Surgical and nonsurgical complications associated with cochlear prosthesis implantation.

Relatively few complications have been reported for cochlear implant surgery in spite of a recent report detailing a complication rate of 11.8 percent. This report highlights both the surgical and nonsurgical complications we have encountered that have resulted in either replacement of the implanted prosthesis or compromise of the sound processing strategy employed by the external unit. These complications make a strong argument for the use of preoperative, intraoperative, and postoperative radiologic examinations. Since the complications reported herein have not been attributed to the implant device proper, we feel cochlear implantation remains a safe and effective procedure for those patients who are untreatable by traditional methods.

Epidermal growth factor binding and action on tympanic membranes.

A significant percentage of tympanic membrane (TM) perforations require some form of therapy to heal. Topical application of epidermal growth factor (EGF), a potent mitogen for epidermal and mesodermal cells, promotes healing of injuries in tissues histologically similar to TM, such as cornea and skin. We evaluated TM as a target tissue for EGF action. Specific, high affinity receptors for EGF were detected in TM (Kd = 3.1 nM, 150 fmol receptor/mg protein). Autoradiography of iodine 125-EGF binding to intact TMs revealed that EGF receptors were present on cells in the stratified squamous epithelial layer and in the stromal/mucoepithelial layer. Repetitive treatment of perforated cat TMs with 20 micrograms of EGF formulated in saline induced substantial hyperplasia of epithelial and stromal layers compared to paired TMs treated with saline. A single treatment of perforated cat TMs with 50 micrograms of EGF formulated in a hydrogel or in shredded Gelfoam produced significantly (p less than .05) smaller perforations at 6 days following the operation compared to paired TMs treated with vehicles. These results demonstrate that TM is a target tissue for EGF and that topical treatment with EGF stimulates healing of TM perforations.

Raeder's syndrome associated with internal carotid artery dilation and sinusitis.

Raeder's syndrome consists of ipsilateral ptosis, miosis and facial pain with intact facial sweating. When not associated with other neurologic signs, the clinical course of this conditions is self-limited. Patients will have resolution of facial pain but persistence of miosis and ptosis. Treatment is symptomatic with arteriography reserved for those patients with protracted symptoms or atypical presentations. A case of Raeder's paratrigeminal syndrome is presented with abnormal dilation of the subcavernous portion of the internal carotid artery thought to be secondary to inflammation of the adjacent sphenoid sinus. Facial pain and the abnormal dilation of the carotid artery resolved, but miosis and ptosis persisted. Because of the therapeutic indication and prognostic value, an awareness of Raeder's syndrome is stressed when evaluating patients with facial pain or possible Horner's syndrome.

Histiocytosis X.

Histiocytosis X may be isolated or generalized in its clinical involvement. Spontaneous resolution may occur, although progression to diffuse systemic disease has also been found. The disease is believed to originate from the mononuclear phagocytic series of cells, although the reason for this activation remains unknown. A possible local reaction to an inciting agent in the nasopharynx or oral cavity has been suggested by the frequent head and neck manifestations in this disease. The prognosis and treatment of patients should be predicated on the staging or extent of disease. Local disease should be treated in a conservative manner. Low dose radiation therapy should be used for inaccessible lesions or lesions in which removal may produce serious morbidity. In the future, randomized treatment protocols need to be undertaken to clarify the status of chemotherapy and immunotherapy in patients with disseminated or aggressive disease.

Ophthalmoplethysmography in head and neck surgery.

Ophthalmoplethysmography (OPG) is a simple, noninvasive diagnostic test in which the cerebral hemispheric blood flow can be indirectly measured. Its use in head and neck surgery is invaluable because it enables the surgeon to predict preoperatively whether a patient will survive carotid artery resection. In a three-year period, nine patients have survived carotid resection on the basis of favorable OPGs, without a death or permanent neurologic complication. A comparison of the results of OPG testing with intraoperative measurement of internal carotid artery pressure showed close correlation in 14 of 20 patients who were tested. Lack of correlation in four patients can be explained by the circumstances of the intraoperative test. This study's findings demonstrate that this test has high clinical reliability.

Solitary neurogenous sarcomas of the head and neck.

The clinical histories of three patients with neurogenous sarcomas involving the head and neck are detailed. The most satisfactory treatment suggested for such tumors involves combined therapy with chemotherapy, radiation, and radical surgical excision. By so doing, potential patient cure might be further increased and survival rates further improved.