Referred otalgia.

Otalgia is the sensation of pain in the ear, while referred otalgia is pain felt in the ear but originating from a nonotologic source. The rich sensory innervation of the ear derives from four cranial nerves and two cervical nerves which also supply other areas in the head, neck, thorax, and abdomen. Pain referred to the ear may originate in areas far removed from the ear itself.

Wegener's granulomatosis of the head and neck.

Wegener's granulomatosis is an uncommon systemic vasculitis with granuloma formation that has many manifestations in the head and neck. The otolaryngologist may be the first physician called upon to examine such a patient. Although this disease was previously fatal, treatment with cyclophosphamide and steroids has produced response rates of 93%.

Tinnitus.

Although tinnitus is usually a benign finding, it can have an extremely adverse effect on a patient's life. Tinnitis is a symptom that can have many different etiologies. This communication deals with the etiology, diagnosis, and available treatment of the condition.

Atypical facial pain.

Atypical facial pain was first described by Temple Fay in 1927 as a vascular syndrome of dull, throbbing pain situated deep in the eye and malar region often referred toward the ear, lateral neck, and shoulders. When this syndrome is encountered in medical practice it is often perplexing to the physician and frustrating to the patient. A systematic approach to this problem will aid in the diagnosis and possible treatment which may be facilitated by a thorough understanding of the anatomic pathways involved in various types of acute and chronic facial pain.

Cartilage palisade tympanoplasty.

Recurrent tympanic membrane perforations are usually caused by underlying conditions such as an adhesive process with a poorly aerated middle ear space, a thermal perforation, infection, or technical error at the time of graft placement. Despite surgical treatment these reperforations pose a significant otologic problem that may lead to the development of chronic otitis media and cholesteatoma. The purpose of this study is to detail the use of a new cartilage palisade tympanoplasty technique that has yielded a 100% tympanic membrane closure rate without recurrent perforations in 52 operated ears over a 2-year period.

Temporal bone fractures.

Temporal bone fractures represent a frequent source of morbidity and are often associated with fatal injuries in the head trauma patient. The initial care of these patients may be the responsibility of the emergency room physician or the neurosurgeon. The treatment of temporal bone fractures is often postponed because more pressing injuries may exist.

Osteomyelitis of the skull base--an unusual manifestation.

A 74-year-old male was seen and evaluated for a pale right tympanic membrane accompanied by posterior neck pain and a mass in the right nasopharynx. Repeated biopsies failed to confirm the expected diagnosis, only yielding lymphatic tissue with chronic inflammation and scarring. The patient was admitted when he suddenly developed ipsilateral cranial palsies, and the radiologic evaluation suggested a vascular tumor.

Disorders of taste.

At least 2 million Americans suffer with chemosensory dysfunction or disorders of taste and smell. In addition to the obvious aesthetic deprivation, loss of taste may affect an individual's health and psychosocial situation. Most taste disorders are associated with antecedent upper respiratory infection, trauma, or allergic rhinitis, or have an idiopathic etiology.

Microscopic endonasal surgery of the paranasal sinuses and the parasellar region.

The anatomic principles and operative techniques currently applied to functional endoscopic endonasal surgery have allowed for significant refinements in another approach to regional pathology that uses the operating microscope, newly designed sinus instruments, and a self-retaining nasal speculum system. The main benefits of this method are the superb widefield stereoscopic vision and the distinct freedom to work bimanually. Additionally, direct bipolar cautery of bleeders is afforded while use of the observer tube or video allows for excellent teaching.

A functional approach to lateral fixation in bilateral abductor cord paralysis.

A modification of the Clerf arytenoidopexy treatment for bilateral vocal cord paralysis is described; it consists of an external approach with complete unilateral division of the posterior cricoarytenoid and interarytenoid muscles. The entire arytenoid is next mobilized and tilted laterally, then fixed into position along the posterior margin of the thyroid cartilage by two or three permanent retention sutures. Careful placement of these sutures renders the laryngeal mucosa maximally undisturbed and is largely responsible for the predictable results achieved with this technique.

Juvenile angiofibromas: a 40-year surgical experience.

A series of 22 patients with histologically confirmed angiofibroma were treated primarily by surgical removal at the University of Freiburg ENT clinic during the 40-year period, 1946-1986. These tumors were staged according to size and extension on the basis of roentgenographic and surgical findings. Specific analysis of the operative approaches and recurrence rate by stage are included.

Diseases of the intrapetrous carotid artery.

In the early years of skull base surgery, total tumor removal was often deemed impossible due to involvement of the intrapetrous carotid artery. In contrast, previously considered unresectable lesions may be removed totally in selected cases, with reasonable expectation of successful treatment at the present time. Current techniques and operative exposures, when modified to accommodate the problem of intracranial extensions of tumor and when approached with neurosurgical collaboration, permit the removal of many of these difficult tumors.

The motor innervation of the soft palate. An anatomical study in guinea pigs and monkeys.

In an effort to gain a more precise understanding of the motor innervation of the soft palate, a neuroanatomical tracer (horseradish peroxidase) was injected into the vela of nine guinea pigs and four monkeys. After 48 h the animals were sacrificed and frozen frontal sections were appropriately reacted with tetramethylbenzidine and counterstained with neutral red, and then evaluated by means of light microscopy. In all specimens retrogradely labeled neurons appeared in the brain stem.

Methods and complications of rhinophyma excision.

For years cosmetic surgeons have sought methods of treatment of large rhinophyma. These include creation of flaps with excision of excess skin, dermabrasion, free-hand shave, and others. The CO2 laser has been used by itself, or in combination with other methods to vaporize the rhinophyma.

Obliterative otosclerosis.

A total of 2,985 stapedectomies were done during the 25-year period 1959 to 1984 in a busy urban otologic practice. One hundred twenty-three of these cases were found to have obliterative otosclerosis which resulted in a drill-out stapedectomy. Postoperatively, a minimum of 2 years follow-up yielded 98 of the original 123 drill-out cases constituting the study group.

Cholesterol granuloma of the petrous apex.

Cholesterol granuloma of the petrous apex is caused by a foreign body response to cholesterol crystals. This condition has infrequently been described, but it can prove to be highly destructive. Obstruction of drainage, with failure of ventilation of a normally aerated space and subsequent hemorrhage, yields blood breakdown products which liberate cholesterol.