Value of flow cytometry in the evaluation of head and neck fine-needle lymphoid aspirates: a 3-year retrospective review of a community-based practice.

OBJECTIVE: To study the clinical efficacy of flow cytometry in patients suspected of having a lymphoma with head and neck pathology. STUDY DESIGN: Retrospective review of 49 patients with lymphoid aspirates having concurrent flow cytometry studies. SETTING: Private practice office-based study. CONCLUSION: Fine-needle aspiration with concurrent flow cytometry is a useful, convenient adjunct to the diagnosis of head and neck non-Hodgkins lymphomas. SIGNIFICANCE: Flow cytometry is a significant improvement over fine-needle aspiration derived cytologic diagnosis alone. Tissue open biopsy may be avoided altogether in some patients with non-Hodgkins lymphoma.

Image-guided endoscopic sinus surgery.

This paper has described a new technique of image guided endoscopic sinus surgery. Being able to define the exact location within the sinus using CT scan while in surgery with the patient has the potential to enhance the procedure's utility and decrease the overall potential complication rate. Use of this technology, however, is not a substitute for a thorough knowledge of the anatomy of the paranasal sinuses or experience in performing endoscopic sinus procedures. Further evaluation of this image-guided technology and experience with it will further define usage parameters in the future.

Value of flow cytometry with fine needle aspiration biopsy in patients with head and neck lymphoma.

Lymphomas frequently present in the head and neck clinically as painless adenopathy or as a swelling of an extranodal site, such as salivary gland or Waldeyer's ring. Most non-Hodgkin's lymphomas are B-cell neoplasms with distinctive clonal proteins that can be readily detected using flow cytometric analysis. In our experience, flow cytometric analysis has been a useful, convenient adjunct in the diagnosis of head and neck non-Hodgkin's lymphomas by fine needle aspiration biopsy.

Fine-needle aspiration: survey of clinical utility.

OBJECTIVES: The goal was to determine the features of clinical usage of fine-needle aspiration (FNA) in this country in terms of utilization, indications, and practice and demographic characteristics of those who use FNA. STUDY DESIGN: A survey was mailed to otolaryngologist-head and neck surgeons (OTO-HNSs) in the United States. The results were totaled and analyzed for indications for FNA performance, practice setting, age, and geographic location of practitioners. RESULTS: The most common indications for use of FNA were in the diagnoses of neck, thyroid, salivary, and other masses in the head and neck. In the survey group the average number of FNAs performed per month was 4.7 per respondent practitioner. FNA was statistically related to age (older physicians performed it less) and region of the country. FNAs are performed at a lower rate in the West. CONCLUSIONS: FNA is a commonly performed procedure. Certain groups of OTO-HNSs (older, located in western states) do not perform FNA as commonly as other OTO-HNSs. Further education regarding the merits of FNA is needed.

The workforce in otolaryngology-head and neck surgery: moving into the next millennium.

OBJECTIVE: The goal was to examine the current scope of otolaryngologists' practices, their geographic distribution, and the roles otolaryngologists and other specialists play in caring for patients with otolaryngic and related conditions of the head and neck. STUDY DESIGN: A large national survey and administrative claims databases were examined to develop practice profiles and compile a physician supply for otolaryngology. A focus group of otolaryngologists provided information to model future scenarios. RESULTS: The current and predicted workforce supply and demographics are at a satisfactory level and are decreasing as a proportion of the increasing population. Empiric data analysis supports the diverse nature of an otolaryngologist's practice and the unique role for otolaryngologists that is not shared by many other providers. Together with the focus group results, the study points to areas for which more background and training are warranted. CONCLUSIONS: This study represents a first step in a process to form coherent workforce recommendations for the field of otolaryngology.

Endoscopic-assisted adenoidectomy.

Adenoidectomy is a commonly performed procedure. The advent of endoscopic sinus surgery has popularized the use of endoscopes. Endoscopic-assisted adenoidectomy (EAA) is a natural progression of this technology to allow a more complete adenoidectomy. Two hundred thirty-six patients undergoing adenoidectomy were evaluated with an endoscopic technique. A routine transoral adenoidectomy was performed first. Then a 4-mm 0 degrees telescope was used transnasally, and residual adenoid tissue was removed from the anterior superior nasopharynx. Invariably, residual adenoid tissue was found after transoral adenoidectomy. The EAA technique is minimally invasive, adds less than 5 minutes to the procedure, and is not associated with excessive bleeding. Readily available telescope and endoscopic equipment is used. The EAA technique is advocated for use as an adjunct to a more complete adenoidectomy.

Endoscopic treatment of inverted papilloma.

Endoscopic resection of inverted papilloma involving the nasal septum and lateral wall of the nose is indicated in selected cases. Careful endoscopic monitoring of the patient every 2-3 months is mandatory. Traditional surgery is reserved for more extensive lesions, recurrent lesions, or patients who have developed squamous cell carcinoma arising from an inverted papilloma. An important part of the procedure is careful informed consent. The patient should be made aware of the possibility of recurrent lesion and the need for more extensive surgery in the future as the result of any recurrence.

