding of what the surgeon tries to achieve with rhinoplasty surgery.

Chronic sinusitis: an update.

An accurate history is essential to the diagnosis of chronic sinusitis. Patients classically present with several weeks of daily facial pain or pressure between the eyes, headache, nasal congestion, postnasal drip, ear pain or blockage, and fatigue. The headache in chronic sinusitis is usually worse in the morning and following head movement. Purulent nasal discharge, spiking fever, an elevated white blood cell count, and intense, brief headache associated with nausea and vomiting are uncommon. Palpation, transillumination of the sinuses and anterior rhinoscopy are of minimal value in making the diagnosis. Fiberoptic nasopharyngoscopy can be used to identify the source of sinus discharge and the cause of obstruction. Although plain sinus radiographs are useful in diagnosing and monitoring acute sinusitis, they are of limited value in confirming chronic sinusitis. The sinuses are better imaged with computed tomographic scanning. Prolonged antibiotic therapy, in combination with decongestants and steroids, is usually effective for chronic sinusitis. In recalcitrant cases, sinus surgery may be necessary.

Effect of uvulopalatopharyngoplasty on upper airway collapsibility in obstructive sleep apnea.

Previous investigators have demonstrated variable responses to uvulopalatopharyngoplasty (UPP) in patients with obstructive sleep apnea. We hypothesized that this variability is due to either (1) differences in baseline pharyngeal collapsibility preoperatively or (2) differences in magnitude of the decrease in pharyngeal collapsibility resulting from surgery. To determine the relationship between changes in collapsibility and the response to UPP surgery, we measured the upper airway critical pressure (Pcrit) before and after UPP in 13 patients with obstructive sleep apnea. During non-REM sleep, maximal inspiratory airflow (VImax) was quantitated by varying the level of nasal pressure (PN), and Pcrit was determined by the level of PN below which VImax ceased. A positive response to UPP was defined by a greater than or equal to 50% fall in non-REM disordered breathing rate (DBR). In the entire group, UPP resulted in significant decreases in DBR from 71.1 +/- 22.4 to 44.7 +/- 38.4 episodes/h (p = 0.025) and in Pcrit from 0.2 +/- 2.4 to -3.1 +/- 5.4 cm H2O (p = 0.016). Moreover, the percent change in DBR was correlated significantly with the change in Pcrit (p = 0.001). Subgroup analysis of responders and nonresponders demonstrated that significant differences in Pcrit were confined to the responders. Specifically, responders demonstrated a significant fall in Pcrit from -0.8 +/- 3.0 to -7.3 +/- 4.9 cm H2O (p = 0.01), whereas no significant change in Pcrit was detected in the nonresponders (1.1 +/- 1.6 versus 0.6 +/- 2.0 cm H2O. No clinical, polysomnographic, or physiologic predictors of a favorable response were found preoperatively.(ABSTRACT TRUNCATED AT 250 WORDS)

Practical management of epistaxis.

Epistaxis is a very common presenting symptom of patients seen in the emergency room or the physician's office. An understanding of the nasal anatomy and physiology is important for proper treatment of these patients. New methods of treatment are discussed briefly.

Selection of video cameras for stroboscopic videolaryngoscopy.

Stroboscopic evaluation for the analysis of laryngeal function and disease has been reemphasized recently and its routine clinical use recommended. Many have found, however, that it is not always possible to obtain consistently satisfactory video images of stroboscopic laryngoscopy. The problem is related to the low intensity of the xenon light source during stroboscopy. The authors have tried many different video cameras available, along with the Brüel & Kjaer Rhino-Larynx Stroboscope type 4914, and two types of endoscopes (flexible and rigid). The cameras included 1) single tube camera, 2) single chip metal oxide semiconductors (MOS) solid-state camera, 3) single chip charge-coupled devices (CCD) solid-state camera, 4) three-tube camera, and 5) three-chip CCD camera. Currently available video cameras and their adaptability for stroboscopic videolaryngoscopy are discussed.

Imaging of acute arterial injury with 111In-labeled platelets: a comparison with scanning electron micrographs.

The relationship between degree of acute arterial injury, extent of platelet deposition, and ability to visualize arterial injury with Indium 111-labeled platelets was studied in 18 rabbits. An aortic lesion was made with a balloon catheter in each animal immediately after injection of autologously labeled platelets. Three nonlesioned rabbits with 111In-labeled platelets served as controls. An additional control study was performed in 12 lesioned rabbits in which nine were injected with 111In-labeled plasma protein and three with 111In-labeled red blood cells. A postmortem scanning electron microscope study of the aortae was made to determine the degree of injury to the intima and the amount of platelet deposition on the damaged arterial wall. The radionuclide scans and scanning electron micrographs were then compared. Lesions were seen in ten of 18 animals with labeled platelets that had extensive regions of denuded endothelium covered by a contiguous layer of platelets. Lesions consisting of patchy deendothelialization and platelet deposition could not be visualized on the scans. Red blood cells and fibrin were not conspicuous on micrographs of the lesions. No lesions were visualized in animals receiving 111In-labeled plasma protein or red blood cells before arterial injury, despite platelet deposition in the lesions.

Cancer mortality among a representative sample of nonsmokers in the United States during 1966--68.

Data are presented on cancer and total mortality among a representative sample of nonsmokers and the total population 35--84 years of age in the United States during 1966--68 that measured the influence of cigarette smoking on mortality rates, independent of other health-related factors. Of all U.S. white males, those who never smoked cigarettes have a total age-adjusted cancer death rate which is 37% less than that of males as a whole and 53% less than that of those who currently smoke cigarettes. Correspondingly, of all U.S. white females, those who never smoked cigarettes have a total age-adjusted cancer death rate which is 15% less than females as a whole and 33% less than that of those who currently smoke cigarettes. The largest cancer rate reduction in the nonsmokers is concentrated in the respiratory system. Nonsmokers have an age-adjusted total death rate which is about 20% less than the population as a whole and about 43% less than current cigarette smokers. These and other results and methodologic issues are discussed.

Comparison of electrically and acoustically evoked responses in the auditory cortex of the guinea pig: implications for a cochlear prosthesis.

Guinea pigs have been used to develop an animal model for evaluation of electric stimulation of the cochlea. Techniques were developed for recording from single neural units in the auditory cortex. Acoustic responses exhibit similar patterns of neural discharge ("on", "off", sustained excitation and inhibition, etc) to those reported for auditory neurons in other species. Similar response patterns are obtained when electric stimulation is used. However, cortical units display characteristic frequency tuning with acoustic stimulation, whereas it becomes increasingly difficult to evoke electric responses as stimulus frequency increases. Recording of gross evoked responses from the same cortical area indicates that the intensity function for electric stimulation is much steeper than that seen for acoustic stimulation.