Treatment of delayed food allergy based on specific immunoglobulin G RAST testing.

This preliminary, descriptive study after extensive clinical experience demonstrates specific IgG food RASTs done in 114 consecutive patients with strong positive histories for delayed food allergy. Elimination of the positive foods was the sole means of treatment. The symptoms leading to the test are detailed, and the method of workup is reviewed. The overall results demonstrated a 71% success rate for all symptoms achieving at least a 75% improvement level. Of particular interest was the group of patients with chronic, disabling symptoms, unresponsive to other intensive treatments. Whereas 70% obtained 75% or more improvement, 20% of these patients obtained 100% relief.

Dysphonia and delayed food allergy: a provocation/neutralization study with strobovideolaryngoscopy.

In most cases the cause of intermittent dysphonia remains undiagnosed. This descriptive study explores the relationship between this problem and delayed food allergy. Double-blind intradermal provocation/neutralization skin tests to food antigens were used to do 12 tests in 10 subjects with food allergies. Strobovideolaryngoscopy was used to document changes in the vocal folds and in the quality of the voice. Double-blind measurements of signs and symptoms, digital audio recordings of the voice for perceptual and acoustic analysis, and aerodynamic laryngeal airflow and resistance measurements were done. The cause of dysphonia appeared to be associated with an increase in thick mucus production and irregular and asymmetric glottic edge edema of the vocal folds. Elimination of the positive specific foods resulted in cessation of dysphonia in all the test subjects. Statistical analysis was not done because of the lack of parametric data for paired analysis, lack of sufficient data points for resampling statistics, and the small sample size.

Allergy and laryngeal disease.

The advent of stroboscopy has proved to be a breakthrough for the laryngologist studying the voice. It has also provided a tool for studying delayed food allergy affecting the larynx. Knowledge in this fascinating area is still in its infancy, but the future is bright. Patients suffering from laryngeal allergy will profit from investigation of allergies by this promising new technique.

The use of the operating microscope in ethmoid surgery.

The operating microscope opens a new world of precision in intranasal sinus surgery by providing binocular vision with excellent illumination. With a self-retaining speculum for better visualization, the surgeon is seated and both hands are free, allowing for better control. Removal of disease is more thorough, complications are reduced, and the need for repeat procedures is diminished.

Microscopic sinus surgery, transnasal ethmoidectomy and sphenoidectomy.

Intranasal ethmoid surgery has traditionally been a "blind procedure" using monocular vision, the delicate control of instruments being less than optimal. The addition of the operating microscope with a special self-retraining retractor speculum is presented in a series of 87 patients over 7 years, 49 of these having had transethmo-sphenoidectomy. Evaluation, anatomy, technique and results are discussed. Whereas the rate of serious complications is reported at 3% in large series, there were no complications in this series. The results of 181 microscopic antrostomies is also discussed. This technique offers considerable added safety to the patient, more self-confidence to the surgeon with binocular vision and much better control of instruments, and allows a more adequate procedure because of less fear of dreaded complications.

Otolaryngologic plain film radiography, with an emphasis on the temporal bone--how to do it. Part one.

Radiologists' mastoid and sinus film reports have often not helped the otolaryngologist clinically. The trend in radiography of the temporal bone has swung almost entirely to tomograms, further de-emphasizing the importance of plain films. A review of the literature reveals that the details for taking films of high quality were worked out prior to 1930, but the equipment available was cumbersome and difficult to use. Applying the available knowledge to today's sophisticated equipment yields films of outstanding quality and gives clinical information of considerable usefulness. The objectives of this article are: 1. to review the literature on plain film otolaryngologic radiography and equipment used. 2. to present previously unpublished material on the exact technique for obtaining films of high quality. 3. to assemble for the first time all the available information on the subject in one source. 4. to present the author's modification of the Waters view for small children, and 5. to stress the clinical usefulness of office radiography in the author's practice.

Flamingo forceps for use in microscopic antrostomy.

The Flamingo forceps is an upbiting cup forceps with an angulated shaft of 7 3/8 in for use in the maxillary sinus using the operating microscope. The design is such that the surgeon's hand is not in the line of vision and the instrument can be used on the right or left side and in various directions.

Microscopic antrostomies in children: a review of the literature in chronic sinusitis and a plan of medical and surgical treatment.

Potential complications, morbidity, treatment failures and "nasal cripples" make one cautious about advising radical sinus surgery. Though antibiotics have greatly reduced the need for radical surgery, some patients do not respond to conservative treatment. Reviewed is pertinent literature concerning treatment of chronic, refractory sinusitis in children, particularly intranasal antrostomy. Medical treatment for chronic sinusitis precedes surgical intervention. Allergic history, nasal cytology and radiographic examination are essential. Since principles of adequate surgical drainage and ventilation have long been established, controlled antrostomy procedure is done with the aid of the operating microscope, creating a nasal mucosal flap. A new instrument is presented---a self-retaining stabilized retractor speculum which allows adequate visualization with the microscope while protecting the mucosal flap and freeing both hands for the procedure.