Fine-needle aspiration biopsy: is anesthesia necessary?

Fine-needle aspiration (FNA) of inflammatory and neoplastic head and neck masses has become a widely used procedure in otolaryngology-head and neck surgery. Using both subjective (patient perception) and objective (complication rate, accuracy) criteria, this prospective study evaluated patients undergoing FNA with and without anesthesia. Seventy-five patients were enrolled into 1 of 3 study groups: group I, no anesthesia; group II, ethyl chloride spray; and group III, lidocaine infiltrative anesthesia. In general, the ease of FNA, complication rates, and accuracy rates were the same for the 3 groups. Patient perception and satisfaction rates were improved in groups II and III. Use of topical or infiltrative anesthesia may enhance the use of FNA in the anxious nervous patient undergoing FNA of a neck mass.

Peritonsillar abscess (PTA) in children.

1. PTA is more common in young adults, but does occur in young children. The average age in this present series was 8 years. 2. Children with progressive sore throat, sometimes despite antibiotics, should cause suspicion of a PTA. Edema and erythema of the affected tonsil with edema of the uvula and displacement toward the opposite side are classically seen. 3. In older or more cooperative children, fine needle aspiration of the affected tonsil allows prompt diagnosis of PTA. 4. Antibiotic therapy should consist of a cephalosporin owing to high tissue concentration within the inflamed peritonsillar tissue. 5. Definitive treatment is a Quinsy tonsillectomy. Immediate tonsillectomy not only drains the abscess, but also eliminates the potential for an occult inferior pole or contralateral abscess. It also spares the child a future hospitalization and surgical procedure.

Simple, new device for needle aspiration biopsy.

Vertigo and dizziness are not common in childhood, but are probably present more often than was formerly thought. These symptoms caused mainly by o700is media and middle ear effusion, two of the most common diseases in children, have been neglected for a long time, both in the literature and in practice, until recently. The purpose of this study was to determine objectively the incidence of balance-related symptoms in children with long-lasting middle ear effusion and to discover whether these symptoms resolve after the insertion of ventilation tubes. One hundred thirty-six children, ages 4 to 9 years, were given electronystagmographic tests and the Bruininks-Oseretsky tests for motor proficiency before and after tube ventilation of the middle ear. The results were compared with those in 74 healthy children with no history of middle ear diseases. Pathologic findings were found in 58% of the children with chronic middle ear effusion, as compared with only 4% of the control group. The symptoms and signs of balance disturbances resolved in 96% of the children after ventilation tube insertion. The results of this study indicate that balance-related symptoms often encountered in young children may result from chronic middle ear effusion and that these symptoms will resolve after evacuation of the effusion and ventilation of the middle ear.

Functional endoscopic sinus surgery: results in the young child.

Recent studies have addressed the usefulness of functional endoscopic sinus surgery (FESS) in both adult and pediatric patients, but little information is available concerning the long-term followup of young children. During a 31 month period, 57 children, age six years or less had FESS performed by a single surgeon. In each case the child had failed aggressive medical management including long-term oral antibiotics. A coronal sinus CT scan was obtained prior to surgery and showed opacification of the maxillary and/or ethmoid sinuses with obstruction of the ostiomeatal complexes. A similar surgical approach was used in each case. There were no major surgical or anesthetic complications noted during the initial procedure or the followup debridement. To evaluate the results of FESS, a questionnaire was mailed to the parents of each patient. The questionnaires were completed 5 to 36 months after surgery (mean 17.3 months). Ninety-three percent of the children showed improvement based on the observations of their parents. Improvement was judged primarily by reduced symptoms, reduced need for antibiotics, and the need for fewer doctor visits during the followup period. In summary, FESS appears to offer a safe and effective technique to control sinus disease in children who do not respond to aggressive medical management. In skilled hands, this technique is associated with few complications and appears to offer relief even in young patients.

Laryngeal nerve monitoring during thyroidectomy.

Electromyographic monitoring of vocal cord function during thyroidectomy is a very useful technique. It is non-invasive and provides valuable intraoperative data regarding the function of the recurrent laryngeal nerve.

The efficacy of a single dose antibiotic regimen in adults undergoing tonsillectomy.

Several studies have indicated that antibiotics given for 5-7 days post-tonsillectomy are beneficial. A prospective double blind randomized study was undertaken to evaluate the efficacy of a long-acting antibiotic (Cefonicid) given prophylactically at the time of tonsillectomy. Dependent variables were percent weight loss, number of doses of pain medications required postoperatively, the number of days required to resume a normal diet, and return to work. The results of all independent tests indicated that there were no statistically significant differences between the Cefonicid group and the placebo group. The results of this study indicate that single dose prophylactic application of Cefonicid is not effective in adults undergoing tonsillectomy